Ambetter From Coordinated Care: What You Need to Know

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Ambetter From Coordinated Care is a member of the Health Insurance Marketplace (HIM) and offers health insurance to residents of 18 states: Arizona, Illinois, Missouri, Ohio, Texas, Arkansas, Indiana, New Hampshire, Pennsylvania, Washington, Florida, Kansas, Nevada, South Carolina, Georgia, Mississippi, North Carolina, and Tennesse.

Ambetter from Coordinated Care is a part of Centene Corporation, a Fortune 500 company with over 30 years of experience in the managed care and specialty health industry.

Health Plans

Ambetter offers three healthcare plan options; Gold, Silver, and Bronze. The Bronze plan gives you lower monthly payments but will cost more in out-of-pocket expenses (deductibles). The Gold plan pays the most toward your care but also comes with a higher premium cost. The Silver plan provides a balance between insurance premium costs and out-of-pocket expenses. Basic essential health plan benefits covered by all plans include:

  • Emergency services
  • Hospitalization
  • Outpatient or ambulatory services
  • Preventive and wellness care
  • Maternity and newborn care
  • Pediatric services
  • Various therapy services (ex. physical therapy)
  • Prescription drugs
  • Laboratory services
  • Mental health and substance abuse services

Optional vision coverage is available through some plans (pediatric coverage for eye exams, prescription eyewear. Optional adult coverage is available through some plans.)

Ambetter has over 60 plans to choose from, offering many choices for those in need of health care.

You can browse the brochures for different plan options. There are many different options available to you and you can choose options based on your federal poverty level, deductible options, out-of-pocket expenses, and coinsurance amounts. The provider directory will help you find a provider in your area.

Here is an example of a Gold Coverage Plan:

  • Emergency services: no charge
  • Emergency transportation/ambulance (air or ground): no charge
  • Urgent care: no charge for in-network providers
  • Annual well-visit/screening/immunization/well-baby: no charge
  • Primary care visit to treat illness or injury and maternity visits: no charge
  • Specialist visits (cardiology, podiatry, chiropractic): no charge
  • Imaging (CT/PET/ MRI): no charge
  • X-rays (diagnostic/Imaging): no charge
  • Inpatient facility fee: no charge
  • Inpatient hospital physical and surgical services: no charge
  • Outpatient surgery physician/surgical services: no charge
  • Laboratory outpatient & professional services: no charge
  • Mental/behavioral health & substance use disorder outpatient services: no charge
  • Rehabilitation eye exam (1 visit per year): 100% coverage
  • Eyeglasses (frame 1 per year): 100% coverage
  • Lenses (per pair): 100% coverage
  • Prescription drugs: no charge for generics, preferred brand drugs, non-preferred brand drugs or specialty drugs.

Member Benefits

  • Rewards program: You can earn up to $250 per year for preventive care measures.
  • Nurse advice line: A registered nurse is available 24/7 to answer questions and give medical advice.
  • Care management: This is a resource program to help those with behavioral conditions or complex medical conditions.
  • Health management programs: support for those with chronic health conditions
  • Pregnancy support for women and babies: specialized support for pregnant mothers and babies.
  • A video library: The video library offers resources to members to help them stay informed. Instructional videos are available for automatic bill pay, care locations, secure member accounts, preventive care services, and how to locate your primary caregiver.

How to Enroll

If you are interested in enrolling for coverage through Ambetter, you'll first provide basic information (family size, income, etc.) to find out what plans you are eligible for (you may be eligible for a subsidy). You’ll then be provided with a list of plan options. After comparing available plans, you can enroll for coverage. You will receive a welcome packet and insurance ID card in the mail.

Although you can only enroll in an Ambetter healthcare plan during open enrollment season if you have a qualifying event you might be able to enroll or change plans outside of the open enrollment window. Qualifying events include:

  • Marriage
  • Birth, adoption, or placement of a child
  • Losing your health coverage (non-voluntary)
  • Relocation (to new zip code)
  • Citizenship status change
  • Release from prison

You'll need to call the company at 1-877-687-1197 to see if you qualify. A special enrollment period typically lasts 60 days after a qualifying life event.

Customer Service Ratings/Reviews

While not accredited, Ambetter has a “B-“ rating with the Better Business Bureau (BBB), based on 33 customer complaints and 15 customer reviews. Overall, Ambetter scored a BBB composite rating of 2.56 out of 5 stars. While companies are under no obligation to seek BBB accreditation, it does allow consumers to see how the company handles and resolves customer complaints.

Ambetter from Coordinated Care has more than 30 years' experience providing healthcare coverage. There are several benefit plans to choose from to fit almost any household budget and medical situation. To find out more about the specific health plans you qualify for, you can visit the Ambetter website or contact a company representative at 1-877-687-1197 (TTY/TDD 1-877-941-9238).

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