Have you recently been looking at Ambetter Health Insurance and want to know more?
You have come to the right place.
We will dive into everything you need to know about Ambetter like plan types, benefits, costs, and much more with our detailed article.
This is your ultimate buyers guide and review to Ambetter in 2024.
Some Key Points
- Ambetter offers one of the lowest rates in the marketplace.
- They offer 3 types of plans through the ACA (HMO, EPO, PPO).
- Centene (a.k.a. Ambetter) is ranked as 5th largest health insurer in the U.S.
Since there is a lot of information in this article, use our content menu to pick certain topics that interest you the most.
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What is Ambetter Health?
Ambetter is a health insurance provider owned by Centene Corporation (one of the biggest health insurers in the United States). As of 2024, Centene ranks as the 5th largest health insurance company in America. They have over 2 million plus members and counting.
While Ambetter is still relatively young as a company (founded in 2014), their parent organization Centene has been around since 1984, insuring individuals and families.
Is Ambetter part of the Affordable Care Act?
Yes, Ambetter officially joined the ACA (Affordable Care Act) also known as Obamacare in 2014, which was the same time the health insurance marketplace opened (HealthCare.gov). Since then, they have been one of the leading health insurers offering individual and family plans
What type of plans does Ambetter have?
Inside the ACA marketplace, there are 4 different kinds of plans for everyone. Ambetter offers HMO, EPO, and PPO plans. Aside from those 3, there are also POS plans (Point of Service) which they do not offer (however almost no insurer provides this).
So, what are they and what are the differences?
1. Ambetter HMO plans
One of the most common plans that Ambetter members have are their HMO (Health Maintenance Organization) plans. This is mainly because they will have the lowest premiums.
Aside from that, you will need to select a PCP and they will have to give you a referral if you want to see a specialist. You must also be in-network to get medical care. Out of the 3, these will have the least flexibility.
2. Ambetter EPO plans
If you want to know which Ambetter plan does not require a referral to see a specialist, then an EPO (Exclusive Provider Organization) plan is what you are looking for. These types of plans are the most popular inside the marketplace.
Think of them as the perfect balance between an HMO and a PPO. You won’t need to select a PCP and have more flexibility. With an EPO, you must stay in-network as well.
3. Ambetter PPO plans
The rarest plan inside the ACA marketplace are PPO plans (Preferred Provider Organization). Ambetter PPO plans can be found in some states (more on this later) and have the most flexibility.
They will have the highest premiums and the main difference is that you can get coverage out-of-network but at a higher cost of course.
What does Ambetter insurance cover?
Like any other insurer inside Obamacare, Ambetter must provide members with essential health benefits. And for those with pre-existing conditions, you will also be able to receive the following:
- Hospitalization
- Preventive care
- Emergencies
- Prescription drugs
- Maternity care
- Mental health & substance services
- Pediatrics
- Rehab
Note that these benefits will all have different prices for the services, and it all depends on which Ambetter plan you choose, the state, deductibles, copays, etc.
The Ambetter Health Insurance Tiers
In the ACA marketplace there are different “tiers” or “metal levels” that customers will find. The most common being, Bronze, Silver, and Gold. These tiers all provide different coverage amounts and vary.
Which one should you go with? Let’s break it down.
Bronze Tier: Ambetter Essential Care
The lowest costing tier is the bronze tier which Ambetter offers as “Essential Care”. These plans will have the lowest premiums but the highest costs when you need medical care. So, it may be best for those who don’t expect frequent care and want to save money.
Silver Tier: Ambetter Balanced Care
The silver tier is the most popular in the marketplace because it is the most balanced of all (hence the name “Balanced Care”). It has the perfect combination of premiums and out-of-pocket costs.
Furthermore, if you qualify, it will have a “Cost-Sharing Reduction” which lowers your premiums slightly. It is the best choice for those who want a “standard” form of health coverage.
Gold Tier: Ambetter Secure Care
Ambetter Gold Tier plans are the caviar of health insurance. These will be the most expensive option out of the 3 but have the lowest out-of-pocket costs when you need medical care. It is best for those who expect to visit the doctor a lot and can spend a little more on their insurance plan.
Now that you know the tiers, know that these may be named slightly differently and have different numbers depending on which state you are in.
How much does Ambetter health insurance cost?
It is hard to predict what an insurance plan costs because of factors like age, location, household size, income, etc. Everything previously mentioned will factor into the ultimate price.
Ambetter has very competitive prices and in many areas, they are the first to pop up as the “cheapest” option. If you want to save money, the HMO plans will always be the cheapest and the EPO plans are the most expensive.
While it varies, Ambetter insurance can cost around $50 a month with a subsidy and over $400+ without a subsidy. Use our health insurance premium calculator tool that gives you an estimate here.
How to apply for Ambetter insurance plans
To apply for Ambetter health plans, you need to go through the health insurance marketplace or contact an agent.
We suggest getting help from a health insurance broker/agent like Cuspide because an error in the application can lead to tax problems down the road.
Compare your options or apply today at (305) 970-8583!
What state is Ambetter health insurance in?
Like other insurers, they will not be found in every state. It is also important to know that depending on the state, Ambetter will go by a slightly different name. As of 2024, Ambetter Health is found in the following 29 states:
- Alabama
- Arizona
- Arkansas
- California
- Delaware
- Florida
- Georgia
- Illinois
- Indiana
- Kansas
- Kentucky
- Louisiana
- Michigan
- Mississippi
- Missouri
- Nebraska
- Nevada
- New Hampshire
- New Jersey
- New Mexico
- New York
- North Carolina
- Ohio
- Oklahoma
- Pennsylvania
- South Carolina
- Tennessee
- Texas
- Washington
Ambetter Insurance Coverage Map 2024
It is important to note that depending on your state they will have different types of coverage (some states only have HMO plans, some don’t have PPO plans, etc.)
Also, coverage is based per county, so it is possible that although they are in your state, they may not be in your county. Get a quote from us at no cost and find out if they are in your area!
What is the Ambetter provider search?
Most health insurance companies have a provider search for their members. The Ambetter provider portal is where members find doctors, hospitals, and services that are part of the network. Meaning that everything you see inside the provider search is accepted by Ambetter.
This tool will be available online through their website or mobile app. Aside from that, members will be able to make payments and find out more about their plan and coverage.
How to use the provider search portal
To use the Ambetter provider portal, you first need to be a member. That means you have already paid for your plan, and have a member ID. After that, you can sign up with your ID get the portal.
Use the search bar to look for nearby doctors, hospitals, or any service you may need. To make things easier, contact your insurance agent as they will have access to a portal as well where they can make payments, order your insurance cards, and more!
Ambetter insurance reviews in 2024
According to Forbes, Ambetter has a 0.32 complaint ratio, which is the lowest overall of all the insurance companies. This was from data collected by the National Association of Insurance Commissioners.
This however does not mean they do not receive any bad reviews because the forums and online communities all like to voice their opinion. Online you will always see bad reviews of all the insurance companies so do not base your purchase off reviews!
Cuspide Rating
Pros and Cons of Ambetter health insurance
Pros
- Monthly premiums are generally lower than most.
- Variety of insurance plans for all different needs.
- MyHealthPays rewards program that offers cash prizes.
- Relatively large provider network.
Cons
- Not available in all 50 states.
While it has more pros than cons it is always best to compare ALL the plans in the marketplace before deciding which one to go with. Checkout where Ambetter ranks amongst the best companies here.
Is Ambetter insurance good for you?
Ultimately, this decision comes down to you but there are a few things you need to consider like costs, needs, and plans.
Find out what your goal with an insurance plan is and go from there. For those that mainly just want the cheapest option possible, Ambetter could be good as they offer some of the lowest rates.
Those that want a more serious coverage have all 3 of the best types of plans available (EPO, HMO, and PPO) for you to choose from.
If they happen to be in your area, look at premiums, the deductibles, out-of-pocket, and copays to see if it suits you. If everything adds up, just know Ambetter will provide great coverage.
Frequently asked questions
If you have a specific question about Ambetter or want to know more, contact us at Cuspide!
Does Ambetter have Medicaid?
Aside from ACA plans, Ambetter also offers Medicaid plans. However, it may not be available in your state as only some will have it. You can check with the Ambetter website directly or go to the Medicaid website and find if they are in your area.
How can I cancel my Ambetter insurance?
There are a few ways to end your coverage. To cancel your Ambetter plan, you need to contact the health insurance marketplace at 1-800-318-2596 or get your health insurance agent to help you.
Keep in mind that once you do end your coverage it will run to the end of the month. So, if you cancelled it on the first couple of days of the month, you will still be able to use it until the end of the month. There is no fee to cancel Ambetter. Just make sure you are 100% sure about your reasoning!
Does Ambetter Health give rewards?
Yes, Ambetter Health Insurance gives rewards through the “myHealthPays” program, where you get paid for doing things like eating right, getting more steps in, and saving! This program is only available to their members (and only in some states).
Ambetter my Health Pays rewards you with cash prizes that can be used for monthly bills, or helping you pay your premiums, etc. For example, you can get up to $200 for completing a wellness exam and a preventive screening! All in all, with the many options you have, you can receive up to $500!
Check out more information through their website and see how you can sign up.
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