Oscar vs. Ambetter Insurance

See how Oscar and Ambetter compare when it comes to availability, types of coverage, customer satisfaction and more.

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We rank Ambetter higher than Oscar because vision and dental benefits are important to thousands of consumers and this coverage is available with Ambetter, but not Oscar. Ambetter sells plans in more states and serves Medicaid members, as well. However, Oscar still has considerable merits with its higher overall customer satisfaction, employer group coverage and a better mobile presence, offering an easier user experience for policy and claim management.

Keep reading to get an in-depth look at how Oscar and Ambetter compare so you can make the best healthcare decision based on your needs.

Oscar vs. Ambetter: Quick Glance

Comparison

Oscar

Ambetter

Plan Structures

EPO, HMO, Medicare Advantage

HMO, PPO, EPO, FSA, HDHP, HSA, POS, Medicaid, Medicare Advantage

Availability

21 states

26 states

Coverage Limit

Varies

Varies

Deductible

Varies

Varies

Maximum Annual Benefit

Varies

Varies

Waiting Period

Varies

Varies

Providers In-Network

N/A

N/A

Covers Telehealth

Yes

Yes (available in 20 states)

Policy Management

Mobile app, online account, phone

Online account and phone

Oscar Pros and Cons

Pros

Cons

Overall better customer satisfaction

Does not disclose the number of their in-network providers

Robust mobile app for customers

Available in fewer states

>> Click here to read our full review of Oscar.

Ambetter Pros and Cons

Pros

Cons

Mental health coverage offered in all health plans

Does not disclose the number of their in-network providers

Coverage available in more states than Oscar

No mobile app function for healthcare account management

More coverage options and plan types than Oscar

 

>> Click here to read our full review of Ambetter.

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Oscar Vs Ambetter: Plan Structures

Ambetter outperforms Oscar in offering more coverage options for its customers. Oscar does not offer Medicaid, dental or vision benefits, which makes it a less ideal choice for low-income families or those who want or need additional coverage. However, Oscar does sell group health plans unlike Ambetter, which can be suitable for those who want health insurance through their employer.

Plan

Oscar

Ambetter

Individual & Family

✓ 

✓ 

Medicare Advantage*

Medicaid

X

Dental

X

Vision

X

Employer Group

✓ 

X

*Medicare Advantage is provided through Superior HealthPlan for Ambetter customers.

Oscar Vs Ambetter: Plan Availability

Ambetter takes the win for availability, offering coverage in 26 states compared to only 21 states for Oscar.

Oscar serves fewer states than Ambetter but also serves states that Ambetter does not. Specifically, consumers in Colorado, Iowa, Kansas, New York, Nebraska and Virginia can purchase health plans from Oscar but not from Ambetter.

  • Arizona
  • Arkansas
  • California
  • Colorado
  • Florida
  • Georgia
  • Iowa
  • Illinois
  • Kansas
  • Michigan
  • Missouri
  • New Jersey
  • New York
  • Nebraska
  • North Carolina
  • Ohio
  • Oklahoma
  • Pennsylvania
  • Tennessee
  • Texas
  • Virginia

Ambetter health plans are purchasable in five more states than Oscar. Similarly, Ambetter serves several states that Oscar does not, including Indiana, Kentucky, Louisiana and Mississippi.

  • 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

* Excludes telehealth coverage

Note for New York consumers: Those seeking Marketplace coverage in New York can do so through Fidelis Care, a fellow subsidiary under the parent company Centene.

Oscar Vs Ambetter: In-Network Providers

Neither Oscar nor Ambetter lists the number of providers they have in their network. However, the Ambetter app through Teladoc states customers can access over 3,100 board-certified healthcare professionals from around the country. These physicians are a mix of in-network providers as well as out-of-network providers.

Oscar Vs Ambetter: Cost

Oscar and Ambetter price each plan differently because several factors go into calculating your healthcare costs, including:

  • Age
  • Deductible
  • Health history
  • Health plan
  • Insurance company
  • State

Plan categories from both Oscar and Ambetter are available in bronze, silver and gold. These health plan tiers dictate the cost of your coverage, not the quality of your medical care:

  • Bronze tier: Lower monthly premium but higher out-of-pocket costs
  • Silver tier: Average monthly payments. Lower out-of-pocket costs compared to bronze but higher than gold
  • Gold tier: Higher monthly payments but lower out-of-pocket costs

Here’s an example of what a silver plan from Oscar would look like:

Cost

Oscar Health Classic Silver Plan

Monthly Premium

$385

Deductible

$4,400

Out-of-Pocket Maximum

$7,900

Primary Care Visit 

$50

Specialist Visits

$75

Urgent Care

$100

If you purchase a bronze plan, you will see a monthly premium lower than $385 but your deductibles and other out-of-pocket costs will be higher. Conversely, a gold plan would charge a premium higher than $385 but those out-of-pocket costs would go down.

Consumers can purchase Medicare Advantage (MA) plans through either Oscar or Ambetter. MA plans combine Medicare Part A (hospital insurance), Part B (medical insurance), and usually Part D (prescription drugs).

You still need to pay the premiums for Medicare parts A and B on top of your MA plan premium — however, Part A is usually free if you’ve paid Medicare taxes for at least 10 years. The 2022 average for Medicare Advantage is $19 per month.

Oscar Vs Ambetter: Coverage Limits

Coverage limits on your healthcare plan vary amongst health insurance companies and plans based on your budget, health concerns and coverage needs. Oscar and Ambetter are not allowed to set a dollar limit on what’s considered essential health benefits while you’re enrolled in a health insurance plan.

Essential health benefits include:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Laboratory services
  • Mental health and substance use disorder services
  • Pediatric services
  • Pregnancy, maternity, and newborn care
  • Prescription drugs
  • Preventive and wellness services/chronic disease management
  • Rehabilitative and habilitative services and devices

Oscar Vs Ambetter: Policy Management

Oscar and Ambetter members can access their health insurance plans through an online portal or by speaking with a representative over the phone. Using either method allows you to find an in-network provider, pay bills, track your spending and manage your claims.

Oscar members can access their health insurance plans through a mobile app called Oscar Health. With the mobile app, you can:

  • Search for symptoms, doctors, and drugs.
  • Use “Doctor on Call” to talk to a clinician for free.
  • Have doctors send prescriptions to your pharmacy, utilizing Oscar’s nationwide pharmacy network.
  • View your health information and Oscar plan info.
  • Message your Concierge team to help with billing questions, finding a doctor and more.
  • Access your digital ID card.

Ambetter does not have an app for policy management but they do offer Ambetter Virtual Access, a mobile app for Teladoc services that is specifically for telehealth appointments. Downloading this app gives consumers access to support and resources for general medical knowledge, primary care, therapy and psychiatry, nutrition and dermatology.

Based on consumer reviews for each company’s mobile app, consumers have a better experience using the Oscar mobile app than the Ambetter app.

Company

Google Play Store

Apple App Store

Oscar Health

3.6/5 stars

4.7/5 stars

Ambetter Virtual Access

1.5/5 stars

2.6/5 stars

Oscar Vs Ambetter: Medical Loss Ratio

The medical loss ratio (MLR) is the amount of premium revenue an insurance company generates versus how much of those premiums are used for clinical services and quality improvement.

Insurance companies are required to spend at least 80% (individual plans) or 85% (group plans) of premium dollars on improvements. If the MLR doesn’t hit 80% or 85%, the difference is refunded in the form of a rebate to policyholders.

Oscar’s MLR as of December 31, 2021 is 88.9%. Ambetter’s MLR is not available at this time. However, Ambetter’s parent company, Centene, issued $207 million in rebates for the 2020/2021 year.

Oscar Vs Ambetter: Enrollment Process

The open enrollment period for 2023 health coverage runs from November 1st, 2022 to  January 15th, 2023. Oscar policies and Ambetter policies can be purchased through your state’s health insurance marketplace. You can also purchase health insurance outside of the enrollment period for qualifying events, such as:

  • Becoming a U.S. citizen
  • Changing jobs
  • Getting married or divorced
  • Giving birth to a child or adopting a child
  • Household income falling below the federal poverty level
  • Losing health coverage (spouse or domestic partner loses their job or dies)
  • Changing residence

Oscar and Ambetter customers can purchase Medicare Advantage plans from January 1st to March 31st each year. Prescription drug coverage (Part D) and Medicare supplement (Medigap) are offered by each company, as well. To get Medicare Advantage, Part D or Medigap, you will need Original Medicare (Part A and B).

Open enrollment for Original Medicare starts October 15 to December 7 of each year. Those who will turn 65 soon can enroll from months before to three months after their 65th birthday.

Oscar and Ambetter both serve Medicaid members. Medicaid enrollment lasts year-round and eligibility is based on your age, income level, number of household members and if you have a pregnancy or disability. You can apply for Medicaid by enrolling through the health insurance marketplace or by contacting your state’s Medicaid department.

Oscar Vs Ambetter: Policyholder Experience

Oscar beats out Ambetter in customer satisfaction according to consumer reviews we read across three review platforms. However, consumers should note that both companies struggled with consumer ratings on their Better Business Bureau profiles.

Company

Oscar

Ambetter

Benzinga

3.5/5 stars

3.5/5 stars

BestCompany

3.2/5 stars 

1.4/5 stars

Better Business Bureau (BBB)

1.2/5 stars

1.12/5 stars

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How To File Claims With Oscar and Ambetter

In-network doctors and medical facilities file claims on your behalf when you get treatment. However, any medical treatment you receive from out-of-network will require you to file a claim for reimbursement yourself.

Oscar generally won’t cover claims from out-of-network providers unless it is an emergency. However, you may be able to get coverage if you have an HMO by calling 1-855-672-2755. Aside from emergencies, Oscar suggests that you contact them for assistance on finding an in-network provider so they can cover your medical costs.

Ambetter customers can submit claims either through the online member portal or by calling provider services at 1-877-644-4613. You can also mail in your request for reimbursement claim form to Ambetter Claims Processing P.O. Box 5010, Farmington, MO 63640-5010.

History of Oscar

In 2012, Oscar CEO Mario Schlosser and his wife were preparing to have a baby and saw how difficult it was to navigate through the healthcare system. Schlosser’s friend, Josh Kushner, had also had a similar frustration in treating an injury. They founded Oscar Health, hoping to help consumers feel less powerless in managing their health. What makes Oscar different is the Concierge Team that guides members and handles customer service questions and coordination of clinical care.

History of Ambetter

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.

Oscar Vs Ambetter FAQs

Is Oscar a PPO?

Most plans from Oscar are either an EPO or HMO, which typically exclude coverage for out-of-network services.

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

Ambetter and WellCare are owned by Centene Corporation. Together, both companies are among the largest providers of Medicaid and Medicare.

Who owns Oscar?

Mario Schlosser is the owner and CEO of Oscar.

Key Takeaways

  • Ambetter has more coverage options than Oscar.
  • Oscar has higher customer satisfaction and a higher-rated mobile app.
  • Oscar has more limited availability than Ambetter.
  • Ambetter offers more ways for customers to file claims.

To help find the best health insurance plan, use SmartFinancial to make sure you’re getting the plan you want for the price you want. Enter your zip code below or call 855.214.2291 to receive your free health insurance quotes.

Sources

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