Ambetter Health Insurance – Private And Senior Plans From Centene Corporation

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.

Although the provider network is fairly extensive, typically, you will not find any of their plans on federal or state Exchanges. Since Marketplace policies must contain 10 “essential health benefits,” and be available during Open Enrollment periods, Celtic contracts do not meet the criteria. These policies are also not eligible for federal subsidies.

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.

Centene Inc. actually 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.

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 states: Washington, Nevada, Arizona, Kansas, Texas, Missouri, Arkansas, Illinois, Indiana, Ohio, Pennsylvania, Mississippi, Tennessee, Georgia, Florida, South Carolina, North Carolina, and New Hampshire.

 

Ambetter Under-65 Plans (Rates And Policies Can Vary By State)

Ambetter Balanced Care 1 – $30 and $60 office visit copays. Urgent Care copay is $100. $5,500 deductible with 20% coinsurance. Generic and preferred brand drug copays are $10 and $50. Mail order is available with $30 and $150 copays.

Ambetter Balanced Care 2 – $30 and $60 office visit copays. Urgent Care copay is $100. $6,500 deductible with 0% coinsurance. Generic and preferred brand drug copays are $15 and $50. Mail order is available with $45 and $150 copays.

Ambetter Balanced Care 4 – $30 and $60 office visit copays. Urgent Care copay is $100. $7,050 deductible with 0% coinsurance. Generic and preferred brand drug copays are $15 and $50. Mail order is available with $45 and $150 copays.

Ambetter Balanced Care 5 – $40 and $80 office visit copays. Urgent Care copay is $100. $7,350 deductible with 0% coinsurance. Generic and preferred brand drug copays are $20 and $60. Mail order is available with $60 and $180 copays.

Ambetter Balanced Care  7 – $50 and $75 office visit copays. Urgent Care copay is $100. $5,100 deductible with 20% coinsurance. Generic and preferred brand drug copays are $10 and $50. Mail order is available with $30 and $150 copays.

Ambetter Balanced Care 9 – $30 and $50 office visit copays. Urgent Care copay is $50. $4,200 deductible with 20% coinsurance. Generic and preferred brand drug copays are $20 and $40. Mail order is available with $60 and $120 copays.

Ambetter Balanced Care 11 – $30 and $60 office visit copays. Urgent Care copay is $100. $6,000 deductible with 40% coinsurance. Generic and preferred brand drug copays are $20 and $50. Mail order is available with $60 and $150 copays.

Ambetter Essential Care 2 – HSA-eligible plan with $6,550 deductible and 0% coinsurance.

Ambetter Secure Care 1 With Three Free PCP Visits – First three pcp visits are free. $1,000 deductible with 20% coinsurance. Generic drug copay is $10. Mail order is available with a $30 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.

Find Celtic Online

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 –  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, education expenses, rent, 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.

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, upper respiratory infections, and stomach ailments.

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 nurses can help diagnose the medical issue and determine if immediate help is needed, and what type of treatment should be performed.

Care Management – Social workers and registered nurses provide case management that helps coordinate services, manage medical conditions, and  find local community resources.

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.

 

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 $35,000 household income

$119 – Essential Care 1

$277 – Balanced Care 11

$290 – Balanced Care 5

 

Cincinnati, Oh. 40-year-old with $30,000 household income

$202 – Balanced Care 11

$206 – Balanced Care 5

$235 – Balanced Care 2

 

Indianapolis, In. 30-year-old with $25,000 household income

$131 – Essential Care 2

$136 – Balanced Care 11

$145 – Balanced Care 5

 

Chicago, Il. 40-year-old with $28,000 household income

$163 – Balanced Care 11

$179 – Balanced Care 4

$191 – Balanced Care 2

 

St. Louis, Mo. 40-year-old married couple with $50,000 household income

$364 – Essential Care 1

$407 – Balanced Care 11

$411 – Balanced Care 5

 

Houston, Tx. 50-year-old married couple with $55,000 household income

$260 – Essential Care 1

$432 – Balanced Care 5

$452 – Balanced Care 11

 

Coverage Area By County

Arizona (Arizona Complete Health) – Maricopa and Pima.

Arkansas (Arkansas Health And Wellness) – All counties.

Florida (Sunshine Health) – Alachua, Broward, Charlotte, Citrus, Clay, Duval, Flagler, Hernando, Highlands, Hillsborough, Lake, Marion, Manatee, Miami-Dade, Okeechobee, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Putnam, Sarasota, Seminole, St. Lucie, and Volusia.

Georgia (Peach Street Health Plan) – 90 counties throughout the state.

Illinois (Illinicare Health) – Cook and DuPage.

Indiana (MHS) – All counties.

Kansas (Sunflower Health Plan) – Johnson, Leavenworth, Miami, and Wyandotte.

Mississippi (Magnolia Health) – All counties.

Missouri – (Home State Health) – All western counties plus selected eastern counties.

New Hampshire (NH Healthy Families) – All counties.

Nevada  (SilverSummit Health Plan) – All counties.

North Carolina – (Ambetter of NC) – Durham and Wake.

Ohio (Buckeye Health Plan) – Allen, Butler, Carroll, Champaign, Clark, Columbiana, Cuyahoga, Darke, Geauga, Greene, Hamilton, Harrison, Lake, Logan, Lorain, Lucas, Mahoning, Medina, Montgomery, Portage, Preble, Shelby, Stark, Summit, Trumbull, Van wert, and Warren.

Pennsylvania (Pa Health And Wellness) – Bucks, Montgomery, and Philadelphia.

South Carolina (Absolute Total Care) – Charleston.

Tennessee – (Ambetter of Tennessee) – Bledsoe, Bradley, Fayette, Franklin, Grundy, Hamilton, Haywood, Lauderdale, Marion, McMinn, Meigs, Polk, Rhea, Sequatchie, Shelby, and Tipton.

Texas (Superior HealthPlan) – 44 counties.

Washington  (Coordinated Care) – Adams, Benton, Chelan, Columbia, Douglas, Franklin, Grant, Jefferson, King, Kittitas, Lewis, Lincoln, Pierce, Snohomish, Spokane, Stevens, Thurston, Walla Walla, and Yakima.