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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

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Quality

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William McNeel Columbus, MS

Its been pretty good for me on my first year of coverage with them in 2022, depending on your plan, I have a zero deductible plan and generally this pays in full for my doctors visits and I also like the $10 Urgent Care visits and it pays for medicines for like illnesses in full and lab work at my doctors office. I personally really don't get sick much or go to the doctor very often. I also like the teledoc call in doctor that comes free with this coverage basically unlimited call in visits. The only dislike(s) I have so far is that my doctor prescribed me Ozempic and they refused to cover it even with filling out PA (pre-authorization) and had me take their recommendations of other medicine for 3 x months only to still deny me. Also its not any good if you go out of your state to a doctor. so if you are from mississippi and get sick in Alabama or Florida and need medical attention you best get back to mississippi to be treated. Also not sure how good or bad it'll ever be for hospital stays or surgeries just yet, I know my sister is on this coverage, as am I and even our local hospital in our home city is not in their coverage network and she got hit with a $1,500 bill that they refused to pay for going to the ER... so you have to be extra careful where you go to make sure its covered and in network. I would recommend knowing in case of a medical emergency where you want to be taken to and treated at.. That also goes for specialist and dental work also. Be sure to call ahead in advance and verify with doctor(s) before going and do not trust what the ambetter website list as approved providers. I had an appointment with my long time (local) dentist and even noticed he was on their listed of accepted & approved providers only to find out on the day of my appointment that they do not accept ambetter or evolve dental coverage. Even told me it was a down right awful insurance that they don't ever pay claims is why they quit accepting it. I was able to find another dentist in my area that accepted my coverage but he wasn't nearly as good of a doctor as my long time dentist. Also I have noticed that specialist that do accept ambetter generally put you on the back burner. example I have had a bad ear ache called an ear nose and throat specialist and they booked my appointment almost a full month out!! I'm like i need treatment now not a month from now but ended up keeping my appointment.. I'm not sure on that myself that my dentist told me about them refusing to pay claims to doctors.. also my primary physician tells me its a horrible last resort insurance to have. He said I do not have insurance with this insurance, but overall I haven't had any issues with them not paying anything so far although I haven't had any XRays or much lab work done. Even the tech lady at Walgreens says I have good insurance so I'm not really sure who to believe on that. Also if having test as I've learned with united healthcare I would still call the insurance company to verify if the procedure, surgery and pre-surgical testing that needs to be done to verify if it needs to be prior authorized and don't trust hospitals or doctors or specialist to do this for you...

10 months ago

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Smileeys Hattiesburg, MS

I wish more people would write the state and general area they live in for these reviews because it seems to make a difference. I live in South Mississippi and Ambetter has overall been a good insurance for me. I work part time and would be on disability or unemployed if I didn't have a wonderful employer who allowed me to go from full to part. However, I am no longer eligible for health insurance through work so I had to go to the marketplace. I actually have better insurance paying very little than my work family does. They have united healthcare and have had so many problems. I am one of the ones the affordable care act has helped tremendously. One thing I really like about ambetter is they have a rewards system that is not hard to do. You get points for flu shot, answering simple questions, watching health videos, etc. I was able to earn $250 this year easily that I paid my electric with. There are only certain bills you can pay or they have merchandise you can get. CVS quit taking my insurance this year but I went to another pharmacy that I discovered I like better. I pay zero dollars for my medication (I take 9 a day) and copays for primary and specialists. What plan you get depends on your income, though. We are a family of four with income around $36,000 for reference. The bad is that they require pre authorization but that's any insurance. They have denied some but then approved it later all except for one. My neurologist really didn't like my insurance and kept telling me they wouldn't approve this or that and I quit seeing him. Probably should have stopped sooner really because that wasn't only problem. I haven't had much contact with live customer service so I can't offer much insight there but I'm often called by automated service to check in with me or tell me about new info. It's equal parts annoying and helpful. They also keep calling to tell me they've noticed I'm not taking my heart medication right but don't say what it is. I don't take heart meds but do take blood pressure meds. Anyway, that's just mildly annoying. On my plan they do not pay for pain management and regular doctors pretty much can't prescribe anymore so that is difficult since I'm in pain almost constantly. They have telehealth and 24 hour nurse's line but I've never used it.

1 year ago

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R. M. Boca Raton, FL

Overall, I like Ambetter 1000x more than past plans I've had, like Humana and BCBS, which were outrageously pricey AND retroactively denied coverage for life-saving treatments, leaving me over $30K in debt. Of course there are pros and cons to every plan, but I stick with Ambetter because the positives far outweigh the negatives. So, for the good: it's affordable, I've had good customer service experiences (once they accidentally denied a claim, saying it was out of network, but quickly corrected this after a phone call), my copays aren't bad (this is important as I'm chronically ill and frequently see multiple specialists), they have a free health coaching plan, and I absolutely love the providers I found. I noticed that the providers' actual billing staff cause most of the billing errors, not Ambetter. The bad: Providers are hard to find, and while copays (like $8 for a PCP visit) are low, coinsurance is NOT. While they've allowed me to receive stellar mental health care, the same can't be said for my back. They required 5 weeks of PT before authorizing an MRI, with me paying 40% out of pocket for each session (I met my out of pocket max, so MRI was 100% covered). Meanwhile, they denied a back brace and stopped covering the pain medication I need to function. The MRI showed a mess: disc bulges, stenosis, degeneration, and bone spurs (and I'm in my 20s). Ambetter initially denied epidural steroid injections. HOWEVER - I've had a LOT of luck with providers winning appeals. My pain med is covered. My injections are authorized as far as I know (they wanted 5 weeks of PT, but I told them I'd done that, so they fixed it). I love all my providers. Yes, some stuff is a real hassle, but I'm very satisfied with Ambetter.

2 years ago

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Gail H Cincinnati, OH

I have had a very positive experience with the ambetter insurance. I have been with many insurance companies in the past and they all come with some very bad problems due to people not want to do their jobs first of all. From what I see the company is trying to improve issues and I'm hoping that more people who are not having problems will post reviews because I feel that this insurance has been better than when I had United Healthcare , Humana , Blue Cross Blue Shield. All of these companies have their issues. Sometimes you just have to call back and talk to someone else because two different people would definitely give you two different outcomes.

3 years ago

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Jonathan Manchester, NH

I've had Ambetter insurance for 2 years and my only complaint is how frequently they call me to make sure I take advantage of all their wellness benefits. I've read the numerous negative reviews and experienced None of what others claim. I have a pricy RX and they cover all but $30/mo. That prescription alone is double my monthly premium so how could I complain? All preventive care is covered including all tests, many in the thousands. I haven't had any 'event' requiring non-routine care so I cannot comment there. I live in NH and I cannot find a Dr or practice/facility/hospital that ISN'T in their network. Overall very satisfied.

3 years ago

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Bronya Duhanova Tampa, FL

This is my second year with Ambetter from Sunshine health in Florida. In our state this is in my opinion the best option on the federal market place. I have Ambetter Balanced care 1 and I pay 40$ a month for me and my son, it is 0 deductible policy (after the tax credit). Copeay for PCP visit is 1$, for specialist 10$. The choice of doctors isn't the best, but if you are a reasonably healthy person, this is sufficient policy. I was able to find a multi practice primary care provider near my home, meaning I have my PCP, OBG, bloodwork and allergologist in one building. I'm also happy with my son's pediatrician. All of the hospitals in Tampa bay area, where we live, take this insurance. Added bonus is "My health pays" account, we get 50$ for each annual preventive visits, gym membership and other services, like HPV virus immunisation for my son. This are deposited to a credit card, what I can use for coinsurance and other health care expenses... Customer service is always pleasant and helpful. My life got significantly easier and less stressful thanks to Ambetter. I highly recommend this insurance plan for your basic health care needs.

5 years ago

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kay molina Miami, FL

I've been with Ambetter roughly 2 or 3 years, the only complaint i have is sometimes they dont cover my medications, but normally is when itsbtier 2+ medications, as i have only tier 1 coverage and i believe they have 4 tiers. They do have prior authorizations doctor's can send in, to see if approved. But I've had very little problems with this insurance company. Im overall very happy, they have excellent coverage fpr vision and good doctors in network. The many times ive called concerning some questiond and occasional problem, they provide good service. The reps I've talked to have done all they can to help me sprt out what i need. I live in Florida and here its Ambetter with Sunshine Health.... Maybe its only decent In Florida, because these reviews are terrible and I've had little problems with them.

5 years ago

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AM

My previous insurance premiums were set to increase 40% in 2017, so I took a chance by changing my health insurance company to Ambetter. So far, I have been very happy. Yes, it was a bit of a hassle to find a PCP in the beginning. Some doctors who were listed turned out not to be PCPs at all. Before choosing Ambetter, I made a list of doctors in network near me, called to confirm that they were accepting new patients (some weren't) and visited several offices on my short list before choosing the doctor I like the best. Other than the first hiccups with choosing a doctor, we are very pleased. We have already completed our annual check ups and tests, had need to visit the doctor and got an appointment for 1 hour after calling, and have had prescriptions filled. This is a good option if, like us, you are relatively healthy and use health care mainly for check ups and routine screenings and prescriptions. I also like that they offer a program to incentivize you to eat healthy and take care of your health. You can earn $ to put toward premiums, co-pays and deductibles. Keeping my fingers crossed that things continue to go smoothly.

5 years ago

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Jon Warneke

Arkansas Company do believe. Trying to edge into possible Government Health Marketplace with several reasonable deductible health plans. Effort in customer service response seems fine. Have fought very hard to stay out of hospital and E.R. so have not had any medical claims review. They were responsive with requested info I requested and their benefits info & summary of benefits were as good as or better than others. The Gov't Marketplace ecchange is a viable choice for many uninsured and underinsured families and those facing uninsurable criteria for the normal Health Insurance underwriting.

5 years ago

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Mark Anthony Miami, FL

It took ,me a few months to get used to how this insurer works. I and my wife have a silver plan and we use the benefits routinely such as chiro and physical therapy, dental exam etc. Our doctors have said our plan gives us more visits per year than other patients plans. We have to spend a lot of time to find the health practitioners that we like but once we do, its great! The ones who are bad we call Ambetter and report the concern and or file a complaint(and believe me there are plenty of bad actors with licenses to practice medicine.) Usually they tell you that such and such a test or treatment that I need is not covered and charge me above the copay and when the visit is done I wonder was what they did anything beyond what is routine? That's when you need to call Ambetter to discuss what took place because there is plenty of fraud perpetrated on the ignorant consumer.

6 years ago

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Lashawn Partee Arlington, TX

I have no complaints with them overall they have provided the needed care for My husband and I. Customer service has been good. He even told me that when he needed assistance with finding a specialist that they actually took time with him to call and find a Specialist that could see him. They have also covered all prescriptions. And my monthly premium is very affordable.

2 years ago

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Hpalmer Marietta, GA

Maybe it depends on where you live. So far my experience with Ambetter in Georgia has been very good. I can't image how I would have paid for $400 plus a month health insurance right now. Plenty of primary care doctors and specialists here that take it at Wellstar and the quality has ranged from so-so to excellent. (I am in the surrounding suburbs of Atlanta). I haven't needed to get ahold of them for anything yet so I can't rate that accurately.

2 years ago

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Maribel Ruiz

I have good experiences with Ambetter,the only thing is some doctors don't accept their insurance but it's getting better.Sometimes u have to call a few times to receive ur card but a million times better than blue cross and blue shield Anthem,had problems with them since day 1,never used it until it was canceled,they wanted $1,300 a month,ridiculous.

3 years ago

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Yolander C Henderson Merrillville, IN

Ambetter is a good company. They're prices aren't too bad, and they contact you personally to inform you when certain preventive care is needed. The only thing I have a problem is with new medications. I have severe migraines, and finally an injection that reduces migraine days to at least half of the migraines per month has been aporoved by the FDA, but it isnt covered. I can't afford to pay my Ambetter premium every month, plus 575 every month for the shot I need!

4 years ago

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Gloria Etta Hamilton Waco, TX

Even though Ambetter did not approve of physician recommended Bariatric Surgery, because I have high blood pressure and in a pre-diabetic condition, I am still grateful to have the insurance. For the most part, it’s a good insurance to have. My copayments are low on prescriptions and office visits. I was badly in need of healthcare and couldn’t afford it before going to Healthcare.gov. I was in so much pain from Osteoarthritis wearing away at my hip joints. I felt like nobody cared even though I have worked hard most of my life. And I still work. Ambetter is all right with me.

4 years ago

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Maria Alvarado Harlingen, TX

All the folks that gave a 1 star need to learn to read to take advantage of the benefits. Just follow the rules . I'll bet this year of 2017 they have paid about $200,000 in benefits with a $600.00 deductible!! Just pay attention to your account on line. Learn to use the online resources . They have several very good providers on network!!! I signed up again for 2018!!

5 years ago

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Tamara Canton, GA

I will tell you they are great however-- warning-- you must use their in-network dr's. I was diagnosed with Thyroid Cancer had to get a total thyroidectomy - radiation, etc. They were awesome. I did have to drive about an hour into Atlanta for the right care. They do have some local PCP. If I have an emergency visit to an ER- meaning my local hospital - NO COVERAGE. I have to drive an hour as there are only one or 2 hospitals in the entire area closest to me i troublesome. Just hope no emergencies pop up.

5 years ago

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Colleen Sheahan ,

I use AM Better for doctor visits, preventive screenings, and medication only. I have had no issues, also get great customer service help. If you pay your monthly premium, stay in network, and do not need surgeries, this plan will work for you

2 years ago

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Lizzy Puentes Tallahassee, FL

Ambetter is a great insurance for where I resided in South Florida. They have lots of perks that you can gain from a point system they have. They also have a great reward system where you get money back if you have the debit card. That money back can be used to pay any bills you have which is so convenient!

2 years ago

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Olha Auburn, WA

I use Ambetter from coordinated care second year. I have a problem when I want click my login, I haven’t access to my health pays rewards. Every time when you visit your doctor must check information about your doctor work with your insurance or no.

3 years ago

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Yous Ibra Richmond, TX

You guys are scaring me. I just joined AmBetter and had my first doctor visit with no issue. I found a doctor about 5 min away from my house and got my 3 months prescription medication fully covered. May be it is too early to say anything about the company but my first impression is okay.

3 years ago

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John Fort Lauderdale, FL

I live in Broward county in FL, and all the very negative reviews are surprising to me. True, their website is not great, but other than that I have had zero issues. Many doctors to choose from, great prescription coverage, even urgent care. I am sorry to hear the problems people say they have, but again, I have had no problems at all with them.

3 years ago

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Tefft Crystal City, MO

I live in Missouri and have had no problems with coverage, copays, payments, or finding a doctor. This past year, I needed several tests, infusions, procedures, and medication. Never had an issue. Hopefully the coverage and copays do not go up next year. I will keep it .

4 years ago

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Sandra Pharr, TX

Don't get this insurance Melissa supervisor in customer service is horrible and won't help you with anything the WORST customer service Ever if you don't want to be ignored and a 0 priority stay away from getting An better coverage

4 years ago

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Rhonda Petrukitas

I have no problems with ambetter in Indiana. My questions get answered correctly. It seems they pay the provider quickly. My husband had to have MRI and brain scans approve. We received in a timely matter. The only complaint I havevisbthr selection of providers are very limited. You have to do a lot of searching find doctors.

4 years ago

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Marsha Moore Indianapolis, IN

I was pleased with Ambetter and appreciated my experience with them.I think they are one of the better choices.Thanks Ambetter moving to Medicare.Wish there was as good of choices as your company unfortunately All well didn't meet my needs

4 years ago

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Vivian Guerra Miami, FL

We have been with Ambetter for 3 years and it has met all our needs. Customer service is excellent and try to help to the max. I did not give it a 5 because their provider list is very limited and not updated frequently

4 years ago

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P. Palmer El Paso, TX

We just started using ambetter this year and have been very happy with our healthcare coverage. The only negative is that not as many providers take it in our area so it has taken us awhile to find new healthcare providers that we trust.

4 years ago

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Robert Louis Archuleta Mesa, AZ

Took them a months to correct an incorrect billing during time they cancelled my policy Took them months to find out why myhealthays card would always decline 125.00 credit for purchases

3 years ago

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Review Source

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Mona-Lissa Tallahassee, FL

Ambetter health insurance really came in handy when I was making doctor visits before I went to college. I didn't however understand their charging process and how I had to pay for treatments and not doctor visits.

1 year ago

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murfday College Station, TX

If monthly premiums were more reasonable, I would have nothing to complain about. EOB are clear and they have a good incentive program to develop healthy habits.

1 year ago

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richard w butler

no improvement; love the low co-pays and 0 dollars on most prescriptions

4 years ago

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Review Source

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Tiauna Anderson Salt Lake City, UT

I always have been able to get through to customer service and I have been happy with our service!

2 years ago