What You Need to Know
Ambetter from Sunshine Health is available through the federal Health Insurance Marketplace in Florida.
Ambetter offers the essential coverage required by the Affordable Care Act as well as extras like telemedicine.
Ambetter recently expanded its coverage to over 60 counties in Florida.
Who Is Ambetter?
Ambetter from Sunshine Health is the federal Health Insurance Marketplace plan available in Florida. Sunshine Health, which has been serving Florida since 2007, also offers Medicare and Medicaid coverage. It has more than 1 million members statewide.1
Ambetter provides Marketplace plans in 20 states nationwide, covering over 2 million members.2 Plans are underwritten by Celtic Insurance Company, part of the multinational Centene Corporation.
Ambetter from Sunshine Health is available at different levels of coverage and offers the essential health benefits required by the Affordable Care Act (ACA), such as maternity care or mental health services. Centene Corporation has over 30 years of experience in the managed care industry.3
Ambetter has added 33 counties for 2021, for a total of 63 counties in Florida.4
What Health Insurance Does Ambetter Offer?
Whether you need coverage for yourself or your family, Ambetter from Sunshine Health has options for you through the Health Insurance Marketplace, depending on your income and family size. With a variety of metal levels, you can choose a plan that suits your needs and budget.
Bronze plans offer the lowest premium with essential care coverage. You may want to consider a silver plan if you need more balanced care. Gold plans require the highest premiums, but also offer the most comprehensive coverage with lower out-of-pocket costs.
What Member Benefits Are Offered by Ambetter?
In addition to basic benefits, including dental and vision coverage, Ambetter from Sunshine Health offers virtual visits and telemedicine. You can call the Nurse Advice Line to see whether an issue requires a doctor’s visit. There’s also a mail-order pharmacy program and a “Start Smart for Your Baby” maternity support program.5 The My Health Pays Rewards Program gives you points for activities like exercising and eating healthy, which you can use to get a discount on costs like premiums and copays.6
Where You Live Matters
The number of in-network providers available may depend on where in Florida you live.
How Do You Enroll in Coverage with Ambetter?
There are several ways to enroll in a plan with Ambetter from Sunshine Health. You can go directly through their website.7 You can also call Ambetter at (877) 687-1169 or through Relay at (800) 955-8770 if you have hearing issues. If you’d like more help, a licensed broker or insurance agent can help you through the signup process.
The Open Enrollment Period for the Health Insurance Marketplace is November 1 through December 15 annually. You can enroll outside that period if you qualify for a Special Enrollment Period, in situations like a job change, having a baby, or losing current insurance.
How Do You File Claims With Ambetter?
If you see an in-network provider, that claim will be filed by your provider to Ambetter. If you see an out-of-network provider, you may need to pay for services and request reimbursement afterward. Forms are available at Ambetter’s website.9 Most claims are paid within 30 days.
It pays to check for in-network providers before receiving services or getting a referral. Sunshine Health has more than 32,000 providers10 in its network, including primary care providers and specialists.
Save Money In-Network
Ambetter plans are HMOs, meaning you’ll save money by using in-network providers and services.
How Is Ambetter Rated?
The Better Business Bureau (BBB) rates Ambetter from Sunshine Health an A+ with accreditation going back to March 19, 2020.11 The BBB also notes several complaints against the company, although they are not used in the rating assessment.
The National Association of Insurance Commissioners (NAIC) Complaint Index didn’t list any complaints about claims or customer service. There was one complaint filed in 201812 related to “no jurisdiction” under marketing and sales.
Best Company gives Ambetter from Sunshine Health 1.4 out of 5 stars based on customer reviews.13 Though Ambetter is considered a budget-friendly option, customers say it offers poor customer service, difficulty with preauthorizations and high claims costs.
What Are the Strengths of Ambetter from Sunshine Health?
Ambetter plans will provide basic, federally mandated healthcare coverage at a relatively low cost, especially if you qualify for a tax credit or cost-sharing reductions on your plan. With three levels of coverage to choose from, you can pick the level that best suits your health needs and your budget.
What are the Weaknesses of Ambetter from Sunshine Health?
Ambetter plans are HMOs, meaning you need to see in-network providers for your services to be covered. If you see an out-of-network provider, it might cost you more out-of-pocket. The number of providers in your network might be limited, depending on where in Florida you live.
You have many choices among Florida health insurance companies for coverage. Research your options to decide whether Ambetter from Sunshine Health offers the right coverage for you. Reach out to the company, either online or by phone, if you’d like to sign up.
The views and opinions expressed are those of the authors and do not necessarily reflect the official policy or position of HealthCareInsider.com or HealthCare, Inc.