When shopping for health insurance, two major carriers in Florida are Ambetter and Florida Blue. But how do these two providers compare when it comes to plan options, affordability, provider networks and member satisfaction? This comprehensive guide examines the key differences between Ambetter and Florida Blue.
A Brief Comparison Table
| Aspects | Ambetter | Florida Blue |
| Overview | ACA exchange brand by Centene | Florida’s BCBS insurer |
| Plans Offered | Individual exchange plans | All markets – individual, employer, Medicare, Medicaid |
| Provider Network | Smaller localized network | Largest statewide network in FL |
| Prescription Drugs | Integrated with medical deductible | Standalone Rx plans offered |
| Member Resources | Robust tools and incentives | Average online tools |
| Accreditation | Not NCQA accredited | NCQA accredited |
| Financial Ratings | No ratings yet as new insurer | Strong ratings from Moody’s and S&P |
| Pricing | Very affordable premiums | Average to high premium pricing |
| Customer Satisfaction | 2.5 to 4 stars out of 5 | 4 out of 5 stars on average |
Overview of Ambetter and Florida Blue
Ambetter is a health insurance marketplace brand owned by Centene Corporation. It offers Affordable Care Act exchange plans in select states including Florida. Ambetter positions itself as a value-based insurance choice focused on local community healthcare.
Florida Blue is Florida’s Blue Cross Blue Shield affiliate. It offers a wide range of group and individual health insurance plans across every county in Florida. As an established non-profit insurer dating back to 1944, Florida Blue has a strong foothold in the state.
Both offer comprehensive medical plans to individuals, families and employers. They also participate in government programs like Medicare Advantage and Medicaid managed care. However, there are some notable differences in their provider networks, plan options, costs and member resources.
Ambetter Pros
- Affordable Premiums
Ambetter premiums are often lower than other insurers for comparable plan coverage. This makes them an affordable option, especially for lower income households.
- Strong Medicaid Plans
For Florida Medicaid recipients, Ambetter offers several plan choices like Ambetter Balanced Care with $0 premiums and robust benefits.
- Focus on Member Resourses
Ambetter provides member assistance like 24/7 nurse advice lines along with programs addressing social determinants of health. Resources aim to improve access and outcomes.
- Shopping Rewards
Members can earn points for taking healthy actions that go towards rewards like gift cards. Shopping rewards incentivize engagement.
- Integrated Pharmacy Benefits
Ambetter applies prescription drug costs towards the medical deductible. There are also copays as low as $1 for certain generics on some plans.
Florida Blue Pros
- Largest Statewide Network
With over 65,000 participating providers, Florida Blue offers the largest network in Florida for access. Ambetter’s network is smaller in comparison.
- Strong Brand Recognition
As the state’s Blue Cross Blue Shield insurer for over 75 years, Florida Blue is a household name that many Floridians trust. Their longevity brings credibility.
- Diversified Products
Florida Blue covers all segments – exchange plans, employer-based plans, individual plans, Medicare, Medicaid, specialty products, travel insurance and more.
- Member Discounts
Members get discounts on services like fitness classes, vision care and complementary health programs that enhance wellbeing.
- Online Resources
Through their website and mobile app, Florida Blue offers robust tools to find providers, manage claims, access records and compare costs.
Also Read: Is Kaiser Permanente Better Than CareFirst?
Key Differences Between Ambetter And Florida Blue
- Plans Offered
Ambetter sells exchange plans under the Affordable Care Act aimed at individuals. Florida Blue offers a diverse range of products inside and outside the marketplace.
- Provider Network
Ambetter has a smaller provider network versus Florida Blue’s expansive statewide network. But Ambetter focuses on local partnerships.
- Prescription Drug Coverage
Ambetter’s exchange plans integrate prescription drugs with medical deductibles and out-of-pocket maximums. Florida Blue also offers stand-alone Rx plans.
- Accreditation
Florida Blue has earned NCQA accreditation for service and care quality. Ambetter plans are currently not NCQA accredited.
- Financial Ratings
Florida Blue maintains strong financial ratings from agencies like Moody’s and S&P affirming their stability. As a newer insurer, Ambetter does not yet have financial ratings.
Choosing the Right Insurer
When choosing between Ambetter and Florida Blue, here are some key factors to weigh:
- Premium Costs – If having the lowest possible premium is vital, Ambetter offers very affordable rates and options for financial assistance.
- Plan Availability – Florida Blue serves all segments, while Ambetter focuses specifically on exchange marketplace plans.
- Provider Choice – Florida Blue offers far more doctors and hospitals to choose from statewide.
- Prescription Drugs – Ambetter exchange plans incorporate Rx costs with medical spending. Florida Blue has stand-alone pharmacy plans.
- Brand Trust – Long-time Floridians often have existing relationships with Florida Blue and trust their stability.
- Member Resources – Ambetter provides some unique member tools and support services.
There are merits to both insurers. Florida Blue is worth considering if you want the largest network, brand familiarity, and product variety. Ambetter offers affordably priced plans and resources for exchange marketplace consumers.
Also Read: Comparison Between Humana And Florida Blue
Choosing a Plan
When evaluating specific plans from Ambetter or Florida Blue, look at:
- Premiums and deductibles fit your budget
- Doctor/hospital you want to use is in-network
- Drugs you take regularly are covered affordably
- Specialists accessible without referrals (if important)
- HMO or PPO plan type aligns with preferences
Compare specific plan benefits side by side to make sure the one you select meets your healthcare and budget needs. Don’t just default to the lowest premium option.
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Member Satisfaction
Both Ambetter and Florida Blue receive decent member satisfaction ratings, but Florida Blue tends to rate higher:
- Florida Blue earns 4 out of 5 stars from members across most plans according to Consumer Reports.
- Ambetter earns 3 out 5 stars on average for exchange plans. Ratings range from 2.5 to 4 stars depending on state and plan.
In national rankings by JD Power, Florida Blue ranks above average nationally in member satisfaction. Ambetter tends to rank average to below average.
While costs and benefits are most critical in choosing a plan, member satisfaction can impact the insurance experience. Checking health insurer ratings on sites like Consumer Reports can provide useful insight.
Switching Insurers
During open enrollment, consumers can switch between Ambetter, Florida Blue and other marketplace insurers without restriction. Outside of open enrollment, you must have a qualifying event like job loss, marriage or moving.
If switching insurers, make sure to check:
- Your doctor participates in the new insurance network.
- Prescriptions you take regularly are covered on the pharmacy formulary.
- You don’t lose credit for deductibles already met on your old plan.
Always report life events like job changes, marriages and moves to your insurer to trigger a special enrollment period. This lets you switch plans without waiting for open enrollment.
Also Read: Differences Between Kaiser And Premera.
Frequently Asked Questions (FAQs)
Yes, Ambetter offers marketplace health insurance plans to Florida residents through the Affordable Care Act exchange. They sell plans in select Florida counties including major metro areas. Their plans meet all ACA coverage requirements.
Ambetter has partnerships with a number of hospitals and health systems in Florida markets where they operate. Some of the larger providers include: Broward Health, Memorial Healthcare System, Baptist Health South Florida, Orlando Health. Check Ambetter’s online provider directory for a full list of their in-network Florida hospitals. Networks can vary by county.
Florida Health Care Plans is a different insurer and is not the same company as Florida Blue. Florida Health Care Plans is owned by Centene Corporation who also owns Ambetter. So Florida Health Care is affiliated with Ambetter, while Florida Blue is a separate non-profit insurer.
Florida Blue only provides health plans within the state of Florida. However, their parent company GuideWell Mutual Holding Corporation partners with other Blue Cross Blue Shield companies across the country. This means Florida Blue plans get reciprocal treatment via the BlueCard program when members travel or get care in other states. Ambetter and Florida Blue give Florida health insurance shoppers two robust options to consider. Compare their provider networks, costs, ratings and benefits to decide which insurer fits your coverage needs and budget best.
Also Read: Choose Between Horizon And UnitedHealthcare.
Final Verdict
Here is a quick recap of key target segments for each insurer:
Ambetter is ideal for:
- Individuals eligible for Affordable Care Act subsidies
- Medicaid recipients in Florida
- Shoppers wanting the lowest premium costs
- Those appreciating member engagement incentives and resources
Florida Blue is ideal for:
- Households who have used Florida Blue previously
- Those wanting robust provider choice and network access
- Medicare-eligible seniors looking for Medicare Advantage
- Employer groups shopping group health plans
- Floridians looking for specialized products like travel insurance
Evaluate your specific needs against their offerings to see if Ambetter or Florida Blue is the right fit.