Anthem Medicare Advantage Plans: The Honest 2026 Review

This is the part most Anthem marketing won’t tell you, and it’s worth taking seriously — 2026 has been a genuinely rough year for Anthem/Elevance on the regulatory front, and this goes well beyond ordinary customer service complaints.

A near-loss of the ability to enroll new Medicare Advantage members nationwide. In February 2026, CMS notified Elevance that it planned to impose “intermediate sanctions” — halting new enrollment in Anthem’s Medicare Advantage plans and suspending member communications — over allegations that Elevance failed for years (CMS cited noncompliance dating back as far as 2018) to properly submit and correct risk-adjustment diagnosis data through CMS’s required systems, instead using unauthorized external flash drives, and improperly asked CMS not to claw back funds tied to unsupported diagnosis codes. Elevance’s stock fell 9% the day the sanctions were disclosed. The company received extensions to fix its compliance, and on May 27, 2026, wired $342 million to CMS as a “remittance of the total overpayment amount.” Elevance’s CFO said the company set aside $935 million total to address the dispute. As of this writing, further compliance deadlines remain, and full resolution is still pending. This is arguably the most serious item on this list — it’s not a customer service complaint, it’s a federal regulator alleging systematic, years-long non-compliance serious enough to nearly shut off new Medicare enrollment for a company covering about 2 million Medicare Advantage members.

A separate, active lawsuit against CMS over star ratings. In July 2026, Elevance sued the federal government, alleging CMS unfairly recalculated a competitor’s (Clover Health’s) 2026 star ratings after a favorable court ruling while refusing to apply the same recalculation to five of Elevance’s own Medicare Advantage contracts — a decision Elevance says costs it roughly $115 million in 2027 quality bonus payments. This one cuts a different direction than the sanctions story above: Elevance is the one alleging unfair treatment here, not the target of an enforcement action. But it reflects a company currently locked in significant, simultaneous regulatory disputes with CMS on two separate fronts.

A hospital industry backlash over a controversial billing policy. Effective January 1, 2026, Anthem began rolling out a “nonparticipating provider” policy in roughly 11-12 states: if any out-of-network physician is involved in an Anthem member’s care at an in-network hospital — even a radiologist or anesthesiologist the hospital doesn’t employ or control — Anthem can cut its payment to that hospital by 10%, and potentially terminate the hospital from its network entirely. The American Hospital Association, along with multiple physician organizations and state hospital associations, has formally and repeatedly urged Elevance to rescind the policy, arguing it undermines the federal No Surprises Act, unfairly punishes hospitals for situations outside their control, and ultimately risks limiting patient access to care. As of mid-2026, the policy remains in effect and the dispute is ongoing. I haven’t confirmed whether New York is among the affected states — worth asking directly if this matters to you.

A real regulatory fine over complaint handling, separately. In January 2026, California’s Department of Managed Health Care fined Anthem Blue Cross $15 million for “longstanding and widespread deficiencies in handling the plan’s member complaints” — grievances and appeals specifically. Anthem is required to work with an independent auditor for up to four years to ensure member complaints are handled properly going forward.

A high volume of ordinary consumer complaints on top of all that. Anthem carries a substantial complaint history on the Better Business Bureau and ConsumerAffairs, with recurring patterns: enrollment and disenrollment errors (including one documented case of a cancer patient improperly enrolled in two plans simultaneously and charged a disenrollment fee), long hold times and being bounced between representatives, and claims denied citing “lack of documentation” that reviewers say wasn’t actually requested. None of this is unique to Anthem — most large national Medicare Advantage carriers face similar patterns — but combined with everything above, 2026 paints a picture of a company under real regulatory and reputational pressure on multiple fronts simultaneously.

Here’s my real take after 18 years of doing this: Anthem is a Medicare Advantage company like most of the others — some really good plans and real network strength in certain areas, and in other areas, not so good. That’s not unique to Anthem. That’s the nature of Medicare Advantage generally, and it’s exactly why we need to teach people to shop and compare every single year rather than assume the plan that worked for them once will keep working.

Carriers make adjustments to attract the customers they want, and — this is the part people don’t like hearing — they also make changes specifically designed to make certain customers want to leave. Insurance is a business. Every carrier, Anthem included, gets reimbursed by Medicare and collects premiums, and they want that reimbursement to exceed what they pay out in claims. That means every carrier, structurally, wants healthier members and lower utilization — just like any other insurance company in any other line of business. Understanding that isn’t cynicism, it’s just how the system is built, and it’s the same for every single carrier I represent, not a knock specific to Anthem.

On the regulatory side, what I laid out above — the CMS sanctions situation, the star ratings lawsuit, the hospital billing dispute, the California fine — is real, and worth knowing. But on the ground, as a broker who actually deals with these carriers’ back offices every week, I’ll say this plainly: Anthem’s customer service and broker support has been better than most in my experience over 18 years. That’s a genuinely different thing than what shows up in a regulatory filing or a consumer complaint database, and both things can be true at once.

No company is going to be the best everywhere, or the best for every person. And here’s the part I really want people to sit with: a Medicare Advantage plan can be great for you for five years, and then change significantly — sometimes even after just one year. That’s not a reason to avoid Medicare Advantage. It’s a reason to actually review your coverage every single Annual Enrollment Period instead of going on autopilot, no matter which carrier you’re with.