Buying your own health insurance can be scary – especially if you are used to getting it only through your employer. However, if you are self-employed, have recently lost your job, or have any other reason to need or buy your own health insurance, you should make sure that you find a balance between cost and coverage.
Ambetter tries to do just that by offering three different levels of plans in different states. In this review by Ambetter Insurance, I will dig into the company in depth so you can determine if it is right for you.
What is Ambetter Insurance?
Ambetter Insurance is a health insurance company that aims to reduce health care costs. Therefore, they design health insurance plans that suit both your needs and your budget.
Ambetter goes beyond health insurance. You are committed to ensuring that the well-being of your customers goes beyond the visits to your doctor and everyday life. As an organization, they say they are active in local communities and are committed to ensuring that their customers live well.
Each of their plans includes programs, tools, and support. Some examples are telemedicine (visit your doctor using a video conference), a reward program, integrated care management, a 24/7 nurse advice center, and more.
Their products are offered by Centene Corporation, a Fortune 500 multinational with over 30 years of managed care industry experience. They also have an extensive portfolio of healthcare solutions that specialize in the organizations they work with, such as: B. Ambetter.
How does Ambetter Insurance work?
Ambetter Insurance offers you three different types of plans: bronze, silver and gold. Each has its own advantages and disadvantages, and you need to determine which is best for you and your situation.
Each plan also varies slightly based on where you live (assuming it’s available in your state). Here is a brief breakdown of each level:
- Bronze: T.Ambetter views this as his primary care plan. It covers your most important health needs. You will tend to see lower monthly premiums but higher expenses.
- Silver: T.This is Ambetter’s Balanced Care Plan that balances the monthly premium you pay and your expenses.
- Gold: This is what Ambetter calls its Secure Care Plan, which gives you security for all of your health needs. In order to achieve this, higher monthly premiums are displayed which help limit the out-of-pocket expenses that may arise later.
Here is a picture of how the three plans work in terms of cost:
Each state has its own plans within these three levels, and you can see the full plan details of your state Here. Plans are currently offered in the following states:
- New Hampshire.
- North Carolina.
- South carolina.
Once you’ve identified your state and a plan you want, fill out the required information and receive a quote for a policy. Regardless of the plan and coverage you choose, every plan has coverage for:
- Emergency care.
- Outpatient or outpatient care.
- Preventive & wellness care.
- Maternity and Newborn Care.
- Pediatric care.
- Mental health and substance abuse.
- Laboratory services.
- Prescription drugs.
- Therapy services.
What does Ambetter insurance cost?
The cost of each type of insurance, especially health insurance, is so different. Because of this, it’s difficult to pin down an exact price, or even a range of prices, for what you are likely to pay.
Some websites will try to give you a specific price on Ambetter (just do a Google search if you don’t believe me) but honestly I wouldn’t rely on it. That’s a baseball number based on a fictional person – not she.
The only way to really understand the cost is to fill out some basic information, including where you live and where Receive an offer tailored for YOU.
Ambetter insurance functions
My Health Pays® program
Earn rewards for healthy activities like good food, exercise, smart savings, and healthier lives. The more actions you finish, the more rewards you will get.
Ambetter works with suppliers and pharmacists to ensure medicines used to treat a range of diseases are covered. Ambetter covers prescription drugs and certain over-the-counter drugs when arranged by an Ambetter supplier.
Note that the Ambetter pharmacy program does not cover all medicines – some require prior approval or are limited in age, dose, and maximum levels. You can also view the lists of preferred medicines on their website.
Nurse advice line
With Ambetter, you can talk to a nurse at any time. They are open 24 hours a day, seven days a week and 365 days a year. The nurse information line will help you and your family get the attention you need, when you really need it. It is manned by experienced nurses who are ready to assist you with any follow-up appointments, urgent matters (i.e. pregnancy pain), or whether or not you need to go to the emergency room.
In the event you have complicated medical or behavioral health needs, Ambetter Care offers management services that are “member-centric, family-oriented, and culturally competent”. Nursing managers are licensed nurses or social workers. They could help you better understand and treat your chronic conditions, find community resources, and more.
And if you suffer from a serious illness, Ambetter has maintenance managers who work with you personally, your GP, and the providers to create a care plan that meets your needs and the needs of your caregiver.
Health management programs
If you have a chronic illness, Ambetter works with the disease management company to offer you solutions to treat diseases. Ambetter wants you to lead a healthy lifestyle so that they can receive support over the phone, through educational resources, and in other ways so that you can better understand and control your condition and have fewer complications. Ambetter also offers behavior-related health services such as depression management.
Start Smart for Your Baby®
Start Smart for Your Baby® (Start Smart) is Ambetter’s unique program for pregnant women that allows you to take better care of yourself and your baby every step of the way. To participate in this program, simply contact Member Services or log into your Ambetter member account to fill out a NOP (Notification of Pregnancy) form.
Ambetter Telehealth was brand new last year and is offered through Teladoc. Telemedicine is simple and accessible around the clock to Ambetter network-internal healthcare providers who are not responsible for emergencies.
It’s available to you when you are at home, at work, or even on vacation. It is possible to get medical information, a diagnosis, or even a prescription via telephone or video conference. You can use Ambetter Telehealth when you need it, or you can make an appointment for a future time that works for you.
My experience with Ambetter
Fortunately, Ambetter works in my state, but it was a little difficult to find where to sign up, which was a bit annoying. Still, I found out and was able to test their service!
When I finally found the page where I could get a price quote, the information requested was pretty simple – zip code, name, email address, and phone number. The only thing that was needed was the zip code.
Next, I had to fill in some basic information about myself, including whether I was a tobacco user (a drop-down menu once you’ve selected your gender):
From there, I had to enter how many people I wanted to insure and how many people were in my household, as well as my annual income – the basics of any health insurance application.
Based on your income level, Ambetter will then tell you whether or not you qualify for savings:
You will then be asked by Ambetter for the desired coverage ratio (these are the plans for bronze, silver and gold):
After choosing the plan, decide whether you have providers that you are already seeing and medications that you are already taking.
Finally, you will be offered a few options:
At this point, you can change your options and sign up for a plan once you’re ready. The important thing is that your preferred providers are covered – this is indicated at the bottom of the screen.
Overall, the process was pretty straightforward. The two main problems I found were finding where to actually get an offer and severe restrictions on where and what was on offer. I had to try three different zip codes (in areas of coverage) before I found one with Ambetter coverage.
In one case, I found that the hospitals I selected were not covered. So you need to be flexible if you are in a covered area and want to work with Ambetter.
The prices of buying your own health insurance seemed pretty normal (I’ve always estimated around $ 1,000 to $ 1,200 a month for a family when I wasn’t employed) so a shadow over $ 300 for a person didn’t surprise me.
Who is Ambetter Insurance best for?
Ambetter insurance is good for people who don’t get health insurance through their employer, have Ambetter plans in their state, and are looking for competitive prices.
People with chronic illnesses will also find value in the various programs on offer, such as care management. Additionally, those who want virtual access to their providers through Teledoc will love the easy access to this service.
Individuals who like to call a nurse on call will be comfortable with the 24 hour service that allows you to speak to a licensed nurse about anything.
Who shouldn’t use Ambetter insurance?
If you have health insurance through your employer, you probably don’t need to worry about Ambetter as you are likely to have adequate coverage through these (if you don’t, or if you need dental or eyesight, Ambetter might be a good addition).
If you are reading this article, you are likely not covered by an employer. Others who don’t benefit from Ambetter are those who live in a state where they don’t offer plans – since there is nothing you really can do about it.
Finally, there is a possibility that you are not getting the best possible price through Ambetter. They don’t actually offer a “bare bones” service, so you pay a premium for the additional services they offer. So if you’re looking for something a little more nude, you might want to look elsewhere.