Ambetter Health Insurance is a plan provider that offers health insurance products to different insurance companies who then sell the plans on state marketplaces. 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 premium. However, the company has subpar reviews and should not be considered for coverage if you want great customer service.
Ambetter Health Insurance: Our Thoughts
Ambetter Health Insurance is a marketplace plan provider who offers health insurance coverage. The company is only an on-exchange health insurance option meaning it does not directly sell the product to you. Instead, depending on the state you live in, health plans will be offered through an insurance company that is partnered with Ambetter.
To enroll in a health plan from Ambetter, you would need to apply on your state health insurance marketplace during an Obamacare open enrollment period. However, you can also purchase Ambetter health insurance if you have a qualifying life event.
Availability of Policies
Ambetter health plans are available for purchase from select states and are offered through different insurance companies. This includes:
|Arkansas||Ambetter from AR Health & Wellness|
|Arizona||Ambetter from Arizona Complete Health|
|Florida||Ambetter from Sunshine Health|
|Georgia||Ambetter from Peach State|
|Kansas||Ambetter from Sunflower Health|
|Mississippi||Ambetter from Magnolia|
|Missouri||Ambetter from Home State|
|Nevada||Ambetter from Silver Summit|
|Ohio||Ambetter from Buckeye Health Plan|
|Texas||Ambetter from Superior|
|Washington||Ambetter from Coordinated 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 come with vision and dental insurance. This is optional insurance that you can add onto your health policy and covers 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.
Below we have provided more details regarding each of the categories of health insurance policy that Ambetter offers. The sample policies shown are for Miami-Dade County in Florida, but your individual plan availability and pricing may differ as it is dependent on the state and county you live in.
Ambetter Essential Care
The Ambetter Essential Care category has Bronze metal plans, which are 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.
|Product||Deductible||Out-of-pocket maximums||Monthly cost for a 40-year-old|
|Ambetter Essential Care 1||$6,800||$6,800||$329.47|
|Ambetter Essential Care 1 + Vision||$6,800||$6,800||$333.27|
|Ambetter Essential Care 1 + Vision + Dental||$6,800||$6,800||$342.15|
As you can see, Ambetter only offers one Bronze plan through the Ambetter Essential Care product. The plan has identical deductibles and out-of-pocket maximums, which means there is no access to copays or coinsurance. Instead, once the deductible and out-of-pocket maximum have been met, you will have no cost for any in-network medical services, as they will be completely covered by the insurer.
Ambetter Balanced Care
Silver metal plans are sold through the Ambetter Balanced Care category, which have lower deductibles and out-of-pocket maximums. However, these plans have more expensive monthly premiums. 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.
|Product||Deductible||Out-of-pocket maximums||Monthly cost for a 40-year-old|
|Ambetter Balanced Care 2||$6,500||$6,500||$460.80|
|Ambetter Balanced Care 1||$5,500||$6,500||$468.18|
|Ambetter Balanced Care 10||$5,000||$6,700||$487.53|
|Ambetter Balanced Care 3||$3,000||$6,500||$491.68|
For some Ambetter Balanced Care policies, the deductibles will be less than the out-of-pocket maximums. Therefore, you would be eligible for coinsurance, during which your insurance provider would pay for a portion of all your medical expenses. Then, once the out-of-pocket maximum is reached, all medical expenses would be 100% covered.
For example, say you owned an Ambetter Balanced Care 2 plan and incurred medical expenses of $7,500. When filing a claim for this bill, the first $6,500 would be paid by you and then the next $1,000 would be paid by the insurance provider. Any other expenses beyond this point would also be covered by the insurer.
Ambetter has some of the cheapest rates available for health insurance. In the graph below we have compared average Ambetter Balanced Care rates from Florida against some of its competitor Silver policies. As you can see, Ambetter has the cheapest rates available in Florida, with its individual quote being $98 less than the next cheapest option offered by Health Options Inc.
Ambetter Secure Care
The Ambetter Secure Care products are Gold metal tier policies, which have the most expensive premiums but also more affordable deductibles and out-of-pocket maximums. These lower levels for deductibles allow you to quickly take advantage of coinsurance benefits. 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 only offers one Gold plan: the Ambetter Secure Care 3. The policy has a deductible of $1,000 and an out-of-pocket maximum of $6,350. Once the deductible has been met, you would begin 20% coinsurance with the insurer. Then, as with other Ambetter health insurance plans, once you reach the out-of-pocket maximum, all medical services are covered by the insurer.
For instance, say you had a medical expense of $1,500. You would be required to pay $1,000 to meet the Ambetter Secure Care 3 deductible. Then, you would pay 20% of the next $500, which is $100. This would bring your total bill to $1,100.
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. In addition, Ambetter's MyHealthPays rewards program allows you to earn reward dollars by completing health wellness goals and activities. As you complete activities, the rewards would be automatically added to your MyHealthPays 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 premium payments
- Doctor copays
- Everyday items at Walmart
- Utilities (gas, electric, water)
- Cell phone 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 what 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.
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 order your policy ID card.
Customer Reviews and Complaints
If you are looking for the cheapest rates for health coverage, then Ambetter Health Insurance is a great option. However, customer reviews for Ambetter Health Insurance are below average to poor. Many policyholders complain about long phone call wait times when dealing with Ambetter employees, along with providers not being paid for medical services. Furthermore, many members reported getting billed incorrectly and not being able to find providers that accept Ambetter insurance in their areas.
These customer reviews are substantiated by the ratings that Ambetter Health Insurance has received. The Better Business Bureau has given the company a “D” rating, meaning they rarely interact with customers or respond to complaints in a timely manner. Ambetter also received an NAIC complaint ratio of 1.12—meaning the company has received more than the median number of complaints based on its size.
Ambetter Health Insurance is a marketplace plan that is operated by CeltiCare Insurance, a subsidiary of the Centene Corp. When you purchase an Ambetter policy, your point of contact for questions would be Celticare. For example, in Florida, Ambetter plans are marketed as Ambetter by Sunshine Health but are operated and underwritten by CeltiCare Insurance.