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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CareSource narrowly wins against Ambetter in this healthcare battle by offering hearing benefits and a wider section of health plan structures. Ambetter is still a good healthcare provider, offering availability in more states and a mobile app with access to telehealth professionals. Fortunately, both health insurance companies have similar customer satisfaction ratings and offer individual, family, dental, and vision plans. The best choice will be whichever company meets your coverage needs at the best price.

Below is our in-depth breakdown of Ambetter and CareSource to help you determine which healthcare provider is better suited for you.

Ambetter vs. CareSource: Quick Glance

Comparison

Ambetter

CareSource

Coverage Options

HMO, PPO, EPO, FSA, HDHP, HSA, Medicaid, Medicare, POS

HMO, Medicaid, Medicare

Availability

Available in 26 states

Available in 21 states

Coverage Limit

Varies

Varies

Deductible

Varies

Varies

Maximum Annual Benefit

Varies

Varies

Waiting Period

Varies

Varies

Providers In-Network

N/A

N/A

Covers Telehealth

Yes (available only in 20 covered states)

Yes (through Teladoc)

Policy Management

Online account, mail and phone

Online account or by mail

Ambetter Pros and Cons

Pros

Cons

More coverage options available than CareCourse

Does not disclose the number of their in-network providers

Available in more states than CareSource

Unable to manage healthcare account through mobile app

Offers mental health coverage for all plans

 

>> Check out our full Ambetter review here.

CareSource Pros and Cons

Pros

Cons

Higher customer satisfaction than Ambetter

Available in only six states

Ohio residents have specialized healthcare for those with complex behavioral health, developmental and intellectual disabilities

Fewer coverage options than Ambetter

Hearing coverage available

Medicare not offered in all states

>> Check out our full CareSource review here.

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Ambetter Vs CareSource: Plan Structures

While Ambetter and CareSource offer similar plans, CareSource comes out slightly ahead by offering hearing benefits. Ambetter does not offer any hearing benefits in its health plans at this time.

Plan

Ambetter

CareSource

Dental

✓ 

Family

Individual

Medicaid

Medicare

✓*

  ✓**

Vision

Hearing

X

*Medicare is provided through Superior HealthPlan for Ambetter customers.
**Medicare Advantage availability varies by state.

Ambetter Vs CareSource: Plan Availability

Ambetter outperforms CareSource when it comes to availability, offering coverage in a whopping 26 states compared to six states for CareSource.

Ambetter members can purchase health plans in the following 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

* Excludes telehealth coverage

Note for New York consumers: Those seeking Marketplace coverage in New York can do so through Fidelis Care, a fellow subsidiary under Centene (parent company).

Serving only six states, CareSource’s availability is relatively limited. West Virginia is the only state that CareSource serves that Ambetter does not. Consumers in the following states can purchase a CareSource health plan:

  • Arkansas (exclusively CareSource PASSE for those with complex behavioral health, developmental and intellectual disabilities.)
  • Georgia
  • Indiana
  • Kentucky
  • Ohio
  • West Virginia

Medicare Advantage-only plans by CareSource are available only in select counties in Ohio. Those who live in certain Northeast counties of Ohio can also get CareSource MyCare Ohio, a program that combines Medicare and Medicaid benefits for qualifying individuals. Similarly, select counties in Georgia, Indiana, Kentucky and Ohio have CareSource Dual Advantage which combines Medicare Advantage and Medicaid into a single plan.

Ambetter Vs CareSource: In-Network Providers

Ambetter and CareSource do not disclose the number of providers within their healthcare networks. However, Ambetter’s app through Teladoc does state that members can access over 3,100 in-network and out-of-network healthcare professionals from around the country.

Ambetter Vs CareSource: Cost

Ambetter and CareSource healthcare plans will vary in cost because of several pricing factors, including:

  • Age
  • Deductible
  • Health history
  • Health plan
  • State

Plan categories from both Ambetter and CareSource are available in bronze, silver and gold. These health plan tiers dictate the cost of your coverage, not the quality of your medical care:

  • Bronze tier: Lower monthly premium but higher out-of-pocket costs
  • Silver tier: Average monthly payments. Lower out-of-pocket costs compared to bronze but higher than gold
  • Gold tier: Higher monthly payments but lower out-of-pocket costs

See below for an example of an Ambetter silver plan. To compare, the monthly premium on a bronze plan would cost less than $407, while costing more for a gold plan.

Cost

Ambetter

Monthly Premium

$407

Deductible

$7,350

Out-of-Pocket Maximum

$7,350

Primary Care Visit

$40

Specialist Visits

$80

Urgent Care

$100

Ambetter and CareSource also sell Medicare Advantage (Part C) plans, which combine Medicare Part A (hospital insurance), Part B (medical insurance), and sometimes Part D (prescription drugs). You will still be paying your premiums for Medicare parts A and B on top of your MA plan premium — however, Part A is typically free if you’ve paid Medicare taxes for at least 10 years. The average cost of an MA plan is $19 per month in 2022.

Ambetter Vs CareSource: Coverage Limits

Your healthcare policy limits will vary between plans since different people have different budgets, coverage needs, and health concerns. Like any other health insurance company, Ambetter and CareSource are prohibited from setting a dollar limit on essential health benefits, which can include:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization (surgery and overnight stays)
  • Laboratory services
  • Mental health and substance use disorder services
  • Pediatric services
  • Pregnancy, maternity, and newborn care
  • Prescription drugs
  • Preventive and wellness services/chronic disease management
  • Rehabilitative and habilitative services and devices

Ambetter Vs CareSource: Policy Management

CareSource and Ambetter offer policy management options via phone or online portal, but CareSource emerges as the winner with its robust mobile app capabilities.

Where both companies are similar: Ambetter and CareSource members can access their health insurance plans through an online portal or by speaking with a representative over the phone. With either method, you can find an in-network provider, pay bills, track spending and manage your claims.

CareSource members can manage their health insurance plans through the CareSource mobile app — a feature unavailable to Ambetter members. With the mobile app, CareSource members can:

  • View their digital insurance ID card
  • Secure access to their personal My CareSource account
  • Find a local doctor, hospital, clinic, urgent care or pharmacy
  • Check their claims, copays, deductibles and balances (if applicable)
  • Make a payment
  • Review their plan benefits
  • Call CareSource 24 and speak with a nurse 24/7
  • Call and speak with member services
  • Explore health rewards opportunities

Ambetter does not have an app for policy management but they do offer Ambetter Virtual Access, a mobile app through Teladoc that provides support and resources for general medical knowledge, primary care, therapy and psychiatry, nutrition and dermatology.

Based on consumer reviews for each company’s mobile app, consumers have a better experience using the CareSource mobile app than the Ambetter teladoc app. The near five-star rating on Google Play and the Apple App Store suggests that the CareSource mobile app offers an excellent and intuitive user experience.

Company

Google Play Store

Apple App Store

Ambetter (through Teladoc)

1.5/5 stars

2.6/5 stars

CareSource

4.2/5 stars

4.2/5 stars

Ambetter Vs CareSource: Medical Loss Ratio

Medical loss ratio (MLR) is the revenue from member premiums received versus how much of it is used for medical care improvement. Insurance companies are required to spend at least 80% (individual plans) or 85% (group plans) of premium dollars on improvements. If the MLR falls below the requirement, the difference is refunded in the form of a rebate for policyholders.

CareSource’s 2021 MLR was 87.8%, which indicates that CareSource is investing premiums into medical care improvement for its members. Ambetter’s parent company, Centene, issued $207 million in rebates for the 2020/2021 year.

Ambetter Vs CareSource: Enrollment Process

The next open enrollment for buying an Ambetter or CareSource health plan through your state’s health insurance marketplace will run from November 1, 2022 to January 15, 2023. Health insurance coverage is still purchasable outside of the enrollment period but only if you experience a qualifying event, such as:

  • Becoming a U.S. citizen
  • Changing jobs
  • Getting married or divorced
  • Giving birth to a child or adopting a child
  • Household income falling below the federal poverty level
  • Losing health coverage (spouse or domestic partner loses their job or dies)
  • Moving to a new residence

Consumers can buy Medicare Advantage, Medigap and Medicare prescription drug (Part D) plans through CareSource and Ambetter during two different enrollment periods each year:

October 15–December 7

  • Switch from Original Medicare to an MA plan
  • Switch from one MA plan to another MA plan
  • Join a Medicare drug plan or switch to another Medicare drug plan
  • Drop Medicare drug coverage completely

January 1–March 31

  • Switch from one MA plan to another MA plan
  • Drop your MA plan and return to Original Medicare

Medicaid enrollment lasts year-round for qualified applicants and you can apply by contacting your state’s Medicaid department or enrolling through your state’s health insurance marketplace. Eligibility will vary by state but typically considers the following:

  • Age
  • Income level
  • Number of people in your family
  • If you are pregnant or have a disability

Ambetter Vs CareSource: Policyholder Experience

CareSource and Ambetter have similar customer satisfaction scores based on numbers pulled from Best Company and the Better Business Bureau. Keep in mind that overall customer satisfaction can vary by state, so you may see that members in one state will have a different experience than members in another.

Company

Ambetter

CareSource

BestCompany

1.4/5 stars

1.2/5 stars

BBB

1.12/5 stars

1.17/5 stars

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How To File Claims With Ambetter and CareSource

In-network care does not require a claim to be filed by the insured for either company. Instead, doctors and medical facilities file claims with the insurance company on your behalf. However, medical services acquired from out-of-network will require you to file a claim yourself.

Ambetter allows its customers to submit claims either through the online member portal or by calling health insurance provider services at 1-877-644-4613. You can also mail in your claim form at Ambetter Claims Processing P.O. Box 5010, Farmington, MO 63640-5010.

CareSource customers can file claims through an online portal or by mail. Below are the addresses paper claims forms can be sent.

Indiana

Kentucky

West Virginia

CareSource

Attn: Claims Department

P.O. Box 3607

Dayton, OH 45401

CareSource

Attn: Claims Department

P.O. Box 824

Dayton, OH 45401

CareSource

Attn: Claims Department

P.O. Box 804

Dayton, OH 45401

History of Ambetter

Ambetter is a health insurance company owned by Centene Corporation, a multinational company, that provides programs and services to underinsured 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 its acquisition, Wellcare Health Plans, serve Medicaid and Medicare members.

History of CareSource

In 1989, CareSource was founded on the premise of providing quality healthcare 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 CareSource Dual Advantage and MyCare Ohio plans. The company employs about 3,800 people and is considered a nonprofit organization.

FAQs

Does Ambetter require pre-authorization for services?

Out-of-network services and providers require prior authorization by Ambetter unless it’s an emergency service. You need a referral from a primary care physician (PCP) to see a specialist unless you’re seeing certain in-network doctors like an obstetrician, gynecologist or psychiatrist.

What states does CareSource cover?

CareSource covers Arkansas, Georgia, Indiana, Kentucky, Ohio and West Virginia. CareSource PASSE is the only health plan available in Ohio and is for those with complex behavioral health and developmental and intellectual disabilities.

How do I find my Ambetter member ID?

You can find your member ID number on the front of your insurance card.

Key Takeaways

  • Ambetter is available in 20 states more than CareSource.
  • Hearing benefits are available in plans sold by CareSource, but not Ambetter.
  • Average consumer review ratings suggest that overall customer satisfaction is higher with CareSource than with Ambetter.
  • CareSource offers a mobile app for policy management, while Ambetter offers an app only for teladoc services.

To help find the best health insurance plan, use SmartFinancial to make sure you’re getting the plan you want for the price you want. Enter your zip code below or call 855.214.2291 to receive your free health insurance quotes.

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