Which health insurance company is the best option for you and your family? Compare Ambetter and WellCare side by side.
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 1985, Wellcare began as a Medicaid provider for the state of Florida, with operations in Tampa, Florida. After the Balanced Budget Act of 1997 was passed, WellCare began offering Medicare Part C, now called Medicare Advantage. In 2003, it offered Medicare Advantage plans with prescription drug coverage. In 2004, Wellcare went public. In November 2013, WellCare appointed Chairman David Gallitano to serve as interim CEO. He increased spending on technology and famously dorned the walls with photographs and portraits of health plan members, including people who suffer from chronic conditions like cancer, homelessness, and hunger. In 2014, WellCare hired Kenneth Burdick as the new CEO and board member. He’d originally joined the company as the president of national health plans but was promoted first to president and COO and eventually CEO. In September 2017, Wellcare announced a rebrand with a focus on holistic health: “Beyond Healthcare: A Better You.” In October 2017, Wellcare announced the UNC Health Alliance primary care physicians and specialists into its Medicare Advantage network. Wellcare operates in 20 states and was recognized by Fortune Magazine as One of the World’s Most Admired Companies in January 2018. In January 2020, Wellcare was acquired by Centene Corporation.
Which health insurance company is better? We've made it easy to compare companies side by side. See how Ambetter and WellCare ranked among the industry ratings.
|Medicare Star Rating||3.57 stars (out of 5)|
|NAIC Complaint Index||1.12% for individual health insurance|
|Market Share Percentage||20%|
The MyWellCare app allows you to keep track of your benefits, look for providers, and use it as a digital ID Card.
|Ambetter Mobile App|
|Ambetter does not currently have a mobile app.|
|WellCare Mobile App|
Ambetter is available through the health insurance marketplace or you can get several free quotes here. Each state has their own marketplace. If you’re not sure where to begin, visit https://www.healthcare.gov/.
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.
Your doctor or care provider should submit a claim to the insurer. You should be covered except for copay. Your insurer will send you an explanation of benefits. If you owe anything, your doctor will send you a bill. If you visit an out-of-network provider, you will not be covered unless it was an emergency. Call 855-672-2755 with any additional questions.
If you are under-insured or uninsured and need low-cost healthcare, Ambetter may be a good option because they offer affordable plans. Ambetter only offers insurance in 15 states (see company overview). Ambetter’s complaint ratio, however, is high in some states.
Ambetter insurance has bronze, silver and gold plans. Ambetter Essential Care has bronze plans, which are cheapest but have the highest deductibles. Ambetter Balanced Care has silver plans, which have lower deductibles and out-of-pocket maximums. Ambetter Secure Care is the gold metal tier policy which has the most expensive premiums but the lowest out-of-pocket maximums.
Ambetter and WellCare are owned by Centene Corporation. Centene’s acquisition of WellCare was expected to be finalized by the first half of 2020. As one entity, they will be one of the largest providers of Medicaid and Medicare.
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.
WellCare provides managed care services through Medicaid, Medicare Advantage and Medicare Prescription Drug plans.
WellCare received 3.57 stars out of 5 by Medicare’s rating system. It has an A+ rating with the Better Business Bureau (BBB).
Wellcare has a network of providers. To find a WellCare provider or to see if your doctor accepts Wellcare, visit here.
Centene acquired Wellcare in January 2020.
|Ambetter Contact Info|
|Address||Ambetter from Coordinated Care, 1145 Broadway, Suite 300, Tacoma, WA 98402|
|Phone||1 (877) 687-1197|
|WellCare Contact Info|
|Address||P.O. Box 31370|
|Phone||1 (800) 960-2530|
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