CareSource vs. Anthem Insurance

Anthem beats CareSource on numerous metrics including the size of its network, the number of states it operates in, the quantity of health insurance coverage types it offers and the quality of its mobile app according to online reviews, meaning many shoppers will likely find Anthem to be the better of the two health insurance companies.

Nevertheless, CareSource’s unique background of providing coverage for Medicaid members and other historically underserved communities may make it an appealing option for lower-income families in certain states.

Continue reading for more CareSource vs. Anthem comparisons that can help you decide which of the two health insurance providers is likely to be a better fit for your circumstances.

CareSource History

CareSource was founded in 1989 with the support of the Ohio state government. Then known as the Dayton Area Health Plan, it was a managed care program designed for Medicaid members.^[1] The nonprofit later changed its name to CareSource and expanded its offerings to include other types of plans such as Medicare and Marketplace health plans.

Click here to read our full CareSource review.

Anthem History

While it has existed under many different names, Anthem has been providing health insurance coverage in the United States since the 1940s. Anthem Insurance Company merged with WellPoint Health Networks in 2004 to form WellPoint, Inc. However, in 2014, the corporation reverted its name to Anthem, Inc.^[2]

Then, the company changed its name again in 2022 and remains Elevance Health to this day, although it still sells health plans under the Anthem Blue Cross Blue Shield brand name.^[3] As of 2019, Anthem is the largest of all the for-profit managed health care companies that are part of the Blue Cross Blue Shield Association.^[2]

Click here to read our full Anthem review.

CareSource vs. Anthem: Quick Glance

CareSource Pros and Cons

Anthem Pros and Cons

CareSource vs. Anthem: Plan Structures

While CareSource and Anthem offer many of the same categories of health insurance coverage, CareSource is more limited in that it doesn’t provide coverage through employers, which is how the majority of Americans obtain health insurance.^[4] Additionally, CareSource doesn’t offer as many different Marketplace plan structures or supplemental health insurance coverage types as Anthem does.

CareSource vs. Anthem: Plan Availability

Anthem solidly beats out CareSource when it comes to availability, although both insurers are limited to a fairly small number of states. You may be able to enroll in an Anthem health plan if you live in one of the following 14 states:^[5]

• California
• Colorado
• Connecticut
• Georgia
• Indiana
• Kentucky
• Maine
• Missouri
• Nevada
• New Hampshire
• New York
• Ohio
• Virginia
• Wisconsin

However, you should note that Anthem Blue Cross Blue Shield coverage is not necessarily available in every county in all of the states listed above. For example, Anthem does not operate in 30 counties around Kansas City, Missouri.^[5]

Meanwhile, CareSource insurance is only available in Arkansas, Georgia, Indiana, Kentucky, Michigan, North Carolina, Ohio and West Virginia. Furthermore, CareSource does not offer all of its plan structures in all eight of these states. For example, members in Kentucky and West Virginia can only sign up for Affordable Care Act (ACA) Marketplace plans through CareSource.^[6]

CareSource vs. Anthem: In-Network Providers

Anthem also has access to significantly more in-network providers than CareSource. As part of the Blue Cross Blue Shield Association, Anthem can tap into a massive network that includes over 1.7 million doctors and hospitals.^[7] Conversely, CareSource has a more modest network consisting of over 100,000 health care providers.^[8]

CareSource vs. Anthem: Cost

The cost of health insurance can vary significantly depending on your circumstances, making it difficult to compare prices between CareSource and Anthem plans. Generally speaking, the average cost of a Marketplace benchmark plan in 2024 is $477 per month.^[9]

If you shop for coverage through the Health Insurance Marketplace, companies like CareSource and Anthem are only allowed to take the following factors into account when setting your health insurance premiums:^[10]

• Age
• Location
• Tobacco use
• Number of people covered by the plan
• Plan tier

The health insurance tiers are a set of four categories that classify health plans based on how they balance premiums with out-of-pocket costs. Bronze and silver plans cost less up front but come with higher out-of-pocket costs such as deductibles, copays and coinsurance. Conversely, gold and platinum plans are more expensive when it comes to your regular premium payments but don’t require you to pay as much out of pocket whenever you receive medical services.^[11]

CareSource vs. Anthem: Coverage Limits

Similarly, coverage limits are not uniform across plans for either CareSource or Anthem, so it’s hard to pinpoint an expected coverage limit for all plan members. Keep in mind that annual and lifetime limits legally cannot be applied to the following 10 essential health benefits:^[12][13]

• Ambulatory patient services
• Emergency services
• Hospitalization
• Pregnancy, maternity and newborn care
• Mental health and substance use disorder services
• Prescription drugs
• Rehabilitative and habilitative services and devices
• Laboratory services
• Preventive and wellness services and chronic disease management
• Pediatric services (including dental and vision care for children)

CareSource vs. Anthem: Policy Management

Both CareSource and Anthem allow policyholders to manage their plans online, over the phone or by mail. In addition, they both have mobile apps that allow users to access ID cards, check the status of their claims, find in-network health care providers and more.

The CareSource mobile app and Anthem’s Sydney Health app have both been reviewed quite favorably overall but Sydney Health has a slight edge over CareSource with near-perfect ratings across thousands of reviews on both Google Play and the App Store.

CareSource vs. Anthem: Medical Loss Ratio

Under the ACA, health insurance companies are required to meet certain requirements regarding their medical loss ratio (MLR), which is the percentage of their revenue from premiums that they use to cover medical care or otherwise improve the experience of their plan members.

Insurers in the individual and small group health insurance markets must maintain a three-year rolling average MLR of 80% or more, while the threshold is set at 85% for insurance carriers in the large group market. Any health insurance company that fails to meet these standards at the end of any given year must pay rebates to all of its policyholders in the affected market.^[18]

CareSource has not announced any MLR rebates since 2015 and the company’s most recent stakeholder report indicates that it has maintained an MLR of 87.8%.^[19][20] Meanwhile, Elevance Health reported an MLR of 87% for 2023, so Anthem plan members shouldn’t expect to receive rebates in 2024.^[21]

CareSource vs. Anthem: Enrollment Process

To enroll in a Marketplace health insurance plan through either CareSource or Anthem, you will generally need to sign up during open enrollment, which takes place from November 1 to January 15 in the majority of states.^[22] Meanwhile, if you qualify for a Medicare Advantage plan, you should keep the Medicare open enrollment dates explained below in mind.^[23]

Outside of these dates, you may still be able to sign up for health insurance if you qualify for a special enrollment period. Special enrollment periods are triggered by major life events that significantly affect your health insurance needs such as the following:^[24]

• Getting married, divorced or separated
• Giving birth to or adopting a child
• Changing or losing your job
• Moving to a new home
• Losing your existing health coverage due to the death of a family member
• Aging out of your parents’ health plan by turning 26
• Becoming a United States citizen
• Leaving prison

CareSource vs. Anthem: Policyholder Experience

Although CareSource has garnered marginally better reviews than Anthem on online review platforms like Best Company and the Better Business Bureau, both carriers have very poor ratings overall. However, you should note that these ratings come from a relatively small sample of reviews, so they may not be representative of the experience of the majority of CareSource or Anthem plan members.

 

How To File Claims With CareSource and Anthem

CareSource and Anthem both allow you to access and submit claims forms online. The exact form you will need to fill out and submit may depend on your location and the type of plan you have.^[29][30] Keep in mind that your medical provider will generally file an insurance claim for you if you receive care in network, meaning you should only have to file your own claim if you receive care out of network.