Anthem Medicare Advantage 2022 Review

Anthem is one of the country’s largest health insurers. It offers Medicare Advantage plans in 14 states as part of the Blue Cross Blue Shield collective and in a handful of other states on its own. Anthem offers competitive premiums and plenty of $0-premium plans, but its ratings for both quality and member satisfaction are slightly below average.

Here’s what you should know about Anthem Medicare Advantage.

Anthem’s offerings have advantages and disadvantages.

• Flexibility for additional benefits: Anthem lets some members choose from a menu of benefits and services like transportation, help with housework or an allowance to spend on assistive devices to add to their plan at no extra cost.

• Flexible care options: Anthem offers a 24/7 nurse line and 24/7 online appointments for virtual care, as well as a house call program for qualifying members.

• Available in relatively few states: Anthem offers its Blue Cross Blue Shield-branded Medicare Advantage plans in only 14 states, and its subsidiaries cover a few more states. Most of Anthem’s competitors have a larger footprint.

• Middling star and satisfaction ratings: Anthem’s average star rating from the Centers for Medicare & Medicaid Services is 3.9 stars (the national average for all providers is 4.37 stars), and Anthem came in fifth out of nine providers in J.D. Power’s member satisfaction study.

• Fewer members in 4-star or better plans: Anthem reports that 72% of its members will be in plans rated 4 stars or better in 2022. That’s a lower rate than most other Medicare Advantage providers.

Anthem offers several kinds of Medicare Advantage plans, and they vary in terms of structure, costs and benefits. Anthem offers Medicare Advantage Prescription Drug plans, or MAPDs, as well as stand-alone prescription drug plans and Medicare Advantage plans without drug coverage.

Plan offerings include the following types:

Most of Anthem’s Medicare Advantage plans include Part D drug coverage, but the company also sells stand-alone Part D prescription drug plans, or PDPs, in 16 states. These plans provide drug coverage for people enrolled in Medicare Part A and Part B, so they don’t provide medical coverage.

Anthem offers two plan options in each state where it sells stand-alone prescription drug plans: a standard option and a “plus” option with enhanced coverage. For example, if you live in Madison, Wisconsin, you have these two options from Blue Cross Blue Shield of Wisconsin:

• Anthem MediBlue Rx Standard.

Here’s how those two plans compare:

*For a 30-day supply of a covered Part D prescription drug at a preferred retail pharmacy after meeting any applicable deductible.

Premiums, deductibles, covered drugs, costs for each tier and pharmacy arrangements all differ by plan. You can enter information about your prescriptions and choose your pharmacy on Anthem’s website to check how each available plan would cover your medications.

Many Anthem Medicare Advantage plans include a variety of extras, some that are built into the plan and others that members select from a menu of “Essential Extras.” Here are some examples, although their availability varies by plan:

• Home safety funds: Members can receive $500 per year for assistive devices or safety features like handrails or temporary ramps.

• Flex account: Members can receive $500 per year to spend on dental, vision or hearing on top of the coverage included in their plan.

• Fitness tracking: Members can receive a fitness tracker and use online programs for fitness, activity and health coaching.

• Food services: Members can receive monthly funds to spend on healthy groceries or have prepared meals delivered at home.

• Home help: Members can be visited in their homes for companionship, help with bathing or dressing, housework or other chores and errands.

• Pest control: Members can have their homes treated to control pests that might cause complications related to chronic medical conditions.

• Transportation: Members can receive rides to and from health appointments.

• SilverSneakers: Members can visit gyms and access live and pre-recorded online fitness classes tailored to older adults.

Here’s how Anthem members can contact customer service:

Anthem offers Blue Cross- or Blue Cross Blue Shield-branded Medicare Advantage plans in 14 states. Including those plans and Medicare Advantage plans from other subsidiaries, Anthem says it has a “Medicare presence” in 24 states and Puerto Rico. The company also offers Medicare prescription drug plans in 16 states.

Anthem is the second-largest health insurer in the country by market share [1]. Anthem reports that it has about 1.85 million Medicare Advantage beneficiaries as of late 2021 [2].

Costs for Medicare Advantage plans depend on your plan, your geographic location and your health needs. One of the costs to consider is the plan’s premium. About 3 in 5 (59.7%) Anthem Medicare Advantage plans have $0 premiums [3].

For 2022 Medicare Advantage plans with a premium, the monthly consolidated premium (including Part C and Part D) ranges from $2.10 to $172. For special needs plans, or SNPs, with a premium, monthly premiums range from $1.70 to $59 [4].

Even as a Medicare Advantage user, you’ll still be responsible for paying your Medicare Part B premium, which is $170.10 in 2022, although some plans cover part or all of this cost. (Most people pay this standard amount, but if your income is above a certain threshold, you’ll pay more.)

Other out-of-pocket costs to consider include:

• Whether the plan covers any part of your monthly Medicare Part B premium.

• The plan’s yearly deductibles and any other deductibles, such as a drug deductible.

• Copayments and/or coinsurance for each visit or service. For instance, there may be a $10 copay for seeing your primary doctor and a $45 copay for seeing a specialist.

• The plan’s in-network and out-of-network out-of-pocket maximums.

• Whether your medical providers are in-network or out-of-network, or how often you may go out of network for care.

• Whether you require extra benefits, and if the plan charges for them.

To get a sense of costs, use Medicare’s plan finding tool to compare information among available plans in your area. You can select by insurance carrier to see only Anthem plans or compare across carriers. You can also shop directly from Anthem’s website by entering your ZIP code.

The Centers for Medicare & Medicaid Services maintains star ratings for Medicare Advantage and Medicare Part D plans on a 5-point scale, ranking plans from best (5 stars) to worst (1 star). The agency bases these ratings on plans’ quality of care and measurements of customer satisfaction, and ratings may change from year to year.

Based on the most recent year of data, Anthem’s 2022 Medicare Advantage and prescription drug plans both get average ratings of 3.9 stars [5]. The average star rating for plans from all providers was 4.37 [6]. Two Anthem plans scored overall ratings of 5 stars: HealthSun Health Plans and Optimum HealthCare, both of which operate in Florida.

Anthem says that it expects more than 70% of its Medicare Advantage members to be in plans rated 4 stars or better in 2022.

There are a few companies that weigh in on health plans or on the strength of the company in question, and we’ve included three here:

See how Medicare Advantage competitors compare to Anthem.

Anthem Inc., headquartered in Indianapolis, Indiana, was formed in 2004 out of a merger between WellPoint Health Networks and Anthem. The company operates Medicare Advantage plans under a variety of subsidiaries, many of which use Blue Cross Blue Shield trade names.

Anthem offers commercial health insurance for individuals and employers; Medicare Advantage and Medicaid plans; life, disability, dental and vision insurance; and services for other government health insurance programs. In 2020, Anthem had $121.9 billion in annual revenue.

• What are the plan’s costs? Do you understand what the plan’s premium, deductibles, copays and/or coinsurance will be? Can you afford them?

• Is your doctor in-network? If you have a preferred medical provider or providers, make sure they participate in the plan’s network.

• Are your prescriptions covered? If you’re on medication, it’s crucial to understand how the plan covers it. What tier are your prescription drugs on, and are there any coverage rules that apply to them?

• Is there dental coverage? Does the plan offer routine coverage for vision, dental and hearing needs?

• Are there extras? Does the plan offer any extra benefits, such as fitness memberships, transportation benefits or meal delivery?

If you have additional questions about Medicare, visit Medicare.gov or call 800-MEDICARE (800-633-4227, TTY 877-486-2048).