Ambetter medical insurance plans are inexpensive private health care options for many individuals and small businesses in the US. Although many consumers are not familiar with this popular carrier, Ambetter specializes in simple, yet affordable no-frills policies that are budget-friendly. You’ll find their most competitive pricing on our website. Coverage is offered in 28 states along with dental/vision options, telehealth, “My Health Pays,” and “Start Smart” for babies.
The provider network is fairly extensive, and typically, you will find their plans on federal or state Exchanges. Since Marketplace policies must contain 10 “essential health benefits,” and be available during Open Enrollment periods, these contracts do meet the criteria. These policies are also eligible for federal subsidies and cost-sharing (Silver-tier plans). Catastrophic plans are not available in most states. Select, Value, and Virtual Access plans are not offered in all states.
Who They Are
They started in Chicago in 1978 and still maintain their home office there. A year later, their policies were available in all states (except one) after they purchased another insurance company. In the late 1990s, they were an early pioneer in offering online policies to customers. A.M.Best Company awarded a “Good” rating that has been maintained for many years. Currently, more than 3 million persons are covered with an Ambetter plan.
Centene Inc. owns the company (purchased in 2008) and is committed to providing innovative policies that are well price-positioned in most areas. Centene specializes in servicing medical benefits to consumers along with persons that are eligible for CHIP and Medicaid. Currently, one of the few types of policies they don’t offer in all states is a short-term plan. If you need that type of coverage, you can purchase it here, which is part of our website. Temporary plans are inexpensive, but do not provide coverage for pre-existing conditions.
Their portfolio includes contracts for Veterans and Military personnel, Medicaid and Medicare-eligible US citizens, correctional healthcare, and under-65 Marketplace coverage. “Whole-Health Solutions” provide the following benefits: nurse advice line and after-hours support, dental, specialty pharmacy, and diabetes management. Digital ID card access is provided for all plans. $) telehealth benefits do not apply to HSA plans until the deductible is met.
NOTE: Centene is the parent company of Ambetter, who offers on-Exchange plans in many states that are eligible for federal subsidies. The current service area includes the following 28 states: Washington, Nevada, Arizona, Texas, Missouri, Arkansas, Illinois, Indiana, Ohio, Pennsylvania, Mississippi, Tennessee, Georgia, Florida, South Carolina, North Carolina, Kentucky, New Mexico, California, Michigan, Mississippi, Oklahoma, Kansas, Louisiana, Alabama, New Jersey, New York, and New Hampshire.
Ambetter Under-65 Plans (Rates And Policies Can Vary By State)
Ambetter Standard Expanded Bronze – $50 and $100 office visit copays. Urgent Care copay is $75. $7,500 deductible with 50% coinsurance. Preferred generic and generic drug copays are $25. Mail order is available with $62.50 copays. Preferred brand drug copays are $50 and $125. Maximum out-of-pocket expenses are $9,400. Diagnostic tests subject to policy deductible.
Ambetter Everyday Bronze – $40 and $90 office visit copays. Urgent Care copay is $50. $8,450 deductible with 50% coinsurance. Preferred generic and generic drug copays are $3 and $30. Mail order is available with $7.50 and $75 copays. Maximum out-of-pocket expenses are $9,250. $50 diagnostic test copay.
Ambetter Choice Bronze HSA – $7,250 deductible with 0% coinsurance. Maximum out-of-pocket expenses are $7,250. HSA-eligible.
Ambetter Elite Bronze – $45 and $115 office visit copays. Urgent Care copay is $60. $0 deductible with 50% coinsurance. Preferred generic and generic drug copays are $3 and $35. Mail order is available with $7.50 and $87.50 copays. Preferred brand drug copay is $195. Maximum out-of-pocket expenses are $9,250. $60 diagnostic test copay.
Ambetter Virtual Access Bronze – $65 (no deductible) and $100 office visit copays. Urgent Care copay is $60. $7,000 deductible with 50% coinsurance. Preferred generic and generic drug copays are $3 and $30. Mail order is available with $7.50 and $75 copays. Maximum out-of-pocket expenses are $8,550. $75 diagnostic test copay.
Ambetter Virtual Access Silver – $40 and $100 office visit copays. Urgent Care copay is $60. $5,700 deductible with 50% coinsurance. Preferred generic and generic drug copays are $3 and $25. Mail order is available with $7.50 and $62.50 copays. Preferred brand drug copay is $75. Maximum out-of-pocket expenses are $7,400. $50 diagnostic test copay.
Ambetter Standard Silver – $40 and $80 office visit copays. Urgent Care copay is $60. $5,900 deductible with 40% coinsurance. Preferred generic and generic drug copays are $20. Mail order is available with $50 copay. Preferred brand drug copay is $40. Non-preferred brand drug copay is $80. Maximum out-of-pocket expenses are $9,100.
Ambetter Standard Silver Value – $40 and $80 office visit copays. Urgent Care copay is $60. $5,900 deductible with 40% coinsurance. Preferred generic and generic drug copays are $20. Mail order is available with $50 copay. Preferred brand drug copay is $40. Non-preferred brand drug copay is $80. Maximum out-of-pocket expenses are $9,100.
Ambetter Clear Silver – $5,400 deductible with 0% coinsurance. Maximum out-of-pocket expenses are $5,400.
Ambetter Clear Value Silver – $5,400 deductible with 0% coinsurance. Maximum out-of-pocket expenses are $5,400.
Ambetter Focused Silver – $45 and $100 office visit copays. Urgent Care copay is $60. $6,300 deductible with 50% coinsurance. Preferred generic and generic drug copays are $5 and $25. Mail order is available with $12.50 and $62.50 copays. Preferred brand drug copay is $75. Maximum out-of-pocket expenses are $8,000. $50 copay for lab tests.
Ambetter Focused Value Silver – $45 and $100 office visit copays. Urgent Care copay is $60. $6,300 deductible with 50% coinsurance. Preferred generic and generic drug copays are $5 and $25. Mail order is available with $12.50 and $62.50 copays. Preferred brand drug copay is $75. Maximum out-of-pocket expenses are $8,000. $50 copay for lab tests.
Ambetter Complete Silver – $30 and $60 office visit copays. Urgent Care copay is $60. $6,000 deductible with 40% coinsurance. Preferred generic and generic drug copays are $3 and $20. Mail order is available with $7.50 and $50 copays. Preferred brand drug copay is $55. Maximum out-of-pocket expenses are $8,500. $30 copay for lab tests.
Ambetter Complete Value Silver – $30 and $60 office visit copays. Urgent Care copay is $60. $6,000 deductible with 40% coinsurance. Preferred generic and generic drug copays are $3 and $20. Mail order is available with $7.50 and $50 copays. Preferred brand drug copay is $55. Maximum out-of-pocket expenses are $8,500. $30 copay for lab tests.
Ambetter CMS Standard Gold – $30 and $60 office visit copays. Urgent Care copay is $45. $2,000 deductible with 25% coinsurance. Preferred generic and generic drug copays are $15. Mail order is available with $37.50 copay. Preferred brand drug copay is $30.Non-preferred brand drug copay is $60. Maximum out-of-pocket expenses are $8,700.
Ambetter CMS Everyday Gold – $35 and $55 office visit copays. Urgent Care copay is $35. $750 deductible with 35% coinsurance. Preferred generic and generic drug copays are $15. Mail order is available with $37.50 copay. Preferred brand drug copay is $60. Maximum out-of-pocket expenses are $7,500.
Ambetter CMS Standard Virtual Access Basic Gold – $30 and $60 office visit copays. Urgent Care copay is $45. $2,000 deductible with 25% coinsurance. Preferred generic and generic drug copays are $15. Mail order is available with $37.50 copay. Preferred brand drug copay is $30. Non-preferred brand drug copay is $60. Maximum out-of-pocket expenses are $8,700.
Ambetter Virtual Access Gold – $20 and $45 office visit copays. Urgent Care copay is $30. $950 deductible with 25% coinsurance. Preferred generic and generic drug copays are $15. Mail order is available with $37.50 copay. Preferred brand drug copay is $50. Maximum out-of-pocket expenses are $8,700.
Ambetter Complete Gold – $15 and $35 office visit copays. Urgent Care copay is $35. $1,450 deductible with 20% coinsurance. Preferred generic and generic drug copays are $5 and $15. Mail order is available with $12.50 and 37.50 copays. Preferred brand drug copay is $30. Maximum out-of-pocket expenses are $7,500.
Plans No Longer Offered
Ambetter Essential Care 1 – $8,600 deductible and 0% coinsurance. Maximum out-of-pocket expenses are $8,600. Preferred generic and generic drug copays are $5 and $20. Mail order is available with $12.50 and $50 copays.
Ambetter Essential Care 2 – HSA-eligible plan with $6,900 deductible and 0% coinsurance. Maximum out-of-pocket expenses are $6,900.
Ambetter Essential Care 5 – $40 and $90 office visit copays. Urgent Care copay is $50. $8,100 deductible with 50% coinsurance. Preferred generic and generic drug copays are $5 and $25. Mail order is available with $12.50 and $62.50 copays. Preferred brand drug copays are $75 and $187.50. Maximum out-of-pocket expenses are $8,700. $50 diagnostic test copay.
Ambetter Essential Care 10 – $8,300 deductible and 50% coinsurance. Maximum out-of-pocket expenses are $8,700. Preferred generic and generic drug copays are $5 and $30. Mail order is available with $12.50 and $75 copays. $60 Urgent Care copay. $50 diagnostic test copay.
Ambetter Essential Care $1,500 Medical Deductible – $40 and $125 office visit copays. Urgent Care copay is $60. $1,500 deductible with 50% coinsurance. Preferred generic and generic drug copays are $5 and $35. Mail order is available with $12.50 and $87.50 copays. Preferred brand and non-preferred brand drug copays are $195 and $250. Maximum out-of-pocket expenses are $8,700. $60 diagnostic test copay.
Ambetter Essential Care $0 Medical Deductible – $45 and $115 office visit copays. Urgent Care copay is $60. $0 deductible with 50% coinsurance. Preferred generic and generic drug copays are $5 and $35. Mail order is available with $12.50 and $87.50 copays. Preferred brand and non-preferred brand drug copays are $195 and $250. Maximum out-of-pocket expenses are $8,700. $60 diagnostic test copay.
Ambetter Secure Care 5 – $15 and $35 office visit copays. Urgent Care copay is $35. $1,450 deductible with 20% coinsurance. Preferred generic and generic drug copays are $5 and $15. Mail order is available with $12.50 and $37.50 copays. Preferred brand and non-preferred brand drug copays are $30 and 30%. Maximum out-of-pocket expenses are $6,300. $15 diagnostic test copay.
Ambetter Secure Care 20 – $35 and $55 office visit copays. Urgent Care copay is $35. $750 deductible with 35% coinsurance. Preferred generic and generic drug copays are $5 and $15. Mail order is available with $12.50 and $37.50 copays. Preferred brand and non-preferred brand drug copays are $60 and 50%. Maximum out-of-pocket expenses are $7,500. $35 diagnostic test copay.
Simple generic prescriptions are often covered with low copayments. Brand preferred and non-preferred drugs are subject to a higher copay or coinsurance,and sometimes subject to a deductible. This type of split-arrangement is typical of many comprehensive medical plans. Obviously, whenever possible, ask your physician to utilize the cheapest RX available option.
Ambetter Health Insurance Plans Include Prescriptions
Like most carriers, if a generic substitute is offered, you should use that drug or you will have to pay the difference in cost of the two drugs. Naturally, your personal physician should have strong input in the decision. Occasionally, the cost difference between both options is not substantial.
All under-65 plans include “essential health benefits,” which include prescription drugs, lab services, hospitalization, wellness and preventative services, newborn and maternity care, pediatric services, ambulatory or outpatient services, substance abuse and mental health treatment, ER, and therapy treatment services.
Previously, a Basic option was offered (through Celtic). It was cheap, economical and although a few corners were cut (which was common), this option was not a bad “first policy” option. Although routine annual physicals and similar treatment were fully covered, only two other types of visits were included in the policy. So if you rarely visited a physician, the plan was very economical and cost-effective.
Additional Under-65 Plan Benefits
My Health Pays Rewards – “Eat Right,” “Move More,” “Be Well,” and “Save Smart” programs are offered. Various awards are offered when members complete designated healthy activities. $50 is awarded for completing a wellbeing survey, and and additional $50 is offered when an annual physical is completed. After receiving a flu vaccine, $25 of awards money is credited. These rewards can be used to pay policy premiums, deductibles, office visit copays, coinsurance, utility bills (electric, gas, or water), education expenses, rent, phone bills, and childcare.
Benefits will vary, depending upon the plan, and state of issue. Pharmacy copays can be used, but only at Walmart. A Visa prepaid card is provided when the first award is earned. Additional reward dollars will accumulate on the card. If a policy terminates, funds must be used within 90 days, or they will be lost. Bancorp Bank is the issuing financial institution. 90 days after coverage terminates, funds are no longer available.
Public transportation must be purchased directly through the servicing company. Passes are not offered through retail outlets.
TeleHealth – Available through Teledoc, the program offers 24/7 network provider availability for non-emergency situations. The service can be used at work, at home, or any other location. Phone and video service is offered. Medical advice and diagnosis, along with prescription drugs are available without physically meeting with a doctor. $0 copay for service (HSA plans must meet deductible first).
More than 3,000 healthcare professionals are available, with an average of 20 years of experience. Common conditions treated include allergies, bronchitis, flu, common cold, sore throat, skin infection, sinusitis, pink eye, strains, and muscle pulls, rash, upper respiratory infections, and stomach ailments. Patient issues are solved 9 out of 10 times after initial visit.
Your Better Health Center – Tools, health and wellness tips, Professional advice, money management, and many other perks are available. Better eating tips, coping with stress, and vaccination tips are discussed. A healthy diet forms the basis of personalized counseling and monitoring. Dietary guidelines emphasize lean meats, fish, beans, nuts, whole grains, fruits, vegetables, and low-fat milk products.
24/7 Nurse Assistance Line – Like Teledoc, service is available 24/7. Licensed registered nurses can help diagnose the medical issue and determine if immediate help is needed, and what type of treatment should be performed. In many situations, an ER visit may not be needed.
Care Management – Social workers and registered nurses provide case management that helps coordinate services, manage medical conditions, and find local community resources. Family-focused treatment helps patients better understand their condition and method of treatment.
Smart Start – This unique program for pregnant mothers provides support and healthcare tips for the entire family. Early and frequent office visits for mother and child are highly recommended. Positive lifestyle habits (balanced meals, proper exercise, and consistent sleep) are promoted. Usage of alcohol, drugs and tobacco are strongly discouraged during a pregnancy. Benefits are available in 25 states.
Ambetter Health Insurance Rates
Shown below are monthly costs of coverage in selected larger Metropolitan areas. Federal subsidies, if applicable, are included in prices.
Philadelphia, Pa. 55-year-old with $41,000 household income
$72 – Essential Care 2 HSA
$83 – Essential Care 10
$101 – Essential Care 5
Philadelphia, Pa. 55-year-old married couple with $60,000 household income
$58 – Essential Care 2 HSA
$79 – Essential Care 10
$116 – Essential Care 5
Cincinnati, Oh. 40-year-old with $32,000 household income
$70 – Essential Care 1
$86 – Essential Care 10
$96 – Essential Care 5
Cincinnati, Oh. 40-year-old married couple with $48,000 household income
$132 – Essential Care 1
$164 – Essential Care 10
$183 – Essential Care 5
Indianapolis, In. 30-year-old with $33,000 household income
$91 – Essential Care 1
$116 – Essential Care 5
$124 – Essential Care 2 HSA
Indianapolis, In. 30-year-old and one child with $47,000 household income
$145 – Essential Care 1
$186 – Essential Care 5
$200 – Essential Care 2 HSA
Chicago, Il. 40-year-old with $32,000 household income
$53 – Essential Care 1
$74 – Essential Care 2 HSA
$84 – Essential Care 5
Chicago, Il. 40-year-old married couple and two children with $90,000 household income
$327 – Essential Care 1
$392 – Essential Care 2 HSA
$425 – Essential Care 5
St. Louis, Mo. 40-year-old married couple with $50,000 household income
$154 – Essential Care 1
$217 – Essential Care 5
$220 – Essential Care 2 HSA
St. Louis, Mo. 40-year-old married couple with two children with $85,000 household income
$319 – Essential Care 1
$422 – Essential Care 5
$425 – Essential Care 2 HSA
Houston, Tx. 50-year-old married couple with $50,000 household income
$277 – Value Silver 30
$279 – Value Silver 31
$314 – Value Silver 32
Houston, Tx. 50-year-old married couple with two children with $70,000 household income
$337 – Value Silver 30
$339 – Value Silver 31
$391 – Value Silver 32
Coverage Area By County
Arizona (Arizona Complete Health) – Cochise, Coconino, Gila, Graham, Greenlee, Maricopa, Pima, Pinal, and Santa Cruz.
Arkansas (Arkansas Health And Wellness) – All counties.
California (Health Net Medi-Cal) – Kern, Los Angeles, Sacramento, San Diego, San Joaquin, Stanislaus, and Tulare.
Florida (Sunshine Health) – 63 counties throughout the state.
Georgia (Peach Street Health Plan) – All but 10 counties throughout the state.
Illinois (Illinicare Health) – Cook, DuPage, Grundy, Henry, Kane, Kankakee, Kendall, Lake, Madison, Mercer, Monroe, Rock Island, St. Clair, and Will.
Indiana (MHS) – All counties.
Kansas (Sunflower Health Plan) – All but 13 counties throughout the state.
Kentucky (WellCare of Kentucky) – Most Eastern and Northern counties.
Louisiana (Louisiana Healthcate Connections) – Ascension, East Baton Rouge, East Feliciana, Iberville, Jefferson, Orleans, Plaquemines, Pointe Coupee, St. Bernard, St. Charles, St. John The Baptist, West Baton Rouge, and West Feliciana.
Michigan (Ambetter From Meridian) – 32 counties.
Mississippi (Magnolia Health) – All counties.
Missouri – (Home State Health) – All but 7 counties throughout the state.
Nebraska (Nebraska Total Care) – All counties.
Nevada (SilverSummit Health Plan) – All counties.
New Hampshire (NH Healthy Families) – All counties.
New Jersey (WellCare Of New Jersey) – Atlantic, Bergen, Burlington, Camden, Cumberland, Essex, Gloucester, Hudson, Mercer, Middlesex, Monmouth, Morris, Ocean, Somerset, and Union.
New Mexico – All counties.
North Carolina – (Ambetter of NC) – Most Eastern and Central counties.
Ohio (Buckeye Health Plan) – Most Western and Eastern counties.
Oklahoma (Ambetter Of Oklahoma) – Mayes, Muskogee, Okmulgee, Payne, Rogers, and Tulsa.
Pennsylvania (Pa Health And Wellness) – Bradford, Bucks, Carbon, Chester, Columbia, Delaware,
South Carolina (Absolute Total Care) – All but 4 counties throughout the state.
Tennessee (Ambetter of Tennessee) – All but 14 counties throughout the state.
Texas (Superior HealthPlan) – Most Central and Eastern counties. “Value” coverage available in
Washington (Coordinated Care) – All but 8 counties throughout the state.