Anthem Blue Cross vs Blue Shield of California: what's the difference?

In most states, “Blue Cross” and “Blue Shield” are one company. California is one of the few states where the two names belong to rival insurers, and the only one of Anthem’s states. For a California employer, that means two separate companies, both among the state’s biggest carriers.

Two companies, one Blue license split in half

Anthem Blue Cross is the trade name of Blue Cross of California, owned by Elevance Health, a public company based in Indianapolis. It holds only the Blue Cross name in California; in 13 other states Elevance holds both names, and its plans are mostly sold as Anthem Blue Cross and Blue Shield.

Blue Shield of California is a California-only nonprofit, which since January 2025 sits under a nonprofit parent called Ascendiun. It holds the Blue Shield name in the state. Blue Shield says it voluntarily caps its net income at 2% of revenue, a pledge dating from 2011.

Size in California

The California Health Care Foundation’s 2026 almanac, using state regulators’ data for December 2024, shows two carriers of similar scale behind Kaiser:

Kaiser held about 48% of California’s commercial enrollment, with Blue Shield and Elevance at roughly 14% to 15% each. Anthem is the bigger of the two in employer plans, especially self-funded ones; Blue Shield is bigger in the individual market.

Small group plans

Both carriers sell HMO and PPO plans to small employers in California. Blue Shield of California is also one of the carriers on Covered California for Small Business for 2027; Anthem is not on that list.

Anthem sells a level-funded product line, Anthem Balanced Funding, in some of its states. We found no named level-funded plan on Blue Shield of California’s site; it sells self-funded arrangements to larger employers.

Larger employers and self-funding

Both sell fully insured HMO and PPO plans to groups of 101 or more and run self-funded plans. Anthem’s self-funded book in California is more than three times Blue Shield’s by the almanac’s count. Blue Shield’s large accounts include CalPERS, which chose it as PPO administrator from 2025.

Employees outside California

Both are Blue companies and take part in BlueCard, the program that links the Blue companies’ networks across the country.

Pharmacy ownership

Anthem’s pharmacy benefit is run by Elevance’s own CarelonRx, which delegates certain core pharmacy services to CVS Health under an agreement running to the end of 2027. Blue Shield announced in 2023 that it would replace a single pharmacy benefit manager with several partners, including Amazon Pharmacy, Mark Cuban Cost Plus Drug Company and CVS Caremark.

Quality and satisfaction scores

California publishes its own Health Plan Report Card (2025-26 edition, based on 2024 data):

In J.D. Power’s 2026 commercial member study, Kaiser ranked highest in California for the 19th year running; neither Anthem nor Blue Shield was the top plan in the region.

On financial strength, AM Best rated Elevance’s Blue insurers A (Excellent) in December 2025, and rated Blue Shield of California’s insurers A (Excellent) in its most recent release we found, from August 2023.

Questions to ask a broker about these two carriers

1. Which of my employees’ doctors and nearest hospitals are in each carrier’s HMO and PPO networks?
2. Which funding types will each carrier offer a group our size in California?
3. How would staff living outside California be covered under each carrier’s network arrangements?
4. How have each carrier’s renewals run for similar groups here?

Our California group health insurance guide describes the state’s market for small employers. Our group health insurance quotes page explains what a broker will ask for, and the form below connects you with a licensed broker.

How we write these: every comparison uses the carriers' own published information, their parent companies' filings and independent surveys, each listed below with its date. We are not paid by, affiliated with or endorsed by any carrier, and we do not rank them, describe their plan benefits or recommend any plan. Carrier and product names are trademarks of their owners. Plans, networks and prices vary by state, county and group size: only a licensed broker or the insurer can say what is available to your business and explain its terms.