Is Ambetter Insurance Medicaid? A Comparison of Two Health Insurance Options

Is Ambetter Insurance Medicaid?

An image to Illustrate How to compare Ambetter and Medicaid
Learn about Ambetter and Medicaid, two health insurance options that may suit your needs and budget. Find out how they differ in terms of eligibility, coverage, costs, and benefits, and how to apply or switch between them/PHOTO: Files

Ambetter and Medicaid are two different health insurance options that may be available to you, depending on your income, location, and eligibility.

But what are the differences between them, and which one is better for you?

Below is a comparison of the two.

What is Ambetter Insurance?

Ambetter is a health insurance company that offers plans on the health insurance marketplace in 26 states and Washington, D.C.

It is owned by Centene, a healthcare company that also serves Medicaid and Medicare members.

Ambetter plans are designed to provide affordable and comprehensive coverage for individuals and families who do not qualify for Medicaid or Medicare, but who may be eligible for financial assistance from the federal government.

Ambetter plans include:

Essential Care: The lowest-cost plans that cover the minimum essential benefits required by the Affordable Care Act (ACA), such as preventive care, emergency services, hospitalization, and prescription drugs.

These plans have high deductibles and copays, but low monthly premiums.

Balanced Care: The mid-range plans that offer a balance between cost and coverage.

These plans cover the essential benefits plus some additional benefits, such as vision and dental care, telehealth, and wellness programs.

These plans have moderate deductibles and copays, and moderate monthly premiums.

Secure Care: The highest-cost plans that offer the most coverage and the lowest out-of-pocket costs.

These plans cover the essential benefits plus additional benefits, such as alternative medicine, chiropractic care, and acupuncture.

These plans have low deductibles and copays, but high monthly premiums.

What is Medicaid?

Medicaid is a joint federal and state program that provides health insurance for low-income and needy people.

It covers children, pregnant women, parents, older people, and people with disabilities.

Each state has its own rules and eligibility criteria for Medicaid, but they must follow certain federal guidelines.

Medicaid covers a wide range of services, such as:

  • Doctor visits
  • Hospital stays
  • Lab tests and X-rays
  • Nursing home care
  • Home health care
  • Family planning
  • Mental health and substance abuse treatment
  • Dental care (for children and some adults)
  • Transportation to medical appointments

How to Compare Ambetter and Medicaid?

To compare Ambetter and Medicaid, you need to consider several factors, such as:

Criteria Ambetter Medicaid
Eligibility – Live in a state where Ambetter operates

– Have a valid Social Security number

– Be a U.S. citizen or legal resident

– Not eligible for Medicaid or Medicare

– Meet income and resource limits set by your state

– Meet other criteria such as age, disability, pregnancy, or family status

– Check eligibility using HealthCare.gov or state Medicaid agency

Coverage – Both cover essential health benefits required by the ACA

– Ambetter may offer more choices of doctors and hospitals, but coverage may vary

– Compare coverage details on the Ambetter website or contact customer service

– Both cover essential health benefits required by the ACA

Medicaid may cover more services and medications

– Compare coverage details on the Medicaid website or contact the state Medicaid agency

Costs – May charge monthly premiums, deductibles, copays, and coinsurance

– Qualify for subsidies or tax credits to lower costs

– May not charge premiums, deductibles, or coinsurance

 

– May require copays or share of costs based on income and state

– Compare costs on the Ambetter website or contact customer service

– Compare costs on the Medicaid website or contact the state Medicaid agency

Conclusion

Ambetter and Medicaid are two health insurance options that may be available to you, depending on your income, location, and eligibility.

Ambetter is a health insurance company that offers plans on the health insurance marketplace, while Medicaid is a joint federal and state program that provides health insurance for low-income and needy people.

They have different eligibility criteria, coverage details, costs, and benefits.

You can compare and choose the option that is best for you by using the online tools and resources provided by both options.

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