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

Ambetter Health, owned by Centene Corporation, sells health insurance plans through the Affordable Care Act (ACA) marketplace, not through Medicaid. However, Ambetter does sell some plans that are designed to work alongside Medicaid or to serve people who have recently lost Medicaid coverage. The confusion arises because Ambetter markets heavily to low-income people and people with chronic conditions — the same populations that use Medicaid — but the company itself is a private insurer, not a government program.

If you see an Ambetter plan on your state's health insurance marketplace during open enrollment, you are looking at a private plan you would pay for (though you may receive a tax credit to reduce the cost). If you are currently on Medicaid, Ambetter does not replace it. If you have lost Medicaid coverage, Ambetter is one option among many private plans you could choose instead.

Key Takeaways

  • Ambetter is a private insurance company that sells plans through the ACA marketplace, not a Medicaid program or a government plan.
  • You can only enroll in an Ambetter plan during the ACA open enrollment period (usually November through January) or if you have a may have access to life event like losing Medicaid.
  • If you are currently on Medicaid, you keep your Medicaid coverage separately; Ambetter would be an additional or replacement plan, not part of Medicaid.
  • Ambetter plans may offer lower premiums or out-of-pocket costs than other marketplace plans, but you should compare all available options in your state before choosing.

How Ambetter differs from Medicaid

Medicaid is a joint federal and state program that provides free or very low-cost health coverage to people who meet income and other requirements set by your state. Medicaid is run by your state health department or a state agency, and may be able to access depends on your income, household size, age, disability status, and other factors that vary by state.

Ambetter is a for-profit insurance company. It sells plans on the ACA marketplace at a price set by the company, though you may receive a federal tax credit that lowers your monthly premium if your income falls within certain ranges. Ambetter does not determine who can buy its plans based on income alone — anyone can purchase an Ambetter plan during open enrollment, regardless of income, as long as they are a U.S. citizen or lawfully present immigrant.

The key difference: Medicaid is a government benefit program with income limits. Ambetter is a private insurance company selling plans on a public marketplace. They serve different populations and operate under different rules.

When Ambetter might be relevant to someone on Medicaid

If you are currently on Medicaid, Ambetter becomes relevant only if your Medicaid coverage ends. This can happen if your income rises above your state's Medicaid limit, if you move to a state with different Medicaid rules, or if you no longer meet other may be able to access requirements. When Medicaid ends, you have a 60-day window to enroll in a marketplace plan like Ambetter without waiting for the annual open enrollment period — this is called a may have access to life event.

Some people also use Ambetter as a supplemental plan while on Medicaid, though this is uncommon and depends on the specific Ambetter plan and your state's rules. You would need to check with Ambetter directly and your state Medicaid office to see whether this is permitted in your situation.

Ambetter also sells plans specifically marketed to people transitioning off Medicaid, sometimes with lower deductibles or copays designed to bridge the gap between free Medicaid coverage and private insurance. These plans still cost money, but they may be cheaper than other marketplace options available to you.

How to find Ambetter plans in your state

Ambetter plans are available through Healthcare.gov (the federal marketplace) or through your state's marketplace if your state runs its own. You can search for Ambetter plans during the annual open enrollment period, which runs from November 1 through January 15 each year. If you have lost Medicaid coverage, you can enroll outside this window by reporting the loss to the marketplace and providing proof of the date your coverage ended.

When you search on Healthcare.gov or your state marketplace, you can filter results by insurance company name. Ambetter plans will appear alongside plans from other private insurers. You can compare premiums, deductibles, copays, and which doctors and hospitals are in-network before you choose. The marketplace will also show you whether you may have access to for a tax credit that would lower your monthly cost.

What to check before choosing an Ambetter plan

If you are considering an Ambetter plan, compare it to other plans available in your area. Look at the monthly premium (the amount you pay each month), the deductible (the amount you pay out of pocket before insurance kicks in), copays for doctor visits and prescriptions, and whether your current doctors and hospitals are in the plan's network. Ambetter plans vary by state and by plan type, so what is available to you depends on where you live.

Also check whether you will receive a tax credit. If your household income is between 100 and 400 percent of the federal poverty line, you may be may be able to access for a credit that reduces your monthly premium. The marketplace will calculate this for you when you enter your income information. A tax credit can make a significant difference in what you actually pay each month.

If you are losing Medicaid, do not wait until the last day of your coverage to look for a new plan. Enroll as soon as you know your Medicaid is ending, so your new coverage starts on the same day your Medicaid ends. If there is a gap, you will be uninsured and responsible for any medical bills during that time.

Other marketplace options if Ambetter is not right for you

Ambetter is one of many private insurers selling plans on the ACA marketplace. Depending on your state, you may also see plans from companies like Blue Cross Blue Shield, Aetna, Cigna, UnitedHealthcare, and regional insurers. Each company offers different plans at different prices, and the plans available to you depend on your zip code and state.

If you have lost Medicaid and cannot afford any marketplace plan even with a tax credit, you may be able to return to Medicaid if your circumstances change, or you may want to contact your state health department or a local community health center to ask about other options. Some states have programs for people who fall through the gap between Medicaid and marketplace coverage.

Frequently Asked Questions

Can I use Ambetter if I am currently on Medicaid?

No, not as a replacement. Ambetter is a separate private plan. If you are on Medicaid, you keep your Medicaid coverage. You could theoretically enroll in an Ambetter plan at the same time, but you would be paying for both, and Medicaid would be your primary coverage. This is rarely done. If your Medicaid ends, then you can switch to Ambetter.

Will Ambetter cost me money?

Yes. Ambetter plans have a monthly premium (the amount you pay to the insurance company each month), and you may also pay copays when you see a doctor or fill a prescription. However, if your income is low enough, you may receive a federal tax credit that reduces or eliminates your monthly premium. The marketplace will show you the credit amount when you compare plans.

What happens if I enroll in Ambetter and then become may be able to access for Medicaid?

If you become may be able to access for Medicaid while enrolled in an Ambetter plan, you can switch to Medicaid. This is considered a may have access to life event. You would contact your state Medicaid office to apply. Once Medicaid is approved, you can cancel your Ambetter plan. You should not pay for both at the same time if you can help it.

Can I enroll in Ambetter outside of open enrollment?

Only if you have a may have access to life event, such as losing Medicaid, losing other health coverage, moving to a new state, getting married, or having a baby. You must report the event to the marketplace and provide proof. If you do not have a may have access to event, you can only enroll during the annual open enrollment period from November 1 through January 15.

How do I know if Ambetter is available where I live?

Go to Healthcare.gov or your state's health insurance marketplace and enter your zip code. Search for plans and filter by insurance company name to see if Ambetter appears. Ambetter does not sell plans in every state or every zip code, so availability depends on where you live. If Ambetter is not available to you, other private insurers will be.