Ambetter Health Insurance – Ambetter Reviews and Complaints 2020

Ambetter Health Insurance Reviews

Ambetter Health Insurance does not offer health plans directly to customers.  Instead, they offer health insurance products to regional insurance companies.  It is these insurance companies that, in turn, sell the plans on their local state marketplaces. Ambetter policies have some of the cheapest rates available when compared to other health insurance plans.  But, they are not available in all states – only a dozen states or so. Health insurance plans from Ambetter are best suited for customers who want cheap, basic coverage.  Member benefits are offered at an affordable monthly premium. However, the company has average to negative reviews overall.  They should not be considered for coverage if you value great customer service.

Ambetter insurance provides health insurance plans on the Health Insurance Marketplace. These plans are also sometimes called Obamacare plans. The health plans are operated by the Centene Corporation. However, if you’re not looking for Obamacare plans, or you don’t live in a regional service area, you’ll need to consider other health insurers.  From the reviews and complaints online, Ambetter is not a very popular health insurance company. Complaints against the provider include poor customer service, difficulty with pre-authorization, and high costs for limited coverage. Most customers do not recommend buying coverage from the company.

Ambetter Health Insurance Overview

Ambetter Insurance offers health insurance coverage as a marketplace plan provider. The company does not sell health care coverage plans directly to the public.  Ambetter is an on-exchange health insurance option meaning it does not directly sell the product. Instead, depending on the state you live in, the company offers health coverage plans through regional partner insurance companies.  Also, to enroll in a health plan, you need to apply during an Obamacare open enrollment period. However, you can also enroll if you have a qualifying life event, like marriage or the birth of a child.

Availability of Policies

Ambetter health plans are available for purchase from select states and are offered through regional insurance companies. Coordinated Care is a part of the Health Insurance Marketplace (HIM) and offers Ambetter health insurance to residents of 17 states: Arkansas, Florida, Georgia, Illinois, Indiana, Kansas, Mississippi, Nevada, New Hampshire, Ohio, Texas, Washington, Massachusetts, New Hampshire, Ohio, Texas, and Washington.  Centene is a Fortune 500 company with more than 30 years of experience in the Managed Care and specialty health industry.        Source: https://www.thebalance.com/

Plan Costs and Options

Ambetter offers health insurance plans in three categories. These health care categories differ in the monthly premium along with the deductibles and maximum out-of-pocket pay caps. However, they all are qualified health plans and cover essential health benefits like urgent care.  Plans can also come with vision and dental insurance. This is optional insurance that you can add onto your health policy.  Add-ons cover services like routing exams, prescription eyewear and teeth cleanings. However, policies with the vision and dental insurance are more expensive and come with an additional monthly premium.

1. Essential Care – Bronxe Plan
2. Balanced Care – Silver Plan
3. Secure Care – Gold Plan

Each plan offers insurance coverage for the essential health benefits listed in the Affordable Care Act.  Of course, the cost-sharing rules for medical expenses are different for each tier.  Members with Essential Care pay lower premiums but have higher out-of-pocket expenses.  Balanced Care, the Silver Plan, offers higher premiums and a lower out-of-pocket spending cap.  Secure Care has higher monthly premiums, but the lowest out-of-pocket expenses of the three plan types.

You need to contact a representative directly for specific coverage and cost information, including the deductible, out-of-pocket expenses, and premium costs.

Essential Care – Bronze Plan

The Essential Care category are the cheapest policies that the company offers but have the highest deductible levels. Bronze plans are best if you are in great health and will not have many routine medical expenses. Typically, these plans are used to cover an extremely high, one-time medical expense.

Ambetter only offers one plan option for the Essential Care Plan. The slight difference in monthly premiums reflect the additional dental and vision add-on options.  The basic plan has a deductible of $6800, and an out-of-pocket maximum of $6800. This means there is no access to copays or coinsurance. Instead, once the deductible and out-of-pocket maximum have been met, you will have no cost for any in-network medical services.  They will be completely covered by the insurer.  Source:  Valuepenguin.com

Balanced Care – Silver Plan

Balanced Care Plans have lower deductibles and out-of-pocket maximums. However, these plans have more expensive monthly premiums. All of these plans are offered with optional vision and dental add-ons.  Of course, vision and dental will increase the monthly premium that you are required to pay.

For some Balanced Care policy options, the deductibles will be less than the out-of-pocket maximums. In that instance, you are eligible for coinsurance.  This means your insurance provider pays for a portion of your medical expenses. Then, once the out-of-pocket maximum is reached, all additional medical expenses are 100% covered.

For example, say you owned an Ambetter Balanced Care 2 Plan and incurred medical expenses of $7,500. When filing a claim for this bill, the first $6,500 would be paid by you and then the next $1,000 would be paid by the insurance provider. Any other expenses beyond this point would also be covered by the insurer.    Source:  valuepenguin.com

Secure Care – Gold Plan

The Secure Care Gold Plan has the most expensive premiums.  But it also has more affordable deductibles and out-of-pocket maximums. These lower levels for deductibles allow you to quickly take advantage of coinsurance benefits. For this reason, the Ambetter Secure Care Gold plan is best if you anticipate high medical costs.  This might include a drug prescription that would need to be filled monthly.

Ambetter only offers one Gold Plan Option: the Ambetter Secure Care 3. The policy has a deductible of $1,000 and an out-of-pocket maximum of $6,350. Once the deductible has been met, you begin 20% coinsurance with the insurer. Then, as with other Ambetter health insurance plans, once you reach the out-of-pocket maximum, all medical services are covered by the insurer.  For instance, say you had a medical expense of $1,500. You would be required to pay $1,000 to meet the Ambetter Secure Care 3 deductible. Then, you would pay 20% of the next $500, which is $100. This would bring your total bill to $1,100.  Source:  valuepenguin.com

Ambetter Member Resources

Being a policyholder with Ambetter, there are added benefits beyond standard health care.  There is a rewards program, a 24/7 nurse advice line and much more.  In addition, Ambetter’s MyHealthPays rewards program lets you earn reward dollars by completing health wellness goals and activities. Some of these activities include completing the Ambetter Wellbeing Survey, getting an annual wellness exam from your primary care provider or receiving an annual flu vaccine.

As you complete activities, the rewards are automatically added to your MyHealthPays card.  The rewards dollars can be used for a variety of expenses such as:

The nurse advice line is a 24/7 phone service.  You can call to ask questions or discuss any concerns about your health. An experienced nurse will listen to your issues and provide advice about what steps you should take next. For example, let’s say you are having back pain.  You could call the nurse, explain the problem and symptoms and then get an answer on whether you should visit a chiropractor.

All member benefits can be accessed through the Ambetter online portal. Through the portal, you can log in to your account.  Once logged in, you can access a variety of services.  For example, pay your premiums, view your health care plan benefits or order a replacement policy ID.

Online Portal

Each Ambetter member has access to the online portal.  Many services and features are available online at no additional charge to the policyholder.  Features include:

• Payment – All payments can be made through this portal.
• Benefits Summary – View health care plan benefits online.
• Logistics – Take care of details like obtaining a replacement member ID card.
• Reminders – The member portal offers extra features, too, such as providing reminders for members when they are due for another doctor’s visit.
• Risk Assessments – Health risk assessment feature to determine which steps to take to live healthier.
• Claims Tracking – Members can track their claims 24/7 through the online portal.
• Member Services – Connect with member services at any hour of the day.
• Subsidy Estimator – Helps members see how much they would receive for reimbursement for a treatment with their benefits. The subsidy may lower what you pay for the monthly premium charge.

Ambetter Unique Features

Ambetter provides more than just logistical tools for members. Many of the extra features they offer demonstrate  that they want their members to be healthier and stay healthy. For example, the 24/7 nurse hotline where members can ask questions about their medical needs immediately.  This allows them to act before serious complications set in.

There are also health-promoting programs.  These support members who are dealing with behavioral health, or maternity and newborn care issues. The Nurse Advice Line is designed to enhance members’ ability to get the most out of their health 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.

Ambetter My Health Pays Rewards Program

My Health Pays is Ambetter’s rewards program.  It is set up to provide incentives for members to live healthier with better habits. For example, you can earn money for taking a sponsored health survey, getting a flu shot, or having an annual wellness exam. Members can also be reimbursed for gym membership payments. You actually get paid to do things that enhance your overall health.  Then, the moneyyou earn can go toward lowering your monthly premiums.  This rewards program is designed to promote health and well-being among Ambetter members.  Unfortunately, the rewards program is only available in some of the states Ambetter serves.

Ambetter Dental and Vision Coverage

Vision as well as dental coverage are available.  But, the benefits and availability vary by region, and from state to state.  Also, the additional benefits depend on the  type of health plan you initially signed up for. Dental benefits, for example, are not available in Texas, but vision insurance is. Dental coverage includes exams, cleanings, and screenings.  Vision benefits include yearly eye exams and glasses or contact lenses. In general, Ambetter has options available for their clients who are seeking vision coverage and dental benefits in addition to standard health insurance.

Ambetter Complaints

If you are looking for the cheapest rates for health coverage, then Ambetter Health Insurance is a solid option. However, customer reviews for Ambetter Health Insurance are below average to poor. Many policyholders complain about long phone call wait times when dealing with Ambetter Customer Service.  There are complaints about providers not being paid for medical services. Other common issues are members getting billed incorrectly and not being able to find providers that accept Ambetter insurance in their areas.

These customer reviews are substantiated by the ratings that Ambetter Health Insurance has received. The Better Business Bureau gives the company a “D” rating.  This rating means the company rarely interacts with customers or responds to complaints in a timely manner. Ambetter also received an NAIC complaint ratio lower than average.  This means the company has receives more than the median number of complaints based on its size.  Ambetter Health Insurance is a marketplace plan provider.  It is operated by CeltiCare Insurance, a subsidiary of the Centene Corp. Therefore, when you purchase an Ambetter policy, your point of contact for questions is CeltiCare. For example, in Florida, Ambetter plans are marketed as Ambetter by Sunshine Health but are operated and underwritten by CeltiCare Insurance.  This business structure somtimes contributes to confusion and frustration regarding who customers should deal with.

Access to Plan Information

Ambetter health plans are intended for people who don’t have health insurance and maybe don’t qualify for typical health coverage.  It is important to keep in mind that Ambetter is part of the Health Insurance Marketplace (HIM). The company sells its health insurance through third parties. Yet, the point of contact for customer questions is CeltiCare.

It is difficult to access specific information about coverage and health plans. Ambetter’s website primarily just explains the gold plan, silver plan, and bronze plan in general.  It also summarizes how essential health benefits are covered by every plan. But, there is not specific information about what typess of coverage are provided, such as Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO).  The website does not mention  things like the prices and benefits you might qualify for.  There is no information about out-of-pocket expenses, copayments, deductibles, covered services specifics, or whether you need prior authorization for certain medical services.  To find out the specific coverage a plan provides, you have to contact a representative directly.  And, that is the key issue.  This is largely due to how unresponsive the Customer Service seems to be, judging by the complaints.

Ambetter Only Offers Marketplace Plans 

Ambetter only offers Marketplace plans. If you are looking for another kind of 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 Ambetter may not be an option for you.

Even if you do reside in one of the states they service, make sure to check the location of their in-network providers.  A primary care physician or specialist may not be available for your state.  Take steps to ensure they have an in-network provider near you.

No Mobile App

Ambetter doesn’t have a mobile app, unlike many of the insurance companies it competes with. Some companies provide this for enrollees to access their accounts right from their phones.  Clearly, this makes communication and logistics much easier.  Because Ambetter doesn’t provide a mobile app, it makes account management slightly less convenient than with other insurance providers.

Ambetter Reviews by Customers

Ambetter Review – 2-Star**   Don’t get this…

“They have listed every doctor in the Tn. and Ga. area but maybe 1 out of every 15 are in their Tenn. Network. My wife finally found a Nurse Practitioner (in another state) that ordered 4 of 5 tests (over time) to be done and every test was denied. The same thing happened when looking for a Dentist. We are overjoyed we can now change this company, we thought open enrollment would never get here soon enough to get my wife some real help. As I said before, STAY CLEAR OR YOU TOO MAY BE SORRY !”  Source: ambetter.pissedconsumer.com/

Throughout the country, Ambetter policyholders are reporting that they are not able to find, or are having difficulty finding, medical providers that will accept Ambetter insurance. Additionally, many policyholders are reporting that they purchased the Ambetter product because they thought that their physicians were “in-network” when, in reality, they were not. These policyholders have been vocal with their frustrations online.

“Doctors listed on the Ambetter website don’t actually take my insurance.  Despite what they claim and what their provider list shows, there are very few doctors, offices, or even hospitals that accept this insurance.  The closest office might be hours away with a 3-month wait for a new patient.   The attorneys at Burg Simpson are investigating a potential lawsuit against Ambetter on behalf of Ohio customers with similar complaints.  Ambetter health plans (Ambetter Balanced Care and Ambetter Secure Care) are offered by Buckeye Health Plan, a subsidiary of the insurance provider Centene Corporation, through the Health Insurance Marketplace (a.k.a. Health insurance Exchange). Centene Corporation has reported that approximately 1.5 million people have purchased its Ambetter product nationwide.” Source:  https://www.burgsimpson.com/ohio

Ambetter Health Insurance – Final Words

Ambetter might be considered a last resort when it comes to choosing an affordable health insurance company. While its plans all have health coverage for preventative care and some vision and dental benefits, it is difficult to access full details of its various plans. Specific information 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 health care coverage, it’s important to research customer reviews.  This will help you to get a sense of Ambetter’s quality — health plans, value, cost, and customer service.  You should carefully compare Ambetter to other health insurance companies before making a final decision about signing up for an Ambetter plan.