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Anthem is the Medicare-facing brand of Elevance Health, one of the largest health insurers in the country, operating through Blue Cross Blue Shield affiliates in a limited set of states. Before comparing costs and benefits, 2026 brings some genuinely significant regulatory news worth knowing upfront — Anthem has had a rough year on that front. Here’s the full, honest picture.
The Quick Verdict
- CMS Star Rating (2026): Around 3.63–3.64 overall, weighted by enrollment — below the national average, though performance varies notably by plan type
- Availability: Roughly 13–14 states, one of the narrower footprints among large national-scale carriers
- The regulatory story: 2026 has been a genuinely difficult year — Anthem is suing CMS over $115 million in disputed star-rating bonus payments, facing hospital industry backlash over a billing policy, and was fined $15 million by California’s insurance regulator for complaint-handling failures
- The nuance: Despite below-average national ratings, Anthem shows strong local J.D. Power scores in specific markets like Ohio and Georgia — a reminder that national averages don’t always reflect your local experience
Understanding the Anthem / Elevance / Blue Cross Blue Shield Structure
Anthem operates as the consumer-facing Medicare brand for Elevance Health (Anthem’s parent company, renamed from Anthem Inc. in 2022), delivered through Blue Cross Blue Shield affiliates in the states where it operates. This dual identity matters:
- Elevance Health provides the financial scale of a major national insurer
- The Blue Cross Blue Shield name carries decades of local trust in the markets where Anthem operates
- Anthem’s Medicare Advantage footprint is currently around 13–14 states — narrower than UnitedHealthcare, Humana, or Aetna, and Anthem has been further reducing its footprint and benefits in some markets for 2026, consistent with a broader industry pullback
2026’s Rough Regulatory Year — What You Should Know
This is worth addressing directly rather than burying it, since it’s genuinely relevant to evaluating Anthem right now:
- Anthem is suing CMS over $115 million in disputed 2026 star-rating bonus payments — a significant, ongoing dispute over how its plans were scored
- A formal, AHA-led hospital industry backlash has emerged over a controversial Anthem billing policy, meaning hospital groups nationally have pushed back publicly against the carrier’s practices
- California’s insurance regulator fined Anthem $15 million for complaint-handling failures — a direct, quantified regulatory penalty specifically about how the company handles member complaints
None of this means Anthem coverage itself is necessarily bad for an individual member, but it’s a meaningfully rougher regulatory year than most competitors are experiencing simultaneously, and it’s worth factoring into your confidence level if you’re comparing Anthem against carriers without similar active disputes.
Star Ratings: Solid HMO/PPO, a Real HMO-POS Problem
Anthem’s star ratings vary substantially by plan type — more so than most carriers in this review series:
| Plan type | 2026 star rating | vs. national average |
|---|---|---|
| HMO | 3.89 | Above the 3.86 average |
| PPO | 3.8 | Above the 3.63 average |
| HMO-POS | Well below average | 0.71 stars below the 4.01 national average — a large gap |
The HMO and PPO numbers are genuinely solid — above their respective national benchmarks. But the HMO-POS gap is large enough that it deserves real scrutiny, particularly if care coordination and chronic condition management matter to you. Interestingly, Anthem’s HMO-POS plans are also its cheapest offering — averaging just $6/month versus a $47 national average, with 64% carrying no premium at all and the lowest out-of-pocket limits in Anthem’s lineup ($4,544, about $528 below the national average). This creates a genuine trade-off: Anthem’s cheapest plan type is also its weakest-rated one.
Membership Decline: A Signal Worth Noting
Anthem lost roughly 368,000 Medicare Advantage members in a recent plan year — a meaningful decline that industry analysts have connected directly to the quality concerns reflected in its star ratings. This kind of attrition is worth factoring in as a real-world signal alongside the survey and ratings data.
The Nuance: Local Performance Can Beat the National Picture
Despite the below-average national CMS ratings, it’s worth being fair here: Anthem shows genuinely strong local J.D. Power satisfaction scores in specific markets, notably Ohio and Georgia — suggesting that on-the-ground member experience in those states can outperform what the national quality metrics alone would predict. Similarly, in New York specifically, Anthem’s Medicare Advantage lineup is a small, focused set of HMO-POS plans (including veteran-focused options), and roughly half of them carry the rare 5-star rating — a strong local exception to the broader HMO-POS weakness described above.
The practical takeaway: national averages can understate or overstate your actual local experience. If Anthem is available where you live, check your specific state and plan’s rating rather than relying on the company-wide numbers in either direction.
Costs and Standard Benefits
- Most Anthem plans include prescription drug coverage plus some dental, vision, and hearing benefits
- Some plans include a flex card covering certain approved expenses
- A number of plans offer a flexible menu of extra benefits at no additional cost — options like transportation or allowances toward assistive devices, dental, hearing, or vision services, letting members choose what matters most to them
- Anthem’s overall lineup has some of the highest maximum out-of-pocket costs among major carriers on certain plans — worth checking closely against the specific plan you’re considering, especially outside the cheaper HMO-POS tier described above
Pros and Cons
Pros:
- Above-average CMS star ratings on both HMO (3.89) and PPO (3.8) plans specifically
- Extremely low-cost HMO-POS option (averaging $6/month, 64% at $0 premium)
- Flexible benefit menus letting members choose the extras that matter most to them
- Genuinely strong local satisfaction scores in specific markets like Ohio and Georgia
- Backed by Elevance Health’s scale alongside the local trust of the Blue Cross Blue Shield name
Cons:
- A significantly large HMO-POS quality gap (0.71 stars below the national average) — its cheapest plan type is also its weakest
- A genuinely difficult 2026 regulatory year: an active CMS lawsuit over disputed bonus payments, hospital industry backlash, and a $15 million state fine for complaint-handling failures
- Below-average overall star rating and a meaningful membership decline in a recent year
- Narrow footprint — only about 13–14 states, with further reductions in some markets for 2026
- Some plans carry among the highest out-of-pocket maximums of major carriers
Frequently Asked Questions
Is Anthem the same as Elevance Health? Elevance Health is the parent company (renamed from Anthem Inc. in 2022); Anthem Blue Cross and Blue Shield is the Medicare-facing consumer brand operating through Blue Cross Blue Shield affiliates in the states where it’s available.
Should the CMS lawsuit and California fine worry me as a member? These are genuinely significant regulatory developments worth being aware of, though they don’t necessarily predict your individual coverage experience. Weigh them alongside your specific state’s local satisfaction data and your specific plan’s star rating.
Why are Anthem’s HMO-POS plans so much cheaper but lower-rated? This isn’t fully explained in available data, but it’s a consistent, notable pattern for 2026 — worth comparing carefully against other plan types or carriers if you’re specifically considering an Anthem HMO-POS plan.
Is Anthem available where I live? Only in about 13–14 states, and its footprint has been narrowing further in some markets for 2026. Confirm current availability in your specific county using the Medicare Plan Finder.
Are Anthem’s local satisfaction scores really better than its national rating suggests? In some markets, yes — Ohio, Georgia, and New York specifically show notably stronger local performance than Anthem’s national averages would suggest. Always check your specific state’s data rather than relying only on the company-wide numbers.
Bottom Line
Anthem presents a genuinely mixed picture for 2026: solid HMO and PPO star ratings, flexible benefit options, and standout local performance in specific states — set against a real HMO-POS quality gap, a below-average national rating, meaningful membership losses, and a notably difficult regulatory year including an active CMS lawsuit and a state fine for complaint handling. If Anthem is available in your area, it’s worth a close look specifically at your state and plan type’s actual performance rather than the national averages alone.
Compare the exact Anthem plans available in your ZIP code using the official Medicare Plan Finder, or speak with a licensed insurance agent or your local State Health Insurance Assistance Program (SHIP) for free, unbiased guidance.
Disclaimer: Star ratings, regulatory information, and figures mentioned in this article are based on 2026 CMS data and industry/news sources, and vary by state, county, and specific plan. Regulatory disputes described may evolve after publication — confirm current status directly with official sources. Always confirm current plan details directly with Medicare.gov, 1-800-MEDICARE, or a licensed agent before making a decision.