What is Ambetter Insurance? A Sunshine Health Guide

Are you looking at your health coverage options? You may have heard of Ambetter insurance. In fact, and it is a major player in the health insurance marketplace. This guide will teach you everything that you need to know. But we are going to get deep into what Ambetter offers. In addition, you’ll find out about its relationship with Sunshine Health. We would like you to make an informed decision. After all – your health is your most important asset.

Finding the Right Health Plans can be an Overwhelming Process. Indeed, there are so many term and options. However, we are here to help ease it for you. Consequently, this article takes the piece by piece of Ambetter insurance. You will be familiar with the plans, benefits and costs. We will also guide you through the enrolment process. Let’s begin this journey together.

Understanding Ambetter Insurance at a Glance

So, what is Ambetter insurance? It is a brand name of health insurance plans. In particular, these plans are offered on the Affordable Care Act (ACA) Marketplace. You may be familiar with this as Obamacare. Centene Corporation is a large healthcare company that owns Ambetter. They are more focused on providing affordable coverage. As a result, their plans are available in many states throughout the U.S.

Ambetter’s primary focus is to provide for individuals and families. These are people who purchase their own insurance. For example, they may not obtain it from an employer. This means freelancers and small business owners. To them finding affordable business insurance and personal health coverage is very important. Ambetter, therefore, strives to meet that need by enabling access to much-needed medical care.

Explaining the Ambetter Insurance and Sunshine Health Connection

You possibly might view the name “Ambetter from Sunshine Health.” At the beginning, this is a bit confusing. Let’s clear it up for you. Think about Centene Corporation as the parent company. It operates in different states under local brand name. In the state of Florida, for instance, that local brand is Sunshine Health. So, the name Ambetter from Sunshine Health is the name of Ambetter insurance plans that are offered in Florida.

This local approach is rather widespread. It helps companies get closest to communities. Consequently, they are able to adapt services to meet a state’s needs. Sunshine Health has a significant presence in the state of Florida. They certainly know the local healthcare landscape. This partnership is to ensure Floridians receive relevant care. If you are outside of the state of Florida, you will see Ambetter paired with another local health company.

“The first wealth is health.”

– Ralph Waldo Emerson

This quote reminds us as to why this is important. Your health is the foundation of everything that you do. One major part of protecting that wealth is to choose the right insurance plan. It’s a big monetary and personal commitment. Therefore, it requires careful thinking the way you would when comparing a State Farm life insurance proposition for the future of your family.

Navigating the Marketplace for Ambetter Insurance

Ambetter insurance plans are only available on the health insurance marketplace. This online market was developed by the Affordable Care Act (ACA). Essentially, it is a one-stop health coverage shop. You may compare the plans of the various companies. You can also check to see if you are eligible for money assistance. This ultimately makes the insurance accessible to everyone.

The Marketplace is user-friendly. It makes a complicated process much easier. For example, you can see your all options at one place. Companies such as Ambetter, and even their competitors such as United Healthcare insurance, list their plans here. In short, this competition helps to keep the prices in check, and gives you as the consumer more power and choice.

Who is Eligible for Marketplace Plans?

To purchase a plan on the Marketplace you must meet certain criteria. First of all, you have to be living in the United States. You must also be a U.S. citizen or must be legally in the country. And what you can’t be is incarcerated. Most important if you have access to affordable job-based insurance you may not be eligible for subsidies. The Marketplace is mainly for individuals who do not have access to any other coverage alternatives.

Financial assistance is a very big part of the Marketplace. Based on your income, help may be available to you. For example: you have premium tax credits on your monthly payments going down. Cost-sharing reductions can also help to reduce your out-of-pocket cost. These subsidies have allowed millions of people to make health insurance coverage a reality.

Key Enrollment Periods You Must Know

You can’t sign up for health insurance just any time. There are special windows for enrolling. Understanding these are absolutely critical. Missing a deadline, for example, might leave you without health insurance. Let’s have a look at the two major periods.

Open Enrollment

The Open Enrollment period is a specific time of year every year. It is usually in the fall, November 1 – January 15 in most states. During this time window, anyone may sign up for a new plan. You can also switch your current Marketplace plan. It is the time to review your health plans. After all, your needs may have changed throughout the past year.

Special Enrollment Periods (SEPs)

What if you are in need of coverage outside of Open Enrollment? Life happens. For instance, you may get married or have a baby. You could also lose your job coverage. These types of events are referred to as “qualifying life events.” In turn, the latter initiate a Special Enrollment Period (SEP).

This is a 60-day period in which to get a new plan. It’s a bit like needing temporary car insurance, after a sudden change, a SEP will give temporary window to get needed essential coverage. You can see the complete list of qualifying events from the official HealthCare.gov website.

A Deep Dive into Ambetter Insurance Plans

Ambetter insurance has plans that come in three “metal” tiers. These are Bronze, Silver and Gold. The tiers, however, cannot be used to indicate the quality of care. They only provide a description of how you and plan share costs. Importantly, all tiers cover the same key benefits. Let’s have a look on what each of the tiers means for your Jordan wallet. Choosing to be the right one is like term life insurance vs. whole life insurance, a balance between upfront cost and a long-term value.

Ambetter Insurance Bronze Plans (Essential Care)

The monthly premium is lowest for Bronze plans. This is their major attraction. However, they have the highest deductibles and copays. A deductible is pleasantly a thing that you will pay before the insurance starts paying. This means that you will pay more out-of-pocket for care. A Bronze plan is good if you generally are healthy. It is a safety net for major unexpected medical events.

Consider it to be catastrophic coverage. You’re covered from very high medical bills. But for routine visits, you will have to pay more out-of-pocket. If you don’t see the doctor regularly this could save you money. In other words, you have the peace of mind of being covered by health insurance coverage. It’s quiet a cutoff location undoubtedly-decent and affordable.

Ambetter Insurance Silver Plans (Balanced Care)

Silver plans are the most popular because of a reason. They provide a pulmonary to medium balance. Your monthly premium will be the higher the more. In contrast, your out of pocket costs are going to be less. They are a good middle-of-the-road option. For this reason, they are successful for many individuals and families.

The real power in the Silver plans is cost-sharing reductions (CSRs). These are additional savings for Silver plans that are not available on other plans. If you earn less than a certain amount, CSRs will reduce your deductible, copayments and coins. This can cause a Silver plan to be even less expensive than a Bronze plan overall. Therefore, you need to check your eligibility for CSRs.

Ambetter Insurance Gold Plans (Secure Care)

Gold plans come with the highest monthly premium. In return, they have the least out-of-pocket costs. Your deductible will be low, and will be much lower. Similarly, your copays for doctor visits and drugs will be small. If you anticipate that you will require frequent medical attention, then a Gold plan is often the best option. This may be because of a chronic condition or because of a planned surgery.

With gold plan, your healthcare costs are more predictable. You are paying more in advance on a monthly basis. However, you will have less surprise bills. This is a source of financial security. As a result, it is easier for you to budget for your health needs. It is for those with low cost as a high priority at the time of service.

Core Benefits: What Do Ambetter Insurance Plans Cover?

All Ambetter insurance plans of all metal tiers are required to cover a set of core services. These are known as the 10 Essential Health Benefits. This is a formality of the Affordable Care Act. It guarantees that all plans cover in a comprehensive manner. And not only are you getting a discount card, but on the contrary, you are getting actual, significant insurance.

This is standardization that benefits consumers. This way it is easier to compare plans. For example, you know that whichever plan you choose, it will have the basics covered. This also protects people against the junk plans with the hidden gaps in the coverage. Let’s see the review of what these essential benefits are.

Essential Health Benefits (EHBs)

The ACA requires most health plans to cover the following 10 categories:

1. Ambulatory patient services: Outpatient, care you receive without being admitted in a hospital.
2. Emergency services: Care for life threatening conditions, which you can get out-of-network.
3. Hospitalization: This covers stays in hospitals for surgery and overnight stays.
4. Maternity and newborn care: Pre- and post-natal care.
5. Mental health and substance use disorder services: This is behavioral health treatment, as well as counseling.
6. Prescription drugs: Doctors-prescribed drugs.
7. Rehabilitative and habilitative services and devices: Those services to help you recover skills (rehab) or acquire new ones (habilitative).
8. Laboratory services: Medical examinations to assist your doctor in understanding your health condition.
9. Preventive and wellness services and chronic disease management: This includes check-ups, cancer screenings and vaccines for no cost to you.
10. Pediatric services, including oral and vision care: But Kathy’s policy does not cover adult dental and vision as essential benefits.

Value-Added Services with Ambetter Insurance

Ambetter goes beyond the required benefits. In addition, they have a number of additional perks for their members. These programs are intended to get you healthy. They can also save you money. These are some of the selling points of Ambetter insurance.

My Health Pays® Rewards Program

This is a special and popular feature. Specifically, the My Health Pays program gifts you for healthy activities. Being able to complete a health assessment gets you money. In addition, you can earn more for getting a flu shot or walking some number of steps. For these rewards, you earn them on a Visa prepaid card. In the future, you can use the money for healthcare expenses such as premiums, deductibles and copays. It’s a good incentive to be healthy.

24/7 Telehealth

Have to see a doctor but can’t leave the house? Fortunately, Ambetter offers their telehealth services. You can dial a doctor through phone or video. This is available 24/7. It’s great for the non-emergency situations. Think colds, flus, or rashes. Plus, it is convenient and it may save you making a trip out to an urgent care clinic. This service had an even larger value in recent years.

Optional Dental and Vision Plans

As said, no adult dental or vision are EHBs. However, Ambetter tends to have these as optional add-ons. You can buy a separate dental plan. This frequently is through someone akin to Humana dental insurance. Having dental and sight is very important for health. It’s great that it is easy to add this coverage at Ambetter. You can even include it in a package with your health plan.

Why Choose Ambetter Insurance? Pros and Cons

Every insurance company has its strengths as well as its weaknesses. No different is Ambetter insurance. It’s important to look at the other side. This will help you to decide if it is a good fit for you. Let’s weigh the pros and cons. A balanced view is vital whether it’s purchasing health coverage or something focused like classic car insurance.

The Advantages of an Ambetter Insurance Plan

First one is affordability is a big pro. Ambetter often has some of the lowest premiums around the Marketplace. When combined with subsidies, their plans can be quite cost effective. For budget minded families this is a huge plus. It makes it possible to get important health insurance coverage.

The My Health Pays program is also a big advantage. It’s a real benefit that can be tangible that other insurers don’t always do. In fact, it is motivating to earn rewards for healthy actions. It can directly reduce your healthcare spending. This is certainly a feature that sets Ambetter insurance apart from many competitors.

Last but not least, Ambetter has wide availability. As part of the Centene brand, it’s in several different states. This provides a number of Americans with another option for their coverage. In some rural counties, Ambetter could be one of the only available options on the Marketplace. In short, more choice is always good for the consumer.

Potential Drawbacks of Ambetter Insurance to Consider

One of the main disadvantages is the network type. Most Ambetter plans are HMOs (Health Maintenance Organizations) or EPOs (Exclusive Provider Organizations). This means that you must, in general, use in-network providers. You also will need a referral from your primary care physician (PCP) to visit a specialist in an HMO. This is not flexible for some people, who may find it to be a problem.

There may be a difficulty to using only in network providers: you need to be careful. If you see an out out network doctor, you may have to pay the entire bill. It’s like how commercial auto insurance might have certain rules as to where a vehicle can operate. You need to know and abide by the man’s plan. Therefore, always check whether your preferred doctors are away from Ambetter’s network before you enroll.

Customer service reviews for Ambetter may be mixed. Some members have excellent experiences. On the other hand, there are others who encountered difficulties with billing or authorizations. It’s a good idea to do some research through reviews of specific states when you live in a different state. You can research through your state’s Department of Insurance or here in the forums on the internet. An official source, such as the Ambetter from Sunshine Health website can also give state specific contact information.

“It is health which is the real wealth and not pieces of gold and silver.”

– Mahatma Gandhi

This quote points out the ultimate goal. The insurance plan is a tool. The real objective, however, is your well-being. Does the plan help you to attain and maintain good health? That is the big question to be answered.

How to Enroll in an Ambetter Insurance Plan

Feeling like you are ready for Ambetter plans? Fortunately, the process to enroll is not complicated. We’ll break down the essential steps for you. Taking a step at a time makes it less dreadful. You can do this!

Step 1: Check Your Eligibility

Visit the health insurance marketplace, the official website at HealthCare.gov, first. You can also use your state’s official marketplace Web site if there is one. You will fill in some basic information, like for example, the size of your household and your estimated income. The system will then tell you whether or not you are eligible for subsidies. This is a most important step of affordability. Knowing what you might save is important, as is knowing how to lower your car insurance cost.

Step 2: Compare Your Options

Once in the system you can search through plans. You will be able to view all the available options in your area. This includes insurance plans from Ambetter insurance and insurance carriers. You can filter between metal tier, premium or deductible. Then, read the “plan details” of each one. Look at the copays for the doctor and the prescription drugs. Compare them side by side to see the differences in them.

This is where you have to check the provider network. Every plan will have a link to plan provider directory. Use this tool to search for your doctors. Also, check for favorite hospitals and pharmacies. Having your trusted providers in-network is a very important factor in your decision.It promotes continuity of care. It’s a matter of getting the right kind of coverage for your needs, similar to professional liability insurance to choose the coverage for your career.

Step 3: Complete Your Application

Have you chosen a plan? Great! The last step is to fill in the application. You will confirm your choice of plan and complete and give more information to complete your enrollment. After you submit, Marketplace will verify you based on the enrollment. You will then be required to pay your first month’s premium directly to Ambetter. And importantly, your coverage will not commence until you make this payment.

Making the Most of Your Ambetter Insurance Coverage

Your journey does not end once you enroll. Now it is time to put your plan to good use. It is important to understand how your Ambetter insurance works. It helps you to get the care that you need. Staying away from unexpected costs will also be helped by it. Let’s cover some final tips.

Finding In-Network Doctors and Facilities

Always use the provider directory in the Ambetter website. It is the most current of all the sources. Before you make an appointment, however, call the doctor’s office. Verify that they are still accepting your level Ambetter plan. Networks can change. A phone call is all it takes to save you a lot of money and trouble. In other words, don’t expect a provider to have in-network. Always verify. This is the same way that having a mechanic certified to work on a specialty vehicle, such as one covered by motorcycle insurance, is similar.

Understanding Your Member Portal

Once you’re a member of Ambetter, start an online account. Your member portal is one very powerful tool. For example, it lets you check your plan documents and allows you to keep track of spending. You can also find in-network providers using the portal. Furthermore, it’s a place where you pay your bill and your rewards. Get the lay of your portal – William and Mary partially blocks this for students on their computers. It is your central location to manage your health plan.

Using the My Health Pays® Program

Don’t get to forgetting about your rewards! Log in to your member portal. You can see what activities are available to do to achieve rewards. For example, fill out your wellness survey. You can also establish your healthy activity goals. Then, track your progress. The use of this program is like having free money.

It’s a great benefit to being an Ambetter insurance member. Make it a habit to check for new ways of earning. This is a topic where more information can be found from an unbiased source such as the Kaiser Family Foundation (KFF) which often analyses such value-added benefits in insurance plans.

Your Health, Your Choice

Choosing a health plan is a huge decision. Ambetter insurance particularly through nonprofits such as the Sunshine Health are a great option. It is focused on affording through the health insurance marketplace. The plans come with great essential benefits. In addition, they have a great deal of extras such as the My Health Pays program too.

However, you need to take into account the network limitations. An HMO or EPO plan requires you to pay attention. You have to stay within your network to keep costs under control. Ultimately, you have to consider the benefits of low premiums to the downside of a restricted network. The best plan though is the one that makes sense from your point of view regarding your health needs and your budget. We hope by reading this guide you have a lot of confidence in making a good decision in this regard.

Frequently Asked Questions (FAQs)