HCSC vs. Ambetter Insurance

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

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HCSC vs. Ambetter: What You Need to Know

Today HCSC serves over 15 million members with a variety of group and individual health care plans, services, and life insurance products. As a pioneer in many states, HSBC was the first to do many things. In Illinois, HCSC was the first to provide coverage for bone marrow transplants, heart transplants and to provide group health insurance to rural and small communities as well as the first CareVan as a mobile immunization program. In Texas, they were the first to provide coverage for cancer treatment, catastrophic diseases like polio, leukemia and diptheria, and they provided healthcare starting at birth. They also provided coverage to migrant farmworkers in Texas. In New Mexico, HCSC was the first to offer PPO coverage, point-of-service coverage, electronics claims exchange with providers, customer service for large group accounts, and in-hospital medical coverage on a per-visit basis. In Oklahoma, HCSC was the first to create a mobile health screening unit and free screenings for vision, hearing, glaucoma, blood, and blood pressure.

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.

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

What is HCSC and Ambetter Insurance Rating?

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

ComparisonHCSCAmbetter
Year Founded19291984
Medicare Star Rating3 stars (out of 5)
BBB RatingA+A+
NAIC Complaint Index0.40% for individual health1.12% for individual health insurance
Market Share Percentage20%
Financial StrengthExcellent
A.M. Best Ratingbb

Pros & Cons of HCSC or Ambetter

Pros

HCSC
  • Affordable marketplace plans with different tiers of coverage.
Ambetter
  • Ambetter provides coverage to individuals who don’t qualify for traditional plans.
  • Very high market share.

Cons

HCSC
  • HCSC only operates in 5 states: Illinois, Montana, New Mexico, Oklahoma, and Texas.
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.

HCSC and Ambetter Mobile Apps Options

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

HCSC Mobile App
HCSC mobile app varies by State.
Ambetter Mobile App
Ambetter does not currently have a mobile app.

HCSC and Ambetter Enrollment Process

HCSC

HCSC offers plans through the health insurance marketplace. You can begin searching plans here or you can get several free health insurance quotes.

Each state has its own marketplace. If you’re not sure where to begin, visit Healthcare.gov. Remember that HCSC only operates in 5 states: Illinois, Montana, New Mexico, Oklahoma, and Texas.

Ambetter

Ambetter is available through the health insurance marketplace or you can get several free quotes. 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 HCSC and Ambetter Insurance

HCSC

To submit electronic claims, you or your billing agent need to use a third-party claims clearinghouse vendor, like Availity. For paper claims, you need to complete the right 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 HCSC Insurance

HCSC

Is HCSC a good health insurance company?

HCSC is one of the oldest health insurance companies. They invented the prepaid hospital care plan. Today, they are one of the largest companies. They have a relatively low complaint ratio, which means that members are probably satisfied with claims processes and service.

Is HCSC and Blue Cross Blue Shield the same?

BCBS stands for Blue Cross Blue Shield, which is a federation of 36 separate health insurance companies. It was formed in 1982. Blue Cross (hospital services) and Blue Shield (physician services) operated separately until 1975 when they became one as Health Care Service (HCSC) Corporation. HCSC is an independent licensee of the Blue Cross and Blue Shield Association.

What is the difference between HCSC and BCBS?

BCBS stands for Blue Cross Blue Shield, which is a federation of 36 separate health insurance companies. It was formed in 1982. Blue Cross (hospital services) and Blue Shield (physician services) operated separately until 1975 when they became one as Health Care Service (HCSC) Corporation. HCSC is an independent licensee of the Blue Cross and Blue Shield Association.

What are some HCSC subsidiaries?

Dearborn Group, Dental Network of America, Inc (DNoA), Medecision, Inc., Availity, LLC, Prime Therapeutics, LLC, and TriWest Healthcare Alliance.

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.

HCSC and Ambetter Insurance Contact Info

HCSC Contact Info
Address300 E. Randolph St. Chicago, IL 60601
Phone1 (800) 654-7385
Websitehttps://www.hcsc.com/
Facebookhttps://www.facebook.com/healthcareservicecorporation/
Youtubehttps://www.youtube.com/user/HealthCareService
Twitterhttps://twitter.com/HCSC
Linkedinhttps://www.linkedin.com/company/blue-cross-and-blue-shield-of-illinois-new-mexico-oklahoma-&-texas/life/4548c167-e254-4ffd-a356-7892967212c3/
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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