ambetter policies have some of the lowest rates available compared to other health insurance plans, but they are not available in all states. ambetter health insurance plans are best if you want basic coverage and member benefits at an affordable monthly rate. but overall customer satisfaction ratings are average and may vary by state since ambetter plans are run by independent companies.
ambetter health sells individual health insurance policies in a state or federal marketplace or through an ambetter insurer’s website.
Reading: What is ambetter insurance rating
availability of policies
if you live in new york, you can purchase coverage through an associated insurer called fidelis 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 are qualified health plans and cover essential health benefits like urgent care.
Some ambetter plans offer optional insurance that you can add to your health policy to cover services like eye exams, prescription glasses and dental cleanings. however, ambetter policies with the dental and vision add-on will have an additional monthly premium.
ambetter has some of the lowest rates available for health insurance. In the chart below, we compare the average rates for ambetter florida silver plans to competitive silver policies. As you can see, Ambetter has mid-range prices compared to other insurers in the state.
better essential care
ambetter’s essential care category has several bronze plans, each with an option to add adult dental and vision coverage, which would increase your monthly payment. Below are three examples of essential care plans. these are some of the cheapest policies offered by the company but have the highest deductible levels. Bronze plans are best if you’re in good health and won’t have many routine medical expenses. These plans are typically used to cover an extremely high one-time medical expense.
With ambetter’s essential care 1 and essential care 2 plans, your health care is free once you meet your deductible and out-of-pocket maximum. But with ambetter essential care 5 plans, you pay a $40 copay each time you see your primary care doctor and $90 for all specialist visits, whether or not you’ve met your deductible.
better balanced care
Ambetter Balanced Care plans are silver policies, which have lower deductibles and out-of-pocket maximums and higher monthly rates than bronze plans.
Below are some of Silver Ambetter’s balanced care products. All of these plans are offered with optional dental and vision add-ons, but this will increase your monthly premium.
for some ambetter balanced care policies, like the balanced care 30 plan, you pay 100% of your health care until you meet the deductible. Once you meet the balanced care 30 deductible, most of your health care is free.
better safe care
ambetter secure care products are gold metal level policies. Gold plans sometimes have high monthly costs, but also more affordable deductibles and out-of-pocket maximums. These lower deductible levels allow you to take advantage of your plan’s benefits quickly. For this reason, the Ambetter Security Care Gold plan is best if you have high medical costs, such as a prescription that needs to be filled monthly.
ambetter offers a gold plan: ambetter secure care 5, with an option to add dental and vision care.
secure care 5 has a deductible of $1,450 and an out-of-pocket maximum of $6,300. except for prescriptions and primary care and specialist visits, you pay 100% of your care until you meet your deductible. once you meet the deductible, you pay 20% of the cost for most of your care.
For example, let’s say you had a medical expense of $1,500. you would pay $1,450 to meet the ambetter security care 5 deductible, then 20% of the remaining $50, or $10, and ambetter would pay the remaining balance.
new ambetter plans for 2022
member resources and unique benefits
As an ambetter policyholder, you’ll have access to additional member benefits like a rewards program and a nurse advice line. ambetter’s my health pays rewards program allows you to earn reward dollars by completing health and wellness activities and goals. As you complete activities, rewards are automatically added to your My Health Pays card.
Some of these activities include completing the ambetter wellness survey, getting an annual wellness exam from your primary care provider, or getting an annual flu shot. reward dollars can be used for a variety of expenses such as:
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 provide advice on the next steps you need to take. 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.
ambetter’s free wellframe mobile app connects members with an advocate to help them with their health care needs and insurance questions. Agents are available anytime to help schedule a virtual health appointment, provide stress management guidance, and more.
All member benefits can be accessed through the ambetter online portal. There, you can log in to your account, pay your premiums, view your health plan benefits, and print or download your policy ID card.
customer comments and complaints
If you’re looking for affordable rates on health coverage, then ambetter health insurance is a great option. ambetter is also good for those who would use member benefits like the 24/7 nurse advice line, dollar rewards for everyday spending, and ambetter’s wellframe app, which scored very highly among users.
However, members expressed frustration with ambetter’s claim handling and customer service. this makes ambetter less attractive to those looking for fast, accurate claims processing and a good customer experience.
many ambetter plans received fewer complaints than companies of similar size, according to the national association of insurance commissioners (naic). For example, Ambetter plans in Florida, Georgia, and South Carolina had low complaint rates. but ambetter north carolina’s complaint numbers were above the norm.
members surveyed by the centers for medicare & Medicaid Services (CMS) gave Ambetter an overall score of 3 out of 5 stars for the plans we reviewed, which is below the average score received by competing plans. Members rated Ambetter on the customer experience, how well providers manage care, and how well Ambetter manages the plan.
ambetter is a subsidiary of centene corp. When you buy a policy from Ambetter, your local plan provides you with customer service. For example, in Florida, your plan would be sold and serviced by Ambetter from Sunshine Health.