Anthem vs UnitedHealthcare: what's the difference for employers?

Anthem and UnitedHealthcare are two of the three largest commercial insurers in the country, by the American Medical Association’s count (2024 data). Here is how they differ in structure, size, networks and ratings.

Size and footprint

Anthem’s 14 states are California (Blue Cross only), Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (outside the Kansas City area), Nevada, New Hampshire, New York (New York City area and upstate), Ohio, Virginia (outside Northern Virginia) and Wisconsin. Outside them, the Blue company is a different business, and our UnitedHealthcare vs Blue Cross Blue Shield page covers that pairing.

Networks

UnitedHealthcare cites more than 1.8 million physicians and health care professionals and over 5,600 hospitals in its own national network (its analysis, June 30, 2026).

Anthem contracts directly with providers in its 14 states, and its members elsewhere use other Blue companies’ networks through BlueCard. The Blue Cross Blue Shield Association says Blue companies together contract with 97% of physicians and 83% of hospitals nationally.

The two figures are counted differently, one as a head count and one as a share, so they do not compare directly. Hospital contracts also change. As of late October 2026, for example, Cleveland Clinic said it was still negotiating with Anthem and would be out of network for Anthem employer-sponsored plans in Ohio from January 1, 2027 without a deal.

Funding types

Both carriers sell fully insured and self-funded plans to employers. UnitedHealthcare also sells to small businesses and has a level-funded line, UnitedHealthcare Level Funded. Anthem sells to small employers in its Blue states, with availability varying by state, and has a level-funded line, Anthem Balanced Funding, in some of them. Our small group health insurance and self-funded health insurance guides explain the funding types in general terms.

Pharmacy businesses

Each parent company owns its own pharmacy benefit business: Optum Rx at UnitedHealth Group and CarelonRx at Elevance.

Member and financial ratings

In J.D. Power’s 2026 commercial member study, Anthem plans were ranked highest in three regions: the Northeast (Connecticut), Ohio and the Southwest (Nevada). UnitedHealthcare was rated in all 22 regions but was not ranked highest in any.

AM Best rates the main insurers of both groups A (Excellent). UnitedHealthcare’s rating was lowered from A+ in August 2025; AM Best pointed to weaker operating results, driven largely by Medicare Advantage costs, and to governance and management changes.

How both have been changing

Both companies’ fully insured employer membership has fallen while self-funded membership grows. Elevance reported fully insured employer membership down about 7% year on year at September 30, 2026. UnitedHealthcare repriced its fully insured plans for 2026, and its fully insured commercial membership fell from about 8.2 million at the end of 2025 to about 7.6 million.

Questions to ask a broker about these two carriers

1. Is our business in one of Anthem’s states, and will both carriers quote a group our size?
2. Which of my employees’ doctors and nearest hospitals are in each carrier’s network, and are any contract disputes due before our renewal?
3. Which funding types will each carrier offer a group our size in our state?
4. How have each carrier’s renewals run for similar groups here?
5. How would employees who live outside our state use each carrier’s network?

Our group health insurance quotes form connects you with a licensed broker who can answer these for your business.

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.