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.

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

Celtic 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.

Basic is…well…a basic plan! It’s cheap, economical and although a few corners are cut (which is expected), this option is not a bad “first policy” option. Although routine annual physicals and similar treatment is fully covered, only two other types of visits are included in the policy. So if you rarely visit a physician, it’s not a big issue. Otherwise, it may not be the best choice.

If you have a major illness or injury, you will pay more out of pocket than the Preferred plan. The same applied to prescriptions. The $500 deductible is doubled to $1,000 and the coinsurance also increases. Once again, if you rarely use brand name drugs, you won’t mind the differences. Naturally, there is no accurate way to predict what your prescription usage is going to be over the long run.

Two additional costs are a $500 hospital confinement and $350 outpatient hospital charge. These would be in addition to any other applicable fees or expenses. If you never use the major medical portion of your policy, these will not be issues. Otherwise, they are another fee that will have to be paid.

 

Use Any Doctor

There is also an “Any Doc” option that allows the customer to utilize any physician regardless of network affiliation. This feature is especially attractive if you live in a rural area or you simply prefer to keep using a doctor that is not in the Celtic network.

The CelticSaver HSA is their version of a Health Savings Account. It features all of the advantages of that type of plan (deductible contributions, control over the delivery of your benefits and rollover of unused funds). Individual deductible options range from $2,000 to $6,000 and family options are $4,000 to $12,000.

Their best pricing seems to be in the $4,000 to $8,000 range. The 30% coinsurance feature is a cost-saver for budget-minded consumers. The creation of a separate account to make tax-deductible contributions is optional. However, if you plan on keeping the policy for an an extended period of time, we advise you to set it up. A Managed Indemnity option is also offered that allows you to use any provider.

All policies include  a “Healthy Lifestyle” benefit that reimburses the policyholder for specifically-designated memberships to exercise clubs and certain similar facilities. The maximum payout is $300 and 1/4 of the membership cost. Also, a free annual vision examination is included with all company plans along with many other eye-care related services including new lenses  annually and new frames every other year. Even a LASIK discount is included.

But what about the most important thing? What about Celtic’s rates? Are they competitive in most areas? Actually, they are. While their policies are rarely the least expensive option when comparing to other insurers such as Blue Cross or Aetna, often one of the available contracts will be a good option to choose for a specific circumstance. So our advice is to keep them on your short list of  companies that you are considering.