Ambetter plan options come in three layers. First, you pick a plan family, such as Premier or Value, which sets your network. Next, you pick a metal level: Bronze, Silver or Gold. Then you look at extras, like Silver plans built for diabetes care or plans with dental and vision included. Your ZIP code decides which ones you can actually buy.
- Ambetter is Centene's ACA Marketplace brand, and its Premier plans sold in 27 states for 2026 coverage.
- Premier plans use Ambetter's broadest network with no specialist referrals, while Value plans assign you a primary care provider and require referrals.
- On average, Bronze plans pay about 60% of covered costs, Silver plans about 70% and Gold plans about 80%.
- Only Silver plans carry cost-sharing reductions, which lower your deductible and out-of-pocket limit if your income qualifies.
- Open Enrollment for 2027 coverage starts November 1, and you need to enroll by December 15 for a January 1 start.
What Is Ambetter Health, and Where Can You Buy It?
Ambetter Health is the Marketplace brand of Centene Corporation. It sells individual and family plans built under the Affordable Care Act (ACA). So every plan covers the ten essential health benefits, and no plan can turn you down for a pre-existing condition. Our Ambetter Health carrier overview covers the company itself.
Availability is local, though. Ambetter Premier plans sold in 27 states for 2026 coverage, but not in every county of those states. Some plan families also exist only in a handful of counties. Before you fall for a plan, open our health insurance guides for every state and check your market.
Ambetter plans also aren't Medicaid, even though some Centene companies run Medicaid plans with similar names. Because the brand names overlap, always confirm you're looking at a Marketplace plan. For a wider view of how networks differ across carriers, see our guide to types of health plans and networks.
Ambetter Plan Options by Network: Premier, Value and Select
Ambetter plan options start with the plan family. The family sets the network, and the network decides which doctors and hospitals your plan pays. Here is how the four families compared for 2026 coverage.
| Plan family | Network | Specialist referrals | Where it sold for 2026 |
|---|---|---|---|
| Premier | Ambetter's broadest network | Not needed | 27 states |
| Value | A smaller set of chosen doctors and hospitals, with an assigned primary care provider | Needed for most care | Certain Florida and Texas counties |
| Select | An exclusive network of chosen providers | Not needed | Certain Georgia counties |
| Solutions | Broad network, sold off the Marketplace | Not needed | Select states, for people with an employer allowance |
What Premier network coverage means
Premier is the family most shoppers see. It comes in Bronze, Silver and Gold, and you can see a specialist without a referral. However, broad doesn't mean unlimited. Like most Marketplace plans, a Premier plan pays for in-network care only, except in emergencies.
So when you see a plan described as Premier network coverage only, read it literally. Stay inside that network, or you may owe the whole bill.
When Value or Select plans make sense
Value plans trade choice for a lower price. Ambetter assigns you a primary care provider (PCP), and that doctor refers you to specialists. That setup works well when you already like a doctor in the Value network. Select plans, by contrast, skip referrals but keep you inside a smaller, exclusive network.
Search your doctors inside the exact plan family, not just Ambetter as a whole. A doctor who takes Premier may not take Value. Use our network search links for every carrier, then call us so we can double-check the result.
Want the full picture first? Read how to look up Ambetter doctors and hospitals before you choose a family.
Bronze, Silver and Gold: How the Metal Levels Work
The second layer of Ambetter plan options is the metal level. It doesn't change the quality of your care. Instead, it changes how you and the plan split the bill. HealthCare.gov lists the plan's average share of covered costs like this:
A Bronze plan keeps premiums low, but you pay more when you need care.
Start with Silver, because only Silver plans carry cost-sharing reductions.
A Gold plan costs more each month but usually less when you see doctors.
Why Silver gets special attention
Cost-sharing reductions (CSRs) are extra savings that lower your deductible, copays and out-of-pocket limit. You get them only on a Silver plan, and only when your household income falls between 100% and 250% of the federal poverty level. For 2027 coverage, CSRs can cut the out-of-pocket limit from $12,000 to as low as $4,000 for one person. Our guide to premium tax credits and other savings shows how to check your income.
What the out-of-pocket limit means for you
The out-of-pocket maximum is the most you pay in a year for covered, in-network care. For 2027 coverage, federal rules cap it at $12,000 for one person and $24,000 for a family. Plans can set lower limits, so compare that number side by side. Learn more about how your yearly spending cap works.
Special Ambetter Plan Types: Diabetes, HSA and Add-Ons
Beyond the basic metal levels, Ambetter builds a few plans for specific needs. Not every state gets them, so treat these Ambetter plan options as a menu to ask about.
Silver plans built for diabetes or asthma care
The Premier Silver Comprehensive Diabetes Care plan offers $0 copays for preferred insulin and select medications. It also covers some diabetic supplies. For 2026, Ambetter sold it in Alabama, Florida, Georgia, North Carolina, New Jersey, Oklahoma, Tennessee and Texas.
A similar Silver plan for asthma and COPD offered $0 copays for preferred medications, pulmonologist visits and pulmonary rehab. For 2026, it sold in Kentucky, North Carolina and Oklahoma. Our guide to coverage choices for people with diabetes explains what else to check.
Ambetter insurance plans with an HSA
Some Ambetter Bronze plans pair with a health savings account (HSA). For example, Ambetter's 2026 plan list in Delaware included a Principal Bronze HSA plan. An HSA lets you save money tax-free for medical costs, so it suits people who want a low premium and can set cash aside.
Plans with dental and vision built in
In some states, Ambetter also sells versions of its plans with vision and adult dental included. That same Delaware list paired most plans with a dental and vision version. If your state doesn't offer one, a separate dental and vision plan can fill the gap.
Off-Marketplace plans for employer allowances
Ambetter Health Solutions plans sell outside the Marketplace. They serve people whose employer gives them an allowance through an ICHRA or QSEHRA, which are accounts that repay you for your own health plan. Solutions plans also come in Platinum, which pays about 90% of covered costs on average.
A licensed Vivna agent can pull every Ambetter family and metal level for your ZIP code, then check your doctors, at no cost to you. Prefer to apply on your own? Start an online Ambetter application with Heather.
How to Decode an Ambetter Plan Name
Ambetter plan names look busy, but they follow a pattern. The metal level always appears in the name. The other words are marketing labels that change by state and year. For example, Ambetter's 2026 Delaware list included these names:
So don't shop by name. Instead, open the Summary of Benefits and Coverage (SBC) for each plan. Then compare these five numbers across every option:
- Monthly premium after any tax credit, since that's what you actually pay
- Deductible, plus which services you can use before you meet it
- Copays for primary care and specialists, because you'll use these most
- Drug tiers on the formulary, which is the plan's list of covered drugs
- Out-of-pocket maximum, so you know your worst-case year
Our side-by-side Marketplace comparison guide walks through an SBC line by line.
Perks Included With Ambetter Health Plans
Ambetter adds a few member programs on top of the plan itself. They shouldn't decide your choice. Still, they add real value when you use them.
My Health Pays rewards
Members can earn up to $500 in rewards for activities like an annual well visit, certain screenings and online challenges. You can spend rewards on premiums, doctor copays, deductibles and coinsurance. Some utility and phone bills qualify too. That said, the program has limits:
- Rewards can't pay pharmacy copays in most states.
- Members in Arizona and Nevada can't put rewards toward premiums.
- Any unused balance disappears the moment your coverage ends.
Virtual 24/7 Care and other extras
Ambetter members can reach a licensed provider by phone or video at any hour through Virtual 24/7 Care. Cost sharing may apply, and on HSA plans it starts only after you meet the deductible. Members also get a 24/7 nurse advice line, mail-order pharmacy and the Start Smart for Your Baby pregnancy program. Ask about these perks when you compare plans.
Does Ambetter Offer Medicare Advantage Plans?
No. Ambetter sells individual and family plans for people who buy their own coverage and aren't on Medicare. Centene sells its Medicare Advantage plans under a different brand, Wellcare. So if you're turning 65, you'll compare Medicare options instead of Ambetter plans. Until then, a Marketplace plan can bridge the gap, so call us if you're retiring early.
How to Pick Among Ambetter Plan Options in Five Steps
- List your doctors and drugs
First, write down every doctor, hospital and prescription you want to keep.
- Check the plan family
Search each doctor in Premier, Value or Select, since networks differ.
- Estimate your savings
Next, see if your income qualifies for a tax credit or Silver savings.
- Compare total yearly cost
Add a year of premiums to the costs you'd likely pay for care.
- Enroll on time
For 2027 coverage, enroll by December 15 so your plan starts January 1.
Example: two Ambetter health plans over one year
Step four matters most, because the cheapest premium isn't always the cheapest year. Here is a simple example with made-up prices, so you can see the math:
- Quiet year with only checkups: about $4,200, since preventive care costs $0
- Big year with surgery: up to $13,200 once you hit the max
- Quiet year with only checkups: about $6,000 in premiums
- Big year with surgery: up to $11,000, so Gold wins here
Pick the network first, the metal level second, and the plan name last.The order our licensed agents follow on every Ambetter call
Ambetter networks can change during the year. Also, a doctor working inside an in-network hospital may still be out of network. So confirm both the doctor and the hospital before planned care. For emergencies, the federal No Surprises Act protects you from surprise out-of-network bills.
Before you decide, read our honest look at Ambetter's strengths and weak spots. Still unsure which family fits? Call a licensed Vivna agent at 888-730-6001.
Ambetter Plan Options: FAQs
What are the main Ambetter plan types?
Ambetter sells four plan families. Premier has the broadest network and no referrals. Value uses a smaller network and requires referrals from your primary care provider. Select uses an exclusive network without referrals, and Solutions plans sell outside the Marketplace for people with an employer allowance. Each family comes in Bronze, Silver or Gold, and some states add Silver plans built for diabetes or asthma care.
Is Ambetter an HMO or a PPO?
It depends on the state. Ambetter's own disclosures list HMO and EPO products in Florida and Texas, plus PPO and POS products in Arkansas. In practice, most Ambetter plans pay for in-network care only, except emergencies. So check the plan type on the Summary of Benefits before you enroll. Our HMO vs PPO comparison explains how each network type works.
Does Ambetter sell plans in Florida?
Yes. For 2026 coverage, Ambetter sold Premier plans in Florida, plus Value plans in certain counties. Because lineups can change each year, check the 2027 plans when Open Enrollment opens November 1. Our Florida health insurance guide compares every carrier in the state, and a Vivna agent can confirm what sells in your county.
How much do Ambetter insurance plans cost?
There's no single price. Your premium depends on your age, ZIP code, tobacco use, household size and metal level. Then a premium tax credit can lower it if your income qualifies. Because Ambetter insurance plans vary so much by county, the only reliable number is a quote for your address. Call us, and we'll price every Ambetter option side by side with other carriers.
Can I change my Ambetter plan during the year?
Usually only during Open Enrollment. For 2027 coverage, Open Enrollment runs November 1, 2026 through January 15, 2027. Outside that window, you need a qualifying life event, such as moving, losing other coverage or having a baby. That event opens a Special Enrollment Period, a short window to enroll or switch. Our library of Ambetter questions and answers covers more scenarios.
Does Ambetter cover pre-existing conditions?
Yes. Every Ambetter Marketplace plan follows ACA rules, so it can't deny you or charge you more because of a health condition. It also covers the ten essential health benefits, including prescriptions, maternity care and mental health care. However, your doctors and drugs still need to be in that plan's network and formulary. Check both before you enroll.
Vivna's licensed agents compare plans from 50+ carriers. Call Monday through Friday, 9am to 6pm.
Sources
- Ambetter Health: Marketplace health plans by family and state
- Ambetter Health: My Health Pays rewards program
- Delaware Department of Insurance: 2026 Celtic individual plan names
- HealthCare.gov: Health plan categories (Bronze, Silver, Gold, Platinum)
- CMS: 2027 premium adjustment and cost-sharing limits guidance
- HealthCare.gov: Open Enrollment dates and deadlines
Vivna Insurance is a licensed, independent health insurance agency (NPN 19168641). We are not affiliated with HealthCare.gov or any government agency. Plan availability, networks and benefits vary by state and change over time.