Anthem is the Blue Cross brand for most of the country’s biggest Blue Cross states, and that creates a specific confusion when you shop for Medicare Advantage. Search “Blue Cross Medicare Advantage” and you will get results from at least a dozen unrelated companies, only some of which sell anything in your county.
This page sorts that out using CMS’s own CY2026 landscape file, which lists the premium, out-of-pocket maximum, drug deductible, and star rating for every Medicare Advantage plan in every county in the country. It covers what Anthem Medicare Advantage plans actually cost in 2026, how they are structured, and where the Anthem brand ends and the other Blue Cross companies begin. Everything here is 2026 plan year data unless labeled otherwise.
What Is Anthem Medicare Advantage
Anthem Medicare Advantage is Medicare Part C sold by Elevance Health under the Anthem Blue Cross and Anthem Blue Cross and Blue Shield names. A private plan replaces Original Medicare as your coverage, Medicare pays the insurer a fixed monthly amount, and the insurer takes on your Part A and Part B benefits plus, on most plans, Part D drugs and extras. If the parts of Medicare are still fuzzy, start there.
For 2026, CMS’s landscape file lists 155 Anthem-branded Medicare Advantage plan segments: 98 individual plans and 57 special needs plans, sold across 811 counties in 12 states (California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Missouri, Nevada, New York, Ohio, Virginia, and Wisconsin). KFF puts Elevance Health at 5% of national Medicare Advantage enrollment in 2026, fifth behind UnitedHealth Group (26%), Humana (20%), CVS Health (12%), and Kaiser Permanente (6%).
How Anthem relates to the other Blue Cross plans
Elevance Health’s own site states that Anthem Blue Cross and Blue Shield and affiliated blue plans are offered in 14 states. Anthem Medicare Advantage plans appear in only 12 of those states in the 2026 CMS file, so being an Anthem member on the commercial side does not guarantee an Anthem Medicare Advantage plan exists where you live.
The bigger point is what happens outside Anthem’s footprint. The Blue Cross Blue Shield Association is a group of independent, locally operated companies, and each one runs its own Medicare business. In the 2026 CMS landscape file, 623 Medicare Advantage plan segments carry a Blue Cross, Blue Shield or Anthem brand, and they come from 24 different parent organizations. Only 155 of those 623 carry the Anthem name, the same 155 counted above.
So “Blue Cross Medicare Advantage” in Illinois or Texas means Health Care Service Corporation. In Michigan it means Blue Cross Blue Shield of Michigan. In Pennsylvania it may mean Highmark, Independence Blue Cross, or Capital Blue Cross depending on the county. Different networks, different premiums, different star ratings, same cross-and-shield logo. Compare the specific plan, not the brand.
How Anthem’s Plans Work
Anthem’s 2026 plan mix is unusual. Of the 155 plan segments, 67 are HMO-POS, 30 are HMO dual-eligible special needs plans, 19 are HMO-POS chronic condition plans, 19 are PPO, 9 are plain HMO, 5 are PPO D-SNP, 3 are regional PPO, 2 are institutional SNP, and 1 is a PPO C-SNP. HMO-POS is the workhorse: a network HMO with a limited point-of-service allowance so certain services can be used out of network at higher cost.
On referrals, Anthem’s own plan comparison page says referrals are required “in some cases” on its Medicare Advantage HMO plans and are not required on its PPO plans. That is softer than most HMO language, so read the Evidence of Coverage for your exact plan number rather than trusting the plan type alone.
Prior authorization applies either way. KFF found that in 2026, 99% of Medicare Advantage enrollees are in plans requiring prior authorization for at least some services, concentrated on expensive care like inpatient stays and skilled nursing. Learning how prior authorization works and how to file a Medicare appeal is worth doing before you need surgery, not after.
Service areas are county-level, which is why national averages mislead. Every one of Anthem’s 26 individual plans in California carries a $0 premium in 2026, but their in-network out-of-pocket maximums run from $499 to $7,550, and all 26 are rated 3.0 stars. Same state, same carrier, same price, wildly different protection.
What It Costs
Every figure below is 2026 plan year data. Plan-level ranges come from CMS’s CY2026 landscape file (data last updated March 2, 2026). The copay ranges come from Anthem’s own published HMO and PPO comparison table.
| 2026 cost item | Anthem range or figure | Notes |
|---|---|---|
| Monthly plan premium, individual plans | $0 to $100 | 66 of 98 plans (67%) are $0; median $0 |
| Monthly plan premium, special needs plans | $0 to $58.80 | 33 of 57 (58%) are $0 |
| Medicare Part B premium (you always pay this) | $202.90 | Standard 2026 rate, up from $185.00 in 2025 |
| Medicare Part B deductible | $283 | 2026 rate, up from $257 in 2025 |
| In-network out-of-pocket maximum | $499 to $9,250 | Median $6,700; 19% of individual plans sit at the $9,250 CMS ceiling |
| Part D drug deductible, individual plans | $0 to $390 | Median $212.50; no Anthem plan charges the $615 legal maximum |
| Primary care copay, in network | $0 to $35 (HMO), $0 to $20 (PPO) | Anthem published range, not plan specific |
| Anthem Prime (HMO-POS) H4161-009, California | $0 premium, $499 in-network cap | $0 drug deductible, 3.0 stars, lowest cap of any Anthem plan |
| Anthem Medicare Advantage (HMO-POS) H5422-011, Georgia | $0 premium, $9,250 in-network cap | $250 drug deductible, 3.5 stars, 145 counties |
| Anthem Medicare Advantage (Regional PPO) R5941-016, Indiana and Kentucky | $97 premium, $9,250 in-network cap | $45 drug deductible, 3.5 stars, 172 counties |
Three things that table hides.
The $0 premium is only the plan’s share. You still owe Medicare $202.90 a month for Part B in 2026 plus the $283 Part B deductible, so a “free” plan is never free. For context, KFF puts the enrollment-weighted average Medicare Advantage supplemental premium at $15 a month nationally in 2026.
Anthem’s out-of-pocket caps are on the high side. The median in-network maximum across Anthem’s individual plans is $6,700, against a national Medicare Advantage average of $5,421 that KFF calculated from the same CMS files. Nearly one in five Anthem individual plans sits at the $9,250 ceiling, which is the most CMS allows a plan to expose you to in network.
Anthem is unusually good on drug deductibles. No Anthem plan charges the $615 Part D maximum in 2026, and the median is $212.50. That is a real edge over carriers that park most plans at the legal cap. Our Medicare Part D cost page explains how the 2026 $2,100 out-of-pocket drug cap changes that math.
One honest gap: Anthem does not publish a per-plan Summary of Benefits at a public URL the way Humana and some other carriers do. You have to enter a ZIP code and work through the shopping tool to see exact copays for a specific plan number, which is why the copay row above is Anthem’s own published range rather than a named-plan figure.
Who It’s Good For and Who Should Skip It
Good if you take expensive brand-name drugs. Anthem’s Part D deductibles top out at $390 in 2026 while several competitors sit most of their plans at $615.
Good if you already use Anthem doctors. In Anthem’s 12 Medicare Advantage states the commercial and Medicare networks overlap heavily, so your existing physicians are more likely to be in network.
Good if you qualify for both Medicare and Medicaid. Anthem runs 35 dual-eligible plan segments in 2026. Read dual-eligible special needs plans before you enroll in a standard plan.
Think twice if star ratings matter to you. Anthem’s individual plans average 3.54 stars in the 2026 file, and only 24% are 4.0 or better. In Kaiser Permanente’s case that number is 100%.
Think twice if you want a low out-of-pocket ceiling. Anthem’s median is $6,700, above the national average, and you have to read plan by plan to find the good ones.
Think twice if you split the year between states. Anthem’s HMO and HMO-POS service areas are county-based, and only 3 of its 155 plan segments are regional PPOs.
Anthem Medicare Advantage vs Original Medicare Plus Medigap
| Anthem Medicare Advantage | Original Medicare plus Medigap | |
|---|---|---|
| Monthly cost | $0 to $100 plan premium plus $202.90 Part B | $202.90 Part B plus a Medigap premium set by the insurer |
| Yearly out-of-pocket limit | Yes, $499 to $9,250 in network | No federal limit, but Medigap absorbs most cost sharing |
| Provider choice | Plan network, county service area, 12 states | Any provider that accepts Medicare, nationwide |
| Referral to a specialist | “In some cases” on HMO plans, none on PPO | Not required in most cases |
| Prior authorization | Required for certain services | Not required in most cases |
| Drug coverage | Built in on 143 of 155 Anthem plans | Separate Part D plan required |
| Dental, vision, hearing | Included on most plans | Not covered |
| Can you buy Medigap? | No. Medicare.gov states you cannot buy Medigap to cover Medicare Advantage out-of-pocket costs | Yes |
The one-way door is the part nobody flags at enrollment. You can move into Medicare Advantage during any Medicare open enrollment period. Moving back to Original Medicare and buying a Medigap policy is harder, because your guaranteed right to buy Medigap without medical underwriting is a six-month window that opens the first month you are both 65 and enrolled in Part B.
Our Medicare Advantage versus Medigap comparison walks that trade in detail, Medicare Advantage versus Original Medicare covers the coverage side, and Medigap cost shows what the alternative premium actually looks like.
The Bottom Line
Anthem publishes less than average. It gives you a copay range and a “most plans are $0” claim, and then makes you enter a ZIP code for anything specific. CMS fills the gap, and CMS is the number to trust: pull the exact contract and plan number for your county rather than shopping the Anthem brand.
Do three things before you enroll for 2026. Check the in-network out-of-pocket maximum first, because Anthem’s spread from $499 to $9,250 is the widest cost variable on the page. Check the star rating for that plan number, not the carrier. And confirm your doctors are in network for that specific plan, since Anthem sells 67 different HMO-POS plans and the networks are not interchangeable.
One timing note. Everything here is 2026 plan year data. CMS said in its 2027 Part D bid fact sheet that it will release the 2027 Medicare Advantage and Part D landscape in mid to late September 2026, and the annual enrollment period for 2027 runs October 15 to December 7, 2026. Premiums and caps will change. Compare against Humana, Aetna, UnitedHealthcare, Cigna, Wellcare, and Devoted Health in your own county, and if money is tight, check Medicare Savings Programs and Extra Help first, because those cut the Part B premium you pay no matter which plan you choose.