2024 Anthem Shield Coverage

Anthem Health Insurance, also known as Anthem Blue Cross Blue Shield, is a for-profit health insurance provider. The company was founded in 2004 and currently has 40 million members enrolled in 14 states. They are a part of the Blue Cross and Blue Shield Association. 

Anthem offers both PPO and HMO plans and Medicare, Medicaid, individual, family, small business, and employer group plans. You can manage your healthcare plan online with Anthem at www.anthem.com

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Anthem Operating States

Anthem Health Insurance is currently offered in 14 states throughout the United States. These states include California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Virginia, and Wisconsin.

Anthem Health Insurance Overview

As more people begin to look for better healthcare options, there are plenty of questions about what’s new for Anthem Health Insurance. Here are a few of the most frequently asked questions regarding Anthem Health Insurance as you learn more about this affordable, quality health care plan.

Does Anthem cover Acupuncture? 

Yes, Anthem Health Insurance covers acupuncture costs performed to relieve pain. Acupuncture treatment may be deemed medically necessary by your doctor due to chronic pain that has lasted at least six months and has not responded to other treatment, such as medication or physical therapy, or for nausea resulting from surgery or chemotherapy. 

Please be weary of receiving acupuncture treatment if you are pregnant, have a pacemaker, or take blood thinners

Does Anthem cover other therapies and treatments?

Coverage for In-Network Providers is limited to a combined 60 day limit per benefit period for physical, occupational, and speech therapy. 

Most Anthem Blue Cross plans (HMO and PPO) have chiropractic benefits. Their PPO plan is limited to 25 visits per calendar year. In most cases, chiropractor visits count towards your physical and occupational therapy limit. The individual must have clinical symptoms of a condition that may be improved or resolved by standard chiropractic therapy. For full coverage, a treatment plan must be clearly documented, the chiropractic procedures must be clearly related to the patient’s condition, and the chiropractic care must be performed by a licensed chiropractor.

Does Anthem Cover Allergy Testing?

Anthem Blue Cross typically covers allergy testing. Specific coverage information can differ state-to-state; check here for more specific plan information.

Allergy testing and desensitization injections can be a great way to determine allergies and prevent bad reactions if determined to be medically necessary by the Primary Care Physician. Allergy testing and immunotherapy are covered if you are referred by your physician.

Does Anthem PPO Cover abortions?

Some job-based health plans cover elective abortions. Patients can search their plan documents or call their insurers directly to check.

However, due to the recent overturning of Roe v. Wade, no American insurance companies cover abortions or abortion-related treatments. 

Does Anthem Cover Gender Reassignment Surgery?

Most gender-affirming surgeries, reconstructive surgeries, and hair removal procedures to treat tissue donor sites for a planned phalloplasty or vaginoplasty procedure are deemed medically necessary when all criteria are met. Click to read the guidelines

The basic requirements for gender reassignment surgery include:

  • The candidate is at least 18 years of age
  • The candidate has been diagnosed with gender dysphoria, including meeting all of the following indications
    • A strong conviction to live as some alternative gender different from one’s assigned gender. 
    • The desire to make the physical body as congruent as possible with the identified sex through surgery and hormone treatment
    • The affirmed gender identity has been present for at least 6 months
    • If significant medical or mental health concerns are present, they must be reasonably well-controlled
    • The gender dysphoria causes clinical or social distress or impairment in social, occupational, or other important areas of functioning. 

Does Anthem Cover Birth Control?

Anthem Health Insurance Plans cover birth control. Specific drug or contraception coverage can be determined here

In most cases, the insurance will cover the generic formula of the drug unless otherwise authorized by a physician. Under the Affordable Health Care Act, insurance companies are required by law to include birth control coverage as part of their health care policies. 

Does Anthem Cover Breast Reductions?

Reduction mammaplasty, or breast reduction, is covered when it is considered medically necessary. All outlined criteria must be met for medical necessity to be determined. Click here to read their guidelines

Please note– breast reduction surgery is deemed to be cosmetic and not medically necessary for: 

  • poor posture
  • breast asymmetry
  • pendulousness
  • problems with clothes fitting properly 
  • nipple-areola distortion 
  • psychological considerations

Several criteria must be met, including a diagnosis of macromastia, the diagnosis of two or more symptoms of hypertrophy (backache, posture change, hygiene problems, or other), and the failure to relieve symptoms using nonsurgical treatment (including exercise, hot/cold treatment, and an appropriate support bra) for at least six weeks. Patients must also be at least 18-years-old  or must have reached breast maturity. 

Does Anthem Cover Infertility Treatment?

Anthem Blue Cross Blue Shield recognizes that infertility is a life-changing event. That’s why they offer choices of fertility treatment with all of their medical plans. Each medical plan includes different services outlined in their Evidence of Coverage.

Diagnostic tests, including tests to rule out endocrine causes of infertility and semen analysis, among other tests, must be performed to determine that infertility treatments are necessary. Treatments may include infertility drugs and operative procedures, but coverage frequently excludes artificial means of conception, such as artificial insemination and in vitro fertilization (IVF). 

Does Anthem Cover STD/STI Testing?

The Affordable Care Act requires Anthem Blue Cross and Blue Shield to cover specific preventive care services, such as screening and counseling for sexually transmitted infections or diseases with no member cost-sharing. The cost-sharing requirement may still apply to preventive care services received from out-of-network providers. 

STD testing may include testing as part of a pregnancy screening, testing for individuals who are deemed high-risk, testing for victims of sexual assault, or routine testing for homosexual men. 

Testing for certain STDs — like HIV, syphilis, chlamydia, and gonorrhea — is one of most effective preventive health benefits that most health plans cover.

Anthem Mental Health Insurance Overview

Does Anthem Cover Mental health? 

Yes, Anthem does cover mental health services, such as:

  • Depression screenings
  • Inpatient & outpatient mental health care 
  • Alcohol misuse: related screening and behavioral counseling

It is important to note that evidence-based treatment, like therapy and psychoanalysis, is covered, but services rendered outside of a therapy setting, such as systematic desensitization or exposure therapy for a specific phobia, are typically not covered. 

Does Anthem Cover Therapy?

Yes, Anthem Blue Cross is one of the top health insurance companies offering mental health care coverage. However, co-payments, deductibles, or visits per year vary by plan. It’s best to clarify coverage with your provider directly by phone. 

Therefore, traditional therapy, like in-office cognitive behavioral therapy, hypnosis,or talk therapy will most likely be covered, but out-of-office therapy may not be.

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Anthem Dental Insurance Overview

Anthem is one of America’s top-rated dental insurance providers with a wide range of affordable and worthwhile plans. With 100% coverage for exams, cleanings, and X-rays without waiting periods included as part of most offerings – it’s easy to see why so many are choosing Anthem’s dental insurance plan over other providers!

Does Anthem Cover Dental?

Your Anthem dental plan ensures that you have access to dentists in your area or anywhere else in the country. You also receive a discount when using one of Anthem Blue Cross’ network partners.

Anthem fully covers:

  • Periodontal maintenance 
  • Periodontal scaling/root planing 
  • Periodontal and oral evaluations 
  • Palliative treatments 
  • Fluoride and sealants 
  • Extensive removal of plaque and tartar buildup (full mouth debridement)

Does Anthem Cover Braces?

While full coverage dental plans do not cover 100% of orthodontia costs, most plans cover part of the cost of preventive orthodontic treatments.

Most plans will cover preventative treatments (like cleanings/check ups), basic treatments (like fillings), and around 75% of coverage for treatments like root canals. Cosmetic procedures, like whitening or tooth shaping, are rarely covered by dental insurance plans – and, unfortunately, braces can fall under the cosmetic category. It is best to check with your insurer to see if you will be covered for braces. 

Does Anthem Cover Braces for Adults?

Dental insurance typically does not cover orthodontic work for adults; however, some Anthem dental plans offer other treatment benefits. 

The rules for braces coverage under Anthem Blue Cross Blue Shield are the same for children as they are for adults – since braces or invisible liner treatments can be considered a cosmetic surgery instead of preventive or basic treatment, they may not be covered. Check your plan and your region’s policies to be sure.

Does Anthem Cover Dental Surgery? 

It all depends on your policy benefits. Most plans include the cost of preventive care, plus a portion of the cost after you meet your deductible for other procedures.Depending on the plan, the amount of coverage offered can vary. 

Most plans will cover preventative treatments (like cleanings/check ups), basic treatments (like fillings), and around 75% of coverage for treatments like root canals. Cosmetic procedures, like whitening or tooth shaping, are rarely covered by dental insurance plans

Does Anthem Cover Wisdom Teeth Removal?

The Anthem dental plan covers a portion of the costs for the removal of an impacted tooth. 

Does Anthem Cover Dental Implants?

No. While some dental services may be discounted with the Anthem dental plans, dental implants are excluded from coverage. The only exception is if the dental implants are associated with a covered prosthetic appliance. 

Dental implants can sometimes be sought out for purely cosmetic reasons, so you may have to check with your plan to see if they will cover your specific implants and the reason why you’re getting them. 

Read more about services covered under Anthem dental insurance here. 

Anthem Vision Insurance Overview

You can choose to buy a Blue View Vision plan by itself or add it to any of Anthem’s health insurance and dental plans. Your coverage includes check-ups, eye exams, as well as yearly eyewear allowances for glasses or contacts with minimal co-pays.

Does Anthem Cover Lasik?

Anthem does not cover the entire cost of Lasik surgery; however, they offer discounts of up to $800 toward the treatment. Typically, no third party insurers or governmental insurers cover the surgery, but they can offer a discount or rebate.

Does Anthem Cover Cataract Surgery? 

Currently, Anthem insurance will cover the basic costs of cataract surgery, including the surgeon fee, facility fee, and anesthesiologist fees. Anthem Blue Cross Blue Shield plans cover cataract surgery, as it’s covered by Original Medicare and seen as a necessary medical procedure. 

Anthem Prescription Drug Insurance Overview

Anthem Blue Cross Blue Shield provides prescription drug benefits, including medications on the Anthem Drug List. This can provide potential savings when your physician prescribes drugs from this list

Does Anthem Cover Hearing Aids?

Many Anthem health insurance plans include part or full hearing aid coverage in many of their benefits packages. Coverage for hearing aids can often be collected through a supplemental or Medigap plan.

Does Anthem Cover a Blood Pressure Monitor?

Yes, in most cases, at-home digital blood pressure monitoring machines are a covered benefit if prescribed by your doctor. Blood pressure monitors may also be covered through your employer.

Does Anthem Cover Cialis?

Currently, Cialis is listed as a “non-formulary drug,” meaning it is not included on a plan’s Drug List. Anthem recommends that you discuss formulary alternatives with your physician.  

A patient must have a diagnosis of erectile dysfunction or benign prostatic hyperplasia, among other criteria, in order for coverage to apply. 

Does Anthem Cover Chantix?

Yes. Currently, you can include Chantix in your tobacco cessation treatment as prescribed by your doctor. Chantix is a smoking cessation treatment that helps people addicted to nicotine curb their cravings and kick the bad habit.

Does Anthem Cover the Shingles Vaccine?

As of 2021, Anthem covers the shingles vaccine for adults 50-years and older. Click here for a full understanding of recommended and covered vaccines. 

Shingrix is a vaccine made of a shingles virus component. It’s given in two doses, with 2-6 months between doses. Because you have to repeat treatment, it is great that the cost is covered. 

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