FAQ

Below you’ll find some helpful questions and answers about the Health Insurance Marketplace and Ambetter plans.

General FAQs

Every state has a marketplace for consumers to shop for health insurance. These are called Health Insurance Marketplaces. Consumers can shop, compare and select a plan that best suits their needs. The Health Insurance Marketplaces allow consumers to do their shopping online, in-person, over the phone, or by mail. Consumers can look at information such as the provider network, benefits, premiums, deductible costs, co-pays, and co-insurance requirements before selecting a plan. Some states have their own marketplaces, also known as state-based exchanges (SBEs). Other states use healthcare.gov.

Anyone can search online for a healthcare plan on their state’s Health Insurance Marketplace. The requirements to get insurance through the Marketplace are:

  • Meet applicable state residency requirements
  • You must be a U.S. citizen, national, or noncitizen who is lawfully present
  • You cannot be currently incarcerated

If you currently receive health insurance coverage from your employer, you likely will continue to receive this coverage. If employer coverage is considered too expensive, you might be eligible to find coverage through your marketplace.

The cost of plans varies by the type of plan you choose. However, you may be eligible for discounts on your plan to help lower your monthly premium amount and other healthcare amounts. These are known as Subsidies and Cost-Sharing Reductions. Learn more on our Healthcare Savings page! If someone doesn’t receive a subsidy due to income status, they are still able to shop for a health plan on the Health Insurance Marketplaces.

This is the set minimum income a family needs for food, clothing, transportation and shelter. The government decides this level. It depends on the size of your family. For more information on the Federal Poverty Level, visit healthcare.gov.

This year, open enrollment on the Healthcare Insurance Marketplaces starts on November 1, 2020 and ends on December 15, 2020. Following this initial enrollment period, open enrollment will typically be every fall.

 

 

Billing FAQs

No, the due date cannot be changed because all payments are required to be paid by the last day of the month. The reason is once the new month starts you are covered and your payment by the last day of the month will avoid any interruption in your coverage due to nonpayment

Your bill will be generated the first week of the current month, between the 6th and 10th day of each month. 

Paperless Billing is a convenient Ambetter billing option. When you sign up for Paperless Billing, you can access your bill from a link in your email. No paper wasted, no mail piled up in your home and no misplaced bills. There is no charge for this option, it’s easy to get started and easy to access your statement online in your member portal account.

Yes, you can sign up for paperless billing over the phone or through your member portal under billing.

The minimum payment required to keep your coverage active is the full premium amount. We cannot accept partial payments. 

Yes. If you receive a tax credit there is a grace period of three months (90-days) before termination. Payments must be brought completely current to avoid termination during this 90-day period. Making partial payments toward your current balance will not prevent cancellation. If you don’t receive a tax credit you will have a 30-day grace period to pay in full to keep your coverage.

If your payment is delinquent, it is at your health care provider’s discretion to see you. This is because when your provider verifies that your coverage is active and services will be covered, it will show your payment is delinquent. Therefore, it is highly recommended to pay your bill prior to the last day of the month.

No, we do not offer payment plans. We recommend that you pay in full within your grace period (90- days if you receive a tax credit, or 30-days if you don’t receive a tax credit).

The billing address to send your payment depends on your state. You can verify the billing address for your state by visiting our website at www.ambetterhealth.com and selecting your state. On your state’s home page, select “Member Resources” and within the drop down box, select “Paying My Bill.” Your billing address will be listed here.  If you don’t have a computer and/or internet access, please call us at 1-833-863-1310 (Relay 711) and we will be happy to assist.

Yes, you may find a MoneyGram location near you by visiting moneygram.com/mgo/us/en/locations or calling 1-800-926-9400. Remember to bring:

  • Cash for your premium payment. (Ambetter will pay your MoneyGram transaction fee.)
  • Your Ambetter member ID number.
  • Receive Code: 17067

Valid refunds are issued from Ambetter.  Member Services will submit a refund request to the Ambetter Billing Department. The Billing Department will then verify the refund request is valid. Valid refund requests take 7-10 business days to process and refunds will be processed to your original method of payment. 

Your bill could be showing double premiums due for two reasons: 1) If you have not paid your bill for last month, you now owe for last month plus the current month. 2) If you’re paying this month’s bill late (after the 12th day of the month), your bill will show the past due balance for this month plus your amount due for next month.

Autopay is a convenient Ambetter payment option. There is no charge for this option and you can choose your Autopay date between the 15th and the last day of the month. Your payment will be charged to the payment method of your choice on the date you choose between the 15th and the last day of the month. You will continue to receive your bill as a reminder that your payment is due. Remember, Autopay will charge the total amount due, so if you’ve fallen behind on your payments, Autopay will charge the complete amount due. Also, if there is any change in your payment method, please call us to update it. Otherwise, your payment will not be processed and your coverage will be at risk of being suspended. 

If you pay on the last day or two of the month by eCheck and/or ACH payments, your benefits may not be accessible until your payment posts – that can be 48 to 72 hours in some cases.  However, credit/debit card payments post immediately.

Some information contained in this FAQ was gathered from these resources:
www.healthcare.govhttp://healthreform.kff.org/