AmBetter - Indiana Health Plans

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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 than other major carriers, such as UnitedHealthcare and Anthem Blue Cross and Blue Shield.

About The Parent Company MHS

MHS is a managed care provider that helps operate the Children’s Health Insurance Program (CHIP), Hoosier Healthwise, and Healthy Indiana. In addition to enrollment duties, they coordinate community events and provide public information about existing and future programs. The National Committee For Quality Assurance (NCQA) has awarded its “commendable” designation to MHS for outstanding services. MHS is actually a wholly-owned subsidiary of Centene Corporation, which is a Fortune 500 company specializing in providing services to government-funded programs for consumers that are without medical coverage. Some of these programs include Medicaid, Aged, Blind, or Disabled (ABD),  and CHIP. 

Gym Membership Benefits:

Ambetter’s gym membership benefits program makes it easier to stay in shape and stay healthy. With Ambetter, you can:

  • Earn $20 on your My Health Pays card every month you visit the gym of your choice at least eight times.
  • Get discounts on gym membership fees at approved locations. They’ve partnered with gyms and health clubs across the country. Just visit Ambetter.mhsindiana.com to find an eligible gym in your area.
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

(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

(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

(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
Pediatric 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
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.

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.

When you begin shopping for a Marketplace health plan, you’ll see plan options with different metal tiers such as Gold, Silver and Bronze plans. But the only difference between these plans is how much premium you’ll pay each month and how much you’ll pay for certain medical services. A Bronze plan typically gives you lower monthly premium payments, but potentially higher out-of-pocket costs – if you end up needing a lot of care. And a Gold plan may have higher monthly premiums, but that helps you limit your out-of-pocket costs later. If you’re looking for a balance on your monthly premium payments and your out-of-pocket costs, Silver plans provide just that. And, Silver plans are the only plans with additional out-of-pocket payment reductions (cost sharing reductions)! This helps lower the costs of your copays, deductibles and coinsurance. So, if you are eligible for a subsidy and cost sharing, Silver plans offer the highest value.

My Health Pays Reward Program

As an Ambetter member, you can earn reward dollars for taking charge of your health. Their My Health Pays™ program rewards you for completing healthy activities. You will receive your My Health Pays™ Visa® Prepaid Card when you earn your first reward. If you already have a My Health Pays™ Visa Prepaid Card, your reward dollars will be added to your existing card. They’ll automatically add any new rewards you earn to your My Health Pays™ Visa Prepaid Card. The more you do, the more reward dollars will be added to your card. It’s that simple!

Start Earning My Health Pays™ rewards today!

Sample image of the My Health Pays Visa card YOU CAN USE YOUR REWARDS TO HELP PAY FOR YOUR HEALTHCARE COSTS, SUCH AS: Your monthly premium payments Doctor copays* Deductibles Coinsurance *My Health Pays™ rewards cannot be used for pharmacy copays.

  HERE IS HOW YOU CAN EARN MY HEALTH PAYS™ REWARDS:
Earn $50 Complete your Ambetter Wellbeing Survey during the first 90 days of your membership and earn $50 in rewards. Start the survey now! Earn $50 Get your annual wellness exam with your primary care provider (PCP). Find a PCP.   Earn $25 Receive your annual flu vaccine in the fall (9/1-12/31) and earn $25 in rewards. Schedule it with your PCP.   Earn up to $20 a month Visit any gym at least eight times in a month and earn up to $20 in rewards. To find a gym near you, visit globalfit.com

Log in to your secure online member account to track your rewards, view your card balance and complete healthy activities, such as your Wellbeing Survey.

Apply Online Now

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Coverage Map
Coverage Map for Indiana 2018

Counties Covered in Indiana by Ambetter

Ambetter Indiana

Overview
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Coverage Map
Hospital List

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