Jane Dotson
Ambetter Health Insurance is a popular choice for Marketplace consumers, offering affordable health insurance plans in 29 states across the US. Ambetter is owned by Centene Corp., one of the largest health insurance companies, and began providing health coverage in 2014. Ambetter's health insurance rates are generally considered cheap compared to its competitors, with the company offering various plans, including Affordable Care Act (ACA) plans. However, Ambetter has received complaints regarding its customer service, with customers reporting issues with finding in-network doctors and incorrect information provided by the company's search tool. Despite this, Ambetter remains a competitive option for individuals seeking health insurance, with its plans offering good coverage and additional perks.
| Characteristics | Values |
|---|---|
| Average monthly cost | $526 |
| Cost factors | age, plan type, metal tier, whether you smoke, location |
| Plan types | HMO, PPO, EPO, POS |
| ACA plans | Bronze, Silver, Gold |
| Coverage | 29 states |
| Network | National |
| Rewards program | My Health Pays |
| Discounts | Gym memberships, online fitness programs, meal delivery services, mental health programs |
| Perks | Telehealth services, 24/7 nurse advice line, mail-order pharmacy program |
| Customer service | Poor, long wait times, incorrect billing, issues with health insurers |
| Availability | Alabama, Arkansas, Arizona, California, Delaware, Florida, Georgia, Illinois, Indiana, Mississippi, Missouri, Ohio, South Carolina, Texas |
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What You'll Learn
Ambetter's My Health Pays rewards program
The amount of the reward varies, with members able to receive $500 or more if they qualify for and complete all activities. Members can log in to their Ambetter Health account and activate My Health Pays to start earning rewards. It is important to note that My Health Pays rewards cannot be used for pharmacy copays, except at Walmart.
The program also offers a discount program, where members can save on gym memberships, online fitness programs, meal delivery services, and mental health programs. Ambetter's My Health Pays rewards program is a great way for members to get recognized and rewarded for their efforts in maintaining a healthy lifestyle.
In addition to the rewards program, Ambetter offers competitive rates for health insurance plans. The cost of Ambetter health insurance varies depending on factors such as age, plan type, metal tier, smoking status, and location. On average, Ambetter health insurance costs around $526 a month, but rates differ by state, with New Hampshire having the cheapest rates at $368 per month for a Silver plan, and New York having the most expensive rates, with a Silver plan costing an average of $644 per month. Ambetter offers four types of health plans: HMO, PPO, EPO, and POS, as well as three Affordable Care Act plans: Bronze, Silver, and Gold. Ambetter's rates are generally lower than those of its competitors, making it a good choice for those seeking affordable health insurance.
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Ambetter's coverage and availability
Ambetter offers a wide range of health insurance plans with varying coverage and availability. The company began providing health coverage in 2014 and now serves over 4 million members across 26 states in the US. Ambetter is owned by Centene Corp., one of the largest health insurance companies, and its plans are available for purchase on HealthCare.gov or state health insurance marketplaces.
Ambetter offers four types of health plans: HMO, PPO, EPO, and POS. HMO plans typically require members to receive care from in-network providers, with out-of-network care generally not being covered. EPO plans are similar, but they do not require a referral from a primary care provider to see a specialist. PPO plans offer more flexibility, allowing members to receive out-of-network care at a higher cost. POS plans are not mentioned in detail, but they are likely to have some features of both HMO and PPO plans.
In terms of coverage, Ambetter provides three out of the four Affordable Care Act (ACA) plans: bronze, silver, and gold. These plans are divided into metal tiers based on costs, with bronze and silver plans having lower premiums but higher out-of-pocket costs. Silver plans have the highest average deductible among the companies analysed by Forbes. Ambetter also offers additional perks, such as the My Health Pays rewards program, which allows members to earn points for healthy living choices, and a discount program for gym memberships, online fitness programs, and mental health programs.
The availability of Ambetter plans varies by state and county. For 2025 coverage, Ambetter offers Value plans in certain counties in Florida, Texas, and Georgia. Health Solutions plans are available in Georgia, Indiana, Mississippi, Missouri, Ohio, and South Carolina. Diabetes care plans will be available in Florida, Georgia, New Jersey, North Carolina, and Tennessee. Ambetter's website provides a tool to select your state and view the specific plans available in your area.
While Ambetter offers affordable rates and good coverage, there have been complaints about the company's customer service and claims handling. Some customers have reported issues with finding in-network doctors and incorrect information provided by the online search tool. It is recommended to call your doctors before purchasing an Ambetter plan to ensure they accept the coverage.
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Ambetter's customer service
One of the main issues with Ambetter's customer service is finding doctors within the plan's network. Customers have reported that the online tool lists doctors as in-network when they are not, which has led to a class-action lawsuit against the company. This issue may be due to Ambetter's limited availability, as it is only available in 26 to 29 states. As a result, customers in certain states may have fewer options for in-network doctors.
Another issue with Ambetter's customer service is related to claims handling, including claim denials. According to data from the National Association of Insurance Commissioners, Ambetter has an average rate of complaints for a company its size, but the number of complaints varies by state. For example, Ambetter from Magnolia Health in Mississippi has 75% fewer complaints than average, while Ambetter in Michigan has over twice as many complaints as the average.
On the positive side, Ambetter offers a My Health Pays rewards program that lets members earn points for healthy living choices, which can be used to offset rates, copays, deductibles, and coinsurance. They also offer a discount program with savings on gym memberships, online fitness programs, meal delivery services, and mental health programs. Additionally, Ambetter Telehealth provides digital access to healthcare services, and customers can track their claims and connect with a nurse hotline online.
Overall, while Ambetter offers cheap rates and some additional perks, their customer service has been criticised for issues with their online tools, limited availability, and claims handling.
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Ambetter's average premiums
Ambetter offers several levels of low-cost health insurance plan options. The company provides individual and family health insurance plans in four different levels. Ambetter's average premiums are lower than most competitors, with Bronze and Silver plans being the cheapest.
A Silver health insurance plan from Ambetter costs $521 per month for a 40-year-old. However, rates vary by state. New Hampshire has the cheapest Ambetter rates, at $368 per month for a Silver plan. Ambetter plans are the most expensive in New York, where a Silver plan costs an average of $644 per month. Ambetter's average monthly rates are lower than those of its competitors. Ambetter is one of the few carriers in the market place that runs on a National Network. This means that if you are in a state where Ambetter is available, you are covered at hospitals outside of your "HMO".
Ambetter's My Health Pays program lets you earn rewards for healthy living choices like exercising, eating a balanced diet, and getting annual vaccines. The reward money can be used for health-related costs and a few other types of bills. Ambetter also has a discount program where you can save on gym memberships, online fitness programs, meal delivery services, and mental health programs.
Ambetter has been accused of intentionally defrauding customers by providing incorrect information about which doctors are inside its network. Customers have reported issues with the company's search tool, which incorrectly states that a doctor is in the network. It is important to call your doctors before buying a plan to ensure they accept the coverage.
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Ambetter's Telehealth services
Ambetter is a good insurance company with affordable rates and good coverage. Ambetter's average monthly rates are lower than those of its competitors. However, its limited availability is a disadvantage. Ambetter is available in 26 states across the U.S. and serves more than 4 million members.
Ambetter Telehealth is a health services provider that offers digital access to healthcare for individuals. With Virtual 24/7 Care, Ambetter members can access in-network telehealth providers, including Teladoc providers, from the comfort of their homes. This service allows members to skip the waiting room and access medical advice, diagnoses, and prescription medications from licensed providers at any time and from anywhere.
Ambetter from Sunshine Health supports healthcare providers in using telemedicine to deliver healthcare services to their patients. Sunshine Health covers services provided via telemedicine to the same extent that they cover the same services in person. However, the initial cost of telemedicine equipment is not covered.
Ambetter's My Health Pays program is another notable feature. This program allows members to earn rewards for healthy living choices, such as exercising, eating a balanced diet, and getting annual vaccines. The rewards are automatically added to the My Health Pays card, which can be used for health-related costs and some other types of bills. Ambetter also offers a discount program with savings on gym memberships, online fitness programs, meal delivery services, and mental health programs.
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Frequently asked questions
The average monthly cost of Ambetter health insurance is $526, but this varies depending on factors such as age, plan type, whether you smoke, and your location. For example, a Silver health insurance plan costs $521 per month for a 40-year-old, but rates differ by state. New Hampshire has the cheapest Ambetter rates at $368 per month for a Silver plan, while New York has the most expensive at $644 per month.
Ambetter offers four types of health plans: HMO, PPO, EPO, and POS.
Ambetter has lower average monthly rates compared to competitors, and it offers PPOs on the ACA marketplace, which is rare. Ambetter also has a rewards program called My Health Pays, where members can earn points to offset rates, copays, deductibles, and coinsurance.
Ambetter has been criticized for its poor customer service, with complaints about long wait times, incorrect billing, and issues with health insurers. There have also been reports of difficulty finding in-network doctors, and the company is currently involved in a lawsuit regarding its doctor network information.
