Critical Alert: Anthem Commercial Coverage Changes
Anthem Commercial Coverage Discontinued
Effective January 1, 2026, Anthem Blue Cross Blue Shield has discontinued coverage for hyaluronic acid (viscosupplementation) injections for most commercial plan members. This change affects employer-sponsored and individual marketplace plans in most states.
Medicare Advantage plans may still provide coverage. Check your specific plan.
If you have Anthem BCBS insurance and need knee injections for osteoarthritis, this guide explains your current options. The coverage landscape has changed significantly, and understanding your plan type is now more important than ever.
Quick Coverage Summary
| Plan Type | HA Injections Covered? | Effective Date |
|---|---|---|
| Commercial (employer) | No | Jan 1, 2026 |
| Individual marketplace | No | Jan 1, 2026 |
| Medicare Advantage | Yes (with requirements) | Still covered |
| Medicaid managed care | Varies by state | Check your plan |
Understanding the 2026 Coverage Change
What Happened
Anthem BCBS updated their medical policy to classify viscosupplementation (hyaluronic acid injections) as not meeting medical necessity criteria for commercial health plans. This follows a broader industry trend among some commercial insurers, despite Medicare’s continued coverage of these treatments.
Who Is Affected
Who May Still Have Coverage
Commercial vs Medicare Advantage: Key Differences
Understanding the difference between Anthem’s commercial and Medicare Advantage plans is essential for joint pain patients.
Commercial Plans (No Longer Covering HA)
Commercial plans include employer-sponsored insurance and individual marketplace (ACA) plans. As of January 2026, these plans:
- Do not cover hyaluronic acid injections
- Still cover cortisone injections
- Still cover physical therapy
- Still cover oral pain medications
- Still cover knee surgery when medically necessary
Medicare Advantage Plans (May Still Cover HA)
Anthem Medicare Advantage plans (for those 65+) must provide at least the same coverage as Original Medicare. Since Medicare covers hyaluronic acid injections, most Anthem MA plans do as well.
If you are 65 or older with Anthem Medicare Advantage, viscosupplementation coverage likely continues. Contact Anthem Medicare services to confirm your specific plan benefits before scheduling treatment.
Anthem Medicare Advantage Coverage Details
If you have Anthem Medicare Advantage, here is what to expect for hyaluronic acid injection coverage.
Coverage Requirements
To qualify for HA injection coverage under Anthem Medicare Advantage, you typically need:
Step Therapy Requirements
Anthem Medicare Advantage plans may require step therapy before approving HA injections. This means you must try other treatments first.
Typical Step Therapy Progression:
Step 1: Conservative Care (3+ months)
- Over-the-counter pain relievers
- Physical therapy
- Weight management
- Activity modification
Step 2: Prescription Options
- Prescription NSAIDs
- Topical treatments
- Cortisone injection(s)
Step 3: Viscosupplementation
- HA injections approved after steps 1-2 prove insufficient
Preferred Brands
Anthem has established preferred brands for hyaluronic acid injections. Using a preferred brand typically means lower costs and faster approval.
| Brand | Injection Schedule | Anthem Status |
|---|---|---|
| Durolane | Single injection | Preferred |
| Synvisc-One | Single injection | Preferred |
| Euflexxa | 3 weekly injections | May require exception |
| Supartz FX | 5 weekly injections | May require exception |
| Gel-One | Single injection | May require exception |
Your specific Anthem Medicare Advantage plan may have different preferred brands or formulary requirements. Always verify which brands are covered under your plan before treatment.
State-by-State Variations
Anthem operates independently in different states. Coverage policies can vary based on state insurance regulations and mandates.
States With Potential Coverage Differences
- California (Anthem Blue Cross): May have different medical policies
- Georgia, Indiana, Kentucky, Ohio, Wisconsin: Anthem BCBS affiliates may vary
- New York (Empire BCBS): State regulations may affect coverage
- Virginia (Anthem HealthKeepers): Medicaid managed care rules differ
How to Check Your State
- Log into your Anthem member portal
- Review your Evidence of Coverage document
- Call the member services number on your card
- Ask specifically about viscosupplementation coverage
What to Do If You Have Anthem Commercial Coverage
If you have Anthem commercial insurance and need knee injections, consider these options.
Option 1: Explore Medicare Eligibility
Learn more: Medicare Coverage for HA Injections
Option 2: Self-Pay Options
Without insurance coverage, hyaluronic acid injection costs typically range from:
| Cost Type | Typical Range |
|---|---|
| Single-injection product | $400-$800 |
| 3-injection series | $700-$1,500 |
| 5-injection series | $1,000-$2,000 |
Some providers offer payment plans or discounted self-pay rates. Ask about cash pricing before scheduling.
Option 3: Alternative Covered Treatments
Anthem commercial plans still cover other joint pain treatments:
Option 4: Switch Plans During Open Enrollment
During annual open enrollment, you can switch to a plan that covers viscosupplementation. Consider:
- Employer plans from other insurers (UnitedHealthcare, Humana, etc.)
- Medicare Advantage if you are 65+
- Plans with broader specialty drug coverage
Appeal Options and Process
Even with coverage discontinued, you have appeal rights.
When to Appeal
- If you have an ongoing treatment series that was interrupted
- If you believe your plan should still cover based on state mandates
- If you have a self-insured employer plan (coverage decisions may differ)
How to File an Appeal
Step 1: Get the Denial in Writing
- Request the specific policy reason for denial
- Note the deadline for filing an appeal
Step 2: Gather Documentation
- Complete medical records
- All imaging reports
- Records of conservative treatments tried
- Medical necessity letter from your doctor
Step 3: Submit Internal Appeal
- Mail or fax to the address on your denial letter
- Include a clear explanation of why coverage should apply
- Attach all supporting documentation
Step 4: Request External Review
- If internal appeals fail, request independent external review
- Contact your state insurance commissioner for assistance
Appeal Tips for Anthem Members
Treatments Still Covered by Anthem
While HA injections may not be covered under commercial plans, Anthem still covers many joint pain treatments.
| Treatment | Commercial | Medicare Advantage | Prior Auth |
|---|---|---|---|
| Cortisone injections | Yes | Yes | Usually no |
| Physical therapy | Yes | Yes | Varies |
| Oral medications | Yes | Yes | Varies |
| Knee bracing | Yes | Yes | Usually no |
| Knee surgery | Yes | Yes | Yes |
Key Takeaways
Summary for Anthem Members
Critical changes:
- Commercial coverage for HA injections discontinued January 2026
- Medicare Advantage plans may still cover
- State variations exist
What you should do:
Find Providers Who Accept Anthem
Locate in-network specialists who can help with knee pain treatment options.
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What happens next?
- 1 We'll verify your insurance coverage
- 2 Match you with quality providers in your area
- 3 Contact you to discuss your options
Questions? Browse our guides:
How to Choose a ProviderContact Anthem
- Commercial Members: Number on your Anthem ID card
- Medicare Advantage: 1-800-264-4000
- Online: Log in at anthem.com to check benefits
- Prior Authorization: Number listed on your plan documents
Related Resources
- Hyaluronic Acid Injections: Complete Guide
- Medicare Coverage for HA Injections
- BCBS Coverage Overview
- Cortisone vs HA Injections Comparison
- Prior Authorization Guide
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This guide provides general information about Anthem coverage policies as of January 2026. Your specific benefits may vary based on your plan type, state, and employer. Always verify coverage with Anthem before receiving treatment.