You are here to get useful information on Ambetter Insurance Vs. Blue Cross Blue Shield for deciding on your health insurance. We tried to collect important information regarding these two health insurance companies. Just keep reading.
Ambetter is a part of Centene Corporation, a multi-line managed care organization. It is a multi-national Fortune 500 company with over 30 years of experience in the managed care industry. Ambetter health insurance plans provide high-quality healthcare services to its members. For example, Ambetter Insurance offers mental and behavioral health services, maternity care, prescription drug coverage, Vision, and dental coverage.
Ambetter Insurance Vs. Blue Cross Blue Shield:
Here is a brief comparison between Ambetter Insurance and Blue Cross Blue Shield:
Provider Network
Blue Cross Blue Shield is an association of several independent health insurance companies. They provide a certain royalty fee to BCBS to use its trademark and sell health care services. BCBS provides network coverage to 41 states of the USA. On the other hand, Ambetter Insurance offers limited range to only 20 states. Arizona, Florida, Illinois, Kansas, Mississippi, New Hampshire, Nevada, Ohio, South Carolina, North Carolina, Texas, Arkansas, Georgia, Indiana, Michigan, Missouri, New Mexico, Pennsylvania, Tennessee, and Washington.
Types of Plans Offered by Ambetter Insurance
Ambetter Insurance offers limited plans for its members. These are –
- Health Maintenance Organisation (HMO)
- Personal Preferred Organisation (PPO)
- Exclusive Provider Organisation (EPO)
Ambetter is a part of the Health Insurance Marketplace (HIM). It is designed for people without health insurance or who don’t qualify for any typical plan. Ambetter does not offer HSA plans; instead, they have divided their programs into three metal tiers –
Bronze Plan
The bronze medal plan is also called the Ambetter Essential Care, the company’s cheapest policy. Although it has the highest deductible, it is best for people with excellent health who don’t have many scheduled medical expenses.
| Product | Deductible | Out-of-pocket maximums | The monthly cost for a 40-year-old |
| Ambetter Essential Care 1 | $6,800 | $6,800 | $329.47 |
| Ambetter Essential Care 1 + Vision | $6,800 | $6,800 | $333.27 |
| Ambetter Essential Care 1 + Vision + Dental | $6,800 | $6,800 | $342.15 |
Silver Plan
Ambetter Balanced Care or Silver Tier plan has lower deductibles and out-of-pocket money. However, the monthly premiums are quite expensive for this plan.
| Product | Deductible | Out-of-pocket maximums | The monthly cost for a 40-year-old |
| Ambetter Balanced Care 2 | $6,500 | $6,500 | $460.80 |
| Ambetter Balanced Care 1 | $5,500 | $6,500 | $468.18 |
| Ambetter Balanced Care 10 | $5,000 | $6,700 | $487.53 |
| Ambetter Balanced Care 3 | $3,000 | $6,500 | $491.68 |
Gold Plan
The Gold Metal tier or the Ambetter Secure Care has the most expensive premiums. But it has more affordable deductibles and out-of-pocket maximums. Hence, it allows you to take advantage of the coinsurance benefits. Therefore, this plan is the best for those with higher medical expenses.
Product | Deductible | Out-of-pocket maximums |
| Ambetter Secure Care 3 | $6,500 | $6,500 |
When you choose Ambetter, you will get the following Essential Health Benefits (EHBs):
- Emergency care
- Outpatient care
- Preventive and Wellness care
- Maternity care
- Pediatric care
- Mental health and Substance abuse care
- Prescription Drugs, etc.
Blue Cross Blue Shield offers the following plans for its members –
- Health Maintenance Organization (HMO)
- Health Maintenance Organization Point-of-Sale (HMO POS)
- Local and Regional Preferred Provider Organizations (PPO)
- Private Fee for Service (PFFS)
- Medical Savings Account (MSA)
- Special Needs Plans (SNPs)
BCBS also offers HAS plans that are divided into the following metal tiers:
Bronze Plan
The bronze plans of the Blue Cross Blue Shield cover 60 percent of your healthcare expenses. That means you have to bear only 40 percent of the overall cost. Bronze plans come with lower monthly payments but have higher out-of-pocket costs.
Silver Plan
The silver plans cover around 70 percent of your overall healthcare expenses. However, there is a twist in this plan. If you are eligible for a cost-sharing reduction subsidy, the silver plan will cover about 73%, 87%, or 94% of your expenditures. As a result, their monthly payments are lower than a gold plan but higher than a bronze plan. If you do not qualify for the cost-sharing reduction, your out-of-pocket costs will be less than a bronze plan but higher than a gold one.
Gold Plan
The gold plans have higher monthly payments but lower out-of-pocket costs. They cover around 80 percent of your healthcare expenses. This means you have to pay only 20 percent of the total expenditure.
Medicare Plans
Ambetter Insurance and Blue Cross Blue Shield offer Medicare plans for their members. If you are an Ambetter member, they will give you access to coverage with Allwell. It is a Medicare Advantage plan offered by Superior HealthPlan and Sunshine Health. You will get coverage not included in the Original Medicare Plan A and B.
On the contrary, Blue Cross Blue Shield offers members Medicare plans through selected healthcare providers. These include Medicare Advantage (Part C), Medical Supplement or Medigap plans, and Prescription Drug Plans (Part D).
Both companies offer their customers various plans with individual benefit levels. If you want to buy any methods, contact your nearest provider and choose the best plan and best place.
Ambetter may be a good option for those with no health insurance or who do not qualify for any typical plan. In addition, they are affordable compared to some health insurance companies. However, Ambetter only serves 20 states, and some states have a high complaint ratio.
Does Blue Cross Blue Shield cover outside the US?
Many people go abroad for work or living purposes for an extended period. Blue Cross Blue Shield offers GeoBlue plans for them.
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