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Our Ambetter Health Insurance Review
Our Ambetter Health Insurance Review
Ambetter has decent pricing compared to competitors analyzed by Forbes Advisor. Its low level of consumer complaints also makes the company worth considering. Ambetter sells Bronze, Silver and Gold marketplace plans for individuals. It also has dental and vision plans, and a My Health Pays rewards program.
Pros
- Average monthly rates are generally lower than competitors’ rates.
- Offers PPOs on the ACA marketplace, which aren’t as common as HMOs and EPOs on the marketplace
- My Health Pays rewards program lets members earn points, which can be used to pay rates, copays, deductibles and coinsurance
- Lower level of consumer complaints filed with state regulators than many competitors
Cons
- Limited availability
On Healthcare.com's Website
Availability
26 states
Types of health plans offered
HMO, EPO, PPO
Telehealth offered
Yes
Table of Contents
- About Ambetter Health Insurance
- Types of Health Insurance Offered by Ambetter
- Types of Plans Available from Ambetter
- Extra Benefits from Ambetter
- Health Insurance Complaints Against Ambetter
- How Much Do Ambetter Health Insurance Plans Cost?
- How Ambetter Costs Compare to Other Companies
- Ambetter Health Plan Comparison
Show more
About Ambetter Health Insurance
Ambetter, which is offered by Centene Corp., one of the largest health insurance companies, began offering health coverage in 2014 and now serves more than 2 million members.
In addition to providing health insurance, Ambetter sells dental and vision coverage.
Featured Health Insurance Partners
1
Aetna
Coverage area
Offers plans in all 50 states and Washington, D.C.
Number of providers in network
About 1.2 million
Physician copays start at
$20
2
Blue Cross Blue Shield
Coverage area:
Offers plans in all 50 states and Washington, D.C.
Number of providers in network
About 1.7 million
Physician copays start at
$10
3
Cigna
Coverage area
Offers plans in all 50 states and Washington, D.C.
Number of providers in network
About 1.5 million
Physician copays start at
$0
Types of Health Insurance Offered by Ambetter
Ambetter offers three types of individual health insurance plans:
- Ambetter Essential Care (Bronze): Bronze plans typically have the cheapest rates, but have the highest out-of-pocket costs when you need health care. A Bronze plan could be right for you if you don’t often need health care services and want to pay the cheapest rates for comprehensive health insurance.
- Ambetter Balanced Care (Silver): Silver plans generally have higher rates than Bronze plans, but lower out-of-pocket costs when you need care. A Silver plan could be a wise decision if you don’t want to pay the higher rates found in Gold plans, but also don’t want the higher out-of-pocket costs in Bronze plans.
- Ambetter Secure Care (Gold): Gold plans usually have higher rates than Bronze and Silver, but lower out-of-pocket costs when you need care. A Gold plan could be good if you expect to need health care services in the next year or if you would prefer to pay more each month with the understanding that you won’t pay as much when you need care.
Optional dental and vision plans may also be available.
Ambetter offers plans in these 26 states. If policies are not offered in your state, check out Forbes Advisor’s list of best health insurance companies.
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Related: Gold, Silver, Bronze Insurance: Which Level Is Best For You?
Types of Plans Available from Ambetter
Ambetter offers three types of insurance plans on the health insurance marketplace:
- HMO: A health maintenance organization (HMO) plan typically requires that you can only see in-network providers who either work directly for or contract with the HMO. You likely will need a referral from your primary care doctor to see a specialist. An HMO typically has lower rates than other types of health insurance.
EPO: An exclusive provider organization (EPO) plan requires you to stay within the plan’s network for the insurance to cover services. You don’t need a referral from your primary care doctor to see a specialist. Rates tend to be about the same as an HMO and lower than those of a PPO.
PPO: A preferred provider organization (PPO) health care plan lets you see providers outside your network and doesn’t require you to get a referral from your primary care provider before seeing a specialist. Out-of-network care usually costs more than if you get care in-network. PPO health insurance premiums are usually higher than other insurance plans.
Ambetter received a three out of five star rating fromHealthCare.gov.
Extra Benefits from Ambetter
Ambetter’s My Health Pays rewards program offers perks to policyholders who meet specific requirements. For example, you earn points for completing an annual wellness screening, eating right and moving more.
Points can be converted into money that you can use to cover health costs such as:
- Monthly rates
- Copays
- Deductibles
- Coinsurance
Ambetter says you can also use your rewards to pay for:
- Utility bills
- Cell phone bills
- Transportation, education, rent and child care
Ambetter Health Management Programs offer phone-based educational tools and support for those with chronic conditions such as asthma, depression, hypertension and lower back pain.
The Start Smart for Your Baby program offers support to those who are pregnant. And policyholders can use a nurse advice line that is available 24 hours a day, seven days a week.
Health Insurance Complaints Against Ambetter
Ambetter has a lower level of complaints filed with state insurance departments than many other health insurance companies, according to data collected by the National Association of Insurance Commissioners.
Ambetter has a 0.32 complaint ratio overall, which means overall it gets fewer consumer complaints to state departments of insurance than the industry average, which is 1.00. (Ratios lower than 1.00 are better.)
Amy Danise | Forbes Advisor
How Much Do Ambetter Health Insurance Plans Cost?
The average cost of an Ambetter insurance plan on the ACA marketplace for a 30-year-old is $408 a month. A 40-year-old pays $460 on average and a 50-year-old spends $642 on average.
Multiple factors determine the cost of a health insurance plan, including the type of plan, the metal tier, your age, how many people are covered and where you live.
Following are some examples of how much you might pay for a Ambetter plan:
Average monthly costs for Ambetter Bronze plan
Average monthly costs for Ambetter Silver plan
Average monthly costs for Ambetter Gold Plan
How Ambetter Costs Compare to Other Companies
Here’s how Ambetter’s average health insurance rates compare to other companies.
Average monthly costs for ACA marketplace plan by company
| Health insurance plan member | Ambetter | Aetna | UnitedHealthcare | Cigna | ||||
|---|---|---|---|---|---|---|---|---|
| Child age 0-14 | $272 | $284 | $267 | $291 | ||||
| Child age 18 | $322 | $338 | $314 | $339 | ||||
| Adult Individual age 21 | $360 | $371 | $355 | $385 | ||||
| Adult Individual age 27 | $377 | $389 | $372 | $412 | ||||
| Adult Individual age 30 | $408 | $421 | $403 | $443 | ||||
| Adult Individual age 40 | $460 | $474 | $454 | $497 | ||||
| Adult Individual age 50 | $642 | $662 | $634 | $696 | ||||
| Adult Individual age 60 | $976 | $1,006 | $963 | $1,052 | ||||
| Couple age 21 | $719 | $741 | $710 | $770 | ||||
| Couple age 30 | $816 | $842 | $806 | $886 | ||||
| Couple age 40 | $919 | $948 | $907 | $994 | ||||
| Couple age 50 | $1,284 | $1,324 | $1,268 | $1,392 | ||||
| Couple age 60 | $1,952 | $2,012 | $1,926 | $2,104 | ||||
| Couple+1 child, age 21 | $992 | $1,025 | $977 | $1,061 | ||||
| Couple+1 child, age 30 | $1,089 | $1,125 | $1,072 | $1,177 | ||||
| Couple+1 child, age 40 | $1,191 | $1,231 | $1,174 | $1,284 | ||||
| Couple+1 child, age 50 | $1,557 | $1,608 | $1,534 | $1,682 | ||||
| Couple+2 children, age 21 | $1,264 | $1,309 | $1,243 | $1,351 | ||||
| Couple+2 children, age 30 | $1,361 | $1,409 | $1,339 | $1,467 | ||||
| Couple+2 children, age 40 | $1,464 | $1,515 | $1,441 | $1,575 | ||||
| Couple+2 children, age 50 | $1,829 | $1,891 | $1,801 | $1,973 | ||||
| Couple+3 or more children, age 21 | $1,536 | $1,592 | $1,510 | $1,642 | ||||
| Couple+3 or more children, age 30 | $1,633 | $1,692 | $1,606 | $1,758 | ||||
| Couple+3 or more children, age 40 | $1,736 | $1,798 | $1,707 | $1,866 | ||||
| Couple+3 or more children, age 50 | $2,101 | $2,175 | $2,068 | $2,264 | ||||
| Individual+1 child, age 21 | $632 | $654 | $622 | $676 | ||||
| Individual+1 child, age 30 | $680 | $704 | $670 | $734 | ||||
| Individual+1 child, age 40 | $732 | $757 | $720 | $788 | ||||
| Individual+1 child, age 50 | $915 | $946 | $901 | $986 | ||||
| Individual+2 children, age 21 | $904 | $938 | $888 | $966 | ||||
| Individual+2 children, age 30 | $953 | $988 | $936 | $1,024 | ||||
| Individual+2 children, age 40 | $1,004 | $1,041 | $987 | $1,078 | ||||
| Individual+2 children, age 50 | $1,187 | $1,229 | $1,167 | $1,277 | ||||
| Individual+3 or more children, age 21 | $1,177 | $1,222 | $1,155 | $1,257 | ||||
| Individual+3 or more children, age 30 | $1,225 | $1,272 | $1,203 | $1,315 | ||||
| Individual+3 or more children, age 40 | $1,277 | $1,325 | $1,254 | $1,369 | ||||
| Individual+3 or more children, age 50 | $1,459 | $1,513 | $1,434 | $1,568 | ||||
| Source: Healthcare.gov. Based on unsubsidized ACA plans. | ||||||||
Find The Best Health Insurance Companies Of 2024
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Ambetter Health Plan Comparison
| Ambetter | Aetna | UnitedHealthCare | Cigna | |
|---|---|---|---|---|
| Types of plans offered | HMO, EPO, PPO | HMO, EPO | HMO, EPO | HMO, EPO |
| Metal tier plans offered (may differ based on location) | Bronze, Silver, Gold | Bronze, Silver Gold | Bronze, Silver, Gold | Bronze, Silver, Gold |
| States where ACA marketplace plans are offered | Arkansas Arizona 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 | Arizona (Banner Aetna) California Delaware Florida Georgia Illinois Missouri Nevada New Jersey North Carolina Texas Virginia | Alabama Arizona Colorado Florida Georgia Illinois Louisiana Maryland Massachusetts Michigan Nevada New York North Carolina Oklahoma Tennessee Texas Virginia Washington | Arizona Colorado Florida Georgia Illinois Kansas Mississippi Missouri North Carolina Pennsylvania Tennessee Utah Virginia |
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