Anthem BlueCross BlueShield Review

Anthem Health Insurance Review (2025-2026)

Anthem remains a key player in the U.S. health insurance landscape, offering a wide range of ACA and Medicare plans across multiple states. Backed by the Blue Cross Blue Shield Association, Anthem provides access to a large provider network, strong supplemental benefits, and new affordability protections—particularly for Medicare Advantage enrollees. As of 2025-2026, Anthem continues to enhance behavioral health access, expand digital tools, and offer more tailored member support.

Pros and Cons

Pros

• Broad ACA and Medicare Advantage coverage in many states
• Strong supplemental benefits like dental, vision, hearing, and SilverSneakers
• Highly customizable MA plans with flexible “Essential Extras”
• Robust digital tools, telehealth, and behavioral health access
• Strong affordability for low-income enrollees through CSRs and APTCs

Cons

• Not a truly national insurer; limited availability in some states and counties
• Average to above-average complaint rates in certain regions
• Premiums could rise in 2026 depending on federal subsidy policy
• Some variability in service quality and provider access by market

Coverage Area (2025-2026)

United States

Anthem offers ACA Marketplace plans in 14 states and Medicare Advantage plans in select counties across states, including Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New York (southeastern), Ohio, Virginia, and Wisconsin. Anthem also participates in Medicaid programs in 8 states.

International

Through its affiliation with the Blue Cross Blue Shield network, Anthem members may access emergency coverage while traveling abroad.

Provider Network

Anthem leverages the vast BCBS network, giving members access to a wide range of doctors, hospitals, and specialists in covered areas.

Plan Types Offered (2025-2026)

Under-65 (Individual & Family)

• ACA Marketplace Plans:
  Available in 14 states, Anthem ACA plans include Bronze and Silver tiers with options for cost-sharing reductions. In Indiana, for example, the Silver Pathway Essentials 7200 plan is $395/month with an $8,700 MOOP. CSRs can reduce the MOOP to as low as $750 for qualifying enrollees.
• Short-Term Medical (STM):
  Not typically offered by Anthem.
• Employer-Sponsored Plans:
  Anthem provides employer group health insurance in select states, with customizable plan designs for businesses.
• Medicaid:
  Offered in 8 states with managed care options tailored to local health needs.

Medicare (65+)

• Medicare Advantage (MA):
  Anthem offers HMO, HMO-POS, PPO, and SNP plans, including Dual-Eligible (D-SNP), Chronic Condition (C-SNP), and Institutional (I-SNP) models. Plans often include dental, vision, hearing, and prescription drugs (Part D), plus “Essential Extras” like prepaid cards for groceries or utilities.
• Medicare Supplement (Medigap):
  Plans vary by state and are less emphasized in Anthem’s portfolio.
• Part D Prescription Drug Plans:
  Integrated into most MA plans; benefits significantly enhanced in 2025 with a $2,000 out-of-pocket cap and elimination of the Part D donut hole.
• Retiree Group Medicare:
  Group MA and PDP plans are available for employers and unions.

Recent Changes in Cost and Options (2025-2026)

Premiums and Rate Changes

While ACA plans remain affordable in 2025, future increases are possible in 2026 if federal subsidies are reduced. MA plans generally offer $0 premiums and copays for preventive care, with capped MOOPs.

Out-of-Pocket Costs

Anthem’s ACA and MA plans offer strong value protections, especially for lower-income members using CSRs. The 2025 Part D redesign limits annual drug expenses to $2,000 and removes the coverage gap.

Medicare Advantage Updates

MA plans continue to expand, with new behavioral health coverage (including marriage/family therapists), improved care coordination for D-SNPs, and coverage for gene therapies and rare conditions.

Plan Enhancements

Anthem members benefit from telehealth, digital health tools, mental health access, and social needs supports like prepaid grocery and transport cards.

Network Agreements

Anthem’s participation in the BCBS network ensures robust provider access in core regions, although local availability varies.

Consumer Experience Snapshot

Complaint Index

Anthem’s NAIC Complaint Index is average to slightly above average, depending on the state and line of business. Common complaints include billing and claims delays.

Satisfaction Scores

Detailed satisfaction metrics are not publicly reported, but Anthem is investing in tools to notify members of unused benefits and enhance transparency in 2026.

Methodology

Our Health Insurance Rating Methodology evaluates insurers on five core dimensions—Coverage Breadth and Accessibility, Plan Variety and Customization, Affordability and Value, Innovation and Care Quality, and Consumer Experience and Transparency—on a scale of 1 to 10. The overall score is the average across these categories, based on public filings, pricing data, plan features, and consumer feedback.

Bottom Line

Anthem offers a high-value mix of ACA and Medicare Advantage plans in select markets, with standout flexibility and strong supplemental benefits. While availability is regionally focused rather than national, Anthem’s commitment to care innovation, affordability protections, and digital tools positions it as a strong contender in 2025 and beyond.

Disclaimer

The views and opinions expressed are those of the authors and do not necessarily reflect the official policy or position of HealthCareInsider.com or HealthCare, Inc.