Ambetter Indiana individual and family healthcare coverage provides affordable plans in 28 counties of the state. Its parent company is Managed Health Services (MHS), and it has been providing quality medical coverage to Hoosier residents for over 21 years. Their marketplace policies are easy to purchase, while their rates tend to be lower than other major carriers.
MHS is a care provider that helps Children’s Health Insurance Program (CHIP), Hoosier Healthwise, and Healthy Indiana. Other thank enrollment duties, they also coordinate community events and offer public information about their programs. The National Committee For Quality Assurance (NCQA) awarded their designation to MHS as “commendable”, for their outstanding services.
The company is a wholly owned subsidiary of Centene Corporation, a Fortune 500 company that specializes in providing their services to government-funded programs meant for customer who lack medical care. The programs include Medicaid, Aged, Blind, or Disabled (ABD), and CHIP. Other special programs also include in-home treatment, managed vision, special-needs coverage, and prescription benefits management.
Ambetter Indiana Provider Network
The company has offices in Indianapolis, Fort Wayne, and Merrillville. Most of the state of Indiana is covered with their services of the state. The 28 countries covered are: Adams, Allen, DeKalb, Elkhart, Huntington, Kosciusko, Marshall, St. Joseph, Wells, Whitley, Boone, Clarke, Daviess, Hamilton, Hancock, Harrison, Hendricks, Henry, Howard, Johnson, Knox, Lake, LaPorte, Madison, Marion, Miami, Montgomery, Porter, Pulaski, Steuben, Tippecanoe, and Vanderburgh.
They have an extensive network provider list that includes primary care physicians, specialists, Urgent-Care locations, hospitals, as well as lots of other medical and rehabilitation facilities. For example, a 40-mile radius in the Indianapolis area offers 13 hospitals that are “in-network.”
What about the Doctors?
When it comes to doctors, there are many to choose from within your area. Primary care physicians specialists, behavioral health, and dental and vision specialists are also widely available. For example, a 20-mile radius in several cities offers the following doctors available for your needs: Bloomington (5), Brownsburg (172), Carmel (198), Evansville (12), Fort Wayne (95), Hammond (106), Indianapolis (212), Lafayette (5), La Porte (25), Lebanon (73), Muncie (54), Richmond (4), South Bend (144), Valparaiso (194), and Vincennes (26).
Gym Membership Benefits
The gym membership of Ambetter makes it easier for you to stay in shape and healthy. You are able to earn $20 on your My Health Pays card each month you visit a gym of your choosing at least eight times. In addition, discounts on gym memberships are also available at approved locations. Partnerships with gyms and health clubs are present across the country.
“Start Smart” For Pregnant Women
Pregnant women also benefit from a special program that provides support, education, and guidance. A “Notification Of Pregnancy” (NOP) form has to be completed before these extra services are provided. Often discussed are maintaining healthy lifestyle habits, resting regularly, and avoiding alcohol, tobacco and drugs. Therapy and counseling are also possible.
Wellness Benefits That Pay You
The current policyholders receive awards when they participate in preventative activities and maintain good health. A My Health Pays Visa Prepaid Card serves to accumulate earned dollars, and you can spend reward points to pay many extra costs like physician copays, deductibles, coinsurance and premiums. Some common items here include $50 for completing the initial “Welcome” survey, $25 for the annual flu shot, $20 for a monthly reimbursement for visiting exercise facilities or gyms at least eight times, and $50 for the annual wellness exam.
2018 Ambetter Indiana Marketplace Plans
There are three tiers of policies. The essential Bronze tier covers basic needs, with the emphasis on major medical expenses. Premiums are the lowest, and the out-of-pocket costs are the highest. The balanced Silver tier offers lower rates and less risk for large claims. If you are able to qualify for a subsidy, this is often the best option for you because of cost sharing. Finally, the secure Gold policies are the most expensive, but they also feature the lowest copays, coinsurance, and deductibles.
Essential Care 1 – Least expensive plan. $6,800 deductible, 0% coinsurance. Maximum out-of-pocket cost per individual is $6,800. Generic drugs $20 copay. Annual eye exam and one pair of glasses included for children.
Balanced Care 4 – $30 and $60 office visit copays. Urgent Care copay $100. Deductible is $7,050. Maximum out-of-pocket expenses $7,050. 0% coinsurance. Generic and preferred brand copays $15 and $50. Non-preferred and specialty drugs must meet deductible.
Secure Care 1 – $1,000 deductible. $6,350 maximum out-of-pocket expenses. Three free pcp office visits allowed. Specialist visits must meet deductible first. $500 deductible applies to all prescriptions except generic drugs ($10 copay). 20% coinsurance when deductible is met.
Federally Subsidized Plans
If your total household income is less than 400% of the Federal Poverty Level (FPL), and if you do not have “affordable” medical coverage from your employer, you are eligible for financial aid for the premium. These become larger as the family grows. A six-person household may qualify for up to $400-$600 per month more than a two-person household can.
How Rates Compare With Other Companies
The sample household is a 43-year-old single person who lives in Hendricks County, with annual income of $30,000. Following are several monthly rates from the competitive plans. Ambetter Essential Care 1 is $145, while Ambetter Essential Care 2 costs this person $149. Anthem offers Pathway X 0 for $158 and Pathway X 5750 for $182. MDwise Marketplace would set our person $191 per month, while CareSource Just4Me Healthcare With Heart costs $194. Ambetter Balanced Care 2 is $206, while Anthem Pathway X 10 is $230.
Ambetter does not offer plans specially made for senior citizens at this time. People who reached 65 years of age and who are Medicare-eligible should feel free to compare the most popular plan options on the website. Open Enrollment period differs from the Under-65 period.