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Ambetter vs. CareSource Insurance
Which health insurance company is the best option for you and your family? Compare Ambetter and CareSource side by side.
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Ambetter vs. CareSource: What You Need to Know
Ambetter is a health insurance company owned by Centene Corporation, a multi-national company that provides programs and services to under-insured and uninsured individuals. Centene is the largest Medicaid managed care organization in the country and the number one insurer on the Health Insurance Marketplace. Each state works differently through Ambetter to provide health insurance marketplace plans, including Medicaid and Children’s Health Insurance Programs (CHIP). Both Centene and it’s a new acquisition, Wellcare Health Plans, serve Medicaid and Medicare members.
In 1989, CareSource was founded on the premise of providing quality health care coverage for Medicaid consumers. Today it offers one of the nation’s largest Medicaid managed care plans. CareSource also offers private health insurance plans on the Health Insurance Marketplace, including Medicare Advantage and MyCare Ohio plans. CareSource has more than 1.9 million members across five states. The company employs about 3,800 people and is considered a nonprofit organization.
To learn more about each company, you can check out the Ambetter Overview and CareSource Overview.
What is Ambetter and CareSource Insurance Rating?
Which health insurance company is better? We've made it easy to compare companies side by side. See how Ambetter and CareSource ranked among the industry ratings.
| Comparison | Ambetter | CareSource |
|---|---|---|
| Year Founded | 1984 | 1989 |
| Medicare Star Rating | 2.5 stars (out of 5) | |
| BBB Rating | A+ | A+ |
| NAIC Complaint Index | 1.12% for individual health insurance | 7.17% |
| Market Share Percentage | 20% | |
| Financial Strength | Excellent |
Pros & Cons of Ambetter or CareSource
Pros
Ambetter
- Ambetter provides coverage to individuals who don’t qualify for traditional plans.
- Very high market share.
CareSource
- CareSource is one of a few options that lower-income, underserved communities have for a managed health plan.
- Affordable marketplace plans with different tiers of coverage.
Cons
Ambetter
- Even though premiums are low for a bronze plan, the out-of-pocket expenses are very high. You have more coverage with the Ambetter Balanced Care plan and even more coverage with the Ambetter Secure Care plan, which has higher monthly payments and low out-of-pocket expenses.
CareSource
- CareSource has a high number of complaints.
Ambetter and CareSource Mobile Apps Options
The CareSource app allows you to view your digital ID Card, find a doctor, file claims, make payments and more.
| Ambetter Mobile App | ||
|---|---|---|
| Ambetter does not currently have a mobile app. | ||
| CareSource Mobile App | ||
|---|---|---|
| iOS | 4/5 | 1K users |
| Android | 3.3/5 | 397 users |
Ambetter and CareSource Enrollment Process
Ambetter
Ambetter is available through the health insurance marketplace or you can get several free quotes here. Each state has its own marketplace. If you’re not sure where to begin, visit https://www.healthcare.gov/.
CareSource
CareSource is available through the health insurance marketplace by searching plans here or you can get several free health insurance quotes here.
Each state has its own marketplace. If you’re not sure where to begin, visit https://www.healthcare.gov/. Also, remember that CareSource only covers Ohio, Kentucky, Indiana Georgia, and West Virginia.
How to File a Claim with Ambetter and CareSource Insurance
Ambetter
If you receive non-emergency services from an out-of-network provider, you may be responsible for the entire cost of the medical bill, unless otherwise required by state or federal regulations. To take full advantage of your Ambetter coverage, it is important to only use in-network providers. To appeal a claim that was denied by Ambetter, the member should contact 1-877-687-1197.
CareSource
CareSource accepts claims in various formats, including paper and electronic claims. Reimbursement is based on the prevailing state Medicaid or Medicare fee schedule. With Marketplace Plans, you can make claims inquiries at (866) 286-9949 (Indiana), (855) 852-5558 (Kentucky), (937) 224-3300 (Ohio), (678) 214 7500, (Georgia) and (855) 202-1091 (West Virginia). Visit your app or www.caresource.com to find the right claim forms for the state in which you live.
Common Questions About CareSource and Ambetter Insurance
Ambetter
Does Ambetter require pre-authorization for services?
Out-of-network services and providers require prior authorization unless it’s an emergency service. You need a referral from a Primary Care Physician to see a specialist unless you’re seeing certain in-network doctors like an obstetrician, gynecologist or psychiatrist.
What is Ambetter My Health Pays® Rewards Program?
You can earn $500 in rewards with My Health Pays, just for doing health-related activities like moving more, saving and eating right and more. The more activities you participate in, the more rewards you earn.
Does Ambetter cover out of state?
Unless it’s an emergency Ambetter will only cover in-network providers so it’s highly likely that a doctor in another state will not be covered. If you have a hospital emergency you may be covered. It’s always best to check by speaking with an agent beforehand if you can.
How do I find my Ambetter member ID?
Your member ID # is on the front of your insurance card.
CareSource
What type of insurance is CareSource?
CareSource’s focus is the underserved population. Most of their health plans have an income cap.
Is CareSource a HealthCare Government plan?
CareSource does offer government-subsidized plans and plans on the marketplace.
How do I know if I qualify for CareSource?
If you qualify for Medicare or Medicaid, you are eligible for CareSource. Your savings on their marketplace plans are also based on total household income. Government plans require that all incomes in the household be taken into consideration, unless the person is not required to file federal taxes.
What states does CareSource cover?
CareSource covers Ohio, Kentucky, Indiana Georgia and West Virginia.
Ambetter and CareSource Insurance Contact Info
| Ambetter Contact Info | |
|---|---|
| Address | Ambetter from Coordinated Care, 1145 Broadway, Suite 300, Tacoma, WA 98402 |
| Phone | 1 (877) 687-1197 |
| Website | https://www.ambetterhealth.com/ |
| https://www.facebook.com/AmbetterHealthcare/ | |
| Youtube | https://www.youtube.com/channel/UC1fien5XXb1voeybJcWr6kQ |
| https://twitter.com/Centene | |
| https://www.linkedin.com/company/centene-corporation/ | |
| CareSource Contact Info | |
|---|---|
| Address | 230 N. Main St., Dayton, OH 45402 |
| Phone | 1 (937) 224-3300 |
| Website | https://www.caresource.com/ |
| https://www.facebook.com/CareSource/ | |
| Youtube | https://www.youtube.com/watch?v=GU8XjYqtJ-0 |
| https://twitter.com/caresource | |
| https://www.linkedin.com/company/caresource/ | |
Fran Majidi manages content on SmartFinancial's website. She's had nearly a decade's worth of experience writing about insurance-related topics. Prior, she was an arts and entertainment editor in New York City. She has a B.A. from Barnard College and an M.F.A. in writing from The New School. She writes books under her given name, Afarin Majidi.
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