Everything You Need to Know About Anthem Blue Cross Blue Shield Health Insurance

The information contained in this blog was updated in January 2024.

For many people, Anthem Blue Cross and Anthem Blue Shield are simply one company. And this is partially true and partially the cause of much confusion, especially for California residents. 

The trade names for the Blue Cross Blue Shield companies vary in certain states. For example, according to their website, Anthem Blue Cross is the trade name of Blue Cross of California. 

And, as explained by another source, 

“In California, Anthem Blue Cross and Blue Shield are actually different companies and are competitors.   In most other states, they are the same company and formed an association, the Blue Cross Blue Shield Association.  Anthem Blue Cross is a for profit company in California, and Blue Shield is a non-profit. Both insurance companies have large networks and very good doctors. 

In California, Anthem Blue Cross is the biggest health insurance carrier.  They have the most volume of health insurance applications and also have the most members.”

While Anthem Blue Cross and Blue Shield of California do compete on many levels in California, the deciding factor for most members is usually their available networks.

As an article at HealthforCalifornia.com website illustrates,

“Blue Shield of California has Sutter in their network. Anthem does not. Regarding Stanford, Anthem offers coverage through the hospital but not the medical group. Blue Shield has both.”

Other Factors for Individual Plans

With these two health insurance California competitors, their premiums tend to be very comparable. Depending on your region, the cheapest California health plan might be offered by Anthem Blue Cross or by Blue Shield of California. However, the rates tend to be about the same. The big difference is, as we’ve noted, the network.

When it comes to the availability of Anthem Blue Cross and Blue Shield of California through Covered California, both are included in the state’s health exchange program and both offer affordable individual plans.

Nationally, customers have rated various Blue Cross Blue Shield companies less than 3.5 stars on Consumer Affairs. The complaints include difficulty in getting medical procedures approved, coverage denials, and limited PPO choices.

The following sections provide an overview of each provider:

Anthem Blue Cross

In California Anthem Blue Cross is the trade name of Blue Cross of California. Anthem is also the second-largest medical insurance provider in the United States by total members, with over 40 million lives covered.

With over 8 million members just in California, Anthem Blue Cross provides coverage for more Californians than any other carrier in the state. Anthem has been a part of California’s health exchange, Covered California, since the start of Obamacare in 2014.

There are many policy options and there is a plan available no matter how much coverage you may want.

Anthem Blue Cross offers HMO, PPO, EPO, and a Health Savings Account (HSA) plans for small groups, large groups, and seniors.  Anthem insures more PPO members in California than any other insurance company and their PPO networks are very extensive and include most doctors and hospitals.

Nationwide, according to one reviewer,

“One of Anthem Blue Cross Blue Shield’s key strengths is its high member loyalty, with 95% of customers saying they would stick with the insurer, the highest score among the companies we ranked. The company also received a strong 3.5 out of 5 stars from the National Committee for Quality Assurance. NCQA evaluates healthcare plans on, among other things, member satisfaction.”

Blue Shield of California

Based in San Francisco, Blue Shield of California has been providing health coverage to California residents since 1939. The HMO plan is known as Blue Shield of California and is one of only two preferred provider organizations that offers plans to all California ZIP codes and counties.

Their PPO plan goes under the name of Blue Shield of California/Blue Shield Life – PPO.

Blue Shield is a nonprofit health plan provider, and in 2011, they pledged to take only two percent of their net income as revenue and give the rest back to their members and community. Since making this pledge, Blue Shield has returned as much as $560 million.

Blue Shield of California serves over 4 million members and is California’s third-largest health plan. It is a not-for-profit corporation that operates exclusively in California and offers coverage for individuals, small and large groups, and Medicare supplemental plans and Medicare Advantage plans.

Overall, Blue Shield is well-liked and considered one of the major players in the health plan industry in California. As one reviewer has pointed out,

“Blue Shield of California gets high marks as a good all-around health insurance provider. It’s a frontrunner for people who are looking for an insurer that delivers high customer satisfaction combined with good value for the money. The company received an impressive 4 out of 5 stars from the National Committee for Quality Assurance. NCQA evaluates healthcare plans on, among other things, member satisfaction.”

Northern California counties served by Blue Shield of California – HMO include Alameda, Santa Clara, San Mateo, Solano, Marin, San Francisco, and Sonoma.

Anthem Blue Cross Blue Shield of California Quality

The State of California’s Office of the Patient Advocate (OPA) Health Care Quality Report Cards are a service provided for consumers. These include a Health Plan Report Card for each provider doing business in the state of California. 

Here are the results of the OPAs report card for Blue Shield of California – HMO 2022-23 Edition

• OVERALL QUALITY OF MEDICAL CARE: Good
• Appropriate Use of Tests, Treatments and Procedures: Good
• Asthma and Lung Disease Care: Good
• Diabetes Care: Very Good
• Heart Care: Good
• Maternity Care: Good
• Behavioral and Mental Health Care: Fair
• Preventive Screenings: Very Good
• Treating Adults: Good
• Treating Children: Fair

In addition, the state’s report card includes a patient rating scorecard:

• PATIENTS RATE OVERALL EXPERIENCE: Very Good
• Getting Care Easily: Fair
• Satisfaction with Plan Services: Excellent
• Satisfaction with Plan Doctors: Good

In addition to Anthem’s HMO plan score, the report card includes the following for Anthem Blue Cross – PPO 2022-23 Edition

• QUALITY OF MEDICAL CARE: Good
• Appropriate Use of Tests, Treatments and Procedures: Good
• Asthma and Lung Disease Care: Good
• Diabetes Care: Good
• Heart Care: Good
• Maternity Care: Very Good
• Behavioral and Mental Health Care: Good
• Preventive Screenings: Good
• Treating Adults: Too few patients in sample to report
• Treating Children: Good

And the state’s report card included this patient rating scorecard for the PPO plan:

• PATIENTS RATE OVERALL EXPERIENCE: Too few patients in sample to report
• Getting Care Easily: Too few patients in sample to report
• Satisfaction with Plan Services: Very Good
• Satisfaction with Plan Doctors: Too few patients in sample to report

Blue Shield ranked relatively well across the board and quite well in particular service areas. 

Areas served by Anthem Blue Cross – HMO includes all of California. Services, however, may vary in availability.

And these are the results of the OPAs report card for Anthem Blue Cross – HMO 2022-23 Edition

• QUALITY OF MEDICAL CARE: Good
• Appropriate Use of Tests, Treatments and Procedures: Good
• Asthma and Lung Disease Care: Fair
• Diabetes Care: Very Good
• Heart Care: Good
• Maternity Care: Very Good
• Behavioral and Mental Health Care: Fair
• Preventive Screenings: Very Good
• Treating Adults: Good
• Treating Children: Good

The patient rating scorecard results were similar to Blue Shield’s:

• PATIENTS RATE OVERALL EXPERIENCE: Too few patients in sample to report
• Getting Care Easily: Too few patients in sample to report
• Satisfaction with Plan Services: Too few patients in sample to report
• Satisfaction with Plan Doctors: Very Good

Remember that in an HMO plan you can only see doctors in your HMO’s network. You will have a primary care doctor and a medical group who refers and coordinates your care to specialists when needed.

With PPO plans, you can choose to see out-of-network doctors. However, you are responsible for managing and paying the cost for out-of-network visits.

The following are the report card results for Blue Shield of California/Blue Shield Life – PPO 2022-23 Edition

• QUALITY OF MEDICAL CARE: Fair
• Appropriate Use of Tests, Treatments and Procedures: Good
• Asthma and Lung Disease Care: Good
• Diabetes Care: Fair
• Heart Care: Fair
• Maternity Care: Fair
• Behavioral and Mental Health Care: Good
• Preventive Screenings: Good
• Treating Adults: Good
• Treating Children: Fair

The patient rating scorecard results were similar to Blue Shield’s:

• PATIENTS RATE OVERALL EXPERIENCE: Very Good
• Getting Care Easily: Fair
• Satisfaction with Plan Services: Very Good
• Satisfaction with Plan Doctors: Good

The OPAs scorecard results for the Anthem Blue Cross PPO plan was not quite as high with diabetes care and heart care each only ranking as “Fair.”

The bottom line, however, is that both Blue Cross and Blue Shield providers are relatively well-rated, affordable, and provide extensive coverage throughout California.

And, with more than 4.5 million health plan members and more than 65,000 physicians across the state, Blue Shield of California is one of the largest provider in California. Anthem Blue Cross, in comparison, has over 8.6 million members in California alone, and covers more Californians than any other carrier in the state.

REBRANDING IN 2022 MEANS NEW NAMES WITH THE SAME SERVICES AND PROVIDERS

Anthem officially became Elevance Health on June 28, 2022. According to the company in an article at Forbes, the new names,

“[W]ill optimize and streamline the company’s brand portfolio, reduce complexities, and further underscore its evolution to deliver solutions beyond traditional health insurance, simplify the healthcare experience, and advance health beyond healthcare.”

Anthem, which has long operated a variety of government and commercial health insurance groups including Blue Cross and Blue Shield plans in 14 states, is currently the nation’s second-largest provider of health benefits after UnitedHealth Group’s UnitedHealthcare.

This was the company’s second corporate rebranding in less than a decade after the parent name was changed in 2014 from Wellpoint to Anthem. This current name change is being made to reflect the company’s businesses and operations.

The changes included the following:

The corporate name changed from Anthem to Elevance Health.

Healthcare services including the IngenioRx pharmacy benefit subsidiary became Carelon operations, and the prescription drug program administrator, or PBM, is now known as CarelonRx.

In some markets, non-Blue Cross plans such as their Medicare and Medicaid insurance products, took on the Wellpoint name, which was formerly the entire company’s corporate name until December of 2014.

Most importantly, for those in California, the 14 Anthem Blue Cross Blue Shield plans in 14 states retained the Anthem and Blue brands.

Your Local Experts for California Health Insurance

JC Lewis Insurance offers California health insurance plans only from the leading health insurance carriers licensed to do business in California. In addition, we are a local, family-owned firm of expert brokers based in Sonoma County.

Not only are we expert brokers, but we are also licensed and certified by each of these insurance carriers to offer coverage to small-group employers and businesses.

And if you’re looking to purchase medical insurance, we are here to help. Bring us your questions about health coverage insurance and you can be confident that JC Lewis Insurance Services will help you find the right solution.