Ambetter Health Insurance Review (2026)

Ambetter's Health Maintenance Organization (HMO), Exclusive Provider Organization (EPO) and Point of Service (POS) plans cost less than national averages for a 40-year-old. Silver HMO costs $28 a month less, Silver EPO $62 less and Silver POS $125 less. Its My Health Pays program adds up to $572 a year in rewards for members who complete preventive care activities.

Its medical care scores, which cover preventive care, disease management and care coordination, range from 64 out of 100 on PPO plans to 74 on HMO plans, based on CMS Quality Rating System data. That's below its member experience scores of 93 to 100. Members who put medical care quality first should compare plans' quality star ratings on HealthCare.gov or their state exchange before enrolling.

Ambetter sells HMO, EPO, PPO and POS plans, but only Arkansas and Texas residents can choose between two plan types.

Metal tiers set how costs split between your premium and your bills when you get care. Ambetter's Bronze HMO has a $7,250 deductible, the amount you pay before the plan shares costs. Gold HMO costs $75 more a month for a 40-year-old and cuts the deductible to $1,057, which favors members who expect regular care.

Ambetter's tiers go from Bronze through Gold, including Expanded Bronze, a Bronze tier that covers a larger share of costs than standard Bronze. Standard Bronze is sold only on HMO plans. Ambetter doesn't sell Catastrophic or Platinum plans, so shoppers who need either should compare other marketplace insurers.

Some Ambetter plans bundle adult dental and vision. Florida's Focused Silver + Vision + Adult Dental HMO costs $829 a month for a 40-year-old, $22 more than Focused Silver HMO without them.

Ambetter sells plans in 23 states, and in 21 of them it sells only one plan type, so your state decides whether you get an HMO, EPO, PPO or POS plan.

Arkansas and Texas are the only states with two Ambetter plan types, PPO and POS in Arkansas and HMO and EPO in Texas. POS plans are sold only in Arkansas and PPO plans only in Arkansas and Oklahoma. So only Arkansas shoppers can buy Ambetter's POS plan at $125 a month below the national average, and only shoppers in Arkansas and Oklahoma pay its PPO rate of $51 above it.

Ambetter's Silver POS plan costs $821 a month for a 40-year-old, $125 below the $946 national POS average, or $1,500 a year. No other Ambetter plan type falls as far below its national average, though $821 is still Ambetter's highest Silver premium. POS plans are sold only in Arkansas, so this pricing reaches only Arkansas shoppers.

Its Silver PPO costs $690 a month, $51 above the national PPO average, or $612 more a year. It's still $113 a month below Blue Cross Blue Shield's $803 PPO average, the only other PPO in MoneyGeek's comparison. So PPO shoppers in Arkansas and Oklahoma pay above the national rate with Ambetter but less than with BCBS.

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

Ambetter gives members health and wellness resources beyond basic medical coverage. Benefits vary by state and plan type. Check your plan documents for complete details.

• My Health Pays Rewards Program. Members can earn up to $572 a year through this program by completing preventive care activities such as annual checkups, health assessments and wellness challenges. Rewards apply toward out-of-pocket medical costs or other health-related purchases.
• Telehealth Services. Virtual doctor visits are available around the clock for non-emergency issues, and many Ambetter plans charge low or no copay for telehealth. That can mean fewer urgent care trips and shorter waits.
• Nurse Care Line. Registered nurses staff the nurse care line around the clock, free for all Ambetter members, offering guidance on symptoms and next steps for care.
• Fitness and Wellness Programs. Ambetter's partner network offers discounted gym memberships and fitness apps, along with other wellness resources. Some plans also include fitness trackers or app subscriptions at reduced rates.
• Case Management Services. Members managing a chronic condition such as diabetes, asthma or heart disease get a dedicated care coordinator. The coordinator connects them with community resources and coordinates care across providers.
• Pharmacy Services. Ambetter members can get 90-day prescription fills through its mail-order pharmacy at a lower cost than retail. Members managing multiple prescriptions can also get medication therapy management.

Among Ambetter's plan types, POS has the lowest denial rate at 15%, compared with 19% on EPO and PPO plans and 20% on HMO plans, plus a 100 out of 100 member experience score. POS plans are sold only in Arkansas, so Arkansas shoppers are the ones who get that claims and service record.

Ambetter's HMO plans have its highest medical care score, 73.82 out of 100, which covers preventive care, disease management and care coordination. That's 6.42 points above its EPO plans. Texas is the only state where Ambetter sells both, so Texans managing a chronic condition get Ambetter's higher medical care score with the HMO.

Ambetter is the ACA marketplace brand of Centene Corporation, which provides health coverage to more than 1 in 15 Americans across all 50 states. Centene launched Ambetter in 2014, the first year of ACA marketplace coverage. Ambetter plans are sold through local Centene subsidiaries with state-specific brand names. Centene also manages Medicaid and CHIP programs under separate brands.

Ambetter's $668 average HMO premium is $106 a month below UnitedHealthcare's $774 and $14 below Cigna's $682. Its 15% to 20% denial rate by plan type is below both insurers' 26% and 23%. UnitedHealthcare scores 86.23 on HMO plan administration, above Ambetter's 84.76, and HMO shoppers pay $1,272 a year more to get it.

Blue Cross Blue Shield costs less for HMO coverage ($609, $59 below Ambetter) and POS coverage ($720, $101 below), and it sells ACA plans in 35 states plus Washington, D.C., vs. Ambetter's 23. Ambetter's $676 EPO average is $164 below BCBS's $840, and its $690 PPO average is $113 below BCBS's $803. HMO and POS shoppers should compare BCBS first. EPO and PPO shoppers pay less with Ambetter.

Ambetter sells marketplace plans in 23 states through Centene subsidiaries with local brand names. In Florida, Silver HMO plans for a 40-year-old cost from $699 a month for Clarity Silver to $842 for Enhanced Diabetes Care Silver With $0 Drug Options + Vision + Adult Dental, a $143 difference within the same tier. Filter by state, plan type and metal tier to see your options.

Rates shown apply to 40-year-olds. Your own rate will depend on your age and location. Request quotes from multiple providers and compare them before applying for a policy.

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

MoneyGeek health insurance provider scores are weighted as follows:

• Affordability (60%): We scored providers on monthly premiums, deductibles and maximum out-of-pocket (MOOP) costs. Within the affordability score, monthly premiums carry the most weight (66.67%), followed by deductible (16.67%) and MOOP (16.67%).
• Customer Experience (30%): Scores are based on the Centers for Medicare & Medicaid Services (CMS) Quality Rating System (QRS) overall rating. This 5-star system helps consumers compare health plans on the Health Insurance Marketplace across three categories: medical care, member experience and plan administration. This page shows QRS-based scores on MoneyGeek's 100-point scale. Providers with the highest overall rating receive the highest score.
• Denial Rate (10%): The percentage of submitted claims rejected rather than approved. Providers with the lowest denial rate receive the highest score.

Data Sources

Health insurance plan and provider data were updated with the Centers for Medicare and Medicaid Services (CMS) exchange data released in October 2025 for the 2026 enrollment period, plus 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. We analyzed plans across all cited metal tiers, including Catastrophic, Bronze, Expanded Bronze, Silver, Gold and Platinum.