When it comes to health coverage in the sunshine state, Ambetter Florida plans rank among the best in the marketplace.
In this article, you will learn everything about Ambetter like the types of plans offered, benefits, costs, availability and much more. Making it easier for you to decide which plan to choose.
This is your complete guide to Ambetter in Florida, let’s dive in!
What is Ambetter Sunshine Health?
Ambetter Sunshine Health is part of the Ambetter brand under Centene Corporation which offers health insurance plans through the Affordable Care Act (Obamacare). While they are in many other states, in Florida it is called “Sunshine Health” (with different states having different names). They started offering plans back in 2014 and continue to do so to this day.
What types of Ambetter Florida plans are available?
In the state of Florida, Ambetter offers both HMO (Health Maintenance Organization) plans and EPO (Exclusive Provider Organization) plans in the marketplace. Both are the most common type of plans offered in the marketplace and have their differences. Depending on your circumstances, one may be a better fit for you.
EPO plans
In the marketplace, EPO plans are one of the most popular options. They have a great balance between flexibility and cost. For example, you won’t need a referral from your PCP to see a specialist. However, just like an HMO, you can only get care inside the plan’s network. They are a bit more expensive than HMO plans.
In Florida, Ambetter has 3 types of EPO plans with slightly different names. They are Ambetter Secure Care, Ambetter Balanced Care, and Ambetter Essential Care. Each differs by copays, deductibles, out-of-pocket maximums, and some even have vision and dental included.
HMO plans
The other most common option in the marketplace are HMO plans which are a bit less flexible compared to their counterparts. These will be the cheapest options out of the 4 types. The main difference is that you will need to select a PCP and requires a referral from them to see a specialist.
In the Florida marketplace, Ambetter offers 3ntypes of HMO plans which are called Ambetter Select and Ambetter Value. They will have slightly different names depending on which tier you get (Bronze, Silver, and Gold).
The benefits of Ambetter Florida plans
Like every other company in Obamacare, Ambetter Sunshine Health will offer essential health benefits. These include services like, emergencies, prescription drugs, hospitalization, doctor visits, pediatrics, mental health, surgeries, etc. On top of that, you will never be denied coverage due to having an existing medical condition.
But besides the basics there are a few things that Ambetter offers that are unique to them only. Let’s dive in and learn more.
My Health Pays Rewards Program
One of the best features of Ambetter is their rewards program called My Health Pays. It incentivizes members to follow a healthy lifestyle. If you sign up you can get reward points for doing things like routine exams, flu shots, taking health assessments, and more. These points you get can be redeemed and be used to pay different expenses like bills, rent, etc.
24/7 Nurse Line
One cool addition to being an Ambetter member is their 24/7 nurse line which lets you speak to a medical professional anytime that you need. This is perfect for non-emergency situations where you may need to get some medical advice.
Telehealth Services
Like the nurse line, this is an online service that lets you speak to a healthcare provider through your phone or video chat. For those who prefer virtual visits, and want to skip the in-person line, this may be a great feature.
What hospitals and doctors are covered by Ambetter Sunshine Health?
It is important to know that companies offer plans based on counties. So, while a company may be in your state if it is not in your county, it will not appear, and you can’t get coverage from them.
As of 2024, Ambetter from Sunshine Health is in every county in Florida, except for Taylor, Flagler, Martin, Hendry, and Monroe County. If you are not in any of those counties, you should have no problem finding a hospital/doctor. You can always use your member portal to search for providers near you or contact us at Cuspide for help!
Below is the provider map so you can see if they are in your area.
Ambetter Sunshine Health coverage map
Pros and Cons of Ambetter in Florida
Overall, here at Cuspide we give Ambetter from Sunshine Health a 4 out of 5 stars for things like affordability, plan types, and customer complaints ratio. It’s important to note that your experience with this company will always be specific to you. Below are the good and the ugly.
PROS
- Cheapest plans across all 3 tiers.
- Rewards programs with prizes.
- Has both EPO and HMO plans to choose from.
- Lower than average customer complaints.
CONS
- May have slight difficulty finding providers.
- Weak customer service.
Ambetter Florida reviews for 2024
While this article is focused on just Florida, you must check out the full Ambetter insurance review we did to see where the company ranks overall.
Ambetter has a customer complaint ratio of 0.32 which is lower than the average compared to other companies. It also has a BBB (Better Business Bureau) rating of B++. We also gathered all the top reviews from reputable sources to show you what they rated them out of 5 stars.
Benzinga
3.0 stars
MoneyGeek
4.0 stars
ValuePenguin
4.0 stars
Cuspide
4.0 stars
Forbes Advisor
3.5 stars
All in all, it ranks as one of the top health insurance companies in the state of Florida and is a solid choice to make for those wanting coverage. While it is important to consider other’s experiences, don’t let that be your buying guide.
How much does Ambetter cost in Florida?
There are lots of factors that go into the price of your plan (income, age, what type of plan you choose, etc.) but the good news is that in Florida, Ambetter has the overall cheapest plans available. Their plans are the cheapest options across the 3 main tiers (Bronze, Silver, and Gold).
Below are the average prices of each tier based on statistics from ValuePenguin.
| Tier | Plan | Cost |
|---|---|---|
| Bronze | Ambetter Standard Expanded | $348 |
| Silver | Ambetter Standard Silver | $440 |
| Gold | Ambetter Standard Gold | $413 |
As you can see, in Florida, the cheapest silver plan available is an Ambetter Standard Silver plan. These are before any subsidy is applied and are based on a 40-year-old applicant. To find out how much you will end up paying you need to see if you qualify for a premium tax credit. Use our calculator tool here that helps you get an estimate.
People usually ask...
If you have specific questions or want to know more, contact us at Cuspide at (305) 970-8583.
Does Ambetter Sunshine Health have dental and vision?
In Florida, Ambetter has dental + vision included through their EPO plans in the marketplace. Their HMO plans do not have vision and dental, so you may have to pay a little extra to get that benefit. Depending on which plan you choose, you may have free routine checkups, or you may have to pay a percentage to get certain services done. Check your plan’s summary of benefits for more info.
Do I need referrals with Ambetter Florida plans?
If you choose an Ambetter EPO plan you will not need a referral to see a specialist doctor. However, if you have an HMO plan you will need to acquire a referral from your primary doctor. EPO plans are more flexible, but they will cost you more than a standard HMO plan from the marketplace.
What is the Ambetter phone number in Florida?
You can call Ambetter from Sunshine Health member services at 1-877-687-1169. Keep in mind that the member number you can call will always be on your insurance card. You can also call us at (305) 970-8583 as we work closely with Ambetter and can help members with any issues.
Enroll in Ambetter Florida plans with Cuspide!
Ready to buy an Ambetter plan in the state of Florida? Call us at Cuspide at (305) 970-8583 and compare from all the best plans to see which one is best for you! Find doctors, make payments, keep up to date, all with us!
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