Ambetter Individual & Family Health Insurance Explained
Open enrollment for health insurance coverage obtained through the federal marketplace is fast approaching. One of the top insurers offered through the Affordable Care Act (ACA) marketplace is Ambetter, which offers state-to-state healthcare coverage and could be a good option for frequent travelers or those who split their residence between homes, such as snowbirds.
If you’re considering ACA healthcare coverage, open enrollment kicks off November 1 for coverage in 2025. The last day to get coverage beginning January 1, 2025, is December 15, 2024. You have until January 15, 2025, to get coverage during the open enrollment period, to begin February 1, 2025. Anyone who qualifies for a special enrollment period, such as moving or having a baby, may also sign up for new ACA healthcare coverage at any time of the year.
As you compare your healthcare coverage options on the ACA marketplace, use this guide to Ambetter individual and family health insurance to see if it’s a fit for you. If you want to see what ACA plans you qualify for in Arizona, fill out this free form for personalized service.
Key Takeaways
- Ambetter is one of the United States of America’s top ACA Marketplace insurers.
- Ambetter offers state-to-state reciprocity, meaning if you have an Ambetter plan in Arizona and spend the summer or other time in a different state, you can visit a doctor who’s contracted with Ambetter in that state.
- Ambetter offers some unique health rewards programs in Arizona, including access to full memberships at YMCA. Members can also receive up to $500 to be used towards deductibles and copays through Ambetter’s My Health Pays® rewards program.
What Is Ambetter?
Ambetter is an ACA Marketplace product offered by Arizona Complete Health. There are Ambetter plans offered in each of the ACA metal tiers that determine how much the insured is responsible for versus what the insurance company’s responsible for. Ambetter plans include:
- Ambetter Bronze Care: This bronze tier plan covers essential healthcare needs. People who are insured on this tier typically see lower monthly premiums, but may experience potentially higher out-of-pocket costs for increased amounts of care.
- Ambetter Silver Care: These silver tier plans require slightly higher monthly premiums compared to bronze plans, but they also lessen out-of-pocket costs when you do need care.
- Ambetter Gold Care: Gold tier plans from Ambetter require the highest monthly premium payment amount but also limit out-of-pocket costs when you need care.
Ambetter 2025 Plans: A Closer Look
Ambetter offers a variety of plans in Arizona for 2025, each with different costs and benefits. To help you understand your options, here's a closer look at the plan categories:
- AMBetter Everyday: This popular Bronze plan offers copays for common services like PCP visits, specialist visits, lab work, urgent care, and mental health. Expenses beyond these copays apply towards the deductible.
| AMBetter Everyday Bronze |
|---|
| Deductible | OOP Max | PCP Co Pay | Spec Co Pay | Urgent Co Pay | |
|---|---|---|---|---|---|
| Bronze | $8,450 | $9,200 | $40 | $90 | $50 |
- AMBetter Standard: This plan category offers Bronze, Silver, and Gold options, giving you more choices to find the right balance of premiums and out-of-pocket costs.
| AMBetter Standard Gold, Silver, & Bronze |
|---|
| Deductible | OOP Max | PCP Co Pay | Spec Co Pay | Urgent Co Pay | |
|---|---|---|---|---|---|
| Gold | $1,500 | $7,800 | $30 | $60 | $75 |
| Silver | $5,000 | $8,000 | $40 | $80 | $60 |
| Bronze | $7,500 | $9,200 | $50 | $100 | $45 |
- AMBetter Complete:
Available in Silver and Gold options, Ambetter Complete offers more flexibility and lower copays compared to the Standard plans.
| AMBetter Complete Gold & Silver |
|---|
| Deductible | OOP Max | PCP Co Pay | Spec Co Pay | Urgent Co Pay | |
|---|---|---|---|---|---|
| Gold | $1,450 | $7,500 | $15 | Deductable | $35 |
| Silver | $6,000 | $8,500 | $40 | $30 | $60 |
- AMBetter Clear:
This Silver plan stands out with one of the lowest out-of-pocket maximums, making it a good choice if you anticipate high medical expenses.
| AMBetter Clear Silver |
|---|
| Deductible | OOP Max | PCP Co Pay | Spec Co Pay | Urgent Co Pay | |
|---|---|---|---|---|---|
| Silver | $6500 | $6500 | $50 | $100 | $50 |
- AMBetter Elite:
This premium Gold plan offers a $0 deductible, low copays, and a low out-of-pocket maximum, providing comprehensive coverage.
| AMBetter Elite Gold |
|---|
| Deductible | OOP Max | PCP Co Pay | Spec Co Pay | Urgent Co Pay | |
|---|---|---|---|---|---|
| Gold | $0 | $5500 | $50 | $60 | $35 |
**Remember:** These are just highlights. Be sure to review the full plan details and consider your individual needs and budget before making a decision.
All plans, no matter what metal tier they’re in, offer essential health benefits. These include coverage for essential medical care and wellness services, including:
- Emergency care
- Outpatient or ambulatory care
- Preventive and wellness care
- Mental health and substance abuse care
- Laboratory services
- Prescription drugs
- Hospitalization
- Maternity and newborn care
- Therapy services
- Pediatric care
- Virtual 24/7 care
There are also
Ambetter Select plans available in Maricopa, Pima and Pinal counties in Arizona. These plans require a lower monthly premium cost and give plan holders the benefit of seeing doctors from the
Banner & Honor Health System. They’re available in all metal levels.
Benefits of Ambetter Plans
Ambetter offers some unique health and wellness rewards programs for its members, as well as a discount program with perks for members. Some Ambetter benefits include:
- Ambetter Perks Member Discount Program: Members can enjoy special rates and discounts on products and services such as restaurant dining, travel, entertainment, technology, gym memberships and food delivery programs.
- My Health Pays®: My Health Pays® is a points-based rewards system that rewards members up to $500 for completing actions such as getting an annual wellness screening.
- YMCA & YMCA360 Membership: Ambetter members have access to full memberships to in-person YMCA locations, as well as can access YMCA360, the virtual version of YMCA.
Ambetter health management programs in Arizona also provide telephone support, behavioral health services, educational tools, tobacco cessation and depression management programs for chronic conditions, including asthma, diabetes, low back pain, depression, hypertension and coronary artery disease.
With lots of member resources and a variety of pricing options, you might find that an Ambetter plan through the ACA Marketplace makes sense for your budget and the unique healthcare needs of your family.
How to Get Individual & Family Insurance Coverage Through Ambetter
If you’re interested in signing up for Ambetter, or you want to compare all your ACA Marketplace plan choices in Arizona, use our free link to see your ACA healthcare options. A professional representative from AZ Health Insurance Brokers will reach out to show you what’s available and answer any questions you have, so you can feel confident you’re signing up for the best plan.
If you have questions about health insurance in general, the AZ Health Insurance Brokers team is here to help. We have private health insurance options available, as well. Contact us for free, at 602.617.4107, by quotes@azhealthinsurance.com or online.
Ambetter Individual & Family Insurance FAQs
What metal tiers are covered in Ambetter ACA Marketplace plans for Arizona?
Ambetter offers bronze, silver and gold metal tier plans in the ACA Marketplace. Residents in Maricopa, Pima and Pinal counties can also access Ambetter Select Plans in all metal levels.
What essential health benefits are covered under Ambetter plans?
Ambetter ACA Marketplace plans cover essential health benefits, including maternity and newborn care, emergency care, hospitalization, outpatient and ambulatory care, preventive and wellness care, pediatric care, mental health and substance abuse care, therapy services, laboratory services and prescription drugs.
What is the Ambetter My Health Pays® Rewards Program?
The Ambetter My Health Pays® Rewards Program gives members up to $500 in rewards for completing healthy actions on the points-based system. These include actions like attending an annual wellness screening and adopting healthy fitness and nutrition habits.
When is open enrollment for Ambetter health insurance on the ACA Marketplace?
Open enrollment for Ambetter health insurance on the ACA Marketplace is between November 1 and January 15. If you enroll by December 15, 2024, coverage will start January 1, 2025. If you enroll after December 15, 2024, and by January 15, 2025, coverage will begin February 1, 2025.
What special enrollment periods apply to Ambetter ACA Marketplace plans?
You may qualify for a special enrollment period to sign up for Ambetter on the ACA Marketplace if you experience a special qualifying event, such as losing health insurance through work, having a baby, moving, getting married, adopting a child or if your household income falls below a certain amount. You typically have 60 days before or 60 days following the event to enroll in an Ambetter plan during a special enrollment period.
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