ACA ambetter insurance
- Thread starter Plantman
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GTFan
Thinks s/he gets paid by the post
Yep got their Silver plan here in the ATL this year. No issues with claims (just routine Dr. visits) and the wife and I both earned almost $500 in health rewards bonuses from them for doing stuff we'd do anyway like yearly checkups, flu shots, exercise etc.
Only issue we had this year was some specialists missing locally from their network, but they have expanded that in 2019. YMMV.
Only issue we had this year was some specialists missing locally from their network, but they have expanded that in 2019. YMMV.
I've been on it for 18 months. Nothing really to report as I've never used up the annual deductible.
They did over spend on admin expenses, so I got a credit for 3.5 years of premiums at todays rates. The notice for 2019 says my rates are going up almost 23x in 2019, but thats because its a really small denominator AND it doesn't take into account IF the subsidy changes in 2019.
When I started ACA they were the ONLY option, so... I treated it like company insurance, I didn't get to chose the provider there either.
They did over spend on admin expenses, so I got a credit for 3.5 years of premiums at todays rates. The notice for 2019 says my rates are going up almost 23x in 2019, but thats because its a really small denominator AND it doesn't take into account IF the subsidy changes in 2019.
When I started ACA they were the ONLY option, so... I treated it like company insurance, I didn't get to chose the provider there either.
Running_Man
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I used Ambetter in 2016 and 2017 and they were better in processing than Blue Cross Blue Shield and far cheaper.
Ed B
Recycles dryer sheets
I use ACA for our grandson. In our zip code BCBS HMO was the only option the last two years. Ambetter EPO popped up as a new option for us.
About 85% of doctors in our area refuse any HMO and certainly the BCBS HMO thru the marketplace. So we are calling doctors offices to see if more of them will accept this new EPO.
About 85% of doctors in our area refuse any HMO and certainly the BCBS HMO thru the marketplace. So we are calling doctors offices to see if more of them will accept this new EPO.
You should also be able to check the provider network on the insurer’s web site. This helps check and verify network participation not only for physicians but also labs and hospitals.
Ed B
Recycles dryer sheets
We did that but found that the database is behind. The pediatrician we are most interested in changed from a group to private practice about a year ago but their database doesn't show that.
I am sure it works well most of the time.
flintnational
Thinks s/he gets paid by the post
We are in Atlanta and have Ambetter for the current year. We have only had routine, below deductible bills but Ambetter has been fine.
I'm on Ambetter for 2018. They had a HSA version, so I was pretty happy. The drug costs were not as good as our previous 3 or so insurers so we've been using Costco Pharmacy. They also didn't cover my PCP, but if I don't cover the deductible it won't make much difference since he has a nominal cash fee. They covered preventive care without a problem. We didn't exceed the deductible this year, so no other claims experience.
We'll stay on Ambetter for 2019 since they cover the hospitals we want and most of our other providers. The cost is close to the lowest, they still offer an HSA plan, and they were OK this year.
We'll stay on Ambetter for 2019 since they cover the hospitals we want and most of our other providers. The cost is close to the lowest, they still offer an HSA plan, and they were OK this year.
Yes, but sometimes providers are listed when in actuality they are not accepting the insurance. I ran into that with caresource a few years ago. I have also read that ambetter was being sued for similar practices in Washington state if my memory serves me correctly.
If one is only checking to confirm one or two physicians, it is easier to just call. On the other hand, If searching to see how many physicians or specialists in a particular area take that insurance, checking the insurer provider network first is a productive way to make a short list of candidates, which then can be verified by phone.
As long as insurers and physicians use and change provider networks for their own purposes and have no liability for omissions or changes, it will never be safe to assume one is covered.
As long as insurers and physicians use and change provider networks for their own purposes and have no liability for omissions or changes, it will never be safe to assume one is covered.
Katsmeow
Give me a museum and I'll fill it. (Picasso) Give me a forum ...
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It is an interesting choice. I am in the DFW area and the cheapest plan is Ambetter EPO. The Blue Cross HMO is $90 more a month.
The thing for me is that I only need coverage for 3 months as I will go on Medicare after that. I get a contribution to healthcare cost through HRA from DH's former employer. I've been on a PPO direct through retiree insurance but it is quite a bit more expensive than either the Ambetter or Blue Cross plans. Since I am healthy I am thinking to save several hundred collars a month for 3 months and go for Ambetter or Blue Cross.
On the one hand, Ambetter gets bad reviews and is in network for only 1 of the 2 major hospital systems here. I "trust" BCBS more than Ambetter but it is an HMO and has a better network overall I think.
But -- odds are I won't need to use either one of them except for may be a prescription. Haven't decided yet....
The thing for me is that I only need coverage for 3 months as I will go on Medicare after that. I get a contribution to healthcare cost through HRA from DH's former employer. I've been on a PPO direct through retiree insurance but it is quite a bit more expensive than either the Ambetter or Blue Cross plans. Since I am healthy I am thinking to save several hundred collars a month for 3 months and go for Ambetter or Blue Cross.
On the one hand, Ambetter gets bad reviews and is in network for only 1 of the 2 major hospital systems here. I "trust" BCBS more than Ambetter but it is an HMO and has a better network overall I think.
But -- odds are I won't need to use either one of them except for may be a prescription. Haven't decided yet....
We're on Ambetter for 2108 with a Bronze HSA plan. We'll be switching to a BCBS Bronze HSA as they are about $400 a month cheaper than Ambetter's Bronze HSA and $600 cheaper than Kaiser's Bronze HSA and $1300 a month cheaper than Kaiser's Silver HSA.
Beldar
Full time employment: Posting here.
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My 2 cents...
For the past 2 years we've used Ambetter/Healthnet since it was the only provider in our area on the ACA exchange. They had decent coverage, although the drug prices were a little high, and our doctor of 20 yrs was not participating. Rather than switch docs I just paid cash for the visits (no big deal).
This time around (2019), BCBS is in the marketplace, and our doc is participating. So we'll switch plans. The drug prices are lower too. Six of one...
Our subsidy is reduced for the same income level, and the Silver Plans (both providers), have increased almost 20% for next year.
_B
For the past 2 years we've used Ambetter/Healthnet since it was the only provider in our area on the ACA exchange. They had decent coverage, although the drug prices were a little high, and our doctor of 20 yrs was not participating. Rather than switch docs I just paid cash for the visits (no big deal).
This time around (2019), BCBS is in the marketplace, and our doc is participating. So we'll switch plans. The drug prices are lower too. Six of one...
Our subsidy is reduced for the same income level, and the Silver Plans (both providers), have increased almost 20% for next year.
_B
wmc1000
Thinks s/he gets paid by the post
I had Ambetter for all of 2017 and the first 4 mos. of 2018 until going on medicare. Managed income to get cost sharing. All my Rx's are generic and were covered at zero cost to me. No issues and even had a colonoscopy which was covered 100%
oscar1
Recycles dryer sheets
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Had AB EPO for 2018 and no issues. However, only use them for catastrophic really since the deductibles are so high ($6,900 in 2018, going to $7,900 in 2019). One thing that is starting to concern me is Ambetter’s 2019 EPO Plan does not cover out-of-network which could become an issue if DW and I travel more.
I have ambetter and was told that I was do for colorectal screening which is supposed to be covered. I think a screening is different from a colonoscopy. I had heard there was some exception to the colonoscopy.
Too late for your enrollment choice, but I just had an awesome experience with Ambetter customer service last night.
There was a snafu with my prescription refills... CVS was claiming co-pays and "grace periods" etc... basically trying to apply my 2019 plan in 2018.
Yesterday about 1:30PM I put in a "what's going on" type inquiry to Ambetter's contact page (basically an email). I got a robo-reply of "unusually high inquiries, we'll get to you when we can".
6:50PM my phone rings. It's a live person from Ambetter who informed me they had just spoken with CVS and all should be fixed now and then told me to go ahead and place my online order while they waited on the phone to ensure it went through OK. The caller "sounded intelligent" (as compared to standard call center fare).
OK... who knows, maybe it was Ambetters fault the 2019 rates were put in play early, but the speed and ease with which they fixed it was very impressive.
There was a snafu with my prescription refills... CVS was claiming co-pays and "grace periods" etc... basically trying to apply my 2019 plan in 2018.
Yesterday about 1:30PM I put in a "what's going on" type inquiry to Ambetter's contact page (basically an email). I got a robo-reply of "unusually high inquiries, we'll get to you when we can".
6:50PM my phone rings. It's a live person from Ambetter who informed me they had just spoken with CVS and all should be fixed now and then told me to go ahead and place my online order while they waited on the phone to ensure it went through OK. The caller "sounded intelligent" (as compared to standard call center fare).
OK... who knows, maybe it was Ambetters fault the 2019 rates were put in play early, but the speed and ease with which they fixed it was very impressive.
