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Ambetter Health Insurance Review: Cheap Rates but Average Customer Satisfaction Ratings

Ambetter Health Insurance Review: Cheap Rates but Average Customer Satisfaction Ratings

Editor's Rating

Dental and vision coverage is available, but policies can be hard to obtain since Ambetter is only offered in limited areas.

Good for

  • Lower rates than many competitors
  • Optional dental and vision coverage

Bad for

  • Customer service experience
  • Limited availability within 26 states
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Editor's Rating

Dental and vision coverage is available, but policies can be hard to obtain since Ambetter is only offered in limited areas.

Good for

  • Lower rates than many competitors
  • Optional dental and vision coverage

Bad for

  • Customer service experience
  • Limited availability within 26 states
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Ambetter policies have some of the cheapest rates available when compared to other health insurance plans, but they are not available in all states. Health insurance plans from Ambetter are best if you want basic coverage and member benefits at an affordable monthly rate. But overall customer satisfaction ratings are average and can vary by state since Ambetter plans are run by separate companies.

Ambetter Health sells individual health insurance policies on a state or federal marketplace or through an Ambetter insurer's website.

Ambetter health insurance: Our thoughts

Ambetter plans work well for consumers who want a good selection of affordable health insurance plans. Almost all Ambetter plans offer optional dental and vision benefits at an added cost. If you don't need dental or vision coverage, you can save money by buying a plan without it.

Ambetter's mobile app, Wellframe, is very popular with customers. But members reported concerns with Ambetter's claim processing performance and their overall customer experience.

You can apply for an Ambetter plan on HealthCare.gov or a state exchange or directly through an Ambetter website. But to qualify for subsidies that help reduce monthly payments or other insurance costs, you must apply through the exchange, or marketplace.

You can buy an Ambetter plan during an Affordable Care Act (ACA) open enrollment period or at another time of year if you have a qualifying life event.

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Availability of policies

Ambetter health plans are available for purchase in 26 states through various insurance companies.

State
Company
ArizonaAmbetter from Arizona Complete Health
ArkansasAmbetter from AR Total Health & Wellness
CaliforniaAmbetter from Health Net
FloridaAmbetter from Sunshine Health
GeorgiaAmbetter from Peach State Health Plan
IllinoisAmbetter of Illinois
IndianaAmbetter from Managed Health Services (MHS)
KansasAmbetter from Sunflower Health Plan
Show All Rows

If you live in New York, you can buy coverage through an associated insurer called Fidelis Care.

Plan costs and options

Ambetter health insurance plans are offered in three categories: Ambetter Essential Care, Ambetter Balanced Care and Ambetter Secure Care. These health care categories differ in the monthly premium along with the deductibles and out-of-pocket maximums. However, they all are qualified health plans and cover essential health benefits like urgent care.

Some Ambetter plans offer optional insurance that you can add to your health policy to cover services like eye exams, prescription eyewear and teeth cleanings. However, Ambetter policies with the vision and dental add-on will come with an additional monthly premium.

Before you shop for plans, keep in mind that you might qualify for help with monthly payments and other costs if you buy a plan through the health insurance exchange. The exchange will determine whether you're eligible based on your income and family size. You can also use our subsidy calculator to see how much you might save on monthly payments.

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Ambetter has some of the cheapest rates available for health insurance. In the graph below, we compared average Ambetter Silver plan rates from Florida against competitor Silver policies. As you can see, Ambetter has mid-range prices compared to other insurers in the state.

Ambetter vs Competitors

Ambetter Essential Care

The Ambetter Essential Care category has several Bronze plans, each with an option to add vision and adult dental coverage, which would increase your monthly payment. Below are three examples of Essential Care plans. These are some of the cheapest policies that the company offers but have the highest deductible levels. Bronze plans are best if you are in great health and will not have many routine medical expenses. Typically, these plans are used to cover an extremely high, one-time medical expense.

Plan
Monthly cost
Deductible
Out-of-pocket max.
Ambetter Essential Care 1$385$8,600$8,600
Ambetter Essential Care 5$418$8,300$8,700
Ambetter Essential Care 2 HSA$423$6,900$6,900

Monthly cost reflects the average for a single 40-year-old in Florida.

With Ambetter's Essential Care 1 and Essential Care 2 plans, your medical care is free once you meet your deductible and out-of-pocket maximum. But with Ambetter Essential Care 5 plans, you pay a copay of $40 any time you see your primary care doctor and $90 for all specialist visits, whether or not you've paid your deductible.

Ambetter Balanced Care

Ambetter Balanced Care plans are Silver policies, which have lower deductibles and out-of-pocket maximums and higher monthly rates than Bronze plans.

Below are some of the Silver Ambetter Balanced Care products. All of these plans are offered with optional vision and dental add-ons, but this will increase the monthly premium that you are required to pay.

Plan
Monthly cost
Deductible
Out-of-pocket max.
Ambetter Balanced Care 30$503$6,100$6,100
Ambetter Balanced Care 12$530$6,500$8,400
Ambetter Balanced Care 11$537$6,000$8,500
Ambetter Balanced Care 24$547$7,450$7,450

Monthly cost reflects the average for a single 40-year-old in Florida.

For some Ambetter Balanced Care policies, like the Balanced Care 30 plan, you pay 100% for your health care until you meet the deductible. Once you meet the Balanced Care 30 deductible, most of your health care is free.

Ambetter Secure Care

The Ambetter Secure Care products are Gold metal tier policies. Gold plans sometimes have expensive monthly costs but also more affordable deductibles and out-of-pocket maximums. These lower levels for deductibles allow you to take advantage of your plan benefits quickly. For this reason, the Ambetter Secure Care Gold plan is best if you have high medical costs — like a drug prescription that would need to be filled monthly.

Ambetter offers one Gold plan: the Ambetter Secure Care 5, with an option to add vision and dental.

For a single 40-year-old in Florida, Ambetter's Gold plan without vision and dental costs $418 per month.

The Secure Care 5 has a deductible of $1,450 and an out-of-pocket maximum of $6,300. Except for prescriptions and primary care and specialist visits, you pay 100% of your care until you meet your deductible. Once you meet the deductible, you pay 20% of the cost for most of your care.

For instance, say you had a medical expense of $1,500. You would pay $1,450 to meet the Ambetter Secure Care 5 deductible, then 20% of the remaining $50, or $10, with Ambetter paying the remaining balance.

New Ambetter plans for 2022

Ambetter added three new plans in 2022 in limited states and counties.

  • Ambetter Select plans: Select plans are offered in specific counties in Florida and Georgia. They offer low monthly rates and require the use of a specific provider network.
  • Ambetter Value plans: Value plans are offered in parts of Florida, Nevada and Texas. They have the lowest rates but have a limited network and require referrals for specialty care.
  • Ambetter Virtual Access plans: Virtual Access plans are available in Michigan, Mississippi, South Carolina and Texas. These plans provide free visits with any virtual primary care doctor within the Teladoc network. Members also have access to the Ambetter provider network in their area.

Member resources and unique benefits

By being a policyholder with Ambetter, you will have access to added member benefits like a rewards program and nurse advice line. Ambetter's My Health Pays rewards program allows you to earn reward dollars by completing health wellness goals and activities. As you complete activities, the rewards are automatically added to your My Health Pays card.

Some of these activities include completing the Ambetter Wellbeing Survey, getting an annual wellness exam from your primary care provider or receiving an annual flu vaccine. The rewards dollars can be used for a variety of expenses such as:

  • Your monthly plan payments
  • Costs you pay toward your health care like doctor copays, deductibles and coinsurance s
  • Utilities (gas, electric, water)
  • Cellphone bill
  • Transportation, education or rent

The nurse advice line is a 24/7 phone service that you can call to ask questions or voice any concerns about your health. The experienced nurse can listen to your issue and provide advice about the next steps you should take. For example, if you are having back issues, you could call the nurse, explain the issue and then get an answer on whether you should visit a chiropractor.

Ambetter's free Wellframe mobile app connects members with an advocate to help with health care needs and insurance questions. Agents are available at any time to help schedule a virtual health appointment, give guidance on stress management and more.

All member benefits can be accessed through the Ambetter online portal. There, you can log in to your account, pay any premiums, view your health care plan benefits and print or download your policy ID card.

Customer reviews and complaints

If you are looking for cheap rates for health coverage, then Ambetter health insurance is a great option. Ambetter is also good for those who would use member perks like the 24/7 nurse advice line, rewards dollars toward everyday expenses and Ambetter's Wellframe app, which scored very highly with users.

However, members did express frustration with Ambetter's handling of claims and customer service. This makes Ambetter less appealing for those looking for prompt and accurate claim processing and a good customer experience.

Ambetter member satisfaction varies by plan and location.

Many Ambetter plans received fewer complaints than similar-sized companies, according to the National Association of Insurance Commissioners (NAIC). For example, Ambetter plans in Florida, Georgia and South Carolina all had a low rate of complaints. But complaint numbers for Ambetter in North Carolina were above the norm.

Members surveyed by the Centers for Medicare & Medicaid Services (CMS) gave Ambetter an overall score of 3 out of 5 stars for the plans we reviewed, which is below the average score received by competitor plans. Members rated Ambetter on customer experience, how well providers manage medical care and how well Ambetter runs the plan.

Ambetter is a subsidiary of Centene Corp. When you purchase an Ambetter policy, your local plan provides your customer service. For example, in Florida, your plan would be sold and serviced by Ambetter from Sunshine Health.

Frequently asked questions

What is the average cost of an Ambetter health insurance plan?

The average cost of a Silver Ambetter plan for a 40-year-old in Florida is $537. This is more expensive than Blue Cross and Blue Shield of Florida (Florida Blue) but cheaper than other competitors like Cigna and Health Options Inc. Your Ambetter costs will vary depending on your location and the plan you choose.

How does the Ambetter deductible work?

The Ambetter deductible works as it would with most health plans. During the deductible period, you pay some or all of your health care costs. Once you pay enough to reach the deductible amount, your insurance plan starts to pay its share. For example, with Ambetter Balanced Care 30, you pay 100% of your health care costs until your costs reach the deductible amount, which is $6,100 for a single person. With other Ambetter plans, you pay a flat copay or a lower percentage of the cost during the deductible period.

Does Ambetter sell plans on the health insurance marketplace?

Ambetter sells plans both on the health insurance marketplace and through individual company websites. Keep in mind that you must buy your policy through the exchange to qualify for subsidies that help with insurance costs.

Methodology

We gathered sample rates using 2022 public use files from CMS for Ambetter and three other companies — Cigna, Health Options Inc. and Florida Blue — to understand how Ambetter's prices for health insurance stacked up against competitors. We gathered sample rates for a single 40-year-old in Florida.

To evaluate Ambetter's customer service, we also considered its ratings by the National Association of Insurance Commissioners (NAIC) and CMS.

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Editorial Note: The content of this article is based on the author’s opinions and recommendations alone. It has not been previewed, commissioned or otherwise endorsed by any of our network partners.

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