Ambetter is a Medicaid plan, not Medicare

Ambetter is a Medicaid managed care plan, which means it serves people who may have access to for Medicaid in their state. It is not a Medicare plan, so it does not cover people age 65 and older based on age alone, and it does not cover people who have paid into Social Security long enough to receive Medicare benefits.

Ambetter is operated by Centene Corporation, one of the largest Medicaid insurers in the United States. The company offers Medicaid plans in multiple states, though not all states use Ambetter. Your state's Medicaid program decides which insurance companies can offer plans there.

If you are looking at Ambetter because you think you might may have access to for Medicaid, the first step is to check whether your state offers Ambetter plans and whether you meet your state's Medicaid income and resource limits. These limits vary significantly by state and by whether you are explore as a parent, a child, a pregnant person, or a person with a disability.

Key Takeaways

  • Ambetter is a Medicaid insurance company, not a Medicare plan, and covers people who may have access to for Medicaid in their state.
  • Not all states offer Ambetter plans, so you will need to check your state's Medicaid website to see if it is available where you live.
  • Medicaid income limits and rules differ by state and by your age, family size, and whether you have a disability.
  • If you are 65 or older and have worked long enough to may have access to for Medicare, you would use a Medicare plan instead of Ambetter Medicaid.

How Ambetter Medicaid differs from Medicare coverage

Medicaid and Medicare are two separate federal programs with different rules, costs, and coverage. Ambetter Medicaid covers people with low income who meet their state's rules. Medicare covers people age 65 and older, some younger people with disabilities, and people with end-stage renal disease, regardless of income.

Medicaid is jointly funded by the federal government and individual states, which is why rules and coverage vary widely. Medicare is a federal program with the same basic rules nationwide. If you are covered by Ambetter Medicaid, you cannot also be covered by Original Medicare or a Medicare Advantage plan at the same time — you are in one program or the other.

Some people age 65 and older may have access to for both Medicaid and Medicare (called "dual may be able to access"). In those cases, Medicare is the primary payer, and Medicaid covers some costs that Medicare does not. But a person in this situation would not use an Ambetter Medicaid plan alone; they would use their Medicare plan plus Medicaid coverage.

Which states offer Ambetter Medicaid plans

Ambetter operates Medicaid plans in roughly 20 states, though this number changes as states add or remove insurance companies from their programs. States that have offered Ambetter plans in recent years include Alabama, Arizona, Florida, Georgia, Indiana, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Nevada, New Mexico, Ohio, Oklahoma, South Carolina, Tennessee, Texas, and Washington, but you should verify this with your state's Medicaid office.

Your state's Medicaid program publishes a list of all insurance companies offering plans in your state. You can find this list on your state's Medicaid website, usually under a section called "Managed Care Plans" or "Health Plans." The list changes each year, so even if Ambetter was available last year, you should check the current year's list before assuming it is still an option.

If Ambetter is not available in your state, your state's Medicaid office can tell you which other managed care plans you can choose from. Most states that use managed care offer at least two or three different insurance companies.

Income limits and who can join Ambetter Medicaid

To join an Ambetter Medicaid plan, you must first may have access to for Medicaid in your state. Medicaid income limits vary by state and by your situation. For example, a parent in one state might may have access to with a monthly income of $1,500, while a parent in another state might may have access to with a monthly income of $2,500. A person with a disability might have a higher income limit than a parent in the same state.

Your state's Medicaid office has a tool on its website where you can enter your income and household size to see whether you might may have access to. This is not a formal information — it is a screening tool. To actually join Medicaid and then choose an Ambetter plan, you will need to contact your state's Medicaid office or use your state's online portal to provide proof of income, citizenship, and residency.

Once you are approved for Medicaid, you can then choose which insurance company's plan you want to use. In states that offer Ambetter, you would select Ambetter from the list of available plans. The enrollment process and important date vary by state and by whether you are a new Medicaid member or switching plans.

What Ambetter Medicaid covers

Ambetter Medicaid plans must cover the services that your state's Medicaid program requires, which include doctor visits, hospital stays, emergency care, prescription drugs, mental health services, and preventive care. Some states require additional services such as dental, vision, or hearing coverage. The exact coverage and any out-of-pocket costs depend on your state's Medicaid rules and the specific Ambetter plan you choose.

Medicaid plans in most states have low or no copayments for preventive services and for visits to doctors in the plan's network. Some services may require a referral from your primary care doctor. Ambetter plans also have a network of doctors and hospitals — using providers outside the network usually costs more or may not be covered at all, except in emergencies.

You can review the specific coverage details for Ambetter plans in your state by looking at the plan documents on your state's Medicaid website or on Ambetter's website. These documents spell out what is covered, what the copayments are, and which doctors and hospitals are in the network.

How to learn about Ambetter is available in your state

Start by visiting your state's Medicaid website. Search for "managed care plans" or "health plans" and look for the list of insurance companies that offer Medicaid plans in your state. Ambetter's official name in the Medicaid system is usually "Ambetter from [Your State Name]" — for example, "Ambetter from Florida" or "Ambetter from Texas."

If you do not find Ambetter on your state's list, it is not available in your state. You can then look at the other insurance companies that are available and compare their plans. Your state's Medicaid office can also answer questions about which plans are available and how to choose one.

If Ambetter is available in your state and you think you might may have access to for Medicaid, contact your state's Medicaid office to start the process. They can tell you what documents you need and how long the process usually takes.

Frequently Asked Questions

Can I have both Ambetter Medicaid and Medicare at the same time?

If you are 65 or older and may have access to for Medicare, you cannot use an Ambetter Medicaid plan as your main coverage. However, if you may have access to for both Medicaid and Medicare (called "dual may be able to access"), you would use your Medicare plan as primary coverage and Medicaid would help pay some costs Medicare does not cover. You would not enroll in an Ambetter Medicaid plan in this situation.

Does Ambetter work the same way in every state?

No. While Ambetter must follow federal Medicaid rules, each state's Medicaid program sets its own income limits, covered services, and copayment amounts. An Ambetter plan in Florida will have different coverage and costs than an Ambetter plan in Texas. Always check your specific state's plan details.

What if I am 65 and do not have enough work history for Medicare?

If you are 65 or older but do not may have access to for Medicare based on your own work history, you may still may have access to for Medicaid if your income and resources are low enough. In that case, you could join an Ambetter Medicaid plan in your state if it is available. Your state's Medicaid office can tell you whether you may have access to.

How do I switch from Ambetter to a different Medicaid plan?

Most states allow you to change Medicaid plans once a year during an open enrollment period, usually in the fall. Some states also allow changes if you have a may have access to life event, such as moving to a new state or losing your job. Contact your state's Medicaid office to find out when you can switch and what the process is.

Is Ambetter the same as Ambetter Health?

Ambetter Health is the consumer-facing brand name for Ambetter Medicaid plans. When you see "Ambetter Health" in your state, it is referring to the Medicaid managed care plan offered by Centene. The terms are used interchangeably.