A Comprehensive Review of Ambetter Health Insurance for 2024: Is It Worth It?

Health insurance is one of the most important decisions you can make for yourself and your family. It can protect you from unexpected medical bills, provide access to quality care, and help you stay healthy. But with so many options available, how do you choose the best one for your needs?

One of the health insurance companies that you may have heard of is Ambetter. Ambetter is a brand name for a network of health plans offered by Centene Corporation, a Fortune 500 company that specializes in managed care. Ambetter offers affordable and comprehensive health insurance plans in 20 states, covering more than 2 million members.

But is Ambetter worth it? How does it compare to other health insurance companies? What are the benefits and drawbacks of choosing Ambetter? In this article, we will answer these questions and more, based on our research and analysis of Ambetter’s plans, prices, customer reviews, and ratings. We will also give you some tips on how to find the best Ambetter plan for your situation.

What is Ambetter Health Insurance?

Ambetter is a type of health insurance that is sold through the Health Insurance Marketplace, also known as Obamacare or the Affordable Care Act (ACA). The Marketplace is a platform where you can shop for and compare different health insurance plans that meet the minimum standards set by the federal government. You can also apply for financial assistance to lower your monthly premiums and out-of-pocket costs, depending on your income and household size.

Ambetter offers three types of plans: Bronze, Silver, and Gold. Each plan has different levels of coverage, deductibles, copays, coinsurance, and out-of-pocket maximums. Generally, Bronze plans have the lowest premiums but the highest deductibles and copays, while Gold plans have the highest premiums but the lowest deductibles and copays. Silver plans are somewhere in between.

All Ambetter plans include the following essential health benefits:

• Preventive care services, such as screenings, immunizations, and wellness visits
• Emergency services
• Hospitalization
• Maternity and newborn care
• Mental health and substance abuse services
• Prescription drugs
• Rehabilitative and habilitative services and devices
• Laboratory services
• Chronic disease management
• Pediatric services, including dental and vision care

In addition to these benefits, some Ambetter plans also offer extra perks, such as:

• Telehealth services, which allow you to consult with a doctor online or by phone 24/7
• Rewards program, which gives you points for completing healthy activities that you can redeem for gift cards
• My Health Pays Visa Prepaid Card, which lets you use your rewards points to pay for qualified medical expenses
• Optional dental and vision coverage for adults
• Optional supplemental coverage for accidental injuries or critical illnesses

How Much Does Ambetter Health Insurance Cost?

The cost of Ambetter health insurance depends on several factors, such as:

• The type of plan you choose (Bronze, Silver, or Gold)
• The state and county where you live
• Your age and tobacco use
• Your income and household size (if you qualify for financial assistance)

To give you an idea of how much Ambetter health insurance costs, we looked at some estimates from [https://www.healthcare.gov/see-plans/] for the state of Florida. Here are the monthly premiums for each plan type:

Ambetter Health Insurance Plan Breakdown

Below we broke down the cost of the Standard Expanded Bronze VALUE health plan:

Plan Information

• Plan Name: Ambetter from Sunshine Health
• Metal Level: Bronze (This indicates the level of coverage. Bronze plans typically have lower premiums but higher out-of-pocket costs.)
• Plan Type: HMO (Health Maintenance Organization – usually requires members to choose a primary care physician and get referrals to see specialists.)
• Plan ID: 86382FL0050017
• Rating: New plan – Not rated (Plan ratings are sometimes available to give an idea of quality, but this is a new plan without a rating yet.)

Costs

• Premium: $371.79/month (The amount you pay monthly for the insurance plan.)
• Deductible: $7,500 (The amount you pay out of pocket for covered health care services before your insurance plan starts to pay.)
• Out-of-pocket Maximum: $9,400 (The most you have to pay for covered services in a plan year. After you spend this amount on deductibles, copayments, and coinsurance, your health plan pays 100% of the costs of covered benefits.)

Co-payments

• Primary Care: $50 per visit from day 1 (The fixed amount you pay for covered health care services from providers in your plan’s network.)
• Specialist Care: $100 per visit from day 1
• Urgent Care: $75 per visit from day 1
• Emergency Room: 50% coinsurance after deductible (You pay a percentage of the total cost for covered health care services, typically after your deductible has been met.)
• Outpatient Mental Health: $50 per visit from day 1
• Generic Drugs: $25 (The amount you pay for generic prescription drugs.)

Additional Information

• Rating: New plan – Not rated (This plan is new, so it doesn’t have a rating yet. Ratings can indicate the quality of a plan.)
• View Plan Details: For a full list of benefits, limits, and exclusions, you would need to review the plan details.

Summary

This Ambetter Bronze plan is an HMO with a monthly premium of $371.79. It has a deductible of $7,500, meaning you will pay this amount out of pocket before your insurance covers certain services. There’s an out-of-pocket maximum of $9,400, limiting the total amount you’ll pay for covered services in a year. The plan has co-payments for various services, and you can refer to the plan details for a comprehensive understanding of benefits, limits, and exclusions.

How Good is Ambetter Health Insurance?

The quality of Ambetter health insurance can vary depending on the state and plan you choose. To help you evaluate how good Ambetter is, we looked at some of the following criteria:

• Customer reviews
• Customer service
• Provider network
• Accreditation

Customer Reviews

One way to gauge how good Ambetter is is to look at what their customers have to say about them. We browsed through several online platforms where people can share their experiences with different health insurance companies, such as Trustpilot, Consumer Affairs, and Yelp.

Based on our observation, Ambetter has a mixed reputation among its customers. Some people praised Ambetter for its low prices, easy enrollment process, and generous rewards program. Others complained about Ambetter’s poor customer service, limited provider network, and denied claims.

Here are some examples of positive and negative reviews we found:

Positive:

“This is the best insurance ever it had saved mylife I went so long without insurance. They keep you informed my payment only 59 cents month and covered all my medicine except pain medication I finally getting to see Dr’s get xrays Mri and CT scans a true blessing from God thank u Ambetter… I love to be a great influencer you even pick your own Dr’s no referrals are needed just 10$ for specialists…I highly recommend,” – Trustpilot review

Negative:

“Paid claims on time.

Very poor customer service. When you call, you are directed to a third world call center, not an Ambetter employee. They don’t speak fluent English nor do they understand fluent English. After a lengthy time and being put on hold multiple times, they eventually disconnect you and you must call back and start the process all over again…..

They put the CUSS!! In customer service.” – Trustpilot review

Customer Service

Another way to measure how good Ambetter is is to look at how they treat their customers. We checked their website [https://ambetterhealth.com/] to see how easy it is to contact them, access your account, find a doctor, file a claim, and get answers to your questions.

Based on our assessment, Ambetter has a decent customer service system, but it could be improved. They have a toll-free phone number that you can call from Monday to Friday, 8 a.m. to 8 p.m. local time. They also have an online portal where you can manage your account, view your benefits, pay your bills, and track your claims. However, they do not have a live chat option or an email address that you can use to reach them. They also do not have a mobile app that you can use on your smartphone or tablet.

Provider Network

Another factor that affects how good Ambetter is is the size and quality of their provider network. A provider network is a group of doctors, hospitals, pharmacies, and other health care providers that have contracted with an insurance company to provide services at discounted rates. The larger and more diverse the provider network, the more choices you have when you need medical care.

According to their website, Ambetter has over 100,000 providers in their network across 20 states. However, the availability and variety of providers may vary depending on your location and plan type. Some states and counties may have more providers than others, and some providers may only accept certain plans.

To find out if your preferred provider is in Ambetter’s network, you can use their online search tool or call their customer service number. You can also ask your provider directly if they accept Ambetter before you make an appointment.

Accreditation

Another indicator of how good Ambetter is is whether they are accredited by an independent organization that evaluates the quality and performance of health insurance companies. Accreditation means that the company meets certain standards of excellence in areas such as customer service, clinical quality, financial stability, and network adequacy.

One of the most recognized accreditation organizations in the health care industry is the National Committee for Quality Assurance (NCQA). NCQA rates health insurance plans based on a scale of 1 to 5 stars, where 5 stars means excellent and 1 star means poor. So, Ambetter’s accreditation by the NCQA is a significant recognition of its quality.

Conclusion

Ambetter offers a variety of plans that cover essential health benefits and comply with the ACA. It also provides some extra perks such as telehealth services, wellness programs, rewards for healthy behaviors, and 24/7 nurse advice line. However, Ambetter health insurance also has some drawbacks such as limited availability, network restrictions, high deductibles or coinsurance, and mixed customer service. The cost of Ambetter health insurance depends on several factors such as location, age, income, plan type, and tobacco use. Ultimately, whether Ambetter is worth it or not depends on your personal needs, preferences, and budget.

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