ambetterhealth.com Reviews 

Ambetter is quick to take my premiums on time but delays when I need them to actually deal with my healthcare on a professional level. From start to finish was frustrating, stressful, and ultimately unacceptable—especially for someone with serious medical needs.
My coverage ended December 31, 2025 at 11:59 PM because Marketplace premiums were raised to nearly five times what I had been paying, making the plan unaffordable. I secured new insurance through my employer and simply needed written documentation confirming my coverage termination—something that should be routine.
Instead, I was told I would have to wait 7–10 business days just to receive proof that my insurance had ended.
This would already be inconvenient—but I repeatedly explained that I am diabetic, have multiple chronic health conditions, and take approximately 13 medications. I made it very clear that being left without documentation could delay care, prescriptions, or coverage transitions. Despite this, I was met with indifference and scripted responses.
I asked multiple times to speak with a supervisor or someone with more system access. That request was denied. The representative could only “create a ticket” and promised a callback at some unknown time. There was no attempt to escalate, no workaround offered, and no sense of urgency—despite knowing the medical risk involved.
Beyond this call with Kai, my overall experience with Ambetter was subpar:
Many medications I had previously been prescribed required excessive prior authorizations
Coverage approvals felt inconsistent and restrictive
Finding in-network doctors was difficult
Services were often denied or delayed
I constantly had to “jump through hoops” to receive basic care
For an insurance company that markets itself as helping people stay healthy, the reality felt very different—especially when immediate help was actually needed.
Being told, essentially, “We were happy to take your money, but now you can wait,” while dealing with diabetes and multiple medical conditions is not acceptable.
I would strongly caution others, particularly those with chronic illnesses or complex medical needs, to think carefully before choosing Ambetter. If you need flexibility, responsive customer service, or timely documentation, this may not be the right plan for you.

Ambetter is barely more than a scam. They are expensive, have high co-pays/ deductibles, don't like to cover services... I paid for a plan this year that was over $500 per month out of pocket, had a deductible over $6k, and was a massive headache at every turn. When I had to go to the ER for a medical emergency, they sent me a letter telling me I should have gone to a walk in clinic... for an issue which, if they had taken 10 seconds to review, they would have seen was not appropriate for a walk in clinic. But the worst was when I went to look at 2026 plans. The cost of a similar plan to my 2025 plan went from 500 to nearly 900 dollars per month. I can't afford that, so I didn't sign up. Ambetter decided on their own to enroll me without my consent and charged me. It's now been well over a week, and even after many phone calls, they have not refunded my money. Ambetter is terrible.

The insurance got me out of their system, before my insurance with them ended, not allowing me to use my rewards of over $200
I guess, the Amber is $200 richer ….It’s all about what is benefiting the insurance

Low (as low as they ever get) premiums but also they change covered services & in-network providers with no communication. I have now had 4+ instances where I sought healthcare by in-network providers for covered services only to receive bills 6 months later claiming they are out of network and/or not covered. In one instance I literally booked through the Ambetter site because it said "get 24/7 virtual care -- $0!" and am now receiving bills for it. Have had to spend hours sitting on hold and getting the runaround from customer service reps trying to get it fixed.

Terrible health insurance. If you have ANY other option for coverage you should take it. Customer service is the worst I have ever experienced. The agents tell you the wrong answer constantly. They read off a script and cannot go beyond that. They literally tell you "trust me" and after several poor experiences there's no way I can trust them. Hold times are long and then you have an unsatisfactory and very frustrating conversation where you receive no help and waste hours of your time. You get a different answer depending on who you speak to each time. The network is misleading. Many doctors listed as "in network" don't actually take Ambetter. For example they showed hundreds of options under a certain specialty as "in network" - when I called through literally every doctor listed only ONE actually took Ambetter and they were terrible. They are such a waste of money and their poor reviews clearly reflect that. Take the time to read through them they provide a good representation of what you will receive.

This will be my third year with Ambetter sunshine health through healthcare.gov marketplace. Earlier this year in 2025 I was approved for Zep bound and lost almost 50 pounds. I sought the opinion of a plastic surgeon regarding rashes/infections and pain in the areas of my breasts as well as my abdomen. I lost almost 50 pounds and had an apron belly as well as sagging breast. I went from a size D to a size B with a massive amount of under arm boob. My plastic surgeon was able to get a Panniculectomy approved. She has since submitted a prior authorization for mastopexy which is a lift. She believes this is medically necessary to alleviate the pain that I am experiencing as well as the rashes and infections underneath my breast. Ambetter has denied the surgery as well as denied the appeal. It is literally without a legitimate reason to deny. And their opinion, it is not medically necessary, but cosmetic to not be in pain. I cannot exercise so how can I maintain weight loss?

Cathylynn DiFrancesco Signed me up for bronze plan. No representative or HEALTH MARKETPLACE could find it ! What is going on???? How am i going from $25 a month to $456. Fix this !

Avoid at all cost. They will let you and your family die before covering anything. Overpriced, a typical scam of a government enforced system.

Complete scam like all insurance companies. Custom service is deliberately routed to an automated voice that purposefully makes it impossible to get a hold of someone. Coverage also sucks.

They fraudulently charged me near $400 over a health plan I NEVER selected they ASSUMED I would spend $450 a MONTH, without my consent. No email no text to verify. But they charged me in the middle of the night while I was asleep worst service ever I tried calling my father spoke to them, customer service only told LIES!

Besides the directories not being up to date, long times between appointments. Customer Service is awful. Unlawfully charged me for the 2026 policy event, though I canceled and chose another plan before the deadline. They say that they can't take a verbal cancellation because it is through the ACA government plan, which is total BS. I spoke to three agents because, as a former licensed health insurance agent, I knew this was incorrect. Would not accept the printout of my new Blue Cross plan with dates proving I canceled. No resolution and no way to cancel over the phone. "I must go through the government."
Update: I contacted a representative at Healthcare.gov on 12/16, and she dialed Ambetter because she said the information they were giving was false, and I was not the only one calling in with this false information from Ambetter. She remained silent while the agent repeated I must contact the government, even though I had purchased Blue Cross HMO for 2026, and it was before the deadline for enrollment (meaning I am not enrolled with Ambetter), and they were NOT authorized to debit a payment. Ambetter repeated that it was up to the government. The Healthcare.gov agent(who had been silent but listening) spoke up and totally read him the riot act and stated he was giving out false information and that Healthcare.gov has nothing to do with my premium and my payment to the insurance company. Therefore, Ambetter unlawfully took from my account. He backtracked and said he would refund my money in 30-35 business days. Could not explain why it would be so long when the payment was still processing in the bank and should be easily reversed (it is a debit card). I called the bank to report fraud and stopped payment. I believe they charged lots of customers on autopay the new, inflated premium, even if they canceled. Then they are slow-rolling the payback. Beware.

Save yourself. When it's time to cancel you plan, you will not get anyone on the phone. I have been on hold for 2 hours at this point but I refuse to pay another month because of their scammy behavior.

I would have given negative star, but it is not available.
Ambetter has the worst customer support I’ve ever dealt with. Nothing works properly, and the system feels completely broken. Many doctors refuse to accept this insurance due to its inefficiency, and I’ve personally been turned away by providers the moment I mentioned Ambetter.

I had a physical exam done by my own PCP, yet Ambetter denied the claim saying a referral from my PCP was required—when the provider is my PCP. After multiple calls and appeals, the confusion only got worse. What’s unbelievable is that the same PCP referred me to a spine specialist and Ambetter approved that referral, while denying the physical exam claim saying he wasn’t my PCP. Total contradiction.

The system is disorganized, customer service gives conflicting answers, and even doctors are clearly frustrated dealing with Ambetter. I would give a negative rating if it were allowed.

I would strongly not recommend this insurance to anyone.

You are stuck with low Quality doctors or and you must travel miles for constructive healthcare. If you need Phycological Health do not obtain this plain. If you just need check ups you good' and there are rewards to watch healthcare videos. Also look out for charges after care and end of the year bigger charges Thanks to the Ballroom man.

If I could give them zero Stars I would they try to force you to do their telehealth thing even though you tell them you're not interested they don't want to pay for any kind of prescriptions honestly they're worse than United healthcare have to fight tooth and nail just to get anything done

Never had a worse experience dealing with ANY company in my 61 years on this planet. Horrible on everything from coverage to rates to customer service.

The only positive thing about having Ambetter is that some places won't even see you if you don't have insurance. With the Ambetter insurance card, at least you can be seen by a doctor.

I’ve been paying the full price for the Elite Gold (QualChoiceLife) plan through the Government Insurance Marketplace and this has been the biggest rip-off I’ve ever experienced with insurance.

Despite having no deductible and coverage that’s supposed to pay a percentage of most services, Ambetter has denied almost every claim we’ve submitted. They’ve forced us to redo my child’s occupational therapy testing (which we already completed just months before switching), and we were told the testing cost would be out of pocket even though our primary care physician and previous OT test said it was necessary. My OT center said Ambetter was the worst insurance they have ever worked with. My other child has a significant speech delay and is nearly nonverbal — Ambetter has denied every claim for speech therapy.

To make matters worse, my husband’s cancer screening, which we were told would be covered, wasn’t paid for either.

For a plan that costs as much as ours (about 1.5x our mortgage), Ambetter has failed to cover even the most basic, essential medical services they promise to. Their app and website constantly crash — the app froze eight times yesterday alone, and the mobile site repeatedly leads to dead pages.

We’re switching as soon as open enrollment begins. If you’re considering Ambetter, think twice before trusting them with your family’s health.

I would leave the ZERO stars if possible as that is what they deserve. WORST HEALTH PLAN EVER!!! If you need a Healthcare.gov health insurer, pay more and get a real health plan. You'll appreciate it when you need to access health care if you do not have these fools. My wife and I have nicknamed them "Am-not-better" which is what you and your family will be if you enroll with them. Health plans in general are anti-patient and anti-payment (for claims) but in a sea of bad health plans AmNotBetter achieves the lowest of the low. All I can keep saying is "enroll somewhere else!!!" This plan sucks to high hell!!!

First ambetterhealth is an umbrella and you MUST talk to the correct subsidiary. They will forward you but most engagements take *hours*

Agents often don't forward correctly - just to get you off their queue (and perhaps some mis knowledge)

Numbers that used to work might no longer.

issues that required intervention - such as web site issues and auto pay - may suddenly break

Website(s) use entry-key - which can only handle ONE current plan - which is often NOT the case when finishing one year and starting a new one the next year (think ACA/Healthcare.gov)

Agents I never felt confident could assure me that I *was* paid through end of year even though I couldn't verify online (due to entry-id issues they could not resolve).

In summary
- website frequently doesn't work and entry-id is often half an issue
- website might not (depends on subsidiary) have accurate or complete information on payments etc
- website doesn't allow you to check both current and future (think ACA) plan accounts
- autopayments frequently dropped (which then gets to web site issues)
- friendly agents are often very incompetent in doing anything other than maybe looking up one payment? Maybe? Nothing further?
- Just overall crappy and if I wasn't stuck with them with ACA/HealthCare.gov I would never ever ever consider them again.

Ambetter insurance is harming my husband's health. He suffered a massive stroke a year ago. They are denying him MRIs and pain injections, which he needs to continue his therapies, which are also being denied. Who should we contact to resolve this?