Blue Cross Blue Shield vs. Ambetter Insurance

Blue Cross Blue Shield beats out Ambetter on most relevant metrics including the diversity of its health insurance products, the number of states it operates in, the size of its network and the quality of its customer care according to customer satisfaction surveys. Nevertheless, Ambetter’s dedicated telehealth app and specialized experience in providing Marketplace coverage may make it an appealing option for shoppers in certain states.

To see more Blue Cross Blue Shield vs. Ambetter similarities and differences, you can read the rest of our health insurance company comparison article below.

Blue Cross Blue Shield History

Blue Cross started out at Baylor University’s hospital in 1929, where hospital administrators aimed to help Dallas public school teachers who were struggling to afford health care by establishing a prepayment plan through which they could pay 50 cents per month to secure coverage for up to 21 days of hospitalization per year. Not long after, Blue Shield began to take root as employers of miners and loggers in the Pacific Northwest made arrangements for their employees to receive care from specific medical practitioners for a monthly premium.^[1]

In the 1940s, Blue Cross and Blue Shield began to set up agreements with each other, enabling them to provide more comprehensive major medical coverage for their respective plan members. The two companies formally merged to form the Blue Cross Blue Shield Association in 1982.^[1] As of 2024, the BCBSA includes 33 subsidiary companies.^[2]

Click to read our full Blue Cross Blue Shield review.

Ambetter History

Ambetter was founded in 2014 with a specialized focus on selling Marketplace health insurance plans.^[3] Its parent company is Centene Corporation, which started out as a nonprofit Medicaid plan in 1984 and later acquired the Medicare-focused company Wellcare in 2020 to complement its existing slate of insurance products.^[4][5]

Click here to read our full Ambetter review.

Blue Cross Blue Shield vs. Ambetter: A Quick Glance

Blue Cross Blue Shield Pros and Cons

Ambetter Pros and Cons

Blue Cross Blue Shield vs. Ambetter: Plan Structures

Blue Cross Blue Shield offers a wider range of health insurance plan structures than Ambetter, ranging from Marketplace plans to government-sponsored programs to employer-sponsored coverage. In contrast, Ambetter only sells Marketplace and supplemental health insurance plans directly to individuals and families.

Blue Cross Blue Shield vs. Ambetter: Plan Availability

The Blue Cross Blue Shield Association provides coverage to a much larger number of Americans than Ambetter, as there are BCBS companies operating in all 50 states, the District of Columbia and Puerto Rico.^[2] Conversely, Ambetter only sells health insurance in the following 29 states:^[6]

Blue Cross Blue Shield vs. Ambetter: In-Network Providers

Blue Cross Blue Shield also wins regarding the number of medical providers it contracts with, as it boasts the largest network in the United States with more than 1.7 million doctors and hospitals.^[2] Meanwhile, the size of Ambetter’s network is undisclosed and Centene Corporation was sued in 2018 for presenting prospective Ambetter policyholders with misleading information about the size of its network.^[7]

Blue Cross Blue Shield vs. Ambetter: Cost

Health insurance prices can vary significantly depending on your circumstances, so it’s best to receive a quote from either Blue Cross Blue Shield or Ambetter rather than relying on an average rate to determine which insurer would be cheaper for you. For general guidance that applies to all insurers, remember that the average monthly premium for a Marketplace benchmark health plan is $477.^[8]

In addition, you should note that health insurance companies that comply with the Affordable Care Act (ACA) can only consider the following five factors when determining your health insurance premiums:^[9]

• Age
• Location
• Tobacco use
• Whether you have an individual or family plan
• Plan tier

Blue Cross Blue Shield vs. Ambetter: Coverage Limits

Likewise, coverage limits can be dramatically different depending on the details of your specific plan regardless of which company you choose. That said, you should keep in mind that Blue Cross Blue Shield and Ambetter cannot impose coverage limits on any of the following health care services:^[10][11]

• Ambulatory patient services
• Emergency services
• Hospitalization
• Pregnancy, maternity and newborn care
• Mental health and substance use disorder services
• Prescription drugs
• Rehabilitative and habilitative services and devices
• Laboratory services
• Preventive and wellness services and chronic disease management
• Pediatric services (including dental and vision care for children)

Blue Cross Blue Shield vs. Ambetter: Policy Management

Blue Cross Blue Shield and Ambetter both allow plan members to manage their policies over the phone or through an online account or mobile app. Keep in mind that Blue Cross Blue Shield has numerous apps for its various subsidiaries, so the app you select and the user experience you encounter will depend on the state you live in.

Meanwhile, you should note that the Ambetter Health app launched in June 2024, so it has not yet received a significant number of reviews online. Additionally, Ambetter offers the Wellframe app, which policyholders can use to access telehealth services.

Blue Cross Blue Shield vs. Ambetter: Medical Loss Ratio

The ACA requires health insurance companies to meet minimum medical loss ratio (MLR) standards, meaning they must put a certain percentage of their premium revenue toward covering care for their policyholders. Insurers who don’t meet the federal standards in a given market must issue rebates to their plan members in that market.^[20]

Health insurance carriers that sell individual or small group health insurance have to maintain an 80% MLR on a three-year rolling average basis, while carriers that sell large group health insurance must maintain an 85% MLR.^[20]

Since the Blue Cross Blue Shield Association consists of numerous independent companies, your eligibility for rebates will depend on which company covers you. For example, BlueCross BlueShield of South Carolina issued MLR rebates in 2022, while Blue Cross Blue Shield of Massachusetts issued rebates in 2023.^[21][22] Meanwhile, Ambetter has not announced any rebates for 2024 and its parent company, Centene Corporation, reported a three-year rolling average MLR of 87.73% at the end of 2023.^[23][24]

Blue Cross Blue Shield vs. Ambetter: Enrollment Process

You can generally enroll in a Marketplace health plan from either Blue Cross Blue Shield or Ambetter during open enrollment from November 1 to January 15 each year.^[25] Conversely, Medicare members looking for Medicare Advantage coverage through BCBS can sign up during the following Medicare open enrollment periods:^[26]

In addition, you can sign up for health insurance at any time if you become eligible for a special enrollment period due to a qualifying life event like one of the following:^[27]

• Getting married, divorced or separated
• Giving birth to or adopting a child
• Changing or losing your job
• Moving to a new home
• Losing your existing health coverage due to the death of a family member
• Aging out of your parents’ health plan by turning 26
• Becoming a United States citizen
• Leaving prison

Blue Cross Blue Shield vs. Ambetter: Policyholder Experience

Though not outstanding, Blue Cross Blue Shield’s ratings on online review platforms are generally better than Ambetter’s. In addition, Blue Cross Blue Shield companies were ranked as the best health insurers in eight regions — Colorado, Delaware/West Virginia/D.C., Heartland, Illinois/Indiana, Michigan, New Jersey, Northeast and Southwest — in J.D. Power’s 2024 customer satisfaction survey.^[28]

^{*rating applies to Centene Corporation as a whole}

How To File Claims With Blue Cross Blue Shield and Ambetter

Regardless of which insurer you opt for, an in-network provider will likely file an insurance claim with that company on your behalf whenever you receive medical care. However, out-of-network providers may not file claims for you, meaning you will likely have to file your own claim to be reimbursed for out-of-network care, assuming your plan covers out-of-network care at all. In this case, you will generally need to fill out and send in a claim form to the branch of Blue Cross Blue Shield or Ambetter that operates in your state.^[33][34]