Is Ambetter Superior Health Plan Medicaid

How Do You Enroll In Coverage With Ambetter From Superior Healthplan

Ambetter Health Insurance Review – Superior Health Plan Review

To enroll in coverage with Ambetter from Superior HealthPlan, you must go through the Health Insurance Marketplace.This occurs during the open enrollment period each year or when qualifying for a special enrollment period. You can use a broker, but only during open enrollment or a qualifying special enrollment period.

Ambetter From Superior Healthplan Available In 145 Texas Counties

Date:11/15/21

AUSTIN, Texas Open Enrollment for the Health Insurance Marketplace in Texas runs through January 15, 2022. Next year, Ambetter from Superior HealthPlan will be offered to Texas residents in seven additional counties, making the program available in 145 counties in the state through the Health Insurance Marketplace.

The COVID-19 pandemic emphasized that affordable and comprehensive health insurance is needed more than ever, said Mark Sanders, President and CEO of Superior HealthPlan. As part of the nations No. 1 Marketplace insurer*, Ambetter from Superior HealthPlan has the experience and resources to help people when it matters most, and were proud to provide reliable coverage to more people throughout Texas.

Ambetter offers a variety of plans for all budgets and needs. This includes Ambetter Value, a new specialized plan aligned with a select group of primary care providers, which can help guide and steer a members utilization through a referral process. Another new plan is Ambetter Virtual Access, which provides members with full virtual primary care access, powered by Teladoc. This plan includes access to licensed virtual primary care providers in addition to Ambetters core network of health care providers and hospitals.

Regardless of plan, Ambetter from Superior HealthPlan provides a variety of additional services and benefits to help members get the most out of their coverage:

Find Ambetter Coverage In Your State

Ambetter has you covered, with plans available in 27 states nationwide. Select your state below to see plans in your area.Don’t see your state listed? Contact us.

If you live in NY, you can enroll in coverage with Fidelis Care .

*Statistical claims and the #1 Marketplace Insurance statement are in reference to national on-exchange marketplace membership and based on national Ambetter data in conjunction with findings from 2021 Rate Review data from CMS, 2021 State-Level Public Use File from CMS, state insurance regulatory filings, and public financial filings.

**For some plans

***$0 cost share applies for in-network telehealth services through Ambetter Telehealth. $0 Ambetter Telehealth cost share does not apply to HSA plans until the deductible is met. Ambetter does not provide medical care.

Don’t Miss: How To Qualify For Medicaid In Ohio

Support For Superior Members Affected By Severe Weather

If you are a member of Superior HealthPlan and are located in an area affected by severe weather, there are services available to help you.

All Superior members who live within the official disaster designated counties and who may need to replace necessary medical equipment, services, or supplies should seek replacement through any available supplier. If you cannot find a supplier, call Member Services to find one for you. Your supplies will be replaced even if you are temporarily outside of the county in which you live.

Ambetter From Superior Healthplan

Ambetter from Superior HealthPlan is Centene Corporations Health Insurance Marketplace product in Texas. Ambetter from Superior HealthPlan is underwritten by Celtic Insurance Company, which is a Qualified Health Plan issuer on the Texas Health Insurance Marketplace. Ambetter is designed to deliver quality, locally-based healthcare services to members through focused, compassionate and coordinated care.

Established to deliver quality health insurance through local, regional and community-based resources, Ambetter from Superior HealthPlan is part of Centene Corporation – a FORTUNE 25 company with more than 30 years of experience in the managed care industry and a robust portfolio of specialty health solutions. Superior HealthPlan believes the health of communities is improved at the individual level, one member at a time. Thats why the company is dedicated to providing affordable and reliable health insurance plans to suit the needs of more than 1.6 million Texans across the state.

Recommended Reading: Medicaid Doctors In Mckinney Tx

Support For Superior Members Affected By Fire In Palo Pinto County

If you are a member of Superior HealthPlan and have been impacted by the fire in Palo Pinto County, there are services available to help you.

All Superior members who have been impacted by the fire in Palo Pinto County and need to replace necessary medical equipment, services, or supplies should seek replacement through any available supplier. If you cannot find a supplier, call Member Services to find one for you. Your supplies will be replaced even if you are temporarily outside of the county in which you live.

Pros & Cons Of Ambetter

Ambetter provides coverage to individuals who dont qualify for traditional plans.

Very high market share.

Even though premiums are low for a bronze plan, the out-of-pocket expenses are very high. You have more coverage with the Ambetter Balanced Care plan and even more coverage with the Ambetter Secure Care plan, which has higher monthly payments and low out-of-pocket expenses.

Does Ambetter From Superior Healthplan Cover Mental Health & Dual Diagnosis Treatment

Yes, per the Affordable Care Act , Ambetter from Superior HealthPlan may be able to provide full or partial coverage for mental health and dual diagnosis treatment in Texas and out of state.

If you struggle with a mental health disorder and substance use disorder , youre not alone. When a mental health disorder and SUD occur at the same time, its known as a dual diagnosis. Studies show that around 50% of those who struggle with mental illness also have SUD.10

Its important to treat co-occurring disorders together. Research suggests that integrated treatment has a far better outcome than treating only one or the other, and there are well-established treatment programs that professionals use for those with a dual diagnosis.11

Who Is Ambetter From Superior Healthplan

What is Ambetter?

Ambetter from Superior HealthPlan, headquartered in Austin, Texas, is a Health Insurance Marketplace product of the Centene Corporation. Based in St. Louis, Mo., Centene is the largest provider of insurance plans under the Affordable Care Act with a 3.29% market share.1

Plans from Ambetter from Superior HealthPlan deliver healthcare services to residents of Texas. The Celtic Insurance Company, headquartered in Chicago, Ill., a qualified health plan issuer in the Texas Health Insurance Marketplace, underwrites the plans.

Superior HealthPlan has 1.5 million members across Texas2 and offers nine products. Ambetter from Superior HealthPlan is the companys Health Insurance Marketplace product, but Superior HealthPlan also offers other health coverage options, such as Medicaid and Medicare Advantage plans.

Ambetter from Superior HealthPlan offers coverage in 138 out of 254 counties in Texas.3 It only offers health maintenance organization and exclusive provider organization plans on the federal Health Insurance Exchange.

Superior HealthPlan began in El Paso, Texas, in 1999 and expanded to 10 office locations serving Texas. It has a network with more than 90,000 providers across the state, including more than 500 hospitals.4

Extent of Coverage

Ambetter from Superior HealthPlan offers coverage in 138 out of 254 counties in Texas.

Also Check: Chiropractors In Denver That Accept Medicaid

Types Of Plans Offered

Its somewhat difficult to access specific information about the types of health plans Ambetter has. Their website primarily just explains the metal tiers for their plans, as well as how essential health benefits are covered by every plan. But to find out what kinds of plans these are , not to mention what prices and benefits you qualify for, youll have to contact a representative. Up front, its important to know that Ambetter is part of the Health Insurance Marketplace . Its Centenes option for HIM plans, which is intended for people who dont have health insurance and maybe dont qualify for typical plans. In HIM territory, Medicare isnt an option, for example, because if you qualify for Medicare, thats the legal option for you to get rather than taking advantage of a plan like Ambetters. Medicaid and CHIP are HIM plans, though. Ambetter has PPOs, HMOs, and EPOs.

They dont offer HSAs though. Theyve divided their plans into three metal tiers: Bronze, Silver, and Gold. All three of these tiers cover essential health benefits, Ambetters term for services like preventative and emergency care, therapy, behavioral health help, medications, maternity, and hospitalization. But the difference in the tiers comes in the costs for premiums and out-of-pocket expenses. Bronze plans have the lowest premiums but the highest OOP costs, and Gold has the highest premiums but the lowest OOP costs. Silver, of course, is the in the middle.

Whats The Difference Between In

One of the important things to consider when evaluating drug rehab centers is whether the program is within the Ambetter from Superior HealthPlan provider network. Every health insurance plan has a network of providers that are contracted to provide care to members at a specific price.13

If a rehab program or other medical provider isnt in the network, you might not get any coverage from your insurance plan, which means you pay the full cost yourself.13 Even if you do receive coverage, youll pay much higher out-of-pocket costs.13

Don’t Miss: Your Texas Benefits Pregnancy Medicaid

How Do You File Claims With Ambetter From Superior Healthplan

To file a claim with the company, especially if it is out-of-network, you will need a copy of the detailed claim or itemized receipt from the provider. This is only done for services that the plan has agreed to cover. Providers typically bills Ambetter directly for covered in-network claims.

Your claim to the insurance company must include an explanation of why you paid for covered services, proof of payment for the services in the reimbursement request along with a completed and signed reimbursement claim form.

Send completed paperwork to:

P.O. Box 5010Farmington, MO 63640-5010

Within 15 days of submission,6 the plan will let you know about your claims acceptance or rejection. If the plan accepts, you can expect payment within five business days.

If rejected, you will receive an explanation about your claims rejection. Sometimes, Ambetter will need more time for a determination and will let you know their timeline.

What Are The Member Benefits From Ambetter From Superior Healthplan

Ambetter from Superior HealthPlan offers several benefits and tools for members. These include:

24/7 Nurse Advice Line.
My Health Pays rewards program.

Mail-order pharmacy.

Transportation.

Members access the rewards program and other benefits through the Ambetter online patient portal. Use the portal to see your benefits, pay your premiums, order new ID cards and more.

Read Also: Medicaid Long Term Care Virginia

What Health Insurance Does Ambetter From Superior Healthplan Offer

Ambetter from Superior HealthPlan offers three plan options that reflect the Health Insurance Marketplace metal plan levels: bronze, silver and gold. Both individual and family plans are available.

Bronze plan. Ambetter Essential Care plans are the companys bronze level plans. They cover essential health benefits,5 including annual health exams, and come with lower monthly premiums. As a tradeoff, deductibles and out-of-pocket maximums are high, which can result in high out-of-pocket costs if you need a lot of care. These plans are best if you are in good health.

Silver plan. Ambetter Balanced Care plans are the companys silver level plans. These plans have lower deductibles and out-of-pocket maximums, but they come with higher monthly premiums. Depending on your income, silver level plans can also offer extra savings.

Gold plan. Ambetter Secure Care plans are the gold metal tier plans. Expect higher monthly premiums but low deductibles and out-of-pocket maximums. These plans are best if you have high medical costs since the low deductibles allow you to take advantage of coinsurance benefits. These plans are best if you have high health costs and need medical care regularly.

Some Ambetter plans come with vision and/or dental benefits for a higher premium, which cover services such as eye exams and dental cleanings. Some plans may be eligible for a Health Savings Account .

EPOs and Providers

Better Health For Your Local Community

What makes Ambetter different? We believe health insurance companies can best deliver quality care on a local level. Thats why it’s our priority to invest in both our communities and our members.

Our employees live and work in the communities they serve, side by side with our members. They’re committed to partnering and volunteering with local organizations to help enrich their neighborhoods and better support you and the health of your community. That means better health for you and our members.

Recommended Reading: Is Qsymia Covered By Medicaid

How To File A Claim With Ambetter

If you receive non-emergency services from an out-of-network provider, you may be responsible for the entire cost of the medical bill, unless otherwise required by state or federal regulations. To take full advantage of your Ambetter coverage, it is important to only use in-network providers. To appeal a claim that was denied by Ambetter, the member should contact 1-877-687-1197.

How Long Does Ambetter From Superior Healthplan Cover Inpatient Alcohol And Drug Rehab Programs

Ambetter How To: Where Should I Go For Care?

Ambetter from Superior HealthPlan offers a variety of health plans, and your level of coverage and the length of time your program will be covered depends on your specific plan. You can call the number on the back of your insurance card to speak to an Ambetter representative who can walk you through your coverage.

Keep in mind that recovery looks different for everyone and theres no one-size-fits-all approach when it comes to treatment. The continuum of care thats right for you will be determined by your doctor after reviewing your history and needs. However, studies show that most people who misuse substances need at least 3 months of treatment to significantly change or stop using substances.12 The best long-term outcomes come with the longer treatment programs.12

What Types Of Addiction Treatment Does Ambetter From Superior Healthplan Cover

Recovery looks different for everyone, and there is no one-size-fits-all approach to addiction treatment. Your doctor will determine what continuum of care is right for you based on factors such as the substance you use, how long youve been using them, and any environmental triggers you may face.

Ambetter from Superior HealthPlan may be able to cover at least some of the cost of medically necessary addiction treatment, including:8, 9

Experienced Healthcare Here For You

When you become an Ambetter member, youre joining an experienced healthcare company. We’ve been part of the health insurance marketplace from the very beginning.

Now, Ambetter has more than 2 million members nationwide. Our 27 state health plans are here for you. We have the years of experience plus local knowledge to help you and your family take charge of your health.

Read Also: South Dakota Medicaid Phone Number

Common Questions About Ambetter

What states accept Ambetter health insurance?

Ambetter offers coverage for individuals in Arizona, Arkansas, Florida, Georgia, Illinois, Indiana, Kansas, Mississippi, Missouri, New Hampshire, Nevada, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas and Washington.

Is Ambetter good health insurance?

If you are under-insured or uninsured and need low-cost healthcare, Ambetter may be a good option because they offer affordable plans. Ambetter only offers insurance in 15 states . Ambetters complaint ratio, however, is high in some states.

How does Ambetter insurance work?

Ambetter insurance has bronze, silver and gold plans. Ambetter Essential Care has bronze plans, which are cheapest but have the highest deductibles. Ambetter Balanced Care has silver plans, which have lower deductibles and out-of-pocket maximums. Ambetter Secure Care is the gold metal tier policy which has the most expensive premiums but the lowest out-of-pocket maximums.

Is Ambetter and WellCare the same company?

Ambetter and WellCare are owned by Centene Corporation. Centenes acquisition of WellCare was expected to be finalized by the first half of 2020. As one entity, they will be one of the largest providers of Medicaid and Medicare.

Does Ambetter require pre-authorization for services?

What is Ambetter My Health Pays® Rewards Program?

Does Ambetter cover out of state?

How do I find my Ambetter member ID?

AYour member ID # is on the front of your insurance card.

Carousel Content With Slides

A carousel is a rotating set of images, rotation stops on keyboard focus on carousel tab controls or hovering the mouse pointer over images. Use the tabs or the previous and next buttons to change the displayed slide.

*For some plans

Healthcare is essential. Ambetter can help.

You can count on us to share helpful information about COVID, how to prevent it, and recognize its symptoms. Because protecting peoples health is why were here, and its what well always do.