CeltiCare’s subsidiary, Centene Corporation, operates Ambetter Superior Health Plans. It is the Health Insurance Marketplace for Individuals (HIM) option. Ambetter offers lower premiums for bronze, silver, and gold coverage categories than BCBS of Texas.
The real savings are with Silver plans. AmBetter’s cheapest plan has a monthly premium that is 30% lower than comparable BlueCross BlueShield Texas plans. Ambetter does not offer HMO plans or Exclusive Provider Organizations (EPO) plans.
There are no PPO plans currently available in Texas’ individual market. Ambetter, which has been selling policies through the ACA exchange in Texas in 2014, has a substantial presence in Texas, including Austin and San Antonio as well as El Paso.
It has added 12 counties to its 2018 list, including Tarrant County, Denton, and Dallas, as well as Rockwall.
There are many options for vision and dental insurance, but it can be difficult to find policies because Ambetter is not available in all areas.
- 1 Ambetter Health Insurance
- 2 Map of the Coverage Area in Texas
- 3 Plan costs and options
- 4 The Good
- 5 The Bad
Ambetter Health Insurance
What is Ambetter?
Ambetter offers affordable Health Insurance Marketplace Plans. Ambetter provides you the tools, benefits, and coverage that you need to take control of your health.
Ambetter Insurance benefits include:
- Telehealth Services
- My Health Pays(r) rewards program
- Healthcare Management Programs
- * Optional vision and dental insurance plans available
- Mail-order pharmacy
- Get Smart for Your Baby(r).
- 24/7 Nurse Advice Line
- Virtual Assistant for Members
- Access to digital ID cards
*For some plans
Ambetter is a trusted healthcare provider. Ambetter is a part of the healthcare insurance market since the beginning.
Ambetter now has over 2 million members across the country. Ambetter offers 20 state-based health plans. Ambetter’s years of experience and local knowledge will help you and your family manage your health.
Ambetter Health Insurance, a marketplace provider of health insurance, offers coverage. It is an on-exchange option for health insurance, so it doesn’t directly sell the product. Ambetter partners with insurance companies to offer health plans in your state.
You will need to enroll in an Ambetter health plan by applying on your state’s open enrollment period for Obamacare. If you have a qualifying event, you may also be eligible to purchase Ambetter insurance.
Map of the Coverage Area in Texas
Ambetter offers complete coverage for Texas healthcare. You can purchase Ambetter plans from selected countries, and they are available through different insurance companies. This includes:
- Deaf Smith
- El Paso
- Fort Bend
- Palo Pinto
- San Jacinto
- San Saba
- Tom Green
- Val Verde
- Van Zandt
Select states have Ambetter Health Plans that can be purchased through their insurance companies. This includes:
|AR Health & Wellness: Ambetter|
|Arizona Complete Health: Ambetter|
|Sunshine Health: Ambetter|
|Ambetter, Peach State|
|Sunflower Health: Ambetter|
|Magnolia Magnolia Magnolia Magnolia|
|Better from the Home State|
|Ambetter starting at Silver Summit|
|Buckeye Health Plan: Ambetter|
|Superior is better|
|Coordinated Care: Ambetter|
Plan costs and options
Ambetter offers three types of Ambetter insurance plans: Ambetter Essential, Ambetter Balanced and Ambetter Secure. The monthly premiums for these health care plans are different, as well as the deductibles or out-of-pocket maximums. They all cover essential health benefits such as urgent care and are all qualified health plans.
Ambetter plans include vision and dental insurance. This optional insurance can be added to your existing health plan and includes services such as eye exams, prescription eyewear, and teeth cleanings. Ambetter policies that include vision and dental will have an additional monthly premium.
We have included more information below about each category of Ambetter’s health insurance policies. These policies are examples of Miami-Dade County, Florida. However, your plan availability and pricing will vary depending on where you live.
Ambetter Essential Care
Ambetter Essential Care has Bronze metal plans. These are the most affordable policies offered by the company, but they have the highest deductibles. If you’re in good health and don’t have any routine medical expenses, bronze plans will be the best. These plans are typically used to pay for a single, very expensive medical expense.
|Product||Deductible||Maximums out-of-pocket||Monthly cost for a 40 year-old|
|Ambetter Essential Care 1||$6,800||$6,800||$329.47|
|Ambetter Essential Car 1 + Vision||$6,800||$6,800||$333.27|
|Ambetter EssentialCare 1 + Vision + Dental||$6,800||$6,800||$342.15|
Ambetter offers only one Bronze plan via the Ambetter Essential Care program. The plan has the same deductibles as well as out-of-pocket limits. This means that there are no access copays. Once the deductible has been met, the insurer will cover all in-network medical services.
Ambetter Balanced Caring
The Ambetter Balanced care category sells silver metal plans. These plans have lower deductibles, out-of-pocket maximums, and are less expensive.
These plans come with higher monthly premiums. Here are some Silver Ambetter Balanced care products. These plans can be purchased with optional vision or dental add-ons. However, this will increase your monthly premium.
|Product||Deductible||Maximums out-of-pocket||The monthly cost for a 40-year-old|
|Ambetter Balanced Caring 2||$6,500||$6,500||$460.80|
|Ambetter Balanced Caring 1||$5,500||$6,500||$468.18|
|Ambetter Balanced Caring 10||$5,000||$6,700||$487.53|
|Ambetter Balanced Caring 3||$3,000||$6,500||$491.68|
Some Ambetter Balanced care policies have deductibles that are lower than the maximums out-of-pocket. You may be eligible for coinsurance. This means that your insurance provider would cover a portion of your medical expenses. Once the maximum out-of-pocket limit is met, then all medical expenses are covered 100%.
Let’s say, for example, that you had $7,500 in medical bills and owned Ambetter Balanced care 2. The first $6,500 of this bill would be covered by you, and the $1,000 after that by the insurance provider. The insurer would cover any additional expenses above this amount.
Ambetter offers some of the lowest rates for health insurance. Below is a graph that compares Ambetter Balanced care rates in Florida with those of Silver policies.
Ambetter is the lowest-priced option in Florida with an individual quote that costs $98 less than Health Options Inc.
Ambetter Secure Caring
Ambetter Secure care products are Gold metal-tier policies. They have the highest premiums, but they also have the lowest deductibles and maximum out-of-pocket costs. You can quickly access coinsurance benefits because of the lower deductibles.
The Ambetter Secure care Gold plan is the best option if you have high-cost medical needs, such as a prescription for a drug that would require filling monthly.
Ambetter offers only one Gold plan: Ambetter Secure care 3. The policy comes with a $1,000 deductible and an out-of-pocket maximum of $6,350. After the deductible is met, you will be able to begin 20% coinsurance with your insurer.
As with all Ambetter plans, you will be covered for all medical expenses once your deductible has been met.
Imagine that you have a $1,500 medical bill. To meet the Ambetter Safe Care 3 deductible, you would need to pay $1,000. You would then have to pay 20% of the $500 remaining, which equals $100. Your total bill would then be $1,100.
- Member resources
- Unique features
- My Health Payments
- Vision and dental
Members of Ambetter have access to an online portal that allows them to view all their benefits and make payments.
They can also obtain a member ID card. You can also receive reminders when you are due to see a doctor or take a health risk assessment, which will help you determine what steps to take to make your life better.
Members can also access Ambetter’s social media accounts and receive member news alerts. You can see Ambetter’s health plans by selecting your state and then the metal type you are most interested in.
There are many plans available with different benefits and prices. The online portal allows members to track their claims 24 hours a day and connect with nurse hotlines or member services at any time of the day.
Members can also see what amount they will receive to reimburse for treatment through the online subsidy estimator. Although many resources are available to members, they do not go beyond what is offered by their basic health insurance company.
However, Ambetter’s online portal, as well as customer service channels, make the member’s experience easier and more secure.
Ambetter offers more than just logistical tools to members. Ambetter’s extra features send the message that they want members to be healthier and more active.
Members can call a nurse hotline 24/7 to get answers and help with medical issues. You can also access health-promoting programs like the StartSmart for Your Baby program that provides support for pregnant mothers.
Ambetter offers support to members who are dealing with chronic illnesses, behavioral health issues, or similar difficulties. Ambetter offers a rewards program called My Health Pays.
Members can get reimbursements for gym memberships, as well as money back for a wellness exam and flu shot. The money can be used to pay a monthly premium or copay.
My Health Matters
Ambetter’s reward program My Health Pays provides incentives to members to adopt healthier lifestyles. This money can be used to pay your next premium, as well as for taking a survey by Ambetter.
24-hour Nurse Line
Customers can reach a nurse 24/7 for any medical concern or other queries. This round-the-clock support adds comfort to the members’ experience.
Vision and Dental
Ambetter offers vision and dental coverage. However, the benefits and availability of each benefit are dependent on the state in which you reside and the plan you have signed up for.
Vision insurance, however, is available in Texas. Texas does not have dental coverage. Vision insurance covers vision and includes screenings, exams, and cleanings.
- Plans offered (HMO and EPO – without PPO or HSA plans).
- Service areas
- Service areas
- Access to plan details
Different types of plans are available
It is difficult to find specific information on the Ambetter health plans. The website only explains the metal levels for each plan, and what essential health benefits are included in every plan. To find out which plans they are (such as HMO, PPO, etc.
Contact a representative to find out more about the benefits and prices you are eligible for. It’s important to note that Ambetter is part of the Health Insurance Marketplace (HIM). Centene offers HIM plans as an option to people who don’t have insurance or don’t meet the requirements for standard plans.
HIM territory doesn’t offer Medicare. This is because Medicare is the legal option if you are eligible for it. Medicaid and CHIP, however, are HIM plans. Ambetter offers PPOs and HMOs as well as EPOs.
However, they don’t offer HSAs. Their plans are divided into three metal tiers: Gold, Silver, and Bronze. These tiers all cover essential health benefits, Ambetter’s term that covers services such as preventative and emergency care and therapy, medication, maternity, and hospitalization.
The cost of premiums and out-of-pocket expenses are what differentiate the tiers. The Bronze plan has the lowest premiums, but the highest OOP cost. Gold plans have the highest premiums, but the lowest OOP cost. Silver is, naturally, the middle.
Only a few states offer better plans. These include Arkansas, Florida and Georgia, Mississippi. Illinois, Indiana. Massachusetts. New Hampshire. Ohio. Texas. Washington. Ambetter is not an option if you don’t reside in one of these states.
No Mobile App
Ambetter does not have a mobile application, unlike many of its competitors. This allows members to access their accounts from their smartphones, which makes communication and logistics much simpler. Ambetter doesn’t offer this service yet, which makes account management a little more difficult than other companies.
Access to plan information
It’s difficult to find information about Ambetter’s health plans. It is difficult to find out the details of HIM plans at Ambetter, such as which ones are available upfront and how much they cost.