Is Ambetter the same thing as Medicaid?
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No, Ambetter is not Medicaid. Medicaid is a needs-based health insurance program for people with low-incomes. Ambetter is a company that offers private health insurance plans through the Health Insurance Marketplace (sometimes at a discount).
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How is Ambetter different from Medicaid?#how-is-ambetter-different-from-medicaid
While both Medicaid and Ambetter provide health insurance, who qualifies and how your coverage works can look very different.
Medicaid is designed for people with limited income and certain qualifying groups, such as children, pregnant people, seniors, and people with disabilities. Since Medicaid is a state-run program, the exact benefits, provider networks, and eligibility rules vary depending on where you live. However, federal rules ensure that all Medicaid programs have certain standard health benefits. Medicaid coverage is typically free or very low cost.
Ambetter, on the other hand, is a health insurance provider that offers plans through the Health Insurance Marketplace—a government website where people compare and purchase plans and apply for needs-based discounts. Ambetter plans cover many of the same standard benefits as Medicaid and sometimes additional services. Ambetter members also typically get access to online member tools and care management services through the Ambetter member portal.
Because Ambetter plans are private insurance plans sold in the Marketplace:
- They may have monthly premiums
- Members usually pay deductibles, copays, or coinsurance
Some people who buy Ambetter plans may qualify for financial assistance through the Marketplace to lower premiums or out-of-pocket costs. However, if you’re eligible for Medicaid, you won’t qualify for these discounts.
Who qualifies for Ambetter?#who-qualifies-for-ambetter
People who qualify for Ambetter plans generally:
- Live in a state where Ambetter offers Marketplace plans; and
- Enroll during Marketplace Open Enrollment (November 1 to January 15) or anytime if you qualify for a special enrollment period
If you have Medicare, you cannot get an Ambetter Marketplace plan, but you may be eligible for Medicaid and Medicare at the same time, called being “dual eligible.”
Who qualifies for discounts on Ambetter Marketplace plans?#who-qualifies-for-discounts-on-ambetter-marketplace-plans
Discounts for Ambetter plans are based on your eligibility for Health Insurance Marketplace financial assistance, which helps lower the cost of monthly premiums and out-of-pocket healthcare expenses.
In general, you may qualify for Marketplace discounts if you:
- Have a household income roughly between 100% and 400% of the federal poverty level, though some states allow subsidies at higher incomes
- Do not qualify for Medicaid, Medicare, or affordable employer-sponsored health insurance
When you apply for coverage through the Marketplace, the system automatically checks whether you qualify for these discounts and shows you the reduced price of Ambetter plans available in your area.
Can I have Medicaid and Ambetter at the same time?#can-i-have-medicaid-and-ambetter-at-the-same-time
While you can technically enroll in an Ambetter Marketplace plan while you receive Medicaid, it rarely makes sense. Medicaid is designed to provide coverage at little or no cost, whereas Marketplace plans often require you to pay monthly premiums and share in the costs of your care for many of the same benefits.
If you qualify for Medicaid, your state’s Marketplace will usually direct you to enroll in Medicaid instead of purchasing a Marketplace plan and you will lose eligibility for Marketplace discounts.
However, if your income changes or you lose Medicaid eligibility for other reasons, you may be able to enroll in an Ambetter Marketplace plan during a special enrollment period.
