Anthem is both — it runs Medicaid plans in some states and Medicare Advantage plans in others, but not in all states

Anthem is a private insurance company that contracts with both the federal Medicare program and state Medicaid programs. This means Anthem sells plans under both names, but which one you can join depends on where you live and which program you're may be able to access for. Anthem does not decide whether you get Medicare or Medicaid — your age, income, and disability status determine that. Anthem straightforward offers insurance plans within whichever program you already may have access to for.

The confusion arises because Anthem's name appears on both types of insurance cards, and the plans work differently even though they're sold by the same company. A Medicare Advantage plan from Anthem is not the same as a Medicaid plan from Anthem, even though both are Anthem products.

Key Takeaways

  • Anthem offers Medicare Advantage plans in most states, allowing people 65 and older to get their Medicare benefits through Anthem instead of Original Medicare.
  • Anthem also runs Medicaid plans in many states for people under 65 with low income, but not all states contract with Anthem for Medicaid.
  • Your state of residence determines whether Anthem offers either plan to you — Anthem's service area varies by program and by state.
  • You cannot have both a Medicare plan and a Medicaid plan from the same company at the same time; you have one or the other based on your age and income.
  • To find out which Anthem plans are available where you live, you need to check Medicare.gov for Medicare Advantage or your state Medicaid office for Medicaid.

Anthem Medicare Advantage plans and how they differ from Original Medicare

Anthem Medicare Advantage is a private insurance plan that delivers your Medicare benefits. If you're 65 or older and enrolled in Medicare Part A and Part B, you can choose to get your coverage through an Anthem Medicare Advantage plan instead of using Original Medicare. Anthem then becomes your insurance company, and you pay Anthem premiums and use Anthem's network of doctors and hospitals.

Medicare Advantage plans typically include prescription drug coverage (Part D) built in, whereas Original Medicare does not. Many Anthem Medicare Advantage plans also cover dental, vision, and hearing — benefits that Original Medicare does not cover. However, you usually pay a copay or coinsurance when you see a doctor, and you must use doctors and hospitals in Anthem's network. If you go out of network, you may pay more or the plan may not cover the visit at all.

Anthem Medicare Advantage is available in most states, but not everywhere. You can see which plans Anthem offers in your area by visiting Medicare.gov during the annual enrollment period (October 15 to December 7 each year) or by calling 1-800-MEDICARE.

Anthem Medicaid plans and who can join them

Anthem Medicaid is a health plan for people under 65 with low income. Each state runs its own Medicaid program and decides which insurance companies it contracts with. Anthem operates Medicaid plans in many states, but not all — your state must have chosen Anthem as a Medicaid plan option for you to join one.

Medicaid covers doctor visits, hospital stays, prescription drugs, and other medical services with little or no cost to you. The exact benefits and rules vary by state because each state designs its own Medicaid program. Some states require you to choose a Medicaid plan (managed care), while others assign you to one automatically. Anthem's role is to process claims and manage the network of doctors you can see.

To find out whether Anthem offers Medicaid plans in your state, contact your state Medicaid office directly. You can find your state office through the Centers for Medicare & Medicaid Services website or by calling 1-800-MEDICARE and asking for your state Medicaid number.

How to find out which Anthem plans are available in your state

The first step is to know which program you're may be able to access for. If you're 65 or older, you're may be able to access for Medicare. If you're under 65 and have low income, you may be may be able to access for Medicaid. Some people may have access to for both (called "dual may be able to access"), but you still enroll in each program separately.

For Medicare Advantage plans, go to Medicare.gov and enter your ZIP code. The site will show you all Medicare Advantage plans available in your area, including Anthem plans if Anthem serves your region. You can also call 1-800-MEDICARE and speak to a representative who can tell you which Anthem Medicare Advantage plans are offered where you live.

For Medicaid plans, contact your state Medicaid office. Your state office can tell you whether Anthem is one of the Medicaid plan options and how to enroll. Many states also have a 211 helpline (dial 2-1-1) that can connect you to your state Medicaid office and answer questions about local plans.

The difference between Anthem's role in Medicare versus Medicaid

In Medicare, Anthem is a private company that contracts with the federal government to deliver Medicare benefits. The federal government sets the rules, but Anthem decides which doctors to include in its network, what copays to charge, and which extra benefits (like dental) to offer. You pay Anthem a monthly premium, and Anthem pays your doctors and hospitals.

In Medicaid, Anthem is a private company that contracts with your state government. Your state sets many of the rules, but Anthem still manages the network and processes claims. Medicaid premiums are usually much lower than Medicare Advantage premiums, and in many states Medicaid has no premium at all. However, Medicaid benefits and coverage rules are set by your state, so they differ from state to state.

In both cases, Anthem is the middleman between you and the government program. Anthem does not decide whether you're may be able to access for Medicare or Medicaid — that's determined by your age, income, and other factors. Anthem only decides whether to offer a plan in your area and what that plan will cover.

What happens if you move to a state where Anthem doesn't offer plans

If you have an Anthem Medicare Advantage plan and move to a state where Anthem doesn't operate, your coverage will end on the last day of the month you move. You'll need to enroll in a new Medicare plan in your new state. You have 60 days after your move to join a new plan without penalty, so contact Medicare.gov or call 1-800-MEDICARE as soon as you know your new address.

If you have an Anthem Medicaid plan and move to a state where Anthem doesn't operate, your coverage will also end. You'll need to enroll in a Medicaid plan offered in your new state. Contact your new state's Medicaid office to find out which plans are available and how to enroll. Some states allow you to enroll when ready after a move, while others have waiting periods.

Moving is considered a may have access to life event, which means you can change plans outside the normal enrollment period. Keep your move documentation (like a lease or utility bill) in case you need to prove your new address.

Common confusion: Can you have both Anthem Medicare and Anthem Medicaid at the same time?

No. You cannot be enrolled in both a Medicare plan and a Medicaid plan from the same company (or any company) at the same time. However, some people are may be able to access for both Medicare and Medicaid — these people are called "dual may be able to access." Dual may be able to access people must enroll in a Medicare plan first, then enroll in a Medicaid plan separately. The two plans work together, with Medicare paying first and Medicaid filling in some of the costs that Medicare doesn't cover.

If you're dual may be able to access and want to use Anthem for both programs, you would enroll in an Anthem Medicare Advantage plan and a separate Anthem Medicaid plan (if Anthem offers both in your state). These are two separate enrollments with two separate insurance cards, but they coordinate with each other. However, not all states allow this combination, and not all Anthem plans are designed to work together, so you should confirm with Anthem or your state Medicaid office before enrolling.

Frequently Asked Questions

Does Anthem work with Medicare or Medicaid?

Anthem works with both. Anthem is a private insurance company that has contracts with the federal Medicare program and with many state Medicaid programs. Which program you use depends on your age and income, not on Anthem's choice.

How do I know if Anthem Medicare Advantage is available where I live?

Visit Medicare.gov and enter your ZIP code, or call 1-800-MEDICARE. Both will show you all Medicare Advantage plans available in your area, including Anthem plans if Anthem serves your region. Anthem's service area changes each year, so check annually during open enrollment.

What if I'm may be able to access for both Medicare and Medicaid?

You enroll in each program separately. Medicare is primary, meaning it pays first. Medicaid then covers some costs Medicare doesn't. If Anthem offers plans in both programs in your state, you can use Anthem for both, but you'll have two separate plans and two separate insurance cards.

Can I switch from Anthem Medicare to Anthem Medicaid or vice versa?

No. Your may be able to access for each program is based on your age and income, not on your choice of insurance company. If you turn 65, you become may be able to access for Medicare and must enroll in a Medicare plan; you would no longer be in a Medicaid plan. If your income changes and you no longer may have access to for Medicaid, your Medicaid coverage ends regardless of which company offers it.

What should I do if Anthem stops offering plans in my state?

Anthem will notify you in writing if your plan is ending. You'll have time to choose a new plan before your coverage ends. For Medicare, you can enroll in any other Medicare plan during the open enrollment period or within 60 days of losing your current plan. For Medicaid, contact your state Medicaid office to find out which plans are available and how to enroll.