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Our Expert Take
Our Expert Take
Ambetter offers four types of health plans (HMO, PPO, EPO and POS), which means you may be able to find a plan that fits your needs. Ambetter’s premiums are better than some competitors, but customer satisfaction may be an issue given the company’s complaint level.
Pros
- Better than average premiums for its Affordable Care Act plans.
- Bronze and gold deductibles are cheaper than some competitors.
- Good digital experience, which includes letting you pay premiums and manage your account online.
Cons
- Complaints about Ambetter are twice as high as the industry average.
- Average silver deductible is higher than the national average.
On Healthcare.com's Website
1.9
Our ratings take into account a product's cost, features, ease of use, customer service and other category-specific attributes. All ratings are determined solely by our editorial team.
Availability
29 states
Average monthly premium
$610
Average annual deductible for a silver plan
$5,963
Table of Contents
- About Ambetter Health Insurance
- When Can You Buy an Ambetter ACA Plan?
- Types of Health Insurance Plans Offered by Ambetter
- Member Benefits from Ambetter
- How Much Do Ambetter Health Insurance Plans Cost?
- How Ambetter Costs Compare to Other Companies
- Ambetter Reviews and Complaints
- Methodology
Show more
Key Takeaways
- Ambetter has lower premiums than some competitors.
- Its average silver deductible is more than the national average.
- Complaints about Ambetter health plans are more than twice the industry average.
- The My Health Pays rewards program lets members earn points, which can be turned into up to $500.
How We Chose the Best Health Insurance Companies
About Ambetter Health Insurance
Ambetter is owned by Centene Corp., one of the largest health insurance companies. Ambetter began providing health coverage in 2014 and now serves more than 4 million members.
In addition to Affordable Care Act (ACA) plans sold through the HealthCare.gov website, Ambetter sells:
- Dental insurance
- Vision insurance
States Where Ambetter Is Available
When Can You Buy an Ambetter ACA Plan?
Open enrollment for the ACA health insurance marketplace is from Nov. 1 to Jan. 15 every year in most states. A few states have slightly different open enrollment periods. You can find your state’s marketplace by going to HealthCare.gov.
Open enrollment is when you can buy an ACA plan or make changes to your current coverage. The only way you can get marketplace coverage outside of the open enrollment period is if you experience a qualifying life event for a special enrollment period. A qualifying life event includes getting married, having a child, moving to a new ZIP code or aging out of a parent’s plan when you turn 27.
Types of Health Insurance Plans Offered by Ambetter
Ambetter offers four types of plans on the health insurance marketplace:
- HMO: A health maintenance organization (HMO) plan typically requires that you get care from in-network providers. Out-of-network care isn’t generally covered. You also typically need a referral to see a specialist.
- EPO: An exclusive provider organization (EPO) plan covers in-network care, similar to an HMO. One difference is that an EPO doesn’t require a primary care referral to see a specialist.
- PPO: Preferred provider organization (PPO) plans generally cost more than other plans but they also offer more flexibility. PPOs let members receive out-of-network care, though at a higher cost than in-network care. PPOs also don’t require referrals to see specialists.
- POS: Point of service (POS) plans combine elements of an HMO and PPO. POS plans generally let you get out-of-network care at a higher cost than in-network care. A plan usually requires that you name a primary care provider and demands a referral to see a specialist.
Ambetter Coverage Tiers
The company offers three metal tiers on the ACA marketplace:
- Bronze
- Silver
- Gold
Insurers can offer bronze, silver, gold and platinum health plans. Bronze plans have the lowest premiums but the highest deductibles and out-of-pocket costs. Gold plans have the highest premiums but lowest out-of-pocket costs.
The metal tier right for you depends on whether you’d prefer to pay higher premiums or higher deductibles. If you want to pay less for coverage, a bronze or silver plan might be right for you. If you’d rather limit out-of-pocket costs when you need care, a gold or platinum plan would likely be a better fit.
Member Benefits from Ambetter
Ambetter plans may offer additional benefits, including:
- Ambetter’s My Health Pays rewards program offers perks to policyholders who meet specific requirements. For example, you earn points for completing an annual wellness screening, eating right and moving more. Points can be converted into money up to $500.
- Ambetter’s website lets you pay premiums, view claims, review plan benefits, print your ID card and view rewards points.
- Ambetter Health Management Programs offer phone-based educational tools and support for those with chronic conditions such as asthma, depression, hypertension and lower back pain.
- The Start Smart for Your Baby program offers support to those who are pregnant.
- Nurse advice line is available 24/7.
How Much Do Ambetter Health Insurance Plans Cost?
Ambetter health insurance costs an average of $610 a month, based on our analysis. But the exact amount you’ll pay varies by multiple factors, including age, plan type, metal tier, whether you smoke and your location.
Age of member | Average monthly costs for an Ambetter plan |
---|---|
Age 21 | $409 |
Age 27 | $428 |
Age 30 | $464 |
Age 40 | $522 |
Age 50 | $730 |
Age 60 | $1,109 |
Source: HealthCare.gov. Based on unsubsidized ACA plans.
Average Ambetter Health Insurance Cost by Metal Plan
ACA marketplace plans are divided by metal tier: bronze, silver, gold and platinum based on costs. Bronze and silver plans have the lowest premiums but the most out-of-pocket costs when you need healthcare. Platinum and gold have higher premiums but fewer out-of-pocket costs.
Bronze and silver plans are the most common type of plan; platinum plans are rare on the marketplace.
Age of member | Average monthly cost for an Ambetter bronze plan | Average monthly cost for an Ambetter silver plan | Average monthly cost for an Ambetter gold plan |
---|---|---|---|
Age 21 | $357 | $414 | $445 |
Age 27 | $374 | $434 | $466 |
Age 30 | $405 | $470 | $505 |
Age 40 | $456 | $529 | $569 |
Age 50 | $637 | $739 | $795 |
Age 60 | $968 | $1,123 | $1,207 |
Source: HealthCare.gov. Based on unsubsidized ACA plans. Ambetter doesn’t offer many Platinum plans, so we didn’t include those averages.
How Ambetter Costs Compare to Other Companies
Ambetter has better than average rates when compared with competitors on the ACA marketplace at HealthCare.gov. Many factors go into health insurance costs, so it’s smart to get health insurance quotes from multiple insurers to compare premiums, out-of-pocket costs and benefits.
Average Monthly Costs for ACA Marketplace Plans by Company
Age of member | Ambetter | Aetna | Blue Cross Blue Shield | UnitedHealthcare |
---|---|---|---|---|
Age 21 | $409 | $396 | $445 | $434 |
Age 27 | $428 | $419 | $467 | $454 |
Age 30 | $464 | $452 | $506 | $492 |
Age 40 | $522 | $508 | $569 | $554 |
Age 50 | $730 | $711 | $796 | $775 |
Age 60 | $1,109 | $1,078 | $1,209 | $1,177 |
Source: HealthCare.gov. Based on unsubsidized ACA plans.
HMOs: Average Monthly Health Insurance Costs
Company | Age 21 | Age 27 | Age 30 | Age 40 | Age 50 | Age 60 |
---|---|---|---|---|---|---|
Ambetter | $401 | $420 | $455 | $512 | $716 | $1,088 |
Aetna | $392 | $415 | $448 | $503 | $704 | $1,067 |
Blue Cross Blue Shield | $385 | $403 | $437 | $492 | $687 | $1,044 |
Cigna | $467 | $489 | $530 | $596 | $834 | $1,267 |
Kaiser Permanente | $389 | $408 | $442 | $497 | $695 | $1,056 |
Molina Healthcare | $407 | $432 | $466 | $524 | $733 | $1,110 |
Oscar | $374 | $392 | $425 | $479 | $669 | $1,016 |
UnitedHealthcare | $425 | $445 | $482 | $543 | $758 | $1,152 |
Source: HealthCare.gov. Based on unsubsidized ACA plans.
EPOs: Average Monthly Health Insurance Costs
Company | Age 21 | Age 27 | Age 30 | Age 40 | Age 50 | Age 60 |
---|---|---|---|---|---|---|
Ambetter | $423 | $443 | $480 | $540 | $755 | $1,147 |
Aetna | $408 | $427 | $463 | $521 | $728 | $1,107 |
Blue Cross Blue Shield | $463 | $488 | $528 | $593 | $830 | $1,259 |
Cigna | $413 | $434 | $470 | $529 | $739 | $1,122 |
Kaiser Permanente | $364 | $381 | $413 | $465 | $650 | $987 |
Oscar | $418 | $438 | $474 | $534 | $746 | $1,134 |
UnitedHealthcare | $450 | $471 | $510 | $575 | $803 | $1,221 |
Source: HealthCare.gov. Based on unsubsidized ACA plans.
PPOs: Average Monthly Health Insurance Costs
Company | Age 21 | Age 27 | Age 30 | Age 40 | Age 50 | Age 60 |
---|---|---|---|---|---|---|
Ambetter | $379 | $397 | $430 | $484 | $677 | $1,028 |
Aetna | $499 | $523 | $566 | $637 | $891 | $1,353 |
Blue Cross Blue Shield | $508 | $532 | $576 | $649 | $907 | $1,378 |
Oscar | $357 | $374 | $405 | $456 | $638 | $969 |
Source: HealthCare.gov. Based on unsubsidized ACA plans.
POS: Average Monthly Health Insurance Costs
Company | Age 21 | Age 27 | Age 30 | Age 40 | Age 50 | Age 60 |
---|---|---|---|---|---|---|
Ambetter | $371 | $388 | $421 | $473 | $662 | $1,006 |
Blue Cross Blue Shield | $440 | $461 | $499 | $562 | $786 | $1,194 |
Source: HealthCare.gov. Based on unsubsidized ACA plans.
Featured Health Insurance Partners
1
Aetna
Coverage area
Offers plans in all 50 states and Washington, D.C.
Number of providers in network
About 1.2 million
Physician copays start at
$20
2
Blue Cross Blue Shield
Coverage area:
Offers plans in all 50 states and Washington, D.C.
Number of providers in network
About 1.7 million
Physician copays start at
$10
3
Cigna
Coverage area
Offers plans in all 50 states and Washington, D.C.
Number of providers in network
About 1.5 million
Physician copays start at
$0
Ambetter Reviews and Complaints
Complaints filed with state insurance departments against Ambetter for individual health insurance plans are more than twice the industry average. This typically reflects member dissatisfaction. If you’re shopping for a health plan, you can likely find companies in your area with a much lower complaint level.
The biggest complaints about Ambetter are related claims handling, including claim denials, according to data from the National Association of Insurance Commissioners.
Methodology
We analyzed 96 data points about coverage and quality to identify the best health insurance companies. Our ratings are based on:
- Average premiums (30% of score): We took the average Affordable Care Act health insurance marketplace rates for the following ages: 21, 27, 30, 40, 50 and 60, and then came up with an overall average. Source: HealthCare.gov.
- Complaints made to state insurance departments (30% of score): We used complaint data from the National Association of Insurance Commissioners.
- Average silver plan deductible (20% of score): The deductible is how much you have to pay for healthcare in a year before the health plan begins picking up a portion of the costs. Companies with health plans that had low deductibles got more points. Source: HealthCare.gov.
- Breadth of health plans (10% of score): Health insurance companies may offer up to four types of plan benefit designs (PPO, HMO, EPO and POS). We gave companies that offered more types of plans more points. Source: HealthCare.gov.
- Metal tier offerings (10% of score): The ACA marketplace has four metal tier levels. We gave points to companies that offered more tier plan options. Source: HealthCare.gov.
Read more: How Forbes Advisor rates health insurance companies
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