UnitedHealthcare vs. Ambetter Insurance

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

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UnitedHealthcare vs. Ambetter: What You Need to Know

UnitedHealth Group was founded in 1977 by Richard Burke and went public in 1984. It was Dr. Paul Ellwood, who coined the term “health maintenance organization,” and who helped Burke start-up UnitedHealth. In 1979, the company created the first network senior health plan.

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 UnitedHealthcare Overview and Ambetter Overview.

What is UnitedHealthcare and Ambetter Insurance Rating?

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

ComparisonUnitedHealthcareAmbetter
Year Founded19771984
Medicare Star Rating4.5 stars (out of 5)
BBB RatingA+A+
NAIC Complaint Index1.12% for individual health insurance
Market Share Percentage0.2
Financial StrengthExcellent
A.M. Best Ratingbb

Pros & Cons of UnitedHealthcare or Ambetter

Pros

UnitedHealthcare
  • Robust health plans and benefits for Medicare and Medicaid recipients.
  • Marketplace plans for individuals and families that do not qualify for Medicaid or Medicare.
  • Popular mobile app makes it easy to stay on top of your account.
  • UnitedHealth is available in all 50 states.
Ambetter
  • Ambetter provides coverage to individuals who don’t qualify for traditional plans.
  • Very high market share.

Cons

UnitedHealthcare
  • Plans are in general more expensive than those of other health insurance providers.
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.

UnitedHealthcare and Ambetter Mobile Apps Options

The Health4Me app from UnitedHealthcare allows you to look for doctors and review your coverage and benefits.

UnitedHealthcare Mobile App
iOS     4.510.1K users
Android     4.616,316 users
Ambetter Mobile App
Ambetter does not currently have a mobile app.

UnitedHealthcare and Ambetter Enrollment Process

UnitedHealthcare

UnitedHealth Group offers plans through the health insurance marketplace. You can begin searching for plans with SmartFinancial's Healthcare Insurance page.

Each state has its own marketplace. If you’re not sure where to begin, visit https://www.healthcare.gov/.

Ambetter

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

UnitedHealthcare

UnitedHealth Group pays network providers directly but if you are billed by a provider, you can contact UnitedHealth Group at 1 (800) 328-5979. If you are filing a claim for an out-of-network provider for an emergency or because you were referred to the provider by UnitedHealth Group you must submit the following information

  • The Policyholder's name and address.
  • The patient's name and age.
  • The number stated on your ID card.
  • The name and address of the provider of the service(s).
  • The name and address of any ordering Physician.
  • A diagnosis from the Physician.
  • An itemized bill from your provider that includes the Current Procedural Terminology (CPT) codes or a description of each charge.
  • The date the Injury or Sickness began.
  • A statement indicating either that you are, or you are not, enrolled for coverage under any other health insurance plan or program. If you are enrolled for other coverage you must include the name of the other carrier(s).

The above information should be sent to: UnitedHealthcare P.O. Box 740800 Atlanta, GA 30374-0800

If filing a claim for Outpatient Prescription Drug Benefits, your claims should be submitted to: Optum Rx P.O. Box 29077 Hot Springs, AR 71903

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 UnitedHealthcare Insurance

UnitedHealthcare

What Are UnitedHealth Medicare Advantage plans?

Medicare Advantage is Medicare Part C, which replaces original Medicare Parts A and B and is administered through a private insurer. Medicare Advantage plans offer some benefits that Original Medicare does not. UnitedHealth also offers special Medicare Advantage plans for patients with Alzheimer’s or chronic dementia.

Is UnitedHealth the same as UnitedHealthcare insurance?

Yes, in 1998, the company rebranded and changed the name UnitedHealthcare insurance to the UnitedHealth Group.

What is UnitedHealth insurance coverage for Individuals and Families?

If you don’t have health insurance through an employer, you can buy private insurance for yourself and/or your family with UnitedHealth insurance. For health insurance rates visit here and fill out a brief form.

What are the UnitedHealth Group benefit plans?

UnitedHealth Group benefit plans are offered by employers. To see if your company offers a plan through UnitedHealth, speak to someone in your human resources department.

Check out our full list of common questions about UnitedHealthcare.

Ambetter

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.

Does Ambetter require pre-authorization for services?

Out-of-network services and providers require prior authorization unless it’s an emergency service. You need a referral from a Primary Care Physician to see a specialist unless you’re seeing certain in-network doctors like an obstetrician, gynecologist or psychiatrist.

Check out our full list of common questions about Ambetter.

UnitedHealthcare and Ambetter Insurance Contact Info

UnitedHealthcare Contact Info
AddressP.O. Box 1459, Minneapolis, MN 55440-1459
Phone1 (800) 328-5979
Websitehttps://www.unitedhealthgroup.com/
Facebookhttps://www.facebook.com/groups/uhgemployees/
Youtubehttps://www.youtube.com/user/UnitedHealthGroup
Twitterhttps://twitter.com/UnitedHealthGrp
Linkedinhttps://www.linkedin.com/company/unitedhealth-group/
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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