Molina Healthcare and Anthem are two significant players in the U.S. health insurance market, each with distinct market positions and offerings as of 2025. These companies continue to compete for market share and customer loyalty in an evolving healthcare landscape.
Molina Healthcare, founded in 1980 and based in Long Beach, California, has grown to become the ninth-largest health insurer in the U.S., holding a 2.04% market share as of early 2025. Known for its focus on government-sponsored healthcare programs, Molina primarily serves Medicaid and Medicare beneficiaries, as well as individuals in the Health Insurance Marketplace.
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Anthem, now known as Elevance Health since its rebranding in 2022, stands as the second-largest health insurer in the country with a 7.08% market share. With roots dating back to 2004, Anthem offers a wide range of health insurance products, including commercial, Medicare, and Medicaid plans, serving approximately 40 million members across various states.
Both insurers offer health plans including Medicare Advantage and Medicaid managed care, but they differ significantly in their target demographics, geographic coverage, and specific plan offerings. This comparison will explore the key differences between Molina Healthcare and Anthem, examining their market positions, plan availability, and approaches to healthcare delivery.
Plan Options & Coverage Types
HMO, PPO, POS, EPO Differences
Molina Healthcare primarily offers HMO plans, focusing on affordability and care coordination for Medicaid, ACA Marketplace, and Medicare Advantage enrollees.
Anthem (Elevance Health) provides a wide range of plan types, including HMO, PPO, EPO, and POS, offering greater flexibility for individuals and businesses.
Individual Plans vs. Employer-Sponsored Plans
Molina is heavily focused on individuals and families, especially through Medicaid and ACA exchanges.
Anthem serves both individuals and large employers, with a strong presence in group health insurance markets.
Medicare Advantage vs. Medicare Supplement
Both Molina and Anthem offer Medicare Advantage (MA) plans, with Molina focusing on Dual-Eligible SNPs (D-SNPs).
Anthem also offers Medicare Supplement (Medigap) plans, which Molina does not currently provide.
Medicaid and ACA Marketplace Options
Molina Healthcare is a major provider in the Medicaid market, with strong ACA Marketplace participation in multiple states.
Anthem also participates in Medicaid and ACA exchanges, depending on the region, with broader plan selections.
Cost & Affordability
Monthly Premiums Comparison
Molina generally offers lower premiums, especially for ACA plans and Medicaid-eligible individuals.
Anthem’s premiums can be higher depending on plan type (PPO vs. HMO), but they offer more flexibility and provider choice.
Deductibles and Copayments
Molina’s plans typically have lower deductibles and fixed copays, ideal for low-income or subsidy-eligible enrollees.
Anthem offers a range of deductible levels, from high-deductible HSA-compatible plans to low-deductible employer plans.
Out-of-Pocket Maximums
Molina often features lower out-of-pocket maximums in its Silver-tier ACA plans.
Anthem provides broader plan customization, with OOP caps varying by plan type and coverage level.
Pricing Transparency
Both companies offer member portals and cost estimators, but Anthem’s tools may be more advanced due to larger infrastructure and resources.
Network Size & Provider Accessibility
Size and Geographic Reach of Provider Networks
Anthem (via Blue Cross Blue Shield networks) has one of the largest networks in the U.S.
Molina’s network is more regional and limited, typically serving Medicaid-heavy areas.
Specialist Access and Referrals
Molina HMO plans usually require referrals from a primary care provider (PCP).
Anthem PPO and POS plans allow direct access to specialists, offering more flexibility.
Availability of In-Network Hospitals and Doctors
Anthem has a broader selection of hospitals and specialists nationwide.
Molina contracts primarily with community providers and clinics in underserved areas.
Out-of-Network Coverage and Reimbursement Rates
Anthem PPO plans cover out-of-network care, often with partial reimbursement.
Molina typically does not cover out-of-network services, unless for emergencies.
Member Benefits & Perks
Wellness Incentives
Anthem offers Blue365 for discounts on fitness memberships, nutrition, and wellness products.
Molina includes basic wellness services like health assessments and preventive screenings, but fewer perks.
Chronic Disease Management Programs
Both providers offer programs for managing chronic conditions like diabetes and heart disease. Anthem’s programs are typically more comprehensive and data-driven.
Telehealth and Virtual Care Offerings
Molina partners with telehealth providers to offer basic virtual care, often at no cost.
Anthem offers more advanced virtual platforms, including 24/7 access, behavioral health, and chronic care coaching.
Mental Health Coverage and Services
Both companies include mental health benefits, but Anthem has a larger behavioral health provider network and more digital therapy options.
Customer Service & Member Experience
Customer Satisfaction Ratings (J.D. Power, NCQA)
Molina receives average to below-average ratings, with common complaints about provider access.
Anthem scores vary by region but often rank above average for commercial and Medicare plans.
Ease of Claims Processing and Disputes
Anthem has a larger infrastructure and generally handles claims faster and more efficiently.
Molina may have delays or administrative issues, especially in high-demand Medicaid markets.
Online Portals and Mobile Apps
Anthem’s digital tools are more robust, with advanced plan management and virtual care access.
Molina’s portal is improving but more limited in functionality.
Responsiveness of Customer Support
Anthem offers 24/7 support, chatbots, and multilingual services.
Molina provides standard customer service, but response times can vary by state.
Reputation & Financial Stability
Financial Strength Ratings
Anthem (Elevance Health) has strong ratings: A (A.M. Best), A2 (Moody’s), and A+ (S&P).
Molina Healthcare also holds stable ratings but is more narrowly focused on government-sponsored plans.
Company Reputation and History
Anthem is one of the largest health insurers in the U.S., with decades of national presence.
Molina is a trusted name in Medicaid and low-income health programs, with a growing ACA footprint.
Consumer Complaints and Regulatory Issues
Both companies have complaints related to prior authorizations or provider access, but Molina’s complaint ratio may be higher in some states due to limited networks.
Medicare-Specific Criteria
Medicare Star Ratings & Member Satisfaction
Molina often scores around 3.5 to 4 stars on Medicare Advantage plans.
Anthem plans usually rank 4 stars or higher, depending on the region.
Additional Medicare Benefits
Both providers include vision, dental, hearing, OTC items, and fitness programs in many MA plans.
Anthem may offer more variety and higher plan quality in competitive markets.
Medigap Availability
Anthem offers Medicare Supplement (Medigap) plans.
Molina does not offer Medigap plans.
Cost-Sharing for Medicare
Molina focuses on $0 premium and low-cost D-SNP plans for dual-eligible members.
Anthem provides a wider variety of Medicare Advantage options, with more cost-sharing flexibility.
Employer & Small-Business Focus
Group Health Plans
Anthem is a leader in employer-sponsored coverage, offering fully insured and self-funded options.
Molina does not actively participate in the employer health market.
Employee Wellness & Incentives
Anthem provides customizable wellness programs and analytics for businesses.
Molina’s offerings are geared toward individual Medicaid and ACA populations.
Customization of Group Policies
Anthem offers extensive group policy customization, particularly for multi-state employers.
Molina does not focus on group plans.
✅ Conclusion: Molina vs. Anthem
Choose Molina Healthcare if you:
- ✅ Qualify for Medicaid or need ACA subsidies
- ✅ Prefer low-cost, HMO-based care
- ✅ Need a D-SNP Medicare Advantage plan
- ✅ Want affordable preventive and chronic care services
Choose Anthem (Elevance Health) if you:
- ✅ Need PPO or employer-sponsored group coverage
- ✅ Want broader provider networks and Medigap options
- ✅ Are a business offering customizable employee benefits
- ✅ Value digital tools, telehealth, and nationwide reach
FAQs: Molina Healthcare vs. Anthem (Elevance Health)
What is the main difference between Molina and Anthem?
Molina Healthcare focuses on government-sponsored health plans, especially Medicaid, ACA Marketplace, and D-SNP Medicare Advantage. Anthem (now Elevance Health) is a major national insurer offering a broader range of plans, including PPOs, employer-sponsored coverage, Medicare Advantage, and Medigap.
Does Molina offer PPO or employer-based plans like Anthem?
No. Molina primarily offers HMO plans and does not operate in the employer-sponsored group insurance market. Anthem offers PPO, EPO, POS, and HMO plans for individuals and businesses, including fully insured and self-funded options.
Which insurer offers better Medicare options?
Molina focuses on Medicare Advantage plans, especially Dual-Eligible Special Needs Plans (D-SNP) for people with both Medicare and Medicaid. Anthem offers Medicare Advantage and Medicare Supplement (Medigap) plans, providing greater flexibility and provider access.
Who has lower premiums—Molina or Anthem?
Molina generally offers lower premiums, especially for Medicaid and ACA plans. Anthem’s premiums may be higher depending on the plan type (especially PPOs), but they come with broader networks and more plan options.
Can I see out-of-network providers with Molina or Anthem?
Molina’s HMO plans usually do not cover out-of-network care, except in emergencies. Anthem PPO plans allow members to see out-of-network providers, though higher cost-sharing may apply.
Which provider offers better telehealth and virtual care?
Both insurers offer telehealth services. Molina partners with providers to offer basic virtual care, often at no cost. Anthem offers 24/7 telehealth, chronic care management, and behavioral health services through a more advanced digital platform.
Which company is better for individuals on a budget?
Molina Healthcare is often the better choice for low-income individuals and families, offering affordable ACA and Medicaid plans with low or no premiums. Anthem also offers ACA plans, but with more plan variety and access flexibility at slightly higher costs.
Which provider has better customer satisfaction?
Anthem generally scores higher in customer satisfaction for Medicare and employer plans. Molina’s ratings are average, with some concerns around provider access and customer service delays in high-demand Medicaid regions.
Blake Nwosu
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Blake Insurance Group
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