Ambetter Health Insurance Review [2024]

Ambetter is a low-cost health insurance option offered solely on the Affordable Care Act health insurance exchange. Ambetter insurance is available in 26 states and comes with highly competitive rates. This company has extensive negative customer reviews, but some customers seem satisfied with their coverage. If you are interested in enrolling in a health insurance plan through Ambetter, you should thoroughly research your options. Contact a health insurance specialist in your area, and be sure to compare quotes to obtain the best plan for your situation.

What is Ambetter insurance?

Ambetter is a Health Insurance Marketplace product line offered through Centene Corporation, a Fortune 25 company that has been in business since 1984. Centene is the nation’s largest Medicaid managed care organization and has been growing in prominence since larger health insurance providers began withdrawing from the marketplace in some states.

Ambetter is not a direct insurance provider but, instead, offers health insurance products that are sold on state marketplaces by other insurance companies. Ambetter works with states to provide low-cost health insurance coverage for individuals who do not qualify for Medicaid or CHIP. Medicaid recipients may still enroll in Ambetter insurance for supplemental coverage.

Where is Ambetter insurance available?

Ambetter partners with insurance companies in different states to offer health insurance products at below-average rates. Depending on the state, Ambetter insurance may be referred to by other names. Ambetter currently serves 26 states, with plans to expand coverage through 2022.

Ambetter Health Insurance is Available in These 26 States

• Arizona
• Arkansas
• 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
• (If you reside in New York, you can enroll in coverage with Fidelis Care through Centene Corporation)

If you applied for a health insurance plan through Ambetter, you should ascertain the name of your state’s specific insurance provider. With this information, you will have an easier time finding in-network doctors. Having the state-specific company name on hand is helpful because many physicians may not know Ambetter by name.

If you need to get in touch with the company, you can call the Ambetter insurance phone number, which is available on the company’s website. You will need to choose your state to find the correct phone number. Policyholders can use their Ambetter insurance login to review plan information and view their digital ID card.

Ambetter Health Insurance Plans

Ambetter’s plans are generally acceptable. Ambetter is on the lower end for health insurance plans. This means that while the premiums may be low, the out-of-pocket costs and deductibles are comparatively higher than competitors. Furthermore, Ambetter works with a very narrow range of physicians. You will not have as many care options as you would find with a more well-known health insurance provider.

Ambetter offers standard tiered plans in the bronze, silver, and gold tiers defined by the Affordable Care Act. Ambetter tiers are respectively named Essential, Balanced, and Secure. Unique to health insurance plans available on the marketplace, Ambetter offers optional vision and dental insurance add-ons. Examine the cost breakdown and coverage details for each tier based on a 30-year-old male living 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 Balanced Care (Silver)

Ambetter Balanced Care plans offer a strategic balance between monthly rates and out-of-pocket expenses.

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 Insurance Reviews

Ambetter has an overwhelming number of negative customer reviews across multiple websites. A large percentage of these critical reviews cite limited coverage options and a lack of in-network physicians. Additionally, many customers seem to be dissatisfied with Ambetter’s customer service representatives and their handling of claims. Some physicians report difficulty receiving payment from Ambetter insurance for services rendered.

Because Ambetter is not really an insurance provider themselves, these reviews can vary significantly based on the insured’s state. Furthermore, Ambetter has various ratings depending on the state’s specific insurance, ranging from A+ to D- by the Better Business Bureau (BBB). Ambetter insurance BBB reviews should be refined by state so you can understand how this company performs in your area.

A closer look at Ambetter’s business structure can help clarify some of these negative reviews. Ambetter itself is not an insurance provider but a health insurance product line. When seeking a physician who is in network with Ambetter, individuals should instead find out the name of their state-specific Ambetter plan. Providing your physician with your Ambetter agent’s phone number can help save you time when navigating pre-authorization forms and claims payments.

By determining your state-specific Ambetter plan, you can have better success finding in-network physicians.

According to some medical billing specialists, Ambetter itself is not well-known by many health care facilities. One example would be Ambetter’s Ohio insurance called Buckeye Health. When seeking care at an Ohio facility, the insured should confirm whether or not the practicing physician works with Buckeye Health, not just Ambetter or Centene.

Insured individuals may check online to see a physician listed as covered on Ambetter’s website. When they call the physician to verify coverage, they may discover that the practice doesn’t work with Ambetter. There have even been cases where medical billing offices claim to have never heard of Ambetter insurance. By determining your state-specific Ambetter plan, you can have better luck finding in-network physicians.

Ambetter is currently involved in a class-action lawsuit filed against parent company Centene Corporation. Suing parties have accused Centene of running a scam and providing fraudulent health insurance. This lawsuit began in 2018 and currently remains open.

Over the last year, Centene has paid out over $360 million to states and institutions to resolve allegations regarding Medicaid overcharges. Late last year, CEO Michael Neidorff agreed to step down due to Medicaid fraud allegations.

Ambetter Health Insurance Benefits

Some unique benefits available through Ambetter insurance include their nationwide coverage. Despite being subcategorized into state health insurance plans, Ambetter keeps their 26 states under one network.

For example, say that you hold an Ambetter health insurance plan in Florida but need medical care while on holiday in Texas. With Ambetter, you can find an in-network doctor in any eligible state.

Ambetter also offers cashback rewards for different health challenges. Sometimes the health challenges can be simple, like taking a survey. Others are more extensive, like getting vaccinations or yearly wellness checkups. Each challenge gives you rewards in the form of points which you can redeem for cash or other prizes.

Ambetter also offers cashback rewards for different health challenges.

Whereas Ambetter suffered from a severe lack of providers a few years ago when they emerged on the ACA marketplace, this issue is resolving due to growing coverage in many states. Ambetter’s parent company, Centene Corporation, has acquired more companies over the past few years, thus expanding their overall reach.

Despite many very critical customer reviews, a more thorough search reveals consumers who are equally satisfied with their coverage. Most positive reviews state that you have more options for coverage and less of a chance to be denied a claim if you can ensure that providers work with your state-specific Ambetter plan.

Ambetter works closely with Medicaid, and there is a lack of providers nationwide who are willing to work with lower-income insurance like Medicaid. This is because physicians cannot bill low-income insurance as much as they can charge a traditional health insurance company.

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Is Ambetter insurance the right choice for you?

Ambetter is an affordable health insurance option for individuals living in eligible states. Ambetter has an overwhelming number of negative reviews across many online sites, including a class-action lawsuit. Reading those low reviews might make you hesitant to enroll in an Ambetter health insurance plan.

It is important to research and determine if the doctors you want to work with are in network. If you are interested in applying for health insurance through Ambetter, you should exercise caution. Consult an expert health insurance agent in your area and compare insurance quotes to acquire the best deal on your coverage.