Kaiser Permanente vs. Anthem: 2026 Comparison

Kaiser Permanente sells ACA plans in seven states with HMO and EPO options. Anthem offers coverage in 13 states across four plan types: HMO, EPO, POS and PPO. 

HMO and EPO plans restrict members to network providers. EPO members can see specialists without referrals while HMO members need primary care physician coordination. Anthem's POS and PPO options add out-of-network access, with PPO offering the most provider flexibility at the highest price.

Kaiser Permanente's HMO plans cost $598 monthly, $80 below the $678 national average and $85 less than Anthem's $683 rate. This saves $960 to $1,020 annually. EPO coverage from Kaiser Permanente costs $548 per month, $183 below the national average and $229 cheaper than Anthem.

The EPO premium gap is the more significant finding for most shoppers. At $229 less per month than Anthem, Kaiser Permanente's average EPO premium translates to annual savings of $2,748, enough to cover most out-of-pocket medical expenses in a year with relatively low healthcare use. Kaiser's HMO pricing advantage is smaller, with annual savings ranging from $960 to $1,020, but still represents a meaningful reduction in healthcare costs.

For people in California, Colorado and Virginia, where both insurers compete, Kaiser Permanente's EPO plans are the better value. The premium savings come without the referral requirements associated with HMOs, making them an attractive option for cost-conscious buyers. The main reason to pay Anthem's higher premiums is if you need broader provider choice or out-of-network access that Kaiser Permanente's integrated network can't provide.

Kaiser Permanente has higher Quality Rating System scores at 94.6 overall compared to Anthem's 83.3, an 11.3-point advantage. Medical care quality shows the widest gap at 96.11 for Kaiser Permanente versus 82.23 for Anthem. Member experience ratings are 91.51 for Kaiser Permanente and 88.99 for Anthem. Plan administration performance is 91.68 for Kaiser Permanente and 81.9 for Anthem.

The claims denial gap is one of the most consequential differences between the two insurers. Anthem denies 22.7% of claims, nearly three times Kaiser Permanente's 8.3% denial rate and well above the national average of 18%. For members, that means a greater likelihood of receiving a denial notice, navigating the appeals process and facing delays in care or reimbursement. If you want to minimize administrative hurdles and reduce the chances of claim disputes, Kaiser Permanente has a clear advantage in markets where it's available.

Anthem uses Attained Age pricing for Medicare Supplement plans, which means your premiums increase as you get older. For Plan G, Anthem's average monthly premiums rise from $218 at age 65 to $273 at age 75, an increase of $55 per month or $660 per year over a decade. Plan F has a steeper curve, increasing from $294 to $379 per month over the same period, which translates to an additional $1,020 annually by age 75. Plan N has the lowest starting premium at $198 per month, but members must pay copays for certain office visits and are responsible for any Part B excess charges.

Plan G has become the standard choice for most new Medicare enrollees because Plan F is no longer available to people who became eligible for Medicare on or after January 1, 2020. Existing Plan F members can keep their coverage, but new enrollees must choose another option. For most 65-year-olds enrolling today, Plan G delivers nearly identical coverage at a lower premium. The only benefit it doesn't cover is the Medicare Part B deductible, which is $283 in 2026. Given that Plan G's premium is well below Plan F's, most beneficiaries come out ahead financially even after paying the deductible themselves.

The premium-versus-MOOP tradeoff is the key difference between Anthem and Kaiser Permanente Medicare Advantage pricing. Anthem's HMO plans cost $29 per month on average compared with $46 for Kaiser Permanente, saving you $204 per year in premiums. Anthem also offers a higher share of $0-premium plans, making it the more affordable option if you expect minimal healthcare use.

But Kaiser Permanente provides stronger financial protection. Its average HMO maximum out-of-pocket limit is $4,815, compared with $7,890 for Anthem, a difference of $3,075. Even after factoring in Anthem's lower premiums, if you reach your MOOP, you'd spend $2,871 more annually with Anthem. If you're managing chronic conditions or expecting substantial medical care, Kaiser Permanente's lower out-of-pocket cap can deliver meaningful savings.

Kaiser Permanente's HMO and HMO-POS Medicare Advantage plans both earn 4.37 stars, outperforming Anthem by 0.48 stars on HMO coverage and 1.07 stars on HMO-POS plans. Anthem scores 3.89 for HMOs, 3.3 for HMO-POS and 3.8 for PPOs. Special enrollment periods and additional member benefits come with plans rated 4.0 stars or higher, giving Kaiser Permanente members more flexibility to switch plans outside standard enrollment windows.