Is Ambetter Insurance Legit?: Complete Guide

Ambetter insurance is an affordable health insurance choice offered in specific states through the Health Insurance Marketplace.

While its monthly rates are low, the deductibles tend to be higher than the norm. Reviews for Ambetter are predominantly negative, but opinions vary significantly by state.

Individuals considering an Ambetter health insurance plan should thoroughly research and conduct due diligence before enrolling.

Ambetter presents an inexpensive health insurance choice exclusively available on the Affordable Care Act health insurance marketplace.

It operates in 26 states, offering notably competitive rates.

Despite widespread negative customer feedback, some satisfied individuals appreciate their coverage.

For those considering an Ambetter health insurance plan, comprehensive research is advised.

Connect with a local health insurance specialist and carefully compare quotes to secure the most suitable plan for your needs.

is Ambetter insurance legit
Ambetter Health Insurance plans may include extra benefits or programs to improve the overall healthcare experience. /photo courtesy

 

What is Ambetter insurance?

Ambetter, part of the Health Insurance Marketplace, falls under the Centene Corporation, an established Fortune 25 company operating since 1984.

Centene stands as the nation’s largest Medicaid managed care organization, gaining prominence as bigger health insurance providers withdrew from specific state marketplaces.

While not an insurer directly, Ambetter offers health insurance products sold by other insurance companies on state marketplaces.

Collaborating with states, Ambetter aims to offer affordable health insurance to those ineligible for Medicaid or CHIP.

Even Medicaid recipients can enroll in Ambetter insurance for additional coverage.

Where is Ambetter insurance available?

Ambetter collaborates with various insurance companies across states to offer health insurance products at rates below the average.

The name of Ambetter Insurance may vary depending on the state.

Presently, Ambetter operates in 26 states and plans to expand its coverage through 2022.

Here are the states where Ambetter operates:

  • Arizona
  • Arkansas
  • California
  • Florida
  • Georgia
  • Illinois
  • Indiana
  • Kansas
  • Kentucky
  • Louisiana
  • Michigan
  • Mississippi
  • Missouri
  • Nebraska
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • North Carolina
  • Ohio
  • Oklahoma
  • Pennsylvania
  • South Carolina
  • Tennessee
  • Texas
  • Washington

(Residents of New York can enroll in Fidelis Care through Centene Corporation)

If you’ve applied for an Ambetter health insurance plan, it’s crucial to determine the specific insurance provider in your state.

This information helps locate in-network doctors, as many may not be familiar with the name Ambetter.

To contact the company, access the Ambetter insurance phone number on their website, and select your state for the correct contact information.

Policyholders can use their Ambetter insurance login to access plan details and view their digital ID card.

Ambetter Health Insurance Plans

Ambetter’s plans are generally acceptable but typically fall on the lower spectrum among health insurance options.

While their premiums are affordable, the out-of-pocket costs and deductibles tend to be higher compared to competitors.

Additionally, Ambetter has a limited network of physicians available, offering fewer care options than more widely recognized health insurance providers.

They provide standard tiered plans following the bronze, silver, and gold classifications outlined by the Affordable Care Act.

Ambetter labels these tiers as Essential, Balanced, and Secure, respectively.

Notably, Ambetter stands out by offering additional vision and dental insurance as optional add-ons, a feature unique among marketplace health insurance plans.

It’s recommended to carefully review the cost breakdown and coverage specifics for each tier, considering the scenario of a 30-year-old male residing in Ohio.

Ambetter Essential Care (Bronze)

Ambetter Essential Care is the lowest-cost option available through Ambetter healthcare insurance.

Essential Care plans have the lowest monthly rates but the highest deductible and out-of-pocket expenses.

Ambetter Plan Monthly Rates Deductible MOOP
Ambetter Essential Care 1 $314.14 $8,600 $8,600
Ambetter Essential Care 10 $328.84 $7,200 $8,400
Ambetter Essential Care 5 $337.60 $8,300 $8,700
Ambetter Essential Care 2 $342.74 $6,900 $6,900

Ambetter Balanced Care (Silver)

The Ambetter Balanced Care plans offer a strategic balance between monthly rates and out-of-pocket expenses.

Ambetter Plan Monthly Rates Deductible MOOP
Ambetter Balanced Care 31 $375.05 $5,450 $6,450
Ambetter Balanced Care 30 $375.25 $6,100 $6,100
Ambetter Balanced Care 32 $382.81 $8,100 $8,700
Ambetter Balanced Care 12 $393.81 $6,500 $8,400
Ambetter Balanced Care 11 $398.35 $6,000 $8,500
Ambetter Balanced Care 24 $405.80 $7,450 $7,450

Ambetter Secure Care (Gold)

Ambetter Secure Care gold tier plans provide the most extensive coverage with the lowest deductibles and out-of-pocket expenses but the highest monthly rates.

Ambetter Plan Monthly Rates Deductible MOOP
Ambetter Secure Care 20 $419.30 $750 $7,500
Ambetter Secure Care 5 $446.11 $1,450 $6,300

Ambetter Insurance Reviews

Ambetter faces a considerable volume of negative customer feedback across multiple platforms.

Many critical reviews highlight restricted coverage options and a scarcity of in-network physicians.

Additionally, dissatisfaction with Ambetter’s customer service representatives and claims handling emerges frequently.

Some healthcare providers mention challenges in receiving payments from Ambetter for services rendered.

As Ambetter isn’t an insurance provider per se but a product line, these reviews fluctuate based on the insured individual’s state.

Moreover, Ambetter’s ratings span a wide spectrum across states, ranging from A+ to D- by the Better Business Bureau (BBB).

It’s essential to refine Ambetter insurance BBB reviews by state for a clearer understanding of the company’s performance in your region.

Understanding Ambetter’s structure is crucial. While Ambetter itself isn’t an insurer, identifying the specific state-based Ambetter plan is vital when seeking in-network physicians. Sharing your Ambetter agent’s contact details with your physician can expedite navigating pre-authorization forms and claims payments.

It’s worth noting that many healthcare facilities may not be familiar with Ambetter but may recognize the state-specific plan, such as Ohio’s Buckeye Health.

Confirming whether the practicing physician collaborates with the state plan, not just Ambetter or Centene is essential when seeking care in Ohio.

Instances occur where physicians listed as covered on Ambetter’s website aren’t affiliated with Ambetter upon verification.

In some cases, medical billing offices claim ignorance of Ambetter insurance.

Determining the state-specific Ambetter plan enhances the likelihood of finding in-network physicians.

There’s ongoing involvement in a class-action lawsuit against Centene Corporation, Ambetter’s parent company, accusing them of operating a fraudulent health insurance scheme since 2018.

Notably, Centene has paid over $360 million to resolve Medicaid overcharging allegations in the last year.

Furthermore, CEO Michael Neidorff stepped down due to Medicaid fraud allegations late last year.

Ambetter Health Insurance Benefits

Ambetter Insurance offers unique benefits, such as nationwide coverage.

Although divided into state-specific health insurance plans, Ambetter maintains a network that spans its 26 states.

For instance, if you have an Ambetter health insurance plan in Florida and require medical care while in Texas on vacation, you can locate an in-network doctor in any eligible state through Ambetter.

Moreover, Ambetter provides cashback rewards for various health challenges, ranging from simple tasks like surveys to more comprehensive ones like vaccinations or annual wellness checkups.

Each challenge rewards points that can be redeemed for cash or other prizes.

Previously faced with a shortage of providers when entering the ACA marketplace, Ambetter’s coverage deficiency has improved due to expanded coverage in numerous states.

Their parent company, Centene Corporation, has acquired additional companies, bolstering their overall reach.

Despite significant critical customer feedback, closer examination reveals satisfied consumers who highlight increased coverage options and fewer claim denials when providers align with the state-specific Ambetter plan.

Ambetter collaborates closely with Medicaid, which faces a scarcity of nationwide providers willing to accept lower-income insurance like Medicaid.

This is because physicians cannot bill low-income insurance at rates comparable to those of traditional health insurance companies.

Is Ambetter insurance the right choice for you?

Ambetter presents an economical health insurance choice for those residing in eligible states.

However, the substantial volume of negative reviews, alongside a class-action lawsuit, might deter you from considering an Ambetter health insurance plan.

Conducting thorough research to verify if your preferred doctors are within the network is crucial.

If considering enrollment with Ambetter, it’s advisable to proceed cautiously.

Seek guidance from a knowledgeable health insurance agent in your vicinity and compare insurance quotes to secure the most advantageous coverage deal.

Frequently Asked Questions

Ambetter Health Insurance is a health insurance brand provided by Centene Corporation. It offers individual and family health insurance coverage through the Health Insurance Marketplace created by the Affordable Care Act (ACA).

Ambetter provides a variety of health insurance plans categorized as bronze, silver, and gold levels. These plans differ in premium costs, deductibles, copayments, and out-of-pocket maximums, enabling individuals and families to select a plan that aligns with their healthcare needs and budget.

Ambetter Health Insurance is accessible in multiple states; however, coverage availability varies per state. It’s essential to verify Ambetter’s presence in your specific state and review the plans and network options offered in your area.

Ambetter Health Insurance typically covers essential health services, including preventive care, doctor visits, hospitalization, prescription drugs, emergency care, mental health services, and maternity care. Specific coverage details may differ based on your chosen plan.

  • How can I find healthcare providers that accept Ambetter Health Insurance?

Ambetter offers an online directory of healthcare providers within their insurance network. You can use their online provider directory tool to search for doctors, hospitals, specialists, and other healthcare professionals accepting Ambetter insurance.

Ambetter Health Insurance generally offers limited or no coverage for out-of-network care, except in emergencies or specific circumstances specified in the plan. It’s advisable to review your plan documents or contact.

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