Ambetter Health Medical Insurance: Comments and Reviews

Ambetter Health Insurance is a health insurance provider that sells its products to different insurance companies. These insurance companies, in turn, market the plans through the offer mechanisms of each state. In this article you will find all the information you need about the health insurance Ambetter Health.

Ambetter policies have some of the cheapest rates available when compared to other health insurance plans, but they are not available in all states.

Ambetter health insurance plans are ideal if you’re looking for basic coverage and some benefits at an affordable monthly premium. However, the company has partial reviews and should not be considered for coverage if you are looking for excellent customer service.

Health Insurance Ambetter Health Insurance

Ambetter Health Health Insurance

Ambetter Health Insurance is an insurance provider that offers different coverage plans. The company does not offer its own insurance, which means that it does not directly sell the product to you. Instead, depending on the state you live in, health plans will be offered through an Ambetter partner insurance company.

To enroll in an Ambetter health plan, you must apply at your state’s health insurance marketplace during the Obamacare open enrollment period. However, you can also purchase health insurance from Ambetter if you have a qualifying life event.

Ambetter Health Medical Insurance: Policy Availability

Ambetter health plans can be purchased in some states and are offered through different insurance companies. For example:

Condition Company
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 monthly premium along with deductibles and out-of-pocket maximums. However, all of them are qualified health plans and cover essential health benefits like urgent care.

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

Below we provide more details about each of the categories of health insurance policies that Ambetter offers. The sample policies below are for Miami-Dade County in Florida, Please note that the availability and price of your individual plan may differ depending on the state and county you live in.

Ambetter Essential Care

Ambetter Essential Care’s Bronze category are the cheapest policies the company offers, but they have the highest deductible levels. Bronze plans are best if you’re in good health and don’t have many routine medical expenses. Typically, these plans are used to cover an extremely high medical expense.

Product Deductible Maximum out of pocket expenses Monthly cost for a person of 40 years
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 a Bronze plan through the Ambetter Essential Care product. The plan has identical deductibles and out-of-pocket maximums, meaning 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 in-network medical services, since they will be fully covered by the insurer.

Health Insurance Ambetter Health: Balanced Care

Silver plans are sold through the Ambetter Balanced Care category, which has 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 add-ons for vision and dental, but this will increase the monthly premium you must pay.

Product Deductible Maximum out of pocket expenses Monthly cost for a person of 40 years
Ambetter Balanced Care 2 $6,500 $6,500 $460.80
Ambetter BalancedCare 1 $5,500 $6,500 $468.18
Ambetter BalancedCare 10 $5,000 $6,700 $487.53
Ambetter Balanced Care 3 $3,000 $6,500 $491.68

For some Ambetter Balanced Care policies, deductibles will be less than out-of-pocket maximums. Therefore, you would be eligible for coinsurance, during which your insurance provider would pay a portion of all your medical expenses. Then, once the out-of-pocket maximum is reached, all medical expenses will be covered at 100%.

For example, let’s say you own an Ambetter Balanced Care 2 plan and incur medical expenses of $7,500. When submitting a claim for this bill, the first $6,500 would be paid by you and 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. Comparatively, Ambetter Balanced Care of Florida’s median rates on its Silver plan are $98 cheaper than the closest equivalent offered by Health Options Inc.

Medical Insurance Ambetter Health: Secure Care

Ambetter Secure Care products are Gold level policies, which have the most expensive premiums but also the most affordable deductibles and out-of-pocket maximums. These lower deductible levels allow you to quickly take advantage of coinsurance benefits. For this reason, the Ambetter Secure Care Gold plan is better if you have high medical costs, such as a prescription for medications that you require monthly, for example.

Ambetter only offers one Gold plan: Ambetter Secure Care 3. The policy has a $1,000 deductible and a $6,350 out-of-pocket maximum. Once the deductible has been met, you start with a 20% coinsurance with the insurer. So, like other Ambetter health insurance plans, once you reach the out-of-pocket maximum, all medical services are covered by the insurer.

For example, let’s say you have a medical expense of $1,500. You would have to pay $1,000 to meet the Ambetter Secure Care 3 insurance 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

As a policyholder with Ambetter, you will have access to additional member benefitssuch as a rewards program and a nurse advice line. Plus, Ambetter’s MyHealthPays rewards program lets you earn reward dollars by completing health wellness goals and activities. As you complete activities, rewards will automatically be added to your MyHealthPays card.

Some of these activities include completing the Ambetter Wellness Survey, getting an annual wellness exam with your primary care provider, or getting an annual flu shot. Rewards dollars can be used for a variety of expenses such as:

  • monthly premium payments
  • doctor copay
  • Deductibles
  • Coinsurance
  • Everyday items at Walmart
  • Utilities (gas, electricity, water)
  • mobile phone bill
  • Transport, education or rent

The Nurse Advice Line is a 24/7 telephone service that you can call with questions or concerns about your health. The experienced nurse can listen to your problem and advise you on the next steps. For example, if you have back problems, you can call the nurse, explain the problem, and then get an answer on whether you should see a chiropractor.

All member benefits can be accessed through the Ambetter online portal. There you can log into your account, pay any premiums, view your health plan benefits, and request your policy ID card.

Customer service and complaints

If you’re looking for the cheapest rates for medical coverage, then Ambetter Health Insurance is a great option. But nevertheless, Ambetter Health Insurance customer feedback is in some cases very negative. Many policyholders complain about long waiting times for customer service by phone, in addition to the fact that in some cases some providers are not paid for medical services. Additionally, many members reported being billed incorrectly and unable to find providers that accept Ambetter insurance in their areas.

These customer comments are substantiated by the ratings Ambetter Health Insurance has received. The Office of Good Business Practices 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 average number of complaints for its size.

Ambetter Health Insurance is a marketplace plan operated by CeltiCare Insurance, a subsidiary of Centene Corp. When you purchase an Ambetter policy, your point of contact for questions is Celticare. For example, in Florida, Ambetter plans are marketed as Ambetter by Sunshine Health but are operated and underwritten by CeltiCare Insurance.

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