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Ambetter

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5.5

Overall Score

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LAST UPDATED: December 5th, 2022
Number 3 in Blue Circle

3 Things to Look for in a Health Insurance Company

  1. Plan Options — Look for an insurer that offers the kind of health plan you need. Some insurers specialize in specific types like Medicare.
  2. Extra Benefits — Look for the extra perks offered by the insurer with your plan like a fitness program or reimbursement. While not a dealbreaker, these benefits are worth noting.
  3. Claims Experience — Look for insurers that offer a good claims experience compared to others. Reading customer reviews can give you a sense of how well an insurer takes care of its plan members.

Ambetter insurance specializes in health insurance plans on the Health Insurance Marketplace in twelve states. These plans are also sometimes called Obamacare plans. Ambetter health plans are operated by the Centene Corporation. If you're looking for another kind of plan or don't live in an Ambetter service area, you'll need to consider other health insurers.

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Attention: Ambetter is a very unpopular health insurance company.

It has received a 1.4/5 star rating from reviews left on Best Company. Roughly 87 percent of the Ambetter reviews on Best Company gave a 1-star rating. Complaints against Ambetter include poor customer service, difficulty with pre-authorization, and high costs for limited coverage. Most customers do not recommend buying healthcare coverage from this insurance company.

View Ambetter Reviews and Complaints

Ambetter health insurance's covered services include preventative and emergency care, therapy, behavioral health help, medications, maternity, and hospitalization. It is an on-exchange health insurance option in the Health Insurance Marketplace.

Health Insurance Marketplace plans offer comprehensive health insurance coverage. For health plans to be on the Marketplace, they must be a qualified health plan that covers the essential health benefits listed in the Affordable Care Act.

To enroll in Ambetter insurance, you need to apply during Open Enrollment. The Open Enrollment period for 2021 healthcare coverage runs from November 1, 2020 to December 15, 2020. If you missed the enrollment period, you may qualify for a Special Enrollment Period after December 15, 2020 if you have a Qualifying Life Event.

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The Good

  • Health Insurance Plan Options
  • Helpful Online Account
  • Member Perks
  • My Health Pays™
  • Dental and Vision Coverage

Health Insurance Plan Options

If you're looking to get an Ambetter plan, you can view health plans by first selecting the state you live in and then selecting the type of health plan tier you're most interested in. From there, your options open up to several different plans with varying prices and benefits.

Ambetter Health Insurance Marketplace plan options include: Ambetter Essential Care (Bronze Plan), Ambetter Balanced Care (Silver Plan), and Ambetter Secure Care (Gold Plan).

Each plan offers insurance coverage for the essential health benefits listed in the Affordable Care Act, but the cost-sharing rules for medical expenses are different for each tiered plan option.

Members with Ambetter Essential Care pay lower premiums but have higher out-of-pocket expenses.

Ambetter Balanced Care, the Silver Plan, offers higher premiums and a lower out-of-pocket limit.

Ambetter Secure Care has higher monthly premiums, but the lowest out-of-pocket expenses of the three plan types.

For specific coverage and cost information, including the deductible, out-of-pocket expenses, and premium costs, you'll need to work with Ambetter directly. Depending on your income, you may qualify for a tax credit subsidy on your monthly premium.

Helpful Online Account

Each Ambetter member has access to an online portal through which they can make all of their payments, view healthcare plan benefits, and take care of logistics like obtaining a member ID card. The member portal offers extra features, too, such as providing reminders for members when they are due for another doctor's visit or allowing them to take a health risk assessment to determine which steps they can take to live healthier.

Members can track their claims 24/7 through the online portal, as well as connect with member services at any hour of the day.

Member Perks

Ambetter provides more than just logistical tools for members. Many of the extra features it offers also send the message that Ambetter wants members to get healthier and stay healthier. These tools include a 24/7 nurse hotline that members can access for questions and medical needs.

There are also health-promoting programs to support members with dealing with behavioral health and maternity and newborn care. Ambetter offers 24/7 Nurse Advice Line and integrated health management to enhance members ability to get the most out of their medical care.

Ambetter also offers telehealth access with some of its plans. With telehealth, members can have phone or video access to in-network providers for non-emergencies.

My Health Pays™

My Health Pays™ is Ambetter's rewards program to provide incentives for members to live healthier with better habits. You can earn money for taking a survey provided by Ambetter, getting a flu shot or having your wellness exam. This money can go toward your next premium. Members can be reimbursed for gym membership payments as well. This rewards program promotes health and well-being among Ambetter members. While this program is great, it's only available in some of the states Ambetter services.

Dental and Vision Coverage

Dental and vision coverage are available with Ambetter, but the benefits and availability of each are entirely specific to the state you live in and the type of health plan you choose.

Dental benefits, for example, is not available in Texas, but vision insurance is. Dental coverage includes exams, cleanings, and screenings, overall, and vision benefits include yearly eye exams and glasses or contacts. Those seeking vision coverage and dental benefits in addition to health insurance can find options through Ambetter.

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The Bad

  • Poor Customer Reviews
  • Access to Plan Information
  • Limited Service Areas
  • No Mobile App 

Poor Customer Reviews

Ambetter has received an overwhelming number of 1-star reviews on Best Company. These Ambetter reviews mention difficulty getting medication and treatments approved for coverage, issues with claims that were difficult to resolve, frustration with customer service, and difficulty finding an in-network provider.

With such a high number of 1-star reviews, you'll likely be better served choosing another insurance provider if you can.

Access to Plan Information

It's somewhat difficult to access specific information about the types of health plans Ambetter has. Its website primarily just explains the metal tiers (gold plan, silver plan, and bronze plan) as well as how essential health benefits are covered by every plan.

To find out what kinds of plans these are, such as Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO), not to mention what prices and benefits you qualify for (like out-of-pocket expenses, copayments, deductibles, covered services specifics,and if you need prior authorization for certain medical services), you'll have to contact a representative.

Upfront, it's important to know that Ambetter is part of the Health Insurance Marketplace (HIM). It's Centene's option for HIM plans, which are intended for people who don't have health insurance and maybe don't qualify for typical plans.

Ambetter only offers Marketplace plans. If you are looking for another kind of insurance plan, like a short-term health insurance, Medicare, or Medicaid, you'll need to find another insurance carrier.

Limited Service Areas

Ambetter plans are available in a some states. These include Arkansas, Florida, Georgia, Illinois, Indiana, Massachusetts, Mississippi, New Hampshire, Ohio, Texas, Washington, and Wisconsin. If you don't live in any of these states, then you'll need to consider another insurance provider.

Even if you do reside in one of the states they service, make sure to check the location of their in-network providers (e.g. a primary care physician, specialist, etc.) for your state to ensure they have an in-network provider near you.

No Mobile App

Unlike many of its competing insurance companies, Ambetter doesn't have a mobile app. Some companies provide this for enrollees to access their accounts right from their phones, making communication and logistics much easier. Ambetter hasn't provided this yet, making account management slightly less convenient than with other companies.

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The Bottom Line

Ambetter should be somewhat of a last resort when choosing an affordable health insurance company. While its plans all have decent health coverage for preventative care and some vision and dental benefits, it is difficult to access full details of its various plans. Data points such as the annual maximum out-of-pocket limit and co-pays are difficult to find on the website.

Plan cost and deductible levels vary among plans. Availability depends on location. Cost is also affected by the number of people on the plan and some demographic information, like age.

While Ambetter's plans offer comprehensive healthcare coverage, it's important to review customer reviews to get a sense of Ambetter's quality — health plans, value, cost, and customer service — and compare Ambetter to other health insurance companies before making a final decision about signing up for an Ambetter plan.

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Star Rating

1.4

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973 Reviews

Review Breakdown

5 grade

5%

4 grade

3%

3 grade

1%

2 grade

3%

1 grade

88%

Sentiment Criteria

Value

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Quality

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Service

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Trustworthiness

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JoJo St Louis, MO

Their customer service can never provide a clear answer and has just straight up told me the wrong answer on multiple occasions. This has caused serious delays in my healthcare. The only way to get a real answer is to complain on their Facebook page. I don't recommend and if I had more money I would go somewhere else.

3 months ago

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Peter Morrison Nashua, NH

I signed up in Aug 2021 for a new plan. I have 2 medications that I take and get refills on a regular basis. Both were covered by the RX plan until now. I went to refill both and one was covered but the other was not? I tried calling the support line and spent 1/2 hour talking with someone in the Pharmacy that tried to tell me my deductible has not been met and was the reason. Also, she claim she saw that I didn't refill my prescriptions last year?? I got frustrated and got no real answer. I am now going to look for new insurance once again. This insurance is not cheap the difficult to see what is covered, how much, and what is not covered. Don't waste your money

8 months ago

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Regina Euless, TX

I've had Ambetter Superior (TX-DFW Area) since 2018. I chose them reluctantly (I researched and saw the bad reviews), but they were the most affordable of the very dismal options. The first year was not as bad as expected, but not great either. It was hard finding a doctor that accepted them, the doctor list on the website was grossly inaccurate and customer service was not helpful. By 2019 more doctors were available in the plan and my husband and I miraculously found doctors that we liked so we stuck with Ambetter for the next few years. Earlier reviews are definitely right about them denying claims though, especially for MRI's: I think it is their policy to deny all claims first. In 2021 I met my deductible very early in the year due to a surgery and I didn't have any problem with Ambetter paying for any service after that. However, the premium for that plan for 2022 nearly tripled and we had to downgrade. We chose Ambetter Value plan, after I checked to see if at least one of our doctors were in network. They were...so they said.. so I proceeded to enroll in that plan. Which was the worst mistake I've made so far this year. Our doctors are not in the network and I still have not found a PCP after searching for 3 days. 90% of the doctors on the list were in an Urgent Care facility. I called Ambetter for help, and they read from the same website list...that is, if they didn't hang up or have me on hold for 30 minutes wishing I'd hang up first. Finally spoke to someone today who actually spoke English as a first language and 1 out of the 5 names she gave me actually had a working number, but the earliest appointment was 4 months out. So we have worthless insurance that we cannot change and I, like the guy who reviewed above, will be contacting anybody I can find to complain because this is just not right.

10 months ago

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James Eason Fort Worth, TX

Ambetter must have an entire team devoted to finding ways NOT to pay a claim. I had several problems with them but the worst is this: In an attempt to feel confident in what I was told, I called Ambetter THREE times before my anti-skin cancer treatment (photodynamic therapy--PDT). All THREE representatives told me I only had to pay my $60 copay and NOTHING else. The doctor's office received a pre-authorization letter stating the same thing. A month later I get the bill and am told that I haven't met my deductible yet. For 1.5 years I fought this, going all the way to the Texas Insurance Commission. They ruled that even though Ambetter told me verbally AND wrote a letter to me (after they reviewed my claim) stating that they should indeed pay the claim, they still didn't. In case that wasn't clear: AFTER REVIEWING MY APPEAL, AMBETTER WROTE ME A LETTER SAYING THEY WOULD PAY THE CLAIM 100%, but they still didn't do and the Insurance Commission wouldn't / couldn't enforce it. Ambetter even went back and listened to the recorded conversations and admitted that I was REPEATEDLY told wrong information. Unbelievable!

1 year ago

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briasativa Dallas, TX

I had Ambetter in Georgia and it was great. I never had problems finding a doctor nearby, it covered my prescriptions, reasonable co-pays and deductibles. I loved it! Since moving to Texas it has gone down hill fast. The website isn't working properly. I can't see my Rewards information, there are hardly any doctors available. I live in DALLAS. It's not like a small town or something. All the doctors I did find (that didn't have their own horrible reviews) ended up being mistakes. When trying to make a first appointment they all informed me they no longer take Ambetter. When I called customer service they couldn't get any better results than I could. What happened?! I'm going to have to change plans just, so I can find a doctor to go to. I have no complaint about the actual insurance but if you can't find a doctor it's worthless. Ugh.

2 years ago

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NobodySpecial Temple, TX

I wasted many hours with them on the phone. It appears that their strategy is to wear you out by wasting your time trying to find 1 actual provider out of the many providers that they claim that are in network according to their website, or any other way possible. During a call, Ambetter might help you search for providers, keep you on hold during their lunch break, waste 4 minutes on every call to run you through a long menu before speaking with someone, ask the same 2 questions on every single call, give you a list of providers that do not take their insurance, refer you to somebody else and finally RINSE AND REPEAT until you drop. Call center employees work cheaper than specialists. START VERY EARLY IN THE YEAR, IF POSSIBLE, WHEN SEARCHING FOR A PROVIDER. Don't waste your time trying to pick the best provider yet. FIRST, just confirm that the provider actually takes Ambetter insurance AND that someone has successfully filed an Ambetter claim with them for what you need to have done. Talk to the person that handles the insurance claims at the doctor's office just to be sure. And then, ask them again 2 more times to be sure. If you are lucky, they are correct. Record all calls to Ambetter, if possible, and use an internet phone service that keeps track of all calls numbers and call lengths. After wasting months with them, I filed a complaint with the Texas Insurance Board. Two weeks later, THEY CALLED ME BACK TO HELP FIND A PROVIDER. The provider I chose was one that was on their website for quite a while, but they only recently signed a contract with them. Surprise. My health problems have all been taken care of by a very good provider. I was very lucky! Best of luck to you! Hope this helps somebody!!!

3 years ago

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Amal Sweis Little Rock, AR

I wish there is an email address to contact them instead of the useless customer service people that keep answering my calls. I needed a proof insurance for all my family for the year 2017 and I had to call them more than 20 times until eventually I received the papers for all my family except my husband whom they denied he had insurance with them, I found my husband's receipts for most of the year and I want to show them that there is something wrong with their system but how can I do that?! they don't even have an office to visit in my state! Me and my family where unlucky in 2017 because someone in the marketplace referred us to ambetter !

4 years ago

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Liss Austin, TX

We had ver little issues with coverage but we also never went to the dr. We only did our yearly exams. What’s upset me with Ambetter is the offered money back rewards for Wellness checks, forms to complete which took 20 mins each, flu shots, etc. We earned $100 and they never sent to us. They told me they sent twice and that my address was my old and that it’s my responsibility to update. Which I had already. They had 6 months to get to me and continued to say because I didn’t update my address. Needless to say all of our monthly bills made to us just fine! Lies from them regarding the address.

4 years ago

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c grossman Bradenton, FL

I have had Ambetter for 2 years. They are a discount insurance. Most of their current contracted doctors are with the local health department. It is very difficult to get an accurate list of approved doctors. I just called Ambetter for a doctor referral and they gave me 4 doctors and I got 2 more listed on their website. I have called of them 5 so far and none of them actually take Ambetter insurance. Very deceptive.

4 years ago

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Nathalie Gooding Miami Beach, FL

They provide decent coverage at an affordable price but their so-called "member resources" are terrible. The website in particular is very poorly designed. Links lead nowhere, information on one page contradicts another, there is little overall logic to the way information is presented and finding a doctor is the most frustrating, fruitless process ever. Calling member services is no better! Each person who answers the phone tells you something different and most are just ill-informed.

5 years ago

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Brieanna Mcnemar Houston, TX

If anyone is looking for a vision office that accepts ambetter in San Antonio, Bright Eyes on Nacodoches does. I'm posting this because it was hard to find a doctor who accepted ambetter (Even when looking on the website) but I finally found someone! FYI not everything is covered but it is decent. The exam was covered and the frames were covered up to $139 on the frames but I paid $40 out of pocket for my lenses. Hope this helps someone!!!!

5 years ago

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Miguel Gonzalez

My biggest complaint is that I have with ambetter is that for over a year and yet I am unable to find a dental provider that covers this insurance. It was a pain finding our current providers, the directory claims many available doctors, dental, and optical but 8 out of 10 do not accept Ambetter. By the way our zip code 78664 which in no way is a small remote city.

7 years ago

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Hatema Catic Palm Beach Gardens, FL

Ambetter suspended my health insurance ,not let me know anything.Never resiveed any bills that I over some money .Some mistake that market place associate did on my application for 2018 enrollment , Ambetter suspended my health plan for 2019 not sending me anything too let me know..Bad customer service

3 years ago

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Pha Port Saint Lucie, FL

They are the worst, and so glad I am going to another insurance company. First they refuse to pay for medication and were acting as doctor for my father which they thought that could slide...but our family is well aware of what most insurance and health system is capable of ... they're bound to receive a lawsuit...

3 years ago

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Karen Winter Springs, FL

Ambetter told me to have a mammogram for prevented health maintenance. They said it’s free to me. I got it done by a provider in Ambetter network but Ambetter has yet to pay the provider and it’s been eight months. The provider said they have thousands of Ambetter patients that have not been paid on. I’m switching to Oscar Insurance.

4 years ago

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Michael North Las Vegas, NV

Great if you don't need anything. I'd have been better off not having insurance and using my VISA card. Seems like they pay providers for 100 tests and visits and then do nothing when you actually have a diagnosis. I'd check ratings before I use another primary from their list!

4 years ago

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Ansley Atlanta, GA

They should call themselves Amworse because if you need any specialty medication, you’re pretty much SOL. I’ve been on a medication for nearly a decade and have appealed their rejection of it without success. An ok health insurance company if you don’t actually need anything to benefit your health.

4 years ago

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Pablo

We called to ask a question and the lady changed the policy without our concent. We are paying 7 times more now.. And they refuse to go back to the previous plan. It indeed ruined my 15th anniversary celebration... I hate companies that get rich through dishonest gain.

5 years ago

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Danita Fisher Loganville, GA

Poor selection of providers, many of whom are subpar. Not a user friendly site and can almost never get the info on there I need. Hard to find contact info online. It's cheap-but you get what you pay for!

4 years ago

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Natalie Gatten Columbia, MO

Ambetter customer service is not very good. I had to call several times trying to figure out if a particular service would be covered by my insurance and each person that I spoke with had a hard time finding it or had no idea what I was talking about.

2 years ago

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Lam truong Everett, WA

I need to visit gastrologist. But when i contacted some places, they didn't take Ambetter Insurance. Even i have to pay $191/month. I am really need help.

6 years ago

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Amy K Mesa, AZ

Went with ambetter because they were the least expensive... when it came to me needing to use the insurance they only paid for 150 of my 1000+ bill! And I had been paying them 450 a month. Useless insurance.

2 years ago

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Sunil D

Provide immediate answers on claims questions instead of repeating what is on the web site which we can see

4 years ago

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Dasha Directo Provo, UT

The prices aren't the best here, so I didn't stick with it. I think other health insurance companies have better prices for the coverage.

3 years ago

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Jason Creech

Billing and customer service is just awful

5 years ago