Ambetter vs. Molina Insurance

See how Ambetter and Molina compare when it comes to availability, types of coverage, customer satisfaction and more.

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While Ambetter offers more coverage options and is available in more states, Molina has better overall customer satisfaction ratings. The Molina mobile app also scores a higher average rating among users compared to Ambetter’s. Fortunately, both health insurance companies offer individual and family plans and Medicare Advantage plans, so the best choice will be the one that meets your coverage needs at the best price.

Below, you’ll find an in-depth breakdown of both companies so you can see which healthcare provider is better suited for you.

Ambetter vs. Molina: Quick Glance

Comparison

Ambetter

Molina

Coverage Options

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

HMO, Medicaid, Medicare, SCHIP

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 (available in all covered states)

Policy Management

Online account and phone

Mobile app, online account, phone

Ambetter Pros and Cons

Pros

Cons

More coverage options offered than Molina

Does not disclose the number of their in-network providers

Coverage offered in more states than Molina

Can’t manage healthcare account through mobile app

Offers mental health coverage for all plans

 

>> Check out our full Ambetter review here.

Molina Pros and Cons

Pros

Cons

Offers telehealth in every state where Molina is available

Does not disclose the number of their in-network providers

Mobile app allows users to manage their healthcare account

Available in fewer states than Ambetter

More options when filing a claim compared to Ambetter

Has fewer coverage options than Ambetter

>> Check out our full Molina review here.

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Ambetter vs. Molina: Plan Structures

Ambetter and Molina offer similar plans, including family, individual, Medicaid and Medicare. Below is a brief comparison of what each health insurer offers.

Plan

Ambetter

Molina

Dental

✓ 

Family

Individual

Medicaid

Medicare*

Vision

*Medicare is provided through Superior HealthPlan.

Ambetter vs. Molina: Plan Availability

When it comes to plan availability, Ambetter comes out ahead, offering health plans in six states more than Molina. Consumers can purchase Ambetter health plans in the 26 states below:

  • 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).

Molina offers health insurance coverage in 21 states — slightly fewer than Ambetter:

  • Arizona
  • California
  • Florida
  • Georgia
  • Idaho
  • Illinois
  • Iowa
  • Kentucky 
  • Massachusetts
  • Michigan
  • Mississippi
  • Nevada
  • New Mexico
  • New York
  • Ohio
  • South Carolina
  • Texas
  • Utah
  • Virginia
  • Washington 
  • Wisconsin

Ambetter vs. Molina: In-Network Providers

Neither Ambetter nor Molina list the number of providers they afford their customers. However, the Ambetter app through Teladoc states customers can access over 3,100 board-certified healthcare professionals from around the country. These physicians are a mix of in-network providers and out-of-network providers.

Ambetter vs. Molina: Cost

Whether you buy a health plan through Ambetter or Molina, average costs can vary significantly based on several factors. Commonly used factors that insurance companies consider when calculating your insurance premium include:

  • Age
  • Deductible
  • Health history
  • Health plan
  • Insurance company
  • State

Ambetter and Molina sell Medicare Advantage (MA) plans, which combine Medicare Part A (hospital insurance), Part B (medical insurance), and sometimes Part D (prescription drugs). The monthly premium for Medicare Advantage will need to be paid along with the premiums for Parts A and B (Original Medicare). The 2022 average for Medicare Advantage is $19 per month.

Medigap helps cover holes in your Part A and Part B plans but will not cover prescription drugs. Like Medicare Advantage, you will need to pay the Medigap monthly premium along with the monthly premiums for Parts A and B. The average cost of Medigap in 2020 was $150 a month.

Ambetter vs. Molina: Coverage Limits

Limits on your healthcare policy will vary between plans since different people have different coverage needs, budgets and health concerns. Health insurance companies are not allowed to set a dollar limit on services that are considered essential health benefits while enrolled in a health insurance plan. Essential health benefits 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. Molina: Policy Management

Ambetter and Molina members can access their health insurance plans through an online portal or by speaking with a representative over the phone. Using the online portal or speaking with a representative will allow you to find an in-network provider, pay bills, track spending and manage your claims.

Additionally, Molina members can access their health insurance plans through a mobile app called My Molina. Those who use the app can:

  • View health coverage
  • View their benefits and eligibility
  • View/download and share ID card
  • Make premium payments (Marketplace only)
  • Message Center
  • Manage their payment profile
  • Save favorite doctors
  • Change PCP (primary care physician)

Ambetter does not have an app for policy management but they do offer Ambetter Virtual Access, a mobile app for teladoc services. By downloading this app, consumers can access 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 Molina mobile app than the Ambetter app.

Company

Google Play Store

Apple App Store

Ambetter (teladoc only)

1.5/5 stars

2.6/5 stars

Molina

4.2/5 stars

4.6/5 stars

Ambetter vs. Molina: Medical Loss Ratio

Medical loss ratio (MLR) is the amount of revenue brought in by premiums from an insurance company that is used for clinical services and quality improvement. Insurance companies are required to spend at least 80% for individuals or 85% for groups of premium dollars on medical care improvements. If the MLR falls below the requirement, the difference is refunded in the form of a rebate for policyholders.

Molina’s MLR was reported at 88% last year, resulting in no rebate payout. Ambetter’s parent company, Centene, issued $207 million in rebates for the 2020/2021 year.

Ambetter vs. Molina: Enrollment Process

Open enrollment for health insurance for 2023 runs from November 1, 2022 to January 15, 2023. Coverage through Ambetter and Molina can be purchased at this time through your state’s health insurance marketplace. Coverage can still be purchased 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 homes

Medicare Advantage, Medigap and Medicare prescription drug plans are offered through Ambetter and Molina, which has its own open enrollment period from January 1st to March 31st each year. To purchase these plans, you will need Original Medicare. Open enrollment for Original Medicare is from October 15 to December 7 of each year.

For those who qualify for Medicaid, enrollment lasts year-round. Eligibility is typically based on your:

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

You can apply for Medicaid by contacting your state’s Medicaid department or by enrolling through the Health Insurance Marketplace. Eligibility requirements for both Medicaid and CHIP will differ by state.

Ambetter vs. Molina: Policyholder Experience

After compiling ratings from third-party rating services and consumer review sites, we’ve determined that Molina has the higher overall score. Molina performed comparably well with  reviews from real customers. However, both companies struggled with their BBB ratings.

Company

Ambetter 

Molina 2.63

Best Company

1.4/5 stars

3.9/5 stars

Benzinga

3.5/5 stars

3/5 stars

BBB

1.12/5 stars

1.14/5 stars

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How To File Claims With Ambetter and Molina

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.

Molina customers are required to file claims by contacting member services at (888) 898-7969 or by mail at Molina Healthcare P.O. Box 22668, Long Beach, CA 90801. Claims for Medicare and Medicaid can also be made online through Availity.

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 new acquisition, Wellcare Health Plans, serve Medicaid and Medicare members.

History of Molina

Molina Healthcare was founded in 1980 by C. David Molina, an emergency room physician in Long Beach, CA. After seeing that patients were being turned away because the hospital would not accept Medi-Cal, he established his first primary care clinic in Wilmington, California in 1980. His goal was to treat the lowest-income patients. For 20 years, his son and fellow physician, J. Mario Molina, ran the company while he served as president and CEO. His younger son, John, was the CFO of Molina Healthcare. The two sons took over the company after their father’s death in 1996.

Ambetter vs. Molina FAQs

Does Ambetter automatically renew my coverage for next year?

Ambetter will send you a notification of renewal in the fall for the following year. Unless you want to make changes to your plan, they will automatically renew your coverage.

What is Molina’s “Dual Options?”

Molina Dual Options is a health plan that contracts with both Medicare and Medi-Cal to provide benefits of both programs to members. This plan is also called Cal MediConnect in California.

Does Ambetter cover surgery?

Ambetter covers necessary surgery but not cosmetic or other elective types of surgery.

Key Takeaways

  • Ambetter is offered in more states than Molina.
  • Ambetter and Molina offer Medicare and Medicaid coverage to eligible customers.
  • Molina ranked better in overall customer satisfaction than Ambetter.
  • Ambetter offers more ways for customers to file claims.

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.

Sources

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