Is Ambetter Health Insurance Legit? Exploring Its Legitimacy

Ambetter offers affordable health insurance in specific states through the Health Insurance Marketplace with low monthly rates but higher deductibles.

Reviews are mainly negative, but opinions vary by state.

Despite criticism, some are satisfied with coverage.

Thorough research is recommended before enrolling.

Connect with a local specialist and compare quotes for the most suitable plan.

Is Ambetter health insurance legit?
While Ambetter Health Insurance is a subsidiary of the reputable Centene Corporation, a Fortune 25 company, it has garnered unfavorable reviews and maintains a low level of customer satisfaction: Image source (Piktochart)

Understanding Ambetter insurance?

Ambetter, a component of the Health Insurance Marketplace, is affiliated with the Centene Corporation, a well-established Fortune 25 entity with a history dating back to 1984.

As the largest Medicaid managed care organization in the nation, Centene has gained prominence by filling the void left by larger health insurance providers that withdrew from specific state marketplaces.

Ambetter, while not functioning as a direct insurer, provides health insurance products that are marketed by other insurance companies on state marketplaces.

In collaboration with states, Ambetter’s objective is to furnish affordable health insurance options for individuals who do not qualify for Medicaid or CHIP.

Even individuals receiving Medicaid can opt to enroll in Ambetter insurance for supplementary coverage.

In which locations can Ambetter insurance be found?

Ambetter collaborates with multiple insurance companies nationwide to provide affordable health insurance. Its name varies by state.

Currently in 26 states, Ambetter plans to expand through 2022, operating in states such as Arizona, California, and Texas.

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

When applying for an Ambetter health insurance plan, identify the specific insurance provider in your state to find in-network doctors.

Contact Ambetter using the insurance phone number on their website, selecting your state for accurate 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 affordable but rank lower in the health insurance landscape.

While premiums are reasonable, out-of-pocket costs and deductibles are higher than competitors.

The provider has a limited physician network compared to more recognized insurers.

They offer standard tiered plans (Essential, Balanced, and Secure) following the Affordable Care Act classifications.

Ambetter distinguishes itself by providing optional vision and dental insurance, a unique feature among marketplace plans.

Reviewing cost breakdowns and coverage specifics for each tier is advisable, especially for a 30-year-old male 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 receives significant negative customer feedback, with criticisms focusing on limited coverage, a shortage of in-network physicians, and dissatisfaction with customer service and claims handling.

Healthcare providers also report challenges in receiving payments for services rendered. Ambetter’s ratings on the Better Business Bureau vary widely across states, ranging from A+ to D-.

It’s crucial to refine Ambetter’s BBB reviews by state for a clearer understanding of its performance in your region. Understanding Ambetter’s structure is essential, as it is a product line, not an insurance provider.

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.

Many healthcare facilities may not be familiar with Ambetter but recognize state-specific plans like Ohio’s Buckeye Health. Confirming collaboration with the state plan, not just Ambetter or Centene, is essential when seeking care.

Instances occur where physicians listed as covered on Ambetter’s website aren’t affiliated upon verification, and medical billing offices claim ignorance of Ambetter insurance.

Determining the state-specific Ambetter plan enhances the likelihood of finding in-network physicians. There’s an ongoing class-action lawsuit against Centene Corporation, Ambetter’s parent company, alleging a fraudulent health insurance scheme since 2018.

Centene has paid over $360 million to resolve Medicaid overcharging allegations in the last year. CEO Michael Neidorff stepped down due to Medicaid fraud allegations late last year.

Ambetter Health Insurance Benefits

Ambetter Insurance offers nationwide coverage through its state-specific health insurance plans spanning 26 states.

This means you can find in-network doctors in any eligible state, providing flexibility for medical care, even when away from your home state.

Ambetter incentivizes healthy behavior with cashback rewards for completing various health challenges, from surveys to vaccinations. Points earned can be redeemed for cash or prizes.

Despite initial coverage challenges in the ACA marketplace, Ambetter has expanded its network through acquisitions by its parent company, Centene Corporation.

While facing criticism, closer inspection reveals improved coverage options and fewer claim denials when aligned with the state-specific Ambetter plan.

Ambetter collaborates closely with Medicaid, addressing the scarcity of providers for lower-income insurance.

Physicians often hesitate due to lower billing rates compared to traditional health insurance companies.

Read more: Is Evolve Health Insurance Legit? 

Is Ambetter insurance the right choice for you?

Ambetter Health Insurance
While Ambetter Health Insurance is a subsidiary of the reputable Centene Corporation, a Fortune 25 company, it has garnered unfavorable reviews and maintains a low level of customer satisfaction: Photo source (Forbes)

Ambetter offers a cost-effective health insurance option for individuals living in qualifying states.

Nevertheless, the significant number of unfavorable reviews and an ongoing class-action lawsuit may dissuade you from contemplating an Ambetter health insurance plan.

It is essential to conduct comprehensive research to confirm the inclusion of your preferred doctors in the network.

If contemplating enrollment with Ambetter, it is recommended to proceed with caution.

Consult with a well-informed health insurance agent in your area and compare insurance quotes to secure the most favorable coverage deal.

FAQs: Ambetter Health Insurance

  1. What is Ambetter Health Insurance? Ambetter is Centene Corporation’s health insurance brand, providing individual and family coverage through the Affordable Care Act’s Health Insurance Marketplace.
  2. What types of plans does Ambetter offer? Ambetter offers bronze, silver, and gold level health insurance plans, allowing individuals and families to choose based on their needs and budget.
  3. Is Ambetter coverage nationwide? Ambetter is available in multiple states, but coverage varies. Check Ambetter’s presence in your state and explore local plans and network options.
  4. What services do Ambetter plans cover? Ambetter typically covers essential health services such as preventive care, doctor visits, hospitalization, prescription drugs, emergency care, mental health services, and maternity care. Coverage specifics depend on the selected plan.
  5. How do I find Ambetter providers? Utilize Ambetter’s online directory to find healthcare providers in their network, including doctors, hospitals, specialists, and other professionals.
  6. Can I use Ambetter for out-of-network care? Ambetter generally provides limited coverage for out-of-network care, except in emergencies or specific plan-specified circumstances. Review your plan documents or contact Ambetter for details.

Leave a Comment