Ambetter Health Insurance Review (2026)

Ambetter offers health insurance plans across multiple metal tiers and network types. Your options depend on your state and coverage needs, but you can choose from HMO, EPO, PPO and POS plans.

Metal tiers determine how you and your plan split costs. Bronze plans have lower premiums but higher out-of-pocket costs, while Gold plans have higher premiums but lower costs when you need care. Most states where Ambetter is available have Expanded Bronze through Gold tier plans, while Catastrophic and Platinum options aren't available through the provider. Check which plan types and tiers are available in your state to find coverage that matches your budget and doctor preferences.

Ambetter is a national health insurance provider operating in 24 states across the United States. Plan types vary by state. The table below shows where Ambetter is available as well as how many plans of each major plan type are accessible in each state:

Our analysis found Ambetter has competitive pricing across most plan types, with pricing on HMO, EPO and POS plans below national averages. Significant savings on POS plans make Ambetter particularly attractive if you want flexibility to see out-of-network providers. However, PPO seekers might find better value elsewhere, as Ambetter's PPO premiums exceed the national average.

Ambetter's premiums vary by plan type, with costs ranging from $668 to $821 monthly. HMO plans have the lowest rates at $668 per month, $28 below the national average. POS plans cost the most at $821 monthly but save you $125 compared to the national average. PPO plans are Ambetter's only option that exceeds typical costs, running $51 above average at $690 per month.

Explore Ambetter’s average cost, deductible and maximum out-of-pocket limits by plan type and metal tier:

Ambetter gives members access to health and wellness resources beyond basic medical coverage. The insurer focuses on preventive care incentives and telehealth access to help you manage your health proactively. These benefits vary by state and plan type, so check your specific plan documents for complete details.

• My Health Pays Rewards Program: Earn rewards for completing preventive care activities like annual checkups, health assessments and wellness challenges. You can use earned rewards to reduce out-of-pocket costs for medical expenses or health-related purchases.
• Telehealth Services: Access virtual doctor visits 24/7 through Ambetter's telehealth platform for non-emergency medical issues. Many plans give access to telehealth visits with low or no copays, saving you time and money compared to in-person urgent care.
• Nurse Care Line: Speak with registered nurses anytime for health questions, symptom guidance and care recommendations. The service is confidential and available at no extra cost to all Ambetter members.
• Fitness and Wellness Programs: Access discounted gym memberships, fitness apps and wellness resources through Ambetter's partner network. Some plans include fitness tracker devices or app subscriptions at reduced rates.
• Case Management Services: Get personalized support from care coordinators if you're managing chronic conditions like diabetes, asthma or heart disease. Case managers help coordinate care between providers and connect you with community resources.
• Pharmacy Services: Use Ambetter's mail-order pharmacy for 90-day prescription fills, often at lower costs than retail pharmacies. The provider also has medication therapy management to help you understand and optimize your prescriptions.

Ambetter's customer experience metrics reveal mixed performance across plan types. The company maintains claim denial rates between 15% and 20%, meaning roughly 80 to 85 out of every 100 claims get approved. Member experience scores stand out as a strength, with all plan types exceeding 92 points and POS plans scoring a perfect 100.

Medical care quality scores present more variation, ranging from 63.76 for PPO plans to 73.82 for HMO plans. These scores fall below the 100-point benchmark with room for improvement in care coordination and clinical outcomes. Plan administration scores remain consistent across all plan types, clustering between 84.76 and 86.6 points.

Our analysis shows Ambetter excels at member service and claim processing but lags in medical care quality metrics. POS plans deliver the best overall experience with the lowest denial rate (15%) and highest member experience score. HMO plans have the strongest medical care coordination, making them worth considering if clinical quality matters most to you. Compare these quality scores with your priorities to choose the right plan type, whether that's responsive customer service, low claim denials or strong clinical coordination.

Ambetter provides health insurance across the U.S. through locally branded Centene subsidiaries. Use the table below to find available plans in your state and compare coverage options:

Rates shown are for 40-year-olds. Your rates will vary by your age and location. Be sure to request quotes and compare multiple providers before applying for a policy.

We rate the best health insurance providers based on premiums, out-of-pocket expenses, customer experience, claims denial rates and plan selection.

MoneyGeek health insurance provider scores are weighted as follows:

• Affordability (60%): When scoring providers on affordability, we considered monthly premiums, deductibles, and maximum out-of-pocket (MOOP) costs. We weighted these factors as follows within the affordability score: monthly premiums (66.67%), deductible (16.67%), MOOP (16.67%).
• Customer Experience (30%): Centers for Medicare & Medicaid Services (CMS)’s Quality Rating System (QRS) overall rating for health-insurance plans. This is a 5-star rating system used to help consumers compare health plans on the Health Insurance Marketplace. Ratings are calculated based on three main categories: Medical Care, Member Experience, and Plan Administration. Providers with the highest overall rating get the highest score
• Denial Rate (10%): Denial rate is the percentage of submitted claims or applications that are rejected instead of approved. Providers with the lowest denial rate get the highest score.

Data sources

Health insurance plan and provider data was updated with the Centers for Medicare & Medicaid Services (CMS) exchange data released in October 2025 for the 2026 enrollment period as well as manual collection of health plan data from state insurance marketplaces for 22 states.

Sample consumer profile

We collected data on all available health plans for consumers ages 18, 26, 40, 50 and 60. Monthly premiums are based on a 40-year-old buyer unless otherwise noted, such as the category for seniors. We analyzed plans for each cited metal tier, which include Catastrophic, Bronze, Expanded Bronze, Silver, Gold and Platinum.