Ambetter is not Medicaid — it's a private insurance company that sells plans on the Medicaid marketplace

Ambetter Health is a for-profit insurance company owned by Centene Corporation. It sells health plans through the Affordable Care Act (ACA) marketplace, which is separate from Medicaid. However, Ambetter does offer plans specifically designed for people who are on Medicaid or who may have access to for Medicaid in their state. This can create confusion because Ambetter plans and Medicaid can work together, but they are not the same thing.

The key difference: Medicaid is a government program run by your state. Ambetter is a private company selling insurance products. When you buy an Ambetter plan through the ACA marketplace, you are buying from a private insurer, even if that plan is marketed toward low-income people or people with Medicaid may be able to access.

Key Takeaways

  • Ambetter is a private insurance company, not a government program like Medicaid.
  • Ambetter sells plans on the ACA marketplace and also offers plans for people transitioning off Medicaid or who live in states without Medicaid expansion.
  • Some Ambetter plans are designed to work alongside Medicaid, but buying an Ambetter plan does not enroll you in Medicaid.
  • If you lose Medicaid coverage, Ambetter may be an option, but you will need to check your state's marketplace to see what plans are available and what you would pay.

How Ambetter plans relate to Medicaid

Ambetter markets plans to people who are uninsured or underinsured, including people who have lost Medicaid coverage or who live in states that have not expanded Medicaid. In some cases, an Ambetter plan can fill a gap when Medicaid ends — for example, if your income rises above your state's Medicaid limit.

Ambetter also offers plans in some states that are specifically designed for people with limited income. These plans may have lower premiums or out-of-pocket costs than standard ACA plans, but they are still private insurance, not Medicaid. You pay Ambetter (or receive a subsidy to help you pay), and Ambetter pays your medical bills.

In a few states, Ambetter participates in Medicaid managed care — meaning Ambetter administers Medicaid benefits on behalf of the state. In those cases, if you are enrolled in Medicaid, you might be assigned to Ambetter as your Medicaid plan. But this is different from buying an Ambetter plan on the ACA marketplace.

When you might see Ambetter if you have Medicaid

If your state uses Medicaid managed care, your state Medicaid program may assign you to Ambetter to manage your Medicaid benefits. This happens automatically in some states; in others, you can choose your plan. In this scenario, Ambetter is acting as your Medicaid plan administrator, and your coverage is still Medicaid — you are not paying Ambetter directly.

If you are considering an Ambetter plan on the ACA marketplace because you are losing Medicaid, you would be switching from government coverage to private insurance. The cost, coverage, and process are different. You would need to enroll through Healthcare.gov or your state's marketplace, and you may be able to get a subsidy based on your income.

The difference in how you enroll

Medicaid enrollment happens through your state's Medicaid office or through Healthcare.gov during open enrollment or when you have a may have access to life event (like losing other coverage). You do not pay a premium for Medicaid; the state pays for your coverage.

Ambetter plans on the ACA marketplace require you to enroll through Healthcare.gov or your state's marketplace. You choose the plan, and you either pay the full premium yourself or receive a tax credit (subsidy) to help pay it. The subsidy amount depends on your income and family size. Even with a subsidy, you may owe a monthly premium, and you will have a deductible and copays when you use care.

What to do if you are losing Medicaid and considering Ambetter

If your Medicaid is ending, you have a 60-day window to enroll in a new plan without waiting for the annual open enrollment period. This is called a may have access to life event. You can use this window to shop for plans on Healthcare.gov, including Ambetter plans, and compare costs and coverage.

Before you choose, check what subsidies you may receive. Enter your expected income on Healthcare.gov, and the site will show you what you would pay for each plan. Ambetter plans may be cheaper than other options in your area, but they may also have higher deductibles or narrower networks. Compare the monthly premium, deductible, copays, and which doctors and hospitals are in the network.

If you are unsure whether you still may have access to for Medicaid, contact your state Medicaid office before your coverage ends. In some states, you may be able to stay on Medicaid even if your income changed, or you may may have access to for a different Medicaid program.

Ambetter in states without Medicaid expansion

In states that have not expanded Medicaid, there is a coverage gap: people with income above the state's Medicaid limit but below the threshold for ACA subsidies may not may have access to for either program. Ambetter markets plans to this group, but these are still private insurance plans sold on the ACA marketplace, not Medicaid.

If you fall into this gap, an Ambetter plan may be one of your only options for coverage. The cost will depend on your age, location, and the specific plan you choose. You can compare plans and see what subsidies you might receive by visiting Healthcare.gov.

Frequently Asked Questions

If I buy an Ambetter plan, does that mean I have Medicaid?

No. Buying an Ambetter plan on the ACA marketplace means you have private insurance from Ambetter. You are not enrolled in Medicaid. However, if your state assigns you to Ambetter to manage your Medicaid benefits, then you have Medicaid coverage administered by Ambetter.

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

Generally, no. If you are on Medicaid, you do not need to buy a separate plan. If you lose Medicaid and buy an Ambetter plan, you would have Ambetter instead of Medicaid. In rare cases, you might have Medicaid and a separate plan, but this is not common and requires specific circumstances.

What happens to my Ambetter plan if I become may be able to access for Medicaid?

If you become may be able to access for Medicaid while you have an Ambetter plan, you can enroll in Medicaid. Your Ambetter plan would end, and Medicaid would become your primary coverage. You should contact both Ambetter and your state Medicaid office to make sure the transition is handled correctly.

Is Ambetter cheaper than Medicaid?

Medicaid has no premium if you may have access to. Ambetter plans have a monthly premium, though you may receive a subsidy to reduce it. Ambetter plans may have lower out-of-pocket costs in some cases, but the total cost depends on your income, the specific plan, and how much medical care you use.

How do I know if Ambetter plans are available in my state?

Visit Healthcare.gov, enter your zip code, and see what plans are available in your area. Ambetter operates in most states but not all. If Ambetter plans are not available where you live, you can compare other private plans or check whether you may have access to for Medicaid.