Humana vs. Anthem BCBS: Medicare Advantage and Commercial Plan Comparison

Humana and Anthem (now Elevance Health) are two of the largest health insurers in the United States, each with distinct strengths and weaknesses in different market segments. Humana is a dominant force in Medicare Advantage; Anthem is one of the largest commercial plan providers through its BCBS licensee status. Understanding how they compare — especially for seniors and employer groups — helps members navigate coverage decisions and fight denials.

Who Are They?

Humana is the second-largest Medicare Advantage insurer in the United States, covering approximately 5 million Medicare Advantage members. It also offers commercial and individual market plans but has increasingly focused on its Medicare and Medicaid segments. Humana operates CenterWell (formerly Kindred at Home and others) as a healthcare services division.

Anthem rebranded as Elevance Health in 2022 but continues to operate health plans under the Blue Cross Blue Shield brand in 14 states (including California/Anthem Blue Cross, Georgia, Indiana, and others). It is the largest BCBS licensee and covers approximately 47 million members across all product lines.

Medicare Advantage: Humana vs. Anthem BCBS

Medicare Advantage is the segment where Humana is most visible and most data-rich for comparison.

CMS Star Ratings

CMS publishes annual Star Ratings (1–5 stars) for Medicare Advantage plans based on quality measures including chronic disease management, member experience, access to care, and administrative performance.

• Humana: Has historically maintained a large share of its enrollment in 4- and 4.5-star plans, which qualify for higher bonus payments from CMS. However, in recent years Humana faced star rating declines attributed partly to lower member experience scores.
• Anthem BCBS MA plans: Ratings vary significantly by state. Some Anthem BCBS MA plans have strong ratings; others fall below the 3.5-star threshold.

Prior Authorization Denied: How to Appeal" class="auto-link">Prior Authorization Denial Rates by Insurer (2026)" class="auto-link">Denial Rates

A 2024 KFF analysis of CMS data found that Medicare Advantage plans deny prior authorization requests at significantly higher rates than traditional Medicare would cover the same services. Both Humana and Anthem (Elevance) Medicare Advantage plans appeared in analyses showing above-industry-average denial rates for certain service categories.

A 2022 HHS Inspector General report found that Humana denied prior authorization requests at higher rates than the Medicare Advantage industry average and that many of those denials were for services traditional Medicare would have covered. Anthem BCBS plans received similar findings.

Post-Acute Care Denials

Both Humana and Anthem MA plans have faced scrutiny for denying coverage for skilled nursing facility (SNF) and inpatient rehabilitation stays that would be covered under traditional Medicare. Denials based on internal criteria (such as "no skilled need" determinations) that exceed what traditional Medicare would require are legally impermissible — Medicare Advantage plans must cover services that traditional Medicare covers.

If you or a family member had SNF or rehab coverage denied under a Humana or Anthem MA plan, this is a strong basis for appeal.

Commercial Plans: Anthem BCBS

In commercial (employer and individual market) insurance, Anthem is significantly larger than Humana. Key considerations:

Network access: BCBS plans generally offer broad networks, particularly for PPO products. Anthem's BCBS-affiliated networks are among the broadest in the country.

Prior authorization: Anthem commercial plans have faced physician complaints about PA volume, particularly for specialty drugs, behavioral health services, and elective procedures.

Mental health parity: Like other large commercial insurers, Anthem has faced MHPAEA enforcement actions in multiple states.

Commercial Plans: Humana

Humana's commercial plan footprint is smaller than Anthem's. Its employer-sponsored plans are concentrated in states where it has strong Medicare Advantage infrastructure.

Complaint Ratios

NAIC data for Humana and Anthem shows complaint ratios that vary by year and state. Both have faced elevated complaint rates in specific markets at specific times, particularly around claim denials and prior authorization disputes.

Appeals at Humana vs. Anthem

For Medicare Advantage members, appeals must follow CMS-mandated procedures:

• Level 1: Plan internal review.
• Level 2: Qualified Independent Contractor (QIC) review.
• Level 3: Administrative Law Judge hearing.
• Level 4: Medicare Appeals Council.
• Level 5: Federal district court.

For commercial plans, both Anthem and Humana follow state-mandated appeal timelines and are subject to state External Independent Review: Complete Guide" class="auto-link">external review processes.

Important: Medicare Advantage external appeal (QIC level) has historically shown high overturn rates — frequently 40–50% of denied Medicare Advantage services are reversed on appeal. This means appeals are worth pursuing.

Fight Back With ClaimBack

Whether your Medicare Advantage plan is through Humana or Anthem, the appeal process is multi-tiered and can be navigated with the right documentation. ClaimBack helps you identify the strongest grounds for appeal.

Start your appeal at ClaimBack

Related Reading

• How to Write an Insurance Appeal Letter
• What Is Medical Necessity?
• Internal vs. External Insurance Appeals