Is Ambetter Medicaid or Medicare? Understanding Which Program Ambetter Covers

Ambetter is a Medicaid plan, not Medicare

Ambetter offers health insurance plans through Medicaid in the states where it operates. It does not offer Medicare plans. If you are looking at Ambetter, you are looking at a Medicaid managed care option — meaning Ambetter is a private insurance company that contracts with your state to deliver Medicaid benefits.

This matters because Medicaid and Medicare are completely separate programs with different rules, costs, and coverage. Ambetter only participates in one of them. If you are under 65 and your state has Ambetter plans available, Ambetter may be an option for you. If you are 65 or older and enrolled in Medicare, Ambetter will not be your plan.

Key Takeaways

Ambetter is a Medicaid managed care plan, not a Medicare plan, and only serves people who are enrolled in Medicaid.
Medicaid is for people with lower incomes; Medicare is for people 65 and older or with certain disabilities, regardless of income.
Ambetter operates in some states but not all, so availability depends on where you live and whether your state contracts with Ambetter.
If you may have access to for both Medicaid and Medicare (called "dual may be able to access"), you would need separate plans for each program.

How Ambetter works as a Medicaid plan

When your state's Medicaid program contracts with Ambetter, Ambetter becomes one of the insurance companies you can choose from during Medicaid enrollment. Your state pays Ambetter a fixed amount per month to cover your medical care. In return, Ambetter provides doctor visits, hospital care, prescriptions, and other covered services through its network of providers.

You do not pay Ambetter a premium if you are on Medicaid — your state covers that cost. You may have small copays when you use services, depending on your state's Medicaid rules and which service you use. Ambetter's job is to manage your care within the Medicaid budget your state gives it.

Not every state contracts with Ambetter. The company operates in some states and not others, and the states it serves can change year to year. If Ambetter is available in your state, it will appear as an option when you enroll in Medicaid or during the annual open enrollment period.

The difference between Medicaid and Medicare

Medicaid is a joint federal and state program for people with lower incomes. There is no age requirement — you can be any age and still may have access to for Medicaid if your income is low enough. Each state runs its own Medicaid program and sets its own income limits, so what qualifies you in one state may not in another. Ambetter operates only in Medicaid.

Medicare is a federal program for people 65 and older, regardless of income. It is also available to some younger people with disabilities or end-stage renal disease. Medicare is the same in every state. Ambetter does not offer Medicare plans.

If you are 65 or older and have Medicare, you cannot enroll in Ambetter. If you are under 65 and have Medicaid, Ambetter may be available to you depending on your state.

What happens if you may have access to for both Medicaid and Medicare

Some people may have access to for both programs — this is called being "dual may be able to access." This usually happens when someone is 65 or older with a low income, or when someone under 65 has a disability and qualifies for both Medicare and Medicaid. If you are dual may be able to access, you need coverage from both programs because they do not overlap.

In this situation, you would enroll in a Medicare plan (which Ambetter does not offer) and a separate Medicaid plan (which Ambetter might offer, depending on your state). Your Medicare plan covers what Medicare covers, and your Medicaid plan covers what Medicaid covers. The two plans coordinate to avoid gaps.

If you think you might may have access to for both programs, contact your state Medicaid office or Medicare directly to understand your options. They can tell you which plans are available to you in your situation.

How to learn about Ambetter is available in your state

Ambetter's website lists which states it serves, and you can search by your state to see if plans are available. You can also contact your state Medicaid office directly — they maintain a list of all insurance companies offering Medicaid plans in your state and can tell you whether Ambetter is one of them.

If Ambetter is available in your state, you will see it as a plan option when you enroll in Medicaid or during the annual open enrollment period (usually November through December). If it is not available, other Medicaid managed care plans will be offered instead.

Ambetter's coverage and network

Ambetter's coverage and provider network vary by state because each state's Medicaid program has different rules. Some states cover dental or vision through Medicaid; others do not. Some states cover mental health services; others limit them. Ambetter follows whatever your state's Medicaid program covers.

Before you enroll in an Ambetter plan, check the provider network to make sure your current doctors are included. You can do this on Ambetter's website by entering your zip code and searching for doctors. If your doctor is not in the network, you may have to switch providers or pay out-of-pocket for out-of-network care.

Frequently Asked Questions

Can I use Ambetter if I have Medicare?

No. Ambetter only offers Medicaid plans. If you are enrolled in Medicare, Ambetter is not an option for you. If you are 65 or older and looking for coverage, you would enroll in a Medicare plan through Medicare.gov or a Medicare Advantage plan offered by a different insurance company.

Does Ambetter cost money if I am on Medicaid?

No. Your state pays Ambetter's premium, so you do not pay a monthly fee. You may have small copays when you use services like doctor visits or prescriptions, depending on your state's Medicaid rules.

What if Ambetter is not available in my state?

Your state Medicaid office will offer other managed care plans you can choose from instead. Contact your state Medicaid office to see which plans are available where you live and how to enroll in one.

If I am dual may be able to access, can I use Ambetter for both Medicaid and Medicare?

No. Ambetter only offers Medicaid plans. If you may have access to for both Medicaid and Medicare, you would need a separate Medicare plan from a different insurance company and an Ambetter Medicaid plan (if available in your state) to cover both programs.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.