Ambetter from Superior HealthPlan Review

Ambetter Health Insurance Review

Ambetter, a Centene Corporation brand, is one of the nation’s largest ACA Marketplace insurers, covering over 4.4 million members as of 2025. Focused exclusively on under-65 coverage, Ambetter provides Bronze, Silver, and Gold plans—along with Value and Select tiers—in 29 states. It recently launched Ambetter Health Solutions for employees using ICHRA funding. While it excels in affordability and plan options, Ambetter faces criticism over customer service, network clarity, and claims management.

Pros and Cons

Pros

• Available in 29 states, including wide county-level coverage
• Broad ACA plan tiers, including new employer-focused ICHRA options
• Low premiums and deductibles in many competitive markets
• Integrated wellness rewards (My Health Pays®) worth up to $500/year
• Digital tools and 24/7 telehealth access included

Cons

• No Medicare, Medicaid, or short-term plans under Ambetter brand
• High complaint rates regarding billing, denials, and network access
• Narrower networks on Value/Select plans may limit provider choice
• Prior authorization and referral rules often cited as frustrating
• No global emergency care; limited to U.S. coverage only

Coverage Area (2026)

United States

Ambetter operates in 29 states, including large footprints in Texas, Florida, and Georgia. The recent expansion added 60 new counties, including coverage in Iowa.

International

Ambetter does not provide international coverage. Emergency care is limited to U.S. services only.

Provider Network

Provider access varies by plan tier (Premier, Value, Select). Some plans require referrals and restrict out-of-network services. Directory accuracy has been a recurring concern.

Plan Types Offered (2026)

Under-65 (Individual & Family)

• ACA Marketplace Plans
  Ambetter offers Bronze, Silver, and Gold tiers, including:
• Premier Plans
  Broadest network, no referrals required.
• Value Plans
  Narrow networks, referrals required. Available in select counties in Texas and Florida.
• Select Plans
  Available in select regions with unique pricing and network terms.
• Solutions Plans
  For Individual Coverage Health Reimbursement Arrangement (ICHRA-eligible) employees in GA, IN, MS, MO, OH, and SC. Learn more about Ambetter Health Solutions.
• TXSMP
  This is a standardized off-exchange gold-tier plan offered in Texas only.
• Short-Term Medical (STM)
  Not offered.
• Employer-Sponsored Plans
  Ambetter Health Solutions supports employers using ICHRAs to fund ACA-compliant coverage.
• Student Health Plans
  Not available.
• Medicaid
  Offered by Centene subsidiaries, but not under the Ambetter brand.

Medicare (65+)

• Medicare Advantage (MA)
  Not available under Ambetter. Medicare coverage is provided through other Centene brands.
• Medicare Supplement (Medigap)
  Not offered.
• Part D Prescription Drug Plans
  Not available.

Retiree Group Medicare: Not offered.

Recent Changes in Cost and Options (2026)

Premiums and Rate Changes

Ambetter maintains low premiums in many states (e.g., Florida) but expects increases in line with national trends—employer plan costs projected to rise 6–8%.

Out-of-Pocket Costs

Plans offer low average deductibles for Silver-tier plans. Ambetter integrates ACA subsidies (APTC, CSR) to improve affordability.

Medicare Advantage Updates

Not applicable—Ambetter does not offer Medicare plans.

Plan Enhancements

Digital enrollment tools, telehealth, mobile access, and mail-order pharmacy services are included. Member perks like Walgreens discounts and My Health Pays® incentives enhance value.

Network Agreements

Ambetter added coverage in 60 counties for 2025–2026 and broadened its ICHRA plan footprint.

Consumer Experience Snapshot

Complaint Index

Ambetter consistently receives more complaints than expected for its size, particularly in areas like billing, prior authorizations, and outdated directories.

Satisfaction Scores

No published ACSI scores. Member feedback is mixed—praise for affordability, criticism for network and support issues.

Methodology

Our Health Insurance Rating Methodology scores insurers across five main categories, each rated on a scale of 1 to 10. The overall score is the average of: Coverage, Breadth and Accessibility, Plan Variety and Customization, Affordability and Value, Innovation and Care Quality, and Consumer Experience and Transparency. Categories assess provider reach, plan diversity, cost structure, care delivery, and member service experiences based on public data, filings, and expert analysis.

Bottom Line

Ambetter is a strong contender for budget-conscious ACA shoppers seeking flexible plan tiers and wellness perks. With growing employer-facing options and wide geographic reach, it delivers competitive value. However, ongoing complaints about claims, billing, and network accuracy suggest that members should carefully research provider participation before enrolling.

Best for

Affordable ACA plans with wellness rewards and digital tools.

Not ideal for

Consumers seeking Medicare, Medigap, global coverage, or premium customer support.

Disclaimer

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.