Ambetter: Company Overview

Ambetter provides coverage to individuals who don’t qualify for traditional plans and is available in 15 states.

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About Ambetter

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.

Centene offers health insurance via Ambetter in 15 states: Arizona (Ambetter from Arizona Complete Health), Arkansas (Ambetter from AR Health & Wellness) Florida (Ambetter from Sunshine Health), Georgia (Ambetter from Peach State), Illinois (Ambetter from IlliniCare Health), Indiana (Ambetter from MHS), Kansas (Ambetter from Sunflower Health), Mississippi (Ambetter from Magnolia), Missouri (Ambetter from Home State), New Hampshire (Ambetter from NH Healthy Families), Nevada (Ambetter from Silver Summit), North Carolina (Ambetter of North Carolina Inc.), Ohio (Ambetter from Buckeye Health Plan), Pennsylvania (Ambetter from PA Health & Wellness), South Carolina (Ambetter from Absolute Total Care), Tennessee (Ambetter of Tennessee), Texas (Ambetter from Superior) and Washington (Ambetter from Coordinated Care).

Ambetter offers prescription drug coverage, mental and behavioral health services, maternity care, newborn care, 24/7 nurse advice line, optional vision and dental coverages, ambulatory services, lab services and more.

Ambetter Facts & Ratings

Year Founded 1984
Market Share Percentage 20%
Financial Strength Excellent
BBB Rating A+
A.M. Best Rating bb
NAIC Complaint Index 1.12% for individual health insurance

Ambetter Mobile App Rating

Ambetter does not currently have a mobile app.

Pros & Cons of Ambetter

  • Ambetter provides coverage to individuals who don’t qualify for traditional plans.
  • Very high market share.
  • 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.

Ambetter Enrollment Process

Aetna is available through the health insurance marketplace or you can get several free quotes here. Each state has their own marketplace. If you’re not sure where to begin, visit https://www.healthcare.gov/.

How to file a claim with 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

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.

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.

What is Ambetter My Health Pays® Rewards Program?

You can earn $500 in rewards with My Health Pays, just for doing health-related activities like moving more, saving and eating right and more. The more activities you participate in, the more rewards you earn.

Does Ambetter cover out of state?

Unless it’s an emergency Ambetter will only cover in-network providers so it’s highly likely that a doctor in another state will not be covered. If you have a hospital emergency you may be covered. It’s always best to check by speaking with an agent beforehand if you can.

How do I find my Ambetter member ID?

AYour member ID # is on the front of your insurance card.

Does Ambetter cover surgery?

Ambetter covers necessary surgery but not cosmetic surgery or other elective types of surgery and procedures, including infertility treatment.

Who underwrites Ambetter insurance?

Several different subsidiaries of Centene Corporation underwrite Ambetter Insurance. For instance, Ambetter of Tennessee is underwritten by Celtic Insurance Company.

Does Ambetter cover mammograms?

Yes, preventive services like mammograms are covered by Ambetter for women age 50 to 54 once a year and women age 55 and over only need a mammogram every 2 years. For women age 50 to 69 mammography is recommended. Women below the age of 50, who have complications are covered if abnormalities are detected.

How to cancel Ambetter insurance?

You should call or write your insurance to cancel your Ambetter insurance. You can find the contact number and address on your ID card.

Is Ambetter insurance part of Medicaid?

Ambetter offers an alternative to Medicaid. It’s an option for people who no longer qualify for Medicaid. Ambetter is owned by Centene, which serves Medicaid and Medicare members.

Does Ambetter cover pregnancy?

Yes, Ambetter has a program for women who are pregnant called “Start Smart for Your Baby.”

What is Ambetter Superior HealthPlan?

Ambetter from Superior HealthPlan is a qualified health plan issuer in the Texas Insurance Marketplace.

Ambetter Contact Info

Address Ambetter from Coordinated Care, 1145 Broadway, Suite 300, Tacoma, WA 98402
Phone 1 (877) 687-1197
Website https://www.ambetterhealth.com/
Facebook https://www.facebook.com/AmbetterHealthcare/
Youtube https://www.youtube.com/channel/UC1fien5XXb1voeybJcWr6kQ
Twitter https://twitter.com/Centene
Linkedin https://www.linkedin.com/company/centene-corporation/

Methodology

The information listed on this page is from our own in house research. It is accurate as of the article publish date. Visit the carrier website for additional information.

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