On this page14 sections
- Ratings and complaints
- Ambetter vs. competitors
- Pricing
- Step by step
- Ambetter legitimacy and licensing
- How much Ambetter costs
- Does Ambetter deny a lot of claims?
- Ambetter network lawsuits
- Complaints and how to avoid problems
- How to cancel or switch Ambetter
- Who should skip Ambetter
- What customers say
- Alternatives
- FAQ
Ambetter is a legitimate ACA Marketplace insurer run by Centene Corporation, and its plans meet the same essential health benefit rules as every Marketplace plan. KFF data actually put Centene's claim denial rate at 14% in 2023, the lowest of the large Marketplace parent companies, against an 18% average. The weak spot is service and networks: 93% of its Trustpilot reviews are one star, and a federal lawsuit filed in 2022 alleges its provider directories listed doctors who did not take Ambetter. Check that your doctors and drugs are covered before you enroll, and compare it with at least one other Marketplace insurer in your county.
- Company
- Ambetter Health is the Marketplace brand of Centene Corporation's subsidiaries, St. Louis, Missouri1
- States
- 29 states in 2026, from Alabama to Washington; off-exchange ICHRA plans in 13 states1
- Members
- 3,494,700 Marketplace members on June 30, 2026, down from 5,862,800 a year earlier1
- Price
- Not published nationally; premiums depend on your ZIP code, age, household and income-based tax credits2
- Claim denials
- Centene: 14% of in-network HealthCare.gov claims denied in 2023, lowest among large parent companies; Marketplace average 19% in 20246
- Rewards
- My Health Pays: up to $500 in rewards in 2026 for activities such as an annual well visit; usable for premiums, copays, and in some states rent and utilities3
- 2027 open enrollment
- November 1, 2026 to January 15, 2027 on HealthCare.gov; enroll by December 15 for January 1 coverage4
Pros
- Low claim denial rate in KFF's 2023 analysis (14%, lowest of the large parent companies)
- Sold in 29 states, with plans you can compare on HealthCare.gov
- My Health Pays rewards of up to $500 in 2026
- Qualified Health Plans with all 10 essential health benefits and $0 preventive care
- Income-based tax credits apply when you buy through the Marketplace
Cons
- Trustpilot score of 1.2 out of 5, with 93% one-star reviews
- Ongoing lawsuit over provider directories that allegedly list unavailable doctors
- Networks are often narrow and can change each year
- Available only in parts of some states
- Customer service and billing are recurring complaint themes
Best for: Marketplace shoppers whose doctors and prescriptions are confirmed in-network and who want a low premium after tax credits.
Skip it if: Your current doctors or hospital aren't in Ambetter's network, or you need frequent specialist care and want a broad network.
Ambetter vs. competitors
| Company | Parent company | HealthCare.gov in-network claim denial rate, 2023 (KFF) |
|---|---|---|
| Ambetter | Centene | 14% |
| Molina Healthcare | Leaving Medicare Advantage drug plans for 2027; Molina | 26% |
| Cigna | Cigna | 21% |
| UnitedHealthcare | UnitedHealth | 33% |
Ambetter pricing at a glance
Marketplace metal levels, which set how Ambetter plans share costs5
| Metal level | Plan pays | You pay | Deductible |
|---|---|---|---|
| Bronze | About 60% | About 40% | High |
| Silver | About 70% | About 30% | Moderate |
| Silver with extra savings | 73% to 96% | 6% to 27% | Low |
| Gold | About 80% | About 20% | Low |
| Platinum | About 90% | About 10% | Low |
These are HealthCare.gov averages, not Ambetter prices. Which levels Ambetter sells depends on your state and county. Extra savings (cost-sharing reductions) apply only to Silver plans. In 2026 all Bronze and Catastrophic plans work with Health Savings Accounts.
Ambetter, step by step
Check if Ambetter sells in your county
Ambetter is in 29 states in 2026, but often only in some counties. Enter your ZIP code on ambetterhealth.com or HealthCare.gov.
Check doctors and drugs
Search the provider directory and drug list for your exact plan, then call your doctor's office to confirm they take that Ambetter plan.
Apply through the Marketplace
Apply on HealthCare.gov or your state exchange during open enrollment, November 1 to January 15 on HealthCare.gov, or with a qualifying life event.
Pay your first premium
Coverage starts only after your first premium is paid. Enroll by December 15 for a January 1 start.
Activate your member account
Set up your online account or app to print ID cards, track claims and turn on My Health Pays rewards.
Renew or switch each year
Review your plan during open enrollment, since premiums, networks and drug lists can change every year.
Ambetter legitimacy and licensing
Yes. Ambetter Health is the brand name for Marketplace plans sold by subsidiaries of Centene Corporation, a public company based in St. Louis. Each state’s Ambetter plan is a Qualified Health Plan issuer licensed by that state, and the plans are sold on HealthCare.gov and state exchanges, so they must cover the 10 essential health benefits.
Ambetter is in 29 states in 2026. Centene reported 3.49 million Marketplace members on June 30, 2026, down from 5.86 million a year earlier, after the enhanced premium tax credits expired at the end of 2025 and Centene raised prices on plans covering 95% of its Marketplace members.
How much Ambetter costs
Ambetter doesn’t publish one national price. Your premium depends on your ZIP code, age, household size, tobacco use and the metal level you choose, and premium tax credits can lower it based on your income. Enter your ZIP code on HealthCare.gov or ambetterhealth.com to see real prices.
2026 prices rose for many people. The extra federal subsidies of 2021 to 2025 expired, and starting January 1, 2026, people who enroll through an income-based Special Enrollment Period can no longer get advance tax credits, according to Centene’s filing. Compare total yearly cost, premium plus deductible, not just the monthly bill.
Does Ambetter deny a lot of claims?
Not more than average, based on federal data. KFF’s analysis of CMS transparency data found Centene denied 14% of in-network claims on HealthCare.gov in 2023, the lowest of the large parent companies, which ranged up to 35%. Across all HealthCare.gov insurers, 19% of in-network claims were denied in 2024.
If a claim is denied, you have the right to an internal appeal and then an external review. KFF found fewer than 1% of denied in-network claims were appealed in 2024, so ask your doctor’s office for help and appeal when a denial looks wrong.
What customers say about Ambetter
Recurring themes across the review sites and complaint records listed above, not individual quotes.
Common praise
- Low premiums for people who qualify for tax credits
- My Health Pays rewards for preventive visits
- Easy online enrollment
- $0 preventive care such as wellness exams and screenings
Common complaints
- Doctors listed in the directory who don't accept the plan
- Denied claims and prior authorization requests
- Billing errors, double charges and slow refunds
- Conflicting answers from customer service
Ambetter network lawsuits
In August 2022, Ambetter members filed a proposed class action, Havrilla v. Centene, in federal court in Illinois. It alleges Ambetter’s provider directories in many states listed doctors who did not take the plan. In May 2024 the court let most of the claims, including racketeering claims, go forward; as of 2026 no class had been certified and there is no settlement or claim form.
A separate lawsuit filed in Arizona in May 2025 alleges inaccurate mental health directories for an Ambetter plan there. These are allegations, not findings. The practical step is the same either way: call your doctors to confirm they accept your specific Ambetter plan before you enroll.
Complaints and how to avoid problems
Ambetter’s Trustpilot page has a 1.2 rating from 320 reviews. Complaints center on denied services and prescriptions, directory doctors who don’t take the plan, billing errors and conflicting answers from customer service.
To protect yourself, keep confirmation numbers for every call, get prior authorization in writing before planned care, and check your premium payments in your member account. If you can’t resolve a problem, file a complaint with your state insurance department.
How to cancel or switch Ambetter
You end or change Marketplace coverage through HealthCare.gov or your state exchange, not just by stopping payments. You can switch plans during open enrollment, November 1, 2026 to January 15, 2027 on HealthCare.gov, or mid-year if you have a qualifying life event such as losing other coverage, moving or having a baby.
Who should skip Ambetter
If your doctors, hospital or specialty drugs aren’t in Ambetter’s network for your county, the low premium won’t help. People with ongoing conditions who need many specialists may do better with a plan that has a wider local network, even at a higher premium.
Alternatives to Ambetter
- HealthCare.gov plan comparison Free and official; shows every Marketplace plan in your county with prices after tax credits, star ratings and doctor search.
- Your state's Blue Cross Blue Shield plan Often has a wider network in its home state, which matters if your doctors aren't in Ambetter's directory. Read review
- Oscar Health Another Marketplace insurer with app-based service to quote side by side where both are sold. Read review
- Medicaid or CHIP If your income is low enough, Medicaid or CHIP coverage costs little or nothing; HealthCare.gov checks this when you apply.
Ambetter reviews
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Frequently asked questions
Is Ambetter good insurance?
It is a regulated ACA Marketplace insurer with all essential health benefits, and KFF found its parent Centene had the lowest claim denial rate among large Marketplace companies in 2023. Reviews on service and networks are poor, so it works best if your doctors are confirmed in-network.
Who owns Ambetter?
Centene Corporation, a publicly traded health insurer in St. Louis, Missouri. Each state's plan is run by a Centene subsidiary, such as Ambetter from Absolute Total Care in South Carolina.
What states is Ambetter in for 2026?
Alabama, Arizona, Arkansas, California, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas and Washington. Coverage may be limited to some counties.
How much is Ambetter per month?
It depends on your ZIP code, age, household and income. Ambetter doesn't publish national rates; enter your ZIP code on HealthCare.gov or ambetterhealth.com to see prices after any tax credit.
Why did my Ambetter premium go up in 2026?
The enhanced federal premium tax credits expired at the end of 2025, and Centene says it raised prices on plans covering 95% of its Marketplace members for 2026. Update your income on your Marketplace application to make sure you get the credit you qualify for.
What is My Health Pays?
Ambetter's rewards program. In 2026 members can earn up to $500 for activities such as an annual well visit and a wellbeing survey, and use rewards toward premiums and some health costs, but not for cash or gift cards.
When can I enroll in Ambetter for 2027?
Open enrollment on HealthCare.gov runs November 1, 2026 to January 15, 2027. Enroll by December 15 for coverage starting January 1; state exchanges may set different deadlines.
Does Ambetter cover out-of-network care?
Coverage outside the network depends on the plan type (HMO, EPO or PPO) in your state. Emergency care is covered, but check the plan's summary of benefits before you count on out-of-network visits.
Is there a lawsuit against Ambetter?
Yes. Havrilla v. Centene, filed in 2022 in federal court in Illinois, alleges inaccurate provider directories. No class had been certified and there was no settlement as of 2026.
How do I appeal an Ambetter denial?
File an internal appeal with your Ambetter plan using the steps in your denial letter. If it's upheld, you can request an external review by an independent reviewer, and your state insurance department can help.
Sources (12)
Facts on this page come from company websites, government agencies and regulators, checked on the dates shown. Editorial standards
- SEC: Centene Corporation Form 10-Q, quarter ended June 30, 2026 (accessed October 12, 2026)
- Ambetter Health: Home page and state list (accessed October 12, 2026)
- Ambetter from Absolute Total Care: Use your benefits (accessed October 12, 2026)
- HealthCare.gov: Dates and deadlines (accessed October 12, 2026)
- HealthCare.gov: Health plan categories (accessed October 12, 2026)
- KFF: Claims denials and appeals in ACA Marketplace plans in 2024 (accessed October 12, 2026)
- KFF: Claims denials and appeals in ACA Marketplace plans in 2023 (accessed October 12, 2026)
- Trustpilot: Ambetter Health (accessed October 12, 2026)
- BBB: Ambetter of Illinois (accessed October 12, 2026)
- InsuranceNewsNet: Consumers sue Centene over Ambetter networks (accessed October 12, 2026)
- OpenClassActions: Havrilla v. Centene case tracker (accessed October 12, 2026)
- ProPublica: Lawsuit over Ambetter mental health directory in Arizona (accessed October 12, 2026)
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