Blue Cross Blue Shield vs. Ambetter Insurance

Which health insurance company is the best option for you and your family? Compare Blue Cross Blue Shield and Ambetter side by side.

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Blue Cross Blue Shield vs. Ambetter: What You Need to Know

Blue Cross was formed in 1929 as a partnership between Baylor University Hospital and its patients who were struggling financially. The administrators of the hospital wanted to make healthcare more affordable for some patients, many of whom were Dallas public school educators on restricted budgets. The initial payment plan set up by Baylor University Hospital consisted of a 50-cent prepay each month for up to 21 days of hospitalization per year. The success of the program lead to enrollment by employees in other professions across Dallas.

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

To learn more about each company, you can check out the Blue Cross Blue Shield Overview and Ambetter Overview.

What is Blue Cross Blue Shield and Ambetter Insurance Rating?

Which health insurance company is better? We've made it easy to compare companies side by side. See how Blue Cross Blue Shield and Ambetter ranked among the industry ratings.

ComparisonBlue Cross Blue ShieldAmbetter
Year Founded19291984
BBB RatingA-A+
NAIC Complaint Index1.12% for individual health insurance
Market Share Percentage14.1%20%
Financial StrengthExcellentExcellent
A.M. Best RatingAbb
S&P RatingA+

Pros & Cons of Blue Cross Blue Shield or Ambetter

Pros

Blue Cross Blue Shield
  • Blue Cross Blue Shield is financially strong and stable
  • As a subsidiary of Anthem Inc. BCBS is one of the most prominent health insurers.
  • Blue Cross Blue Shield offers global coverage and a global coverage app on itunes and GooglePlay.
  • BCBS is available in 50 states and is accepted by 90% of doctors and specialists.
Ambetter
  • Ambetter provides coverage to individuals who don’t qualify for traditional plans.
  • Very high market share.

Cons

Blue Cross Blue Shield
  • Blue Shields prices are slightly higher than the average.
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.

Blue Cross Blue Shield and Ambetter Mobile Apps Options

Each state has its own Blue Cross Blue Shield app on iTunes and GooglePlay. The app allows users to find doctors, hospitals, and pharmacies, view claims, pay bill, and manage prescriptions.

Blue Cross Blue Shield Mobile App
Blue Cross Blue Shield mobile app varies by State.
Ambetter Mobile App
Ambetter does not currently have a mobile app.

Blue Cross Blue Shield and Ambetter Enrollment Process

Blue Cross Blue Shield

Blue Cross Blue Shield is available through participating employers for group insurance. You can also buy an individual or family plan directly from Blue Cross Blue Shield, the health insurance marketplace or you can get several free quotes here.

You can also contact 888.630.2583 to learn more about Blue Cross Blue Shield options for individuals and families or find a local BCBS company by visiting here.

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/.

How to File a Claim with Blue Cross Blue Shield and Ambetter Insurance

Blue Cross Blue Shield

If you use a network doctor or hospital, your claims will be submitted by that provider. If you see an out-of-network provider, you need to submit the claim yourself. You must submit a completed claim form or alternative documentation via fax or mailing address. As an alternative to sending a claim form, supply a description of services, a bill of charges from the provider and any medical documents you received from your provider.

For medical and/or dental services in the U.S. Puerto Rico or the U.S Virgin Islands, Use these claim forms. For anywhere else or on a cruise ship outside the U.S. use the Blue Cross Blue Shield Global Core international claim forms. For prescriptions inside or outside the U.S. or U.S. territories: Use these claim forms.

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.

Common Questions About Ambetter and Blue Cross Blue Shield Insurance

Blue Cross Blue Shield

Is Blue Cross the same as Blue Shield?

Blue Cross and Blue Shield took their partnership a step farther, by consolidating staff and operations, forming the Blue Cross Blue Shield Association in 1982. The Blue Cross and Blue Shield Association (BCBSA) is a federation of 36 independent, community-based and locally operated Blue Cross and Blue Shield companies.

How does Blue Cross Blue Shield work?

Blue Cross Blue Shield (BCBS) offers employer-provided health insurance or group health insurance. BCBS also offers individual and family health plans.

What is the Blue365® program?

Blue365 is a free health and wellness discount program offered to members. It includes discounts on gym memberships, fitness gear, healthy eating options and more.

Does Blue Cross Blue Shield cover outside the US?

For people living or working abroad for an extended period of time, there are GeoBlue plans available through BCBS.

Ambetter

What states accept Ambetter health insurance?

Ambetter offers coverage for individuals in Arizona, Arkansas, Florida, Georgia, Illinois, Indiana, Kansas, Mississippi, Missouri, New Hampshire, Nevada, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas and Washington.

Is Ambetter good health insurance?

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.

How does Ambetter insurance work?

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.

Is Ambetter (Centene Corp) and WellCare the same company?

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.

Blue Cross Blue Shield and Ambetter Insurance Contact Info

Blue Cross Blue Shield Contact Info
Address225 North Michigan Ave, Chicago, IL 60601
Phone1 (888) 630 - 2583
Websitehttps://www.bcbs.com/
Facebookhttps://www.facebook.com/AnthemBlueCrossBlueShield/
Youtubehttps://www.youtube.com/user/bluecrossblueshield
Twitterhttps://twitter.com/BCBSAssociation
Linkedinhttps://www.linkedin.com/company/blue-cross-and-blue-shield-association/
Ambetter Contact Info
AddressAmbetter from Coordinated Care, 1145 Broadway, Suite 300, Tacoma, WA 98402
Phone1 (877) 687-1197
Websitehttps://www.ambetterhealth.com/
Facebookhttps://www.facebook.com/AmbetterHealthcare/
Youtubehttps://www.youtube.com/channel/UC1fien5XXb1voeybJcWr6kQ
Twitterhttps://twitter.com/Centene
Linkedinhttps://www.linkedin.com/company/centene-corporation/

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