anthem blue cross and blue shield has several affordable plans, one of the largest hospital and doctor networks among all insurers, and well-rated member resources and digital tools. but the company has a poor reputation for customer service, has been repeatedly fined for violating customer complaint practices, and has a high claim denial rate.
With 42 million medical policyholders in 14 states, Anthem Insurance is one of the largest insurance companies in the country.
anthem is a good health insurance company for most people. Policies are often affordably priced, although they are often not the cheapest health insurance plans in the state. There are also many plans available, allowing you to select the best option for your budget and medical needs.
anthem’s size is a key distinguishing feature, and the company is a subsidiary of the even larger blue cross blue shield association, which accounts for more than 90% of the doctors and hospitals in throughout the country as part of its provider network. Anthem’s size has advantages such as being widely recognized and having the financial clout to provide members with good technology tools and helpful medical resources. there are also downsides, such as poor customer service and lack of customization.
In addition, Anthem has a history of coverage violations that favor your bottom line, including notable claim denials and termination of coverage for those with costly medical bills. our research shows that anthem denies claims at double the industry average rate.
If you’re worried about being denied insurance coverage for expensive treatments or if you need ongoing medical care, a unitedhealthcare policy may be a better option because it has very few complaints and above-average customer satisfaction.
options and types of plans
anthem was named one of our best insurance companies because of its large network of providers, which gives you many options for obtaining medical services. Anthem has a variety of health insurance plans available including options for individuals, families, Medicare, Medicaid, and group insurance.
individual and family health insurance
Health insurance plans are available through an employer, through the Marketplace, or directly from Anthem. For medical coverage, plan types include:
when shopping for health insurance through the marketplace, the size of anthem health insurance means you may see several types of plans available in your region, and there may be options at all levels, including catastrophic, bronze, silver, gold and platinum.
anthem also offers other types of insurance through its website, including:
For seniors and those who are eligible for Medicare, Anthem offers several coverage options.
anthem works with state partners to provide medicaid coverage and administer health insurance to those with low incomes, disabilities or other requirements. Anthem Medicaid plans are available in California, Indiana, Kentucky, Nevada, Virginia, and Wisconsin. Even if you sign up for Medicaid through the government, you may still have an Anthem version of health insurance.
anthem insurance cost
anthem’s individual health insurance plans are generally priced slightly lower than many competitors. You may find great deals on policies, and in Kentucky, the Anthem Blue Cross and Blue Shield plan is the cheapest health insurance in the state.
Comparing Anthem’s average cost to other insurance companies, the $477 monthly cost for a Silver Anthem policy is slightly higher than Cigna’s and much lower than Oscar’s.
The rate you pay for insurance will vary based on your personal details, where you live, and the level of coverage you select. In 2022, individual health insurance plans are likely to be priced slightly higher, with the rate of increase varying by state.
expected rate increase for anthem insurance in 2022
in connecticut, where rates are expected to increase 12.3%, that could mean an extra $60 per month for a silver-level insurance policy. The best way to mitigate upcoming health insurance rate increases is to compare quotes from health insurance plans to make sure you’re getting the best rate for the level of coverage you need.
how much is the copay with anthem?
The average cost, including copays and coinsurance, is $60 for a primary care visit and $150 for an urgent care visit, based on Anthem claims data. however, the amount you pay when you visit the doctor or receive medical services will vary depending on your plan. for example, a gold plan might have a $30 copay for a primary care doctor visit and a bronze plan might have a $75 copay for the same service. In general, paying more each month for health insurance will result in lower copays and coinsurance when you need medical care.
where is the anthem available?
anthem health insurance policies are available in 14 states across the country. there is a wide geographic distribution including the northeastern, midwestern, and pacific states.
In the states where it operates, anthem is typically a major player in the health insurance market, and in nine states, anthem is one of the top three companies with the largest enrollments in the individual market.
anthem has a complex business structure of subsidiaries, and it’s not always easy to decipher anthem versus blue cross blue shield. Anthem health insurance plan names may change depending on the state you are in, and some Anthem subsidiaries do not have Anthem in their name. Common examples include HMO Colorado, Empire plans in New York, and CompCare plans in Wisconsin.
member resources and unique features
anthem insurance offers several features that can enhance your coverage, help you get more value from your plan, and improve the way you manage your health care.
customer comments and complaints
anthem insurance has a history of denying coverage and canceling policies to those in need of expensive medical care.
In recent years, Anthem has had several claim denials that became high-profile news, and the insurance company has been repeatedly fined millions of dollars for issues such as failing to resolve consumer complaints, failing to address claims complaints within a reasonable time. time frame and cancel health insurance coverage for those who submitted costly medical bills.
In addition, anthem insurance denies claims twice as often as the industry average. Using publicly available data on individual health insurance plans purchased through the marketplace, we found that Anthem denied 36% of medical claims during calendar year 2019. By comparison, the average rate of claim denials in the health insurance marketplace of health was 17%.
The reasons Anthem denies claims may provide some insight into this high rate. About a quarter of claim denials within Anthem’s network are because the service was excluded from coverage, and 9% are because a referral was required. the majority, 60%, are classified with the reason “other”.
In addition, we see that anthem medicare advantage members are slightly less satisfied than average. according to a 2021 survey of j.d. Power, Anthem’s Medicare Advantage Plans scored 797 on a 1,000-point scale, which is slightly lower than the industry average of 806. The top-ranked company was Kaiser Foundation Health Plan with 846.
Other metrics show mixed reviews for Anthem Insurance. For example, in the National Association of Insurance Commissioners’ (NAIC) Complaint Index, Anthem ranks very well or very poorly depending on Anthem’s division or subsidiary. The major multi-state organizations have a low complaint rate, but at the state level, there is a high complaint rate in California, New York, Maine, Georgia, and New Hampshire. Similarly, the better business bureau (BBB) also shows mixed reviews based on subsidiary and status.
anthem is a publicly traded subsidiary of the blue cross blue shield association. is financially strong, and am best gives the company a rating of (“excellent”), indicating that the company has the financial ability to pay claims.
frequently asked questions
methodology and sources
Insurance policy cost data was obtained from the Centers for Medicare and Medicaid Services (CMS) using a 40-year-old sample in Virginia. the averages were calculated based on the level and the insurer. Claim denials were calculated using the CMS Health Insurance Exchange’s public use files to ensure transparency in coverage.