Blue Cross Blue Shield vs. Ambetter Insurance

Learn how Blue Cross Blue Shield and Ambetter measure up when it comes to nationwide availability, network size, plan options and more.

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In a Blue Cross Blue Shield (BCBS) versus Ambetter comparison, we’ve determined BCBS as the superior option for its availability, wider selection of health care plans and mobile app availability. While Ambetter is still a good choice, due to its limited availability, lack of a mobile app and limited health plan types we ranked it below BCBS, which also boasts the highest customer satisfaction in several regions.

Keep reading to learn how BCBS and Ambetter compare in plan availability, network size, health insurance coverage options and more.

Blue Cross Blue Shield vs. Ambetter: A Quick Glance

 

BCBS

Ambetter

Plan Structures

HMO, PPO, CDHP, EPO, FSA, HMO-POS, Indemnity, HSA, Medicaid, Medicare, POS

PPO, HMO, HSA, POS, EPO

Availability

50 states

26 states

Coverage Limit

Varies

Varies

Deductible

Varies

Varies

Maximum Annual Benefit

Varies

Varies

Waiting Period

Varies

Varies

Providers In-Network

1.7 million

N/A

Covers Telehealth

Yes

Yes

Policy Management

Mobile app, online account, phone

Mobile app (teladoc only), online account, phone 

Blue Cross Blue Shield Pros and Cons

Pros

Cons

Available in 50 states and accepted by 90% of doctors and specialists

Medicare Advantage plans not available in all states

Superior financial strength rating

 

Rated highest in customer satisfaction with commercial health plans in several regions

 

>> Read our full Blue Cross Blue Shield review.

Ambetter Pros and Cons

Pros

Cons

24-hour nurse line via mobile app

No mobile app for policy management (teladoc only)

Standalone dental and vision plans available

Does not sell commercial health plans

>> Click to read our full Ambetter review.

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Blue Cross Blue Shield Vs Ambetter: Plan Structures

BCBS comes out on top when it comes to available health insurance plan structures. Consumers can purchase individual and family plans, standalone vision and dental insurance plans and Medicare Advantage (MA) plans through BCBS.

Ambetter’s selection of health plan structures is limited, offering only individual and family plans plus dental and vision benefits. However, its parent company, Centene corporation, sells all types of health plans, such as MA plans through Wellcare.

Plan

Blue Cross Blue Shield

Ambetter

Individual & Family

Medicare Advantage

X*

Dental

Vision

Small Business

X

* MA plans are sold under the Wellcare brand, which is also under the Centene umbrella

Blue Cross Blue Shield Vs Ambetter: Plan Availability

When it comes to availability, BCBS wins. BCBS individual and family health insurance plans are available in all 50 states, while Ambetter plans are only available in the following 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

Keep in mind that availability can vary based on the type of health insurance plan. For example, BCBS does not sell MA plans in Alaska, Mississippi or Wyoming.

Standalone vision and dental plans for adults by Ambetter are not sold in Washington, New Mexico and New Jersey. Ambetter does not sell Medicare plans, but these plans are available through Wellcare, a subsidiary under a shared parent company, Centene.

Blue Cross Blue Shield Vs Ambetter: In-Network Providers

BCBS claims to have the largest health insurance provider network with more than 1.7 million contracted doctors and hospitals nationwide. More than 90% of doctors and specialists in all 50 states accept BCBS coverage.

Ambetter does not disclose how many providers are within their network but it is likely smaller because they only serve 26 states. However, Ambetter does highlight a teladoc network of over 3,100 licensed healthcare professionals with an average of 20 years experience.

Blue Cross Blue Shield Vs Ambetter: Cost

Health insurance companies use the following factors to calculate your monthly premium and out-of-pocket costs:

  • Age
  • Health habits (e.g., smoking, drinking)
  • State
  • Deductible
  • Plan category (see next section)
  • Location

Generally, younger people who are healthy and don’t have smoking or drinking habits enjoy relatively affordable health insurance plans. Older people, who have a higher likelihood of illnesses, will likely pay more for health insurance.

Blue Cross Blue Shield vs. Ambetter: Coverage Limits

Coverage limits can vary significantly between plans because different people have different budgets and health concerns. Both BCBS and Ambetter health insurance plans come in bronze, silver and gold categories, allowing consumers to choose which plan works best for them. The plan category determines your costs and does not reflect the quality of care.

  • Bronze: Plan with a low monthly premium but higher out-of-pocket costs (e.g., deductible, copay, coinsurance).
  • Silver: Plan with average monthly payments. Out-of-pocket costs are lower than a bronze plan but higher than a gold plan.
  • Gold: Plan with high monthly payments but lower out-of-pocket costs.

Blue Cross Blue Shield Vs Ambetter: Policy Management

BCBS and Ambetter members can manage their policy by phone or by logging into the online member portal, where they can access their virtual ID card, manage their monthly premiums, find an in-network provider, review their claim status and more.

BCBS’s mobile app is specific to your state. Ambetter does not have a mobile app for policy management on either the Google Play store or Apple App Store. However, there is an app solely for teladoc appointments but it is available only in Michigan, Mississippi, South Carolina and Texas.

Blue Cross Vs Ambetter: Medical Loss Ratio

The 2010 Affordable Care Act enforces the medical loss ratio (MRL), which requires large health insurance companies to spend at least 80% of premium dollars on medical improvements. When a company’s MLR is below 80% during that year, the difference will be refunded to the customers.

In 2022, BCBS is expected to issue MLR rebates in several states, including Texas, Massachusetts, North Carolina and Minnesota. Centene, Ambetter’s parent company, has issued rebates of $207 million for the 12-month period ending December 31, 2021.

Blue Cross Blue Shield Vs Ambetter: Enrollment Process

Consumers can purchase a health plan from BCBS or Ambetter during the ACA open enrollment period, which runs from November 1, 2022 to January 15, 2023 in most states.

Consumers may only purchase a health plan outside the open enrollment period if they have a qualifying event, such as:

  • Change in marital status
  • Having or adopting a child
  • Moving to a new address
  • Losing health coverage
  • Change in employment status
  • Death of someone who shares your health plan
  • Household income falls below the federal poverty level
  • Becoming a U.S. citizen

Blue Cross Blue Shield Vs Ambetter: Policyholder Experience

Blue Cross companies ranked highest for customer satisfaction with commercial member health plans in nine of the 22 geographic regions analyzed. In this 2022 U.S. Commercial Member Health Plan Study, J.D. Power ranked the best health insurance companies based on billing, payment, cost, coverage, member benefits, customer service, information and communication as well as provider choice.

Ambetter was not ranked because the company does not sell commercial health plans. In a member survey by Superior Healthplan, Ambetter consumers rated Ambetter based on access to care, plan administration, healthcare quality and other factors. Ambetter’s average score was 76%, which is above average.

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How To File Claims With Blue Cross Blue Shield and Ambetter

Whether you’re a BCBS or Ambetter customer, your insurer will typically submit a claim without any action needed on your part. If there’s a reason you need to be reimbursed for an expense you paid yourself, ask your provider for a claim reimbursement form. The form will have instructions on what information is needed and how to submit the claim.

Talk to your health insurance company about what costs you can expect if you see a provider outside your network. In many cases, you will be responsible for the full cost of using an out-of-network provider unless it’s an emergency.

Blue Cross Blue Shield History

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 led to enrollment by employees in other professions across Dallas.

Today, BCBS is a collection of 34 independent and locally operated companies operating across all 50 states and is considered among the largest health insurance companies in the U.S. BCBS health plans are available in all 50 states and BCBS is among the largest health insurance companies in the U.S.

Ambetter History

Ambetter is a health insurance company owned by Centene Corporation, a multi-national 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.

Today, Ambetter serves over two million consumers. While Ambetter is not available nationwide, this health insurance company is steadily increasing its accessibility to more consumers across the U.S.

FAQs

Is Ambetter a high-deductible health plan?

Ambetter health insurance does include bronze plans, which typically carry lower monthly premiums and higher deductibles. Silver and Gold plans that charge higher premiums and lower deductibles are available, as well.

Is Florida Blue the same as Blue Cross?

Florida Blue is a member of the larger Blue Cross Blue Shield Association, which is a collection of 34 independent and locally operated Blue Cross Blue Shield companies.

Is Blue Shield the same as BCBS?

Both Blue Shield and Blue Cross are companies that deliver health insurance companies to local communities nationwide. The Blue Cross Blue Shield Association is a collection of independent Blue Cross and Blue Shield companies.

Key Takeaways

  • Blue Cross Blue Shield (BCBS) offers a wider selection of health plans, including individual and family plans, Medicare Advantage plans, commercial health plans and dental and vision benefits.
  • BCBS sells individual health insurance plans in 50 states, while Ambetter health insurance plans are available in only 26 states.
  • Outside qualifying events, the next time consumers can enroll in a BCBS or Ambetter health plan is during open enrollment (November 1, 2022 to January 15, 2023).

Looking for an individual or family health plan in your area? Just enter your zip code below or call 855.214.2291 and we’ll match you with a health insurance plan with essential health benefits that match your coverage needs and budget.

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