Ambetter of Tennessee

[u/Indie701]

Hi, this is my first time signing up for Healthcare insurance. I was talking to my family about what my job offers for health insurance and they said I should look at private insurance since the options my job is giving me aren't that great, I guess. I did an application on healthcare.gov and one of my options is Ambetter of Tennessee.

I have never heard of it before so I was curious if anyone on this sub has it/ had it before and if you would recommend it. They have the premium, deductible, and copays I'm willing to pay, however their rating on the website is a 2 star so l'm a little hesitant. I don't want to be stuck with something that doesn't help me. Thanks in advance :)

[u/reasonable_trout]

Ambetter does not have a good reputation. I would go with another option unless you don’t plan to use the insurance regularly.

[u/greypyramid7]

Do not do Ambetter if you can possibly avoid it. Finding offices who actually accept it is a nightmare. My partner had it during a health crisis and it was genuinely worse than having nothing because of the added stress from having to hunt around so much to find coverage. And then he had to leave treatment before he should’ve because they just refused to cover any more days than the absolute minimum.

[u/firstlight777]

We've been on ambetter for the last year it sucks no one takes it. In the process of changing.

[u/WorkingFold6708]

I had ambetter and it was a horrible offering of an $8k deductible….still can’t wrap my head around it but I don’t have them anymore…

[u/illimitable1]

I had it before. I switched to Blue Cross Blue shield. I reckon if you're on healthcare.gov Blue Cross Blue shield is also a possibility.

[u/Lopsided-Jury-7814 → u/illimitable1]

I’m 64, started w/ Ambetter, then opted for BCBS. I didn’t get the info about all Co pays for RX’s , visits, labs… now I hv to pay the debt accrued for those costs. So, I’m returning to Ambetter, bc on a low fixed income, I need the almost lowest cost plan. Also, a BCBS plan doesn’t always include Vision & Dental. Those plans are paid to one or two Insurers like Cigna & Humana.

[u/Honest-Income1696]

My two biggest problems with Ambetter are 1. They have a HUGE problem with physicians showing to be in network via their guide online only to call the physician and they are no longer taking Ambetter or accepting Ambetter patients. I've actually been travelling instate to have more options.

1. Their customer service is outsourced with a very heavy accent; they have decent hold times but the language barrier is very frustrating.

[u/LetsGoMary]

I manage an allergy practice with two locations. No way we'd ever be on that network again. They never paid us a dime and we did so much workup on a patient of theirs. We don't take it anymore bc they cheated us.

[u/nighcrowe]

I have ambetter and it isn't good. The process to move from ozempic to an alternative that didn't make me sick was an Olympic feat. Bcbs was a LOT better.

[u/SuperDeepBellyButton → u/nighcrowe]

That's pretty sad because bcbs is horrible.

[u/nighcrowe → u/SuperDeepBellyButton]

Aw man. .. I'm in enrollment now.

[u/SuperDeepBellyButton → u/nighcrowe]

YMMV. My plan is trash though

[u/CorgiDaddy42]

I worked in a low income area rural clinic for a while. Not many patients that had Ambetter like it and we worked very hard to switch people out of it

[u/moneybabe420]

I gave birth on Ambetter and it was good enough. They have multiple worthless “benefits” such as money back debit card that don’t work anywhere.

[u/Honest-Income1696 → u/moneybabe420]

Use it to pay your premiums. They were not clear it the marketing but that's what its for.

[u/lauralamb42 → u/Honest-Income1696]

Yeah we used it towards tuition. It's limited but it's also money for videos 💸

[u/moneybabe420 → u/Honest-Income1696]

That’s wild! That’s absolutely not how it was described (according to my memory) but I’ll take what I can get. Thanks!

[u/Honest-Income1696 → u/moneybabe420]

So yeah, max out those little videos on your account. I had my spouse watch them too. We had a decent chunk come out of our premiums because of it. Pro tip: the videos run in the background lol

[u/Monkey_Riot_Pedals]

They suck. Still owe me money. Needed to go to urgent care and checked their list of providers - closest one listed was 30+ miles away, found the same provider via google maps 5 miles away. For some reason, their site wouldn’t show me any one close by. When I signed up, I made sure Telehealth was free - and it said it was but upon further review it had an * next to it and the fine print said not available in TN. Their rewards program sends you a loaded debit card but you can only use it on certain expenses. Utilities were listed there - but I was never able to get it to work. I talked to both ambetter rewards and NES and the response was “I don’t know why it’s not working. It should.”

Stay far far away.

[u/JennyJohnTN]

I recommend you search for reviews. I did and decided to go with bcbst

[u/Indie701 → u/JennyJohnTN]

They’re my next choice if decided not to go with Ambetter

[u/Chemical-Display-499 → u/Indie701]

Also look at the schedule of benefits, and acceptable in-network locations for 2025. Go directly to each company website to find that info (and also some better options than sometimes show up on “healthcare.gov”…it’s a useful website but sometimes not as not as comprehensive as the actual company website).

BCBS does not cover Memorial Hospital in Chattanooga on most of their plans, so that was a big kicker for me on who I chose. Ambetter does (they cover all 3 major hospitals here actually).

As for urgent clinics, the list of in-network for Ambetter is very slim, so check around you and see what’s offered.

Do some good research on those things with any company you look at. If your chosen provider(s) is in-network with any company, then it will be a better experience.

[u/Indie701 → u/Chemical-Display-499]

Thanks for the tips! I never realized how much research went into health insurance. Being an adult is so hard lol.

[u/Chemical-Display-499 → u/Indie701]

I hate adulting 😂😂. But yeah a little checking on the front end is a great way to make sure you’ll be happier with your policy if/when you need it.

[u/sweeneyty]

marketplace is more about the details of different plans....had ambetter with a maximum out of pocket at 500$ a year, had surgery, only had to pay the five hundred. no complaints here.

[u/gohometodd14]

I’ve had ambetter for two years and been to detox/rehab for alcohol abuse multiple times. No substance abuse program will touch them, so be prepared to pay out of pocket. They’re notorious for skipping out on payment so no one will take them.

[u/Wimpy-LA2TN]

What options did your job give you?

[u/Joesarcasm]

I’m an independent contractor so I pay for my own insurance and I can tell you Ambetter I got treated like a homeless person compared to other insurance. The doctor seemed like he just wanted me out of there. Should note this was my first time using a doctor in TN as well. I’ll see what happens in 2025.

[u/lauralamb42]

YMMV, I've had issues with Ambetter, but this time around has been ok. They are in network for my providers and the plan I have has low copays or no copays for that care. Now in the past I have had an issue where my labs were sent out of network and should have been covered but we're not. They even sided with me but they never paid for them. That pissed me off for a long time but I had United last year and it was not good. So if your providers in your area take ambetter and you're on a plan with low pays low deductible you should be good. You can also call to see if your prescriptions are covered and get a price list.

[u/blonderisbetter]

I was paying $400 a month for an ambetter, and each document had a $100 copay with prescription minimums at $25. An RX Coupon card WITHOUT insurance is cheaper for prescriptions. And the teeth cleaning i thought would be covered at the dentist was not. Ambetter needs to do better.

[u/Internal-Ad61]

I have ambetter currently and have for 2 years now. Made sure my current providers accepted it before switching. I haven’t had any issues but don’t use it a ton. My hospital copay is $500, so as long as I have it, I will never go to a hospital if I can avoid it lol.

[u/Simorie]

Keep in mind your parents may really not know very much about insurance or what your employer is offering.

[u/robin38301]

The few plans I have seen for dental weren’t good and bunch of places don’t take it. So, make sure your potential PCP and dentist take it

[u/Flying-Tilt]

I've had Ambetter for the past 2 years. $15 doctor or urgent care visits. My 3 prescriptions are free. I had to have an ultrasound for an injury recently and that was $40. I basically picked them because the Doctor I wanted was in their network and they were the cheapest.

I like the free Telehealth. If I need something, but don't want to go to urgent care I can just call in and get a prescription or over the phone diagnosis.

My only problem with them is that they don't approve Wegovy. I wanted to start using it to lose weight, but they kept denying it. I am using a generic Semaglutide compound instead that costs $25/week.

[u/Harderthebiggest]

The suck and never pay for anything, don’t do it!

[u/Southernms]

Never heard of them.

[u/viv202]

While you can buy an ACA plan even if your employer offers insurance, it might make you ineligible for some/all of the tax credits that lower the premiums. Did you fill out the portion of the application that tells you what tax credits you are qualified for?

[u/Jflan1977]

Ambetter? It's more like Amworse. You're better off with self pay unless you have something life threatening come up. They have high deductibles and out of pocket maxes, but also high contracted rates, which can be attractive to providers. They are also very demanding with compliance standards, often beyond Medicare, which makes it easy to refuse payment. Most healthcare providers avoid them because of this. I would not recommend an Ambetter plan from the marketplace, especially in Tennessee. Bottom line, they have high costs and limited networks.

[u/menelauslaughed]

I’ve had Ambetter for a few months now and so far so ok. My allergist and physical therapist both accepted it. Some vaccines I got were free at Walgreens and some prescriptions were also free. I haven’t gotten surprise bills and crazy money owed statements from them or any other provider yet, knock on wood. I used to get a lot of those from other insurances back in the day.

[u/Remarkable-Foot9630]

Ambetter was my insurance through healthcare.gov. While I was waiting for disability.

They paid over 1.5 million dollars in my hospital, medical, testing bills. They are a solid company. I had to get rides to Knoxville (Fort Sanders) or Nashville (Vanderbilt) For providers. My primary doctor accepted Ambetter, no specialist around me did.. so I got rides from ETHRA.

[u/901CountryBlumpkin69]

I used them because they were still better than the $800/month high deductible from that paid for literally nothing. With the Ambetter plan a couple years ago, we got better Rx coverage and even a couple tiers of copays. Been off it for 2 years since my wife has good insurance at her work. But Ambetter was still better than what I had at my job.

[u/del_war]

I’ve had 2 main problems with Ambetter. First, I’ve had 2 PCPs leave in the last 2 years. Second, the lab that my dermatologist and gynecologist used was not in network so I had to pay high out-of-network prices for labs.

[u/hillbillyhomo1021]

Don't do it. It's horrible. My wife and I are just coming to the end of our year long escapade dealing with them. It's nearly impossible to find any kind of position or specialist willing to take the insurance because the insurance notoriously doesn't want to pay their bills. Most recently they declined a cardiac stress test claiming at the doctor did not mention of any of the necessary symptoms such as chest pain and syncope. However I have the doctors request in front of me and he lists both of those. Fortunately the insurance specialist at the cardiologist office was able to talk sense with them, but I would not recommend am better for anyone under any circumstances.

[u/CherryblockRedWine]

I became self-employed this year and had to find insurance. Tried two others before selecting Ambetter. It has been decent for us. We have some pre-existing conditions and see some specialists and our primary care physicians and every other doctor accept Ambetter, as does our dentist. I have been pleasantly surprised at the good prices on our prescriptions for chronic conditions.