Ambetter Logo

Ambetter

star star_half star_border star_border star_border

5.5

Overall Score

error This company may not service all states.
See states serviced
LAST UPDATED: November 22nd, 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.

report_problem

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.

thumb_up

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.

Get Quote

thumb_down

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.

gavel

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.

Was this content helpful?
thumb_up Yes thumb_down No

We'll Introduce You!

Call our recommended rep over at Ambetter below.

1-(877) 326-1271

Star Rating

1.4

star star_half star_border star_border star_border

971 Reviews

Review Breakdown

5 grade

5%

4 grade

3%

3 grade

1%

2 grade

3%

1 grade

88%

Sentiment Criteria

Value

star star_half star_border star_border star_border

Quality

star star_half star_border star_border star_border

Service

star star_half star_border star_border star_border

Trustworthiness

star star_half star_border star_border star_border
cancel

Filter by:

arrow_drop_down

Sort by:

arrow_drop_down
info
star star star star_border star_border

Bill Hov Lakeland, FL

The coverage for the money is excellent. The doctors on their list are usually new or foreign (or both!) and getting an appointment from these doctors can be a hassle. The WORST part is their customer service. A 2 minute answer is taking over 30 minutes from India! You can hardly understand what they are saying. I rarely need to call but all I needed was a date for max out of pocket and they have no clue! WORST CUSTOMER SERVICE EVER!!!!!

2 weeks ago

star star star star_border star_border

RenoHal77 Reno, NV

After a good 6 months trying to get my online account access in order with customer service, I finally figured it out myself. I was using the wrong email address to log in with even though it was the same as what was in my account. Apparently you can have a different login email than what's in your account for communications. That is so confusing. They didn't even catch that.

6 months ago

star star star star_border star_border

Christopher Primosh Little Rock, AR

Benefits are terrific but, the rewards pays card... I had my hip surgery October 2017, I was going to use the card for my electric bill and November, after 8 months I was finally able to activate it. Between October 15th and January 21st I Must Have Spent at least 3 hours on the phone with these people until I finally gave up just this morning I thought hey I'll give it a shot. I finally got my benefits, the people on the phone with ambetter their representatives had no idea how to activate the card put me through multiple people and then finally hang up each and every time although they did ask for a call back number in which they never called back they were very uninformed

4 years ago

star star star star_border star_border

KMS Overland Park, KS

I'm the medical proxy for a friend who had a stroke on 1/8/2018 and his Ambetter policy has performed beyond my expectations. I'm not sure why it's totally subsidized but he pays $0 for an exchange bronze plan (HMO) with a $6800 deductible. Any HMO is going to have fewer providers and more restrictions, but the main problem seems to be that it's new in the market and the provider list changes constantly. Having met his deductible on day one of his hospitalization, the plan is paying for home therapy, nurse visits, and has a decent drug plan. I don't have any problems with the website which is every bit as informative as my own BCBS plan. No major complaints from us.

4 years ago

star star star star_border star_border

Jack Lewisville, TX

I'm very sorry to hear the negative stories from other members. I have been fairly pleased with Ambetter. True, they are very picky about who you can see and what they'll pay for. Thus, you definitely have to do your homework up front. You can't just go see the doctor you like; verify they're in Ambetter before you go. In mid-2017 I became a cancer patient. This included chemotherapy and surgery in 2017, and we had no significant problems with Ambetter. I say no significant, as there were times that we received bills from someone "out of network"; for example, the hospital is under plan, but perhaps the lab they use isn't. However, that isn't strictly an Ambetter issue, as we've underwent that through the years with both Blue Cross and Humana. Three stars because it could become a bit tricky to find a doc you really feel comfortable with. I like my primary guy, and the oncologists have been great. On the other hand, there isn't a physician out there that my wife is comfortable with. To conclude: Ambetter isn't perfect, but it's not bad. Do your homework before charges, and even be prepared just in case there's an emergency.

4 years ago

star star star star_border star_border

Glad to have insurance Boerne, TX

I have had a good experience with Ambetter, after I digested the fact that the provider directory on the web site is inaccurate & the customer service reps are pretty dumb. I apologized to my GP for being paid poorly and he said Ambetter pays him fairly. They seem slow to approve referrals: my GP had to telephone a few times to get approvals, but the MD staff in referral department was very helpful once my doc talked to them. The plan I have gives $$ incentives for taking their exercise/lifestyle quizzes, for getting a flu shot, having an annual checkup, and the money is transferred to the Ambetter credit card promptly. I am glad to have coverage and I have had no other problems. The monthly bill and the Member Explanation of Benefits is straightforward.

5 years ago

star star star star_border star_border

Clair Melton

I've been buying insurance through the ACA for 4 years, after almost 20 years of going without. I get what I can afford, which isn't much. But hey, I'm used to how capitalism works. Normally, I require only basic maintenance services, so my experiences have been fairly uneventful. But this year I broke my arm down at the wrist, which required surgery. While Ambetter was a little frustrating to work with initially (info on the website is outdated, so multiple phone calls were required to find out which doctors/surgical centers to use), once I got the important info from them, I didn't have a single problem with their providing coverage, and doing so at the expected amounts. That's how insurance is supposed to work, so I'm quite satisfied with that aspect. However, I just got notice that my network physicians have terminated their contract with Ambetter. When I look online, it says my nearest gynecologist (for example) is several hours away. So that's a problem. I'll be calling them to see if there are actually some in my city to choose from. Wish me luck!

5 years ago

star star star star_border star_border

Rebecca a Cecil Hernando, FL

THE ISSUES I HAVE WITH AMBETTER IS THEIR IN NETWORK PROVIDERS ARE FEW AND FAR BETWEEN. AMD WHEN I CALL MY SUPPOSE TO BE AGENT HE SOUNDS LIKE HE WORKS FROM HOME AND JUST ROLL OUT OF BED EVERY TIME WHETHER IT IS DAY OR NIGHT. THEN HE ENVER HAS ANSWERS FOR ME SAYS HE IS NOT MY AGEENT THEN GIVES ME HIS SONS NUMBER WHO IS SUPPOSED TO BE MY AGENT ACCORDING TO THE DAD BUT THE SON SAYS HIS DAD IS. SO CONFUSING - I JUST WANT ANSWERS AND GET NONE.

4 years ago

star star star star_border star_border

Tom & Misty Mathein New River, AZ

While I have good health care with Ambetter, their customer service is terrible. I have now been sitting on hold for over an hour and counting.... Trying to get answers to questions is one of the most difficult things I find with this company. In addition, when you send your payment, they do not credit your account right away. So even though it is in their possession, as confirmed by my bank, you can still get a late notice in the mail, threatening cancellation. The processes overall leave a lot to be desired.

4 years ago

star star star star_border star_border

Harold Ferris Atlanta, GA

Ambetter misled me on 4 occasions, saying that they would cover my child when playing sports for her school. The team coach revealed, in a 3 way call with Ambetter, that they in fact DO NOT COVER my child. The school has secondary insurance ( not primary) and Ambetter will not pay anything unless the secondary (backup) insurance pays first. Even talking to a supervisor (Cathy A. ) at Ambetter did no good. Why lie, Just tell me the truth! You know you don't cover. Don't waist every ones time!

4 years ago

star star star star_border star_border

Michael Main San Antonio, TX

I found it hard to find doctors. The company web site listed doctors (in my case I was looking for an ENT) but when I tried to make an appointment I was told the docs didn't accept Ambetter. I called Ambetter and asked them to find an ENT locally who accepted their insurance, they never called me back. I changed insurance

2 years ago

star star star star_border star_border

Sandra Virginia Beach, VA

Ambetter, please check and update the doctor's phone numbers on your website. I keep getting calls for a doctor in FL where the area code is wrongly listed as 757. This wastes so much time for clients and for me. Thank you.

4 years ago

star star star star_border star_border

bettina perkins Leander, TX

I have ambetter, it is a transparent company..do not buy this insurance, they will give you the run around! Report them to your State Insurance Commission, it's the only way they will stop their practices.

6 years ago

check_circle

Review Source

star star star star_border star_border

Jay Jones Bertram, TX

Been with them several years and they are so-so, probably about like most insurance companies. They're provider network is a little thin. They've done fine on small claims but I don't trust that they would honor a major one. The awards program/rebate is useful for easy items (flu shot), but some of the other awards take too many hours to earn.

1 year ago