Ambetter from Sunshine Health Insurance Review

Ambetter from Sunshine Health is Florida’s ACA Marketplace plan, offered through Sunshine Health, a subsidiary of Centene Corporation. Sunshine Health has served Florida since 2007 and covers more than 1 million members through Medicaid, Medicare, and Marketplace products. Ambetter provides ACA Marketplace coverage in 29 states and insures more than 4.4 million members nationwide as of 2025.

Ambetter plans in Florida are underwritten by Celtic Insurance Company, part of Centene Corporation, a managed care leader with over 30 years in the industry. Ambetter focuses on affordable coverage for individuals and families under 65, offering a range of ACA-compliant options with built-in telehealth and wellness programs.

Pros and Cons

Pros

• Available in 63 Florida counties, including recent expansions
• Wide range of ACA plans (Bronze, Silver, Gold) with Value and Select tiers
• Competitive pricing in many Florida markets
• My Health Pays® rewards program worth up to $500 annually
• 24/7 telehealth and digital tools included

Cons

• No Medicare, Medigap, or short-term medical coverage
• Higher-than-average complaints about billing, claims, and provider networks
• Narrower networks for Value/Select plans may restrict provider access
• Prior authorization and referral rules can be burdensome
• U.S.-only emergency coverage (no international benefits)

Coverage Area (2026)

• Florida: Ambetter from Sunshine Health is available in 63 counties, following recent expansions across the state.
• National: Ambetter operates in 29 states with a strong presence in Florida, Texas, and Georgia.
• International: Coverage is limited to U.S.-based services; international emergency care is not included.

Provider Network: Ambetter plans in Florida offer access to more than 32,000 providers, though availability varies by county and plan tier. Value and Select tiers may restrict provider choice and often require referrals.

Plan Types Offered

• ACA Marketplace (Individual & Family, Under-65):
  • Bronze Plans: Lowest premiums, higher out-of-pocket costs
  • Silver Plans: Balanced coverage, eligible for cost-sharing reductions
  • Gold Plans: Higher premiums but lower out-of-pocket expenses
  • Value & Select Plans: Narrower networks at lower costs, available in certain counties
• Employer-Sponsored (ICHRA Solutions): Not offered in Florida under Ambetter brand
• Short-Term Medical: Not available
• Student Health Plans: Not available
• Medicaid/Medicare: Offered by Sunshine Health but not under the Ambetter label

Recent Changes and Benefits

• County Expansion: Ambetter added 33 new counties in Florida for a total of 63.
• Member Benefits:
  • Virtual visits and 24/7 telemedicine
  • Nurse Advice Line
  • Mail-order pharmacy program
  • Start Smart for Your Baby® maternity support program
  • My Health Pays® rewards for healthy behaviors, redeemable for premiums, copays, and other costs
• Enrollment: Available through the federal Marketplace (HealthCare.gov), Ambetter’s website, licensed brokers, or by phone. Open Enrollment runs November 1–January 15, with Special Enrollment options available for qualifying life events.

Consumer Experience Snapshot

• Complaint Index: Ambetter consistently receives more complaints than expected for its size, particularly around billing, claims denials, and provider directory accuracy.

Satisfaction: Mixed feedback—members often praise affordability and benefit, but cite frustration with claims processing and customer service.

Bottom Line

Ambetter from Sunshine Health is a strong option for budget-conscious ACA shoppers in Florida, offering affordable Bronze, Silver, and Gold plans with added wellness perks and digital tools. Its wide county coverage makes it accessible across much of the state.

However, narrow networks and frequent consumer complaints around billing and claims mean prospective members should carefully review provider directories and understand referral requirements before enrolling.

Best for: Affordable ACA coverage with telehealth, maternity support, and wellness rewards.

Not ideal for: Seniors, those seeking Medicare/Medigap, or members who need broad provider access and premium-level customer service.