AmBetter Indiana

Plan Overviews

Ambetter individual and family healthcare coverage in Indiana provides affordable options in 28 counties. The parent company, Managed Health Services (MHS) has been providing quality medical coverage to Hoosier residents for 21 years. Marketplace policies can easily be purchased, and rates are often lower thanother major carriers, such as UnitedHealthcare and Anthem Blue Cross and Blue Shield.

Plan Name Secure Care 1 with 3 Free PCP Visits – Standard Balanced Care 1 Balanced Care 2 Balanced Care 4 Balanced Care 10 Balanced Care 12 Essential Care 1
Medical Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim.(Ind/Fam) $1,000/$2,000 $5,500/$11,000 $6,500/$13,000 $7,050/$14,100 $4,500/$9,000 $3,500/$7,000 $6,800/$13,600
Prescription Drug Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim.(Ind/Fam) $500/$1,000 Integrated with medical ded. Integrated with medical ded. Integrated with medical ded. Integrated with medical ded. Integrated with medical ded. Integrated with medical ded.
Metal Level Gold Silver Silver Silver Silver Silver Bronze
Out-of-Pocket MaximumAn out-of-pocket maximum is the most you'll have to pay during a policy period (usually a year) for health care services(Ind/Fam) $6,350/$12,700 $6,500/$13,000 $6,500/$13,000 $7,050/$14,100 $6,500/$13,000 $7,150/$14,300 $6,800/$13,600
Annual Well Visit/ Preventive Care No charge No charge No charge No charge No charge No charge No charge
PCP Office Visit 20% after ded. 30 30 30 20 30 No charge after ded.
Specialist Office Visit 20% after ded. 60 60 60 40 65 No charge after ded.
Imaging(CT/PET Scans, MRIs) 20% after ded. 20% after ded. No charge after ded. No charge after ded. 20% after ded. 20% after ded. No charge after ded.
X-rays & Diagnostic Imaging 20% after ded. 20% after ded. No charge after ded. No charge after ded. 20% after ded. 20% after ded. No charge after ded.
Urgent Care 20% after ded. 100 100 100 100 75 No charge after ded.
Emergency Room* $250 after ded. 20% after ded. No charge after ded. No charge after ded. 20% after ded. $400 after ded. No charge after ded.
Emergency Transportation* 20% after ded. 20% after ded. No charge after ded. No charge after ded. 20% after ded. 20% after ded. No charge after ded.
Inpatient Facility Fee 20% after ded. 20% after ded. No charge after ded. No charge after ded. 20% after ded. 20% after ded. No charge after ded.
Inpatient Hospital Physician & Surgical Services 20% after ded. 20% after ded. No charge after ded. No charge after ded. 20% after ded. 20% after ded. No charge after ded.
Outpatient Facility Fee 20% after ded. 20% after ded. No charge after ded. No charge after ded. 20% after ded. 20% after ded. No charge after ded.
Outpatient Surgery Physician/Surgical Services 20% after ded. 20% after ded. No charge after ded. No charge after ded. 20% after ded. 20% after ded. No charge after ded.
Labs & Diagnostics 20% after ded. 20% after ded. No charge after ded. No charge after ded. 20% after ded. 20% after ded. No charge after ded.
Mental/Behavioral Health & Substance Use Disorder Outpatient Services 20% after ded. 30 30 30 20 30 No charge after ded.
Rehabilitation Outpatient Services(Includes Speech, Occupational, Physical Therapy) 20% after ded. 20% after ded. No charge after ded. No charge after ded. 20% after ded. 20% after ded. No charge after ded.
Skilled Nursing Facility 20% after ded. 20% after ded. No charge after ded. No charge after ded. 20% after ded. 20% after ded. No charge after ded.
Pediatric Vision- Routine Eye Exam(1 visit per year) 100% Covered 100% Covered 100% Covered 100% Covered 100% Covered 100% Covered 100% Covered
Pediatric Vision- Eyeglasses(frames, 1 per year) 100% Covered 100% Covered 100% Covered 100% Covered 100% Covered 100% Covered 100% Covered
Pedicatric Vision- Lenses(per pair) 100% Covered 100% Covered 100% Covered 100% Covered 100% Covered 100% Covered 100% Covered
Pharmacy*
(Generic / Preferred / Non-preferred / Specialty)
$10 / $25 after Rx ded. / $75 after Rx ded. / 30% after Rx ded. $10 / $50 / 20% after Rx ded. / 20% after Rx ded. $15 / $50 / No charge after ded. / No charge after ded. $15 / $50 / No charge after ded. / No charge after ded. $10 / $50 / 20% after ded. / 20% after ded. $15 / $50 / $100 / 40% $20 / No charge after ded. / No charge after ded. / No charge after ded

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Adult Vision Coverage
(Ages 19 years of age and older*) Your Cost(In-Network Providers only) Out-of-network Subject to Deductible
Routine Eye Exam (1 visit per year) 100% covered Not Covered No
Eyeglasses (frames, 1 item per year) Covered up to $130 Not Covered No
Lenses (per pair):
Single 100% covered Not Covered No
Bifocal 100% covered Not Covered No
Trifocal 100% covered Not Covered No
Lenticular 100% covered Not Covered No
Contact Lenses:      
Contact lenses (in lieu of glasses) Covered up to $130 Not Covered No
Contact lens fitting 100% covered Not Covered No
Specialty lens fitting Covered up to $50 Not Covered No
Adult Dental Benefits

(Ages 19 years of age and older, does not include Pediatric Dental Coverage)

Annual Maximum Dental Benefit**

$1,000 per covered person per calendar year

 

 

Routine Dental (Class 1)

Your Cost (In-Network Providers only)

Out-of-network

Subject to Deductible

Routine Oral Exam (1 per 6 months)

No charge, subject to Annual Maximum

Not Covered

No

Routine Cleaning (1 per 6 months)

No charge, subject to Annual Maximum

Not Covered

No

Bite-wing X-ray (1 per 12 months)

No charge, subject to Annual Maximum

Not Covered

No

Full Mouth X-ray (1 per 60 months)

No charge, subject to Annual Maximum

Not Covered

No

Panoramic Film (1 per 60 months)

No charge, subject to Annual Maximum

Not Covered

No

Topical Fluoride Application (2 per 12 months)

No charge, subject to Annual Maximum

Not Covered

No

Palliative Treatment for relief of pain (minor procedures)

No charge, subject to Annual Maximum

Not Covered

No

Basic Dental (Class 2)

Your Cost (In-Network Providers only)

Out-of-network

Subject to Deductible

Silver Fillings (1 per 2 years)

50% coinsurance, subject to Annual Maximum

Not Covered

No

Tooth Colored Fillings (1 per 2 years, front teeth only)

50% coinsurance, subject to Annual Maximum

Not Covered

No

Therapeutic Pulpotomy on permanent teeth (1 per lifetime per tooth)

50% coinsurance, subject to Annual Maximum

Not Covered

No

Scaling & Root Planning (1 per 24 months)

50% coinsurance, subject to Annual Maximum

Not Covered

No

Periodontal Maintenance (4 in 12 months)

50% coinsurance, subject to Annual Maximum

Not Covered

No

Simple Extractions

50% coinsurance, subject to Annual Maximum

Not Covered

No

Surgical Extractions

50% coinsurance, subject to Annual Maximum

Not Covered

No

Removal of Impacted Teeth

50% coinsurance, subject to Annual Maximum

Not Covered

No

Alveoloplasty

50% coinsurance, subject to Annual Maximum

Not Covered

No

Relines (1 per 36 months)

50% coinsurance, subject to Annual Maximum

Not Covered

No

Rebase (1 per 36 months)

50% coinsurance, subject to Annual Maximum

Not Covered

No

Adjustments

50% coinsurance, subject to Annual Maximum

Not Covered

No

Repairs

50% coinsurance, subject to Annual Maximum

Not Covered

No

*If you require coverage for Pediatric Dental please shop on the Health Insurance Marketplace for a stand alone dental plan.

**Dental Annual Maximum Benefit does not apply toward any other maximums.

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Coverage Map
Coverage Map for Indiana 2018

Counties Covered in Indiana by Ambetter

Ambetter Hospital Network
With offices in Indianapolis, Fort Wayne, and Merrillville, Ambetter offers low-cost healthcare throughout much of the state. The 28 participating counties are Adams, Allen,  DeKalb, Elkhart, Huntington, Kosciusko, Marshall, St. Joseph, Wells, Whitley, Boone, Clarke, Daviess, Hamilton, Handcock, Harrison, Hendricks, Henry, Howard, Johnson, Knox, Lake, LaPorte, Madison, Marion, Miami, Montgomery, Porter, Pulaski, Steuben, Tippecanoe, and Vanderburgh.

Network Providers

The network provider list is quite extensive, and includes primary care physicians, specialists, Urgent-Care locations, hospitals, and many other medical and rehabilitation and treatment facilities. For example, if you lived in the Indianapolis area, the following hospitals  would be considered “in-network.” We used a 40-mile radius.

  • Community Hospital East
  • Westview
  • Community Hospital South
  • Community Hospital North
  • Heart and Vascular
  • Community Hospital East
  • Hendricks Regional
  • Johnson Memorial
  • Riverview
  • Hancock Memorial
  • Witham Memorial
  • Community Hospital Of Anderson
  • Putnam County

What About Doctors?

The availability of primary care physicians (PCP) allows you to choose from many doctors within your area. Specialists, behavioral health, dental and vision options are also plentiful. We listed below the number of network PCPs in several large and small cities. After each city, shown is the number of providers within a 20-mile radius. Typically, the number of available providers increases each year. NOTE: A 24/7 nurse advice line is also available. Registered and licensed nurses can provide professional assistance to current policyholders.

  • Bloomington – 5
  • Brownsburg – 172
  • Carmel – 198
  • Evansville – 12
  • Fort Wayne – 95
  • Hammond – 106
  • Indianapolis – 212
  • Lafayette – 5
  • La Porte – 25
  • Lebanon – 73
  • Muncie – 54
  • Richmond – 4
  • South Bend – 144
  • Valparaiso – 194
  • Vincennes –  26

NOTE: You can also search for your Ambetter provider here.

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