Anthem Blue Cross Blue Shield Hospital Visit Cost
With 42 million health insurance members across 14 states, Anthem insurance is one of the largest insurance companies in the country. There are many plans to choose from, and members have access to useful resources and digital tools. Plus, monthly rates are usually a good value, and the company has a large network of providers. However, the company has a poor reputation for customer service, has repeatedly been fined for violating customer grievance practices, and has a high rate of claim denials.
- Our thoughts
- Plan options and types
- Cost of Anthem insurance
- Where is Anthem available?
- Member resources and unique features
- Customer reviews and complaints
Our thoughts
Anthem is a good health insurance company for most people. Policies are usually affordably priced, even though they're not usually the cheapest health insurance plans in the state. There are also many plans available, letting you select the best option for your budget and medical needs.
The size of Anthem is a key distinguishing feature, and the company is a subsidiary of the even bigger Blue Cross Blue Shield Association, which has more than 90% of doctors and hospitals nationwide as part of its network of providers. Anthem's size has advantages such as being widely recognized and having the financial weight to provide members with good tech tools and helpful medical resources. There are also downsides including poor customer service and a lack of personalization.
Additionally, Anthem has a history of coverage violations that favor its bottom line including notable claim denials and dropping coverage for those who submit expensive medical bills. Our research shows that Anthem denies claims at twice the rate of the industry average.
If you are concerned that insurance coverage will be denied for expensive treatments or you need ongoing medical care, a policy from UnitedHealthcare may be a better choice because it has very few complaints and above-average customer satisfaction.
Plan options and types
Anthem was named as one of our best insurance companies because of its large network of providers, giving you many choices for where you get 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:
- HMO (health maintenance organization): Only covers in-network medical care, and referrals are required from a primary care physician.
- EPO (exclusive provider organization): Only covers in-network medical care, and you can visit specialists without a referral.
- PPO (preferred provider organization): More expensive plans that cover both in-network and out-of-network medical care.
When buying health insurance through the marketplace, the size of Anthem health insurance means you could see several plan types available in your region, and there can be options across all tiers including Catastrophic, Bronze, Silver, Gold and Platinum.
Anthem also offers other types of insurance through its website including:
- Prescription drug plans
- Dental insurance
- Vision insurance
- Short-term health insurance
- Supplemental insurance (accident, critical illness, hospital recovery)
Medicare
For seniors and those who are eligible for Medicare, Anthem offers several coverage options.
- Medicare Advantage (Part C): These combination plans bring together Original Medicare benefits of Part A and B with options for prescription drug coverage, vision and dental insurance, and wellness benefits. Anthem's Medicare Advantage plans didn't make it into our list of the best Medicare Advantage plans, but the health coverage options are still strong, with both HMO and PPO plans available.
- Prescription drugs (Part D): For stand-alone prescription drug coverage, Anthem offers three Part D plan options including MediBlue Rx Enhanced, Plus and Standard.
- Medicare supplement (Medigap): Supplement plans can improve the coverage you get with Original Medicare, helping to pay deductibles and coinsurance. There are several options available through Anthem, including Plan F, G and N.
- Dental and vision insurance: Anthem provides dental and vision coverage either as a stand-alone plan or as a component of Medicare Advantage Part C plans. This flexibility gives you the option to add on coverage or to bundle your coverage with other parts of Medicare.
Medicaid
Anthem works with state partners to provide Medicaid coverage and administer health insurance to those who have a low income, disabilities or other qualifiers. 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 actually have a version of Anthem health insurance.
Cost of Anthem insurance
Anthem health insurance individual plans are usually priced slightly lower than many competitors. You may find some great deals on policies, and in Kentucky, the Anthem Blue Cross and Blue Shield plan is the cheapest health insurance in the state.
| Average monthly cost of Anthem insurance | |
|---|---|
| Catastrophic | $288 |
| Bronze | $362 |
| Expanded Bronze | $382 |
| Silver | $477 |
| Gold | $487 |
Averages based on a 40-year-old in Virginia.
When comparing the average cost of Anthem to that of other insurance companies, the $477 monthly cost for a Silver Anthem policy is slightly higher than that of Cigna and much lower than that of Oscar.
Find Cheap Health Insurance in Your Area
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, and the rate of increase varies by state.
2022 expected rate increase for Anthem insurance
- Connecticut: 12.3%
- Colorado: 0.3%-7.3%
- Indiana: 2.8%
- Maine: 8.5%
- New York: 10.2%
In Connecticut, where rates are expected to increase 12.3%, that could mean an extra $60 per month for a Silver-tier insurance policy. The best way to mitigate the upcoming health insurance rate increases is to compare quotes for 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 a visit to urgent care, according to Anthem's claims data. However, the amount you pay when visiting the doctor or getting medical services will vary based on your plan. For example, a Gold plan could have a $30 copay for a primary care physician visit, and a Bronze plan could have a $75 copay for the same service. In general, paying more each month for health insurance will usually result in lower copays and coinsurance when you need medical care.
Where is Anthem available?
Anthem health insurance policies are available in 14 states across the country. There is a wide geographic distribution including the Northeast, Midwest and Pacific states.
In states where Anthem operates, it is usually 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. The names of Anthem health insurance plans can change based on what state you're in, and some Anthem subsidiaries don't have Anthem in their name. Common examples include HMO Colorado, Empire plans in New York and Compcare plans in Wisconsin.
| State | Anthem insurance subsidiary |
|---|---|
| California | Anthem Blue Cross Blue Cross of California |
| Colorado | HMO Colorado Inc. Rocky Mountain Hospital and Medical Service Inc. |
| Connecticut | Anthem Health Plans Inc. |
| Georgia | Blue Cross Blue Shield Healthcare Plan of Georgia Inc. Blue Cross Blue Shield of Georgia |
| Indiana | Anthem Insurance Cos. Inc. |
| Kentucky | Anthem Health Plans of Kentucky Inc. |
| Maine | Anthem Health Plans of Maine Inc. |
| Missouri | Rightchoice Managed Care Inc. Healthy Alliance Life Insurance Co. HMO Missouri Inc. |
| Nevada | HMO Nevada/HMO Colorado Inc. Rocky Mountain Hospital and Medical Service Inc. |
| New Hampshire | Anthem Health Plans of New Hampshire Inc. Matthew Thornton Health Plan Inc. |
| New York | Empire BlueCross BlueShield Empire HealthChoice Assurance HealthPlus HP LLC |
| Ohio | Community Insurance Co. |
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Member resources and unique features
Anthem insurance offers several features that can improve your coverage, help you get more value from your plan and improve how you manage your health care.
- Add-on coverage: Anthem offers stand-alone vision and dental insurance. Adding these policies on to your health insurance plan can be a simple solution for combining multiple coverage types while only using one insurer.
- Telehealth: Anthem has several telemedicine options, and members can have access to the 24/7 NurseLine, LiveHealth Online for virtual doctor visits and telehealth systems directly from their doctor or hospital.
- Support for healthy living and mental health: Members can also access resources like weight management programs, coaching, discounted gym memberships, stress management, mental health support and SilverSneakers memberships.
- Anthem mobile app: With Anthem's app, you can access digital ID cards, find a doctor, check your plan's benefits and costs, ask questions, sync your account with a fitness tracker and more.
Customer reviews and complaints
Anthem insurance has a history of denying coverage and canceling the policies of those who need expensive medical care.
In recent years, Anthem has had several claim denials that became high-profile news stories, and the insurance company has been repeatedly fined millions of dollars for issues such as failing to resolve consumer complaints, failing to address claims grievances within a reasonable time frame and dropping the health insurance coverage of those who submitted expensive medical bills.
In addition, we found that 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. In comparison, the average rate of claim denials across the health insurance marketplace was 17%.
The reasons that Anthem denies claims can provide some insight into this high rate. About one-quarter of Anthem in-network claim denials 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."
Additionally, we see that Anthem Medicare Advantage members are slightly less satisfied than average. According to a 2021 survey from J.D. Power, Anthem's Medicare Advantage plans scored a 797 on a 1,000-point scale, which is slightly lower than the industry average of 806. The top-ranking company was Kaiser Foundation Health Plan with an 846.
Other measurements show mixed reviews for Anthem insurance. For example, on the National Association of Insurance Commissioners (NAIC) complaint index, Anthem is ranked either very well or very poorly based on the Anthem division or subsidiary. The major multistate organizations have a low rate of complaints, but at the state level, there is a high rate of complaints in California, New York, Maine, Georgia and New Hampshire. Similarly, the Better Business Bureau (BBB) also shows mixed reviews based on the subsidiary and state.
Anthem is a publicly traded subsidiary of the Blue Cross Blue Shield Association. It's financially strong, and AM Best gives the company an A ("Excellent") rating, indicating the company has the financial ability to pay claims.
Frequently asked questions
Is Anthem good insurance?
Anthem is a good insurance company for most people. The policies are usually popular in states where they're available, and the company has a large network of medical providers. Keep in mind that Anthem has a reputation for denying claims, and you may be able to avoid problems by carefully reviewing plan documents or contacting the insurance company before receiving care.
What type of insurance is Anthem?
Anthem offers different types of health insurance, and plan types include HMO, PPO, EPO, prescription drug plans, vision, dental, short-term insurance and supplemental insurance. Policies are available for individuals and families. Seniors can sign up for Medicare plans, and those with low incomes can get Medicaid plans administered by Anthem.
Does Anthem Blue Cross work in other states?
The health care network specified by your Anthem insurance policy will determine whether you have access to in-network providers in other states. When submitting an out-of-state claim, you must contact Anthem's customer service department because the process may be different.
Methodology and sources
The cost data for insurance policies was sourced from the Centers for Medicare and Medicaid Services (CMS) using a sample 40-year-old in Virginia. Averages were calculated based on tier and insurer. Claim denials were calculated using the CMS Health Insurance Exchange Public Use Files for Transparency in Coverage.
Source: https://www.valuepenguin.com/anthem-health-insurance-review
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