Ambetter vs. Kaiser Permanente: What You Need to Know
Ambetter is a health insurance company owned by Centene Corporation, a multi-national company that provides programs and services to under-insured and uninsured individuals. Centene is the largest Medicaid managed care organization in the country and the number one insurer on the Health Insurance Marketplace. Each state works differently through Ambetter to provide health insurance marketplace plans, including Medicaid and Children’s Health Insurance Programs (CHIP). Both Centene and it’s new acquisition, Wellcare Health Plans, serve Medicaid and Medicare members.
After the war ended the shipyard workforce fell from 90,000 to 13,000. Only 12 of 75 medical group providers remained. On July 21, 1945, the Permanente Health Plan opened to the public to continue the health care delivery set up by Kaiser and Garfield. In 10 years, more than 300,000 people enrolled in Northern California with the support of two unions, the International Longshoremen’s and Warehousem*n’s Union and the Retail Clerks Union.
In 1953, the name of the health plan and the hospitals were changed from Permanente to Kaiser Permanente. Even today, there are ties between the nonprofit Kaiser Foundation Health Plan and Hospitals and the Permanente Medical Groups.
To learn more about each company, you can check out the Ambetter Overview and Kaiser Permanente Overview.
What is Ambetter and Kaiser Permanente Insurance Rating?
Which health insurance company is better? We've made it easy to compare companies side by side. See how Ambetter and Kaiser Permanente ranked among the industry ratings.
| Comparison | Ambetter | Kaiser Permanente |
|---|---|---|
| Year Founded | 1984 | 1945 |
| Medicare Star Rating | 5 stars (out of 5) | |
| BBB Rating | A+ | A+ |
| NAIC Complaint Index | 1.12% for individual health insurance | 0.36% for group health |
| Market Share Percentage | 20% | |
| Financial Strength | Excellent |
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Pros & Cons of Ambetter or Kaiser Permanente
Pros
Ambetter
- Ambetter provides coverage to individuals who don’t qualify for traditional plans.
- Very high market share.
Kaiser Permanente
- Affordable marketplace plans with different tiers of coverage.
- Low complaint ratio for group health plans.
Cons
Ambetter
- 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.
Kaiser Permanente
- Kaiser Permanente is only available in California, Colorado, Georgia, Hawaii, Maryland, Oregon, Virginia, and Washington D.C.
Ambetter and Kaiser Permanente Mobile Apps Options
The Kaiser Permanente app allows users to find doctors, hospitals, and pharmacies, view claims, and pay your bill. They also offer an app called Humana Pharmacy which helps you to manage your prescriptions.
| Ambetter Mobile App | ||
|---|---|---|
| Ambetter does not currently have a mobile app. | ||
| Kaiser Permanente Mobile App | ||
|---|---|---|
| iOS | 3.1 | 2K users |
| Android | 4.3 | 16,728 users |
Ambetter and Kaiser Permanente Enrollment Process
Ambetter
Ambetter is available through the health insurance marketplace or you can get several free quotes here. Each state has their own marketplace. If you’re not sure where to begin, visit https://www.healthcare.gov/.
Kaiser Permanente
Kaiser Permanente offers plans through the health insurance marketplace. You can begin searching plans here or you can get several free health insurance quotes here.
Each state has their own marketplace. If you’re not sure where to begin, visit https://www.healthcare.gov/. You can also schedule a personal appointment with a local Kaiser Permanente Medicare specialist: 1-866-973-4588.
How to File a Claim with Ambetter and Kaiser Permanente Insurance
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.
Kaiser Permanente
To submit claims for reimbursem*nt, contact member services at 1-888-901-4636. Otherwise, you should be covered except for copay. If you need reimbursem*nt for Medicare Part D prescriptions, you must use the Member reimbursem*nt drug claim form (PDF). For all other prescriptions (non-Medicare and Medicare without Part D) you must use this Prescription claim form (PDF).
Common Questions About Kaiser Permanente and Ambetter Insurance
Ambetter
How to cancel Ambetter insurance?
You should call or write your insurance to cancel your Ambetter insurance. You can find the contact number and address on your ID card.
Is Ambetter insurance part of Medicaid?
Ambetter offers an alternative to Medicaid. It’s an option for people who no longer qualify for Medicaid. Ambetter is owned by Centene, which serves Medicaid and Medicare members.
Does Ambetter cover pregnancy?
Yes, Ambetter has a program for women who are pregnant called “Start Smart for Your Baby.”
What is Ambetter Superior HealthPlan?
Ambetter from Superior HealthPlan is a qualified health plan issuer in the Texas Insurance Marketplace.
Kaiser Permanente
What is Kaiser Insurance?
Kaiser Permanente is a nonprofit, group-practice health plan with headquarters in Oakland, California. It is an example of high-quality, integrated health care.
Does Kaiser Permanente have good reviews?
Kaiser Permanente has a better than average complaint ratio, especially for it’s group plans.
Who is eligible for Kaiser Permanente?
Individuals, families and people whose employers offer Kaiser Permanente are eligible for coverage. Kaiser also offers Medicare Supplement plans and Medicare Advantage, which is the alternative to Original Medicare.
What pharmacies accept Kaiser Permanent’s health insurance?
If your health plan benefits include a prepaid prescription drug plan, you must use a Kaiser pharmacy to obtain drugs at plan prices. You can fill your initial prescription at many MedImpact pharmacies, which include Walgreens, CVS, Rite Aid, Kroger, Safeway and Costco, but you’ll need to order any refills through a Kaiser Permanente pharmacy or a mail-order refill service through Kaiser.
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Ambetter and Kaiser Permanente Insurance Contact Info
| Ambetter Contact Info | |
|---|---|
| Address | Ambetter from Coordinated Care, 1145 Broadway, Suite 300, Tacoma, WA 98402 |
| Phone | 1 (877) 687-1197 |
| Website | https://www.ambetterhealth.com/ |
| https://www.facebook.com/AmbetterHealthcare/ | |
| Youtube | https://www.youtube.com/channel/UC1fien5XXb1voeybJcWr6kQ |
| https://twitter.com/Centene | |
| https://www.linkedin.com/company/centene-corporation/ | |
| Kaiser Permanente Contact Info | |
|---|---|
| Address | 1 Kaiser Plaza, Oakland, CA 94612 |
| Phone | 1 (510) 271-5910 |
| Website | https://healthy.kaiserpermanente.org/ |
| https://www.facebook.com/kpthrive/ | |
| Youtube | https://www.youtube.com/channel/UCqZdtT_o6xZbMkRbLZJ7Zvg |
| https://twitter.com/aboutKP | |
| https://www.linkedin.com/company/kaiser-permanente/ | |
