Ambetter Health Plans - TEXAS
What’s New in 2026
- Midland County added to 2026 Premier Network Coverage
- Virtual 24/7 Care
- All Ambetter Health members have access to virtual services through Teladoc Health.
- 24/7 help for non-emergency medical issues through Virtual 24/7 Care.
- Members get access to medical professionals via phone or video for non-emergency health issues.
- Easy way to get fast care when in outlying or rural areas.
- Avoid long wait times at in-person urgent care clinics or physician offices.
About Ambetter
Ambetter from Superior HealthPlanExternal Link is Centene CorporationExternal Link‘s Health Insurance Marketplace product. Ambetter Health exists to improve the health of its beneficiaries through focused, compassionate and coordinated care. Our approach is based on the core belief that quality healthcare is best delivered locally.
Ambetter plans are currently available in most Texas counties depending on whether you choose Ambetter Premier EPO or Ambetter Value HMO.
Provider Network Highlights – 2026
Austin Metro
• St. David’s Healthcare – HCA Healthcare System
• Ascension Seton
Dallas and Fort Worth Metro
• Texas Health Resources
• Medical City – HCA Healthcare System
• Baylor Scott & White Health System
• Methodist Health System
• City Hospital at White Rock
• Dallas Medical Center & Dallas Regional Medical Center – Prime Healthcare
El Paso (El Paso County)
• El Paso Healthcare System – HCA Healthcare System
• The Hospital’s of Providence
Houston Metro
• HCA Houston Healthcare System
• Memorial Hermann Health System
• CHI St. Luke’s Health
• Saint Joseph Medical Center
San Antonio (Bexar County) Metro
• Baptist Health System
• Methodist Health System – HCA Healthcare System
Ambetter Networks – learn more about each network by using the toggles towards the bottom of the page
PREMIER EPO
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A broader provider network: You’ll have access to more hospitals and specialists across the state.
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You typically don’t need a referral to see a specialist.
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More flexibility in choosing in-network providers, but you’ll still need to stay in-network for most coverage (unless emergency).
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Good choice if you value access and freedom of provider choice.
VALUE HMO
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More limited (“select”) network: fewer provider/hospital options in network.
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Requires a Primary Care Physician (PCP) and referrals for many specialist visits.
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Generally aimed at lower-premium plans—so it could cost less per month, but you give up some flexibility.
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Best for people who are comfortable with sticking to one PCP and network, and perhaps have fewer expected specialist visits.
Wellness & Rewards
Rewards, savings, fitness, nutrition, and personalized support – all in one place.
Top Features:
- Plan – View coverage details and track deductible and maximum OOP amounts.
- Billing – Pay monthly premiums, manage autopay, and view invoices.
- Provider Search – Find doctors, pharmacies, and urgent care. Change primary care provider.
- ID Cards – View, order, or download ID cards. Save ID card to Apple Wallet.
- Claims – View claims history and download Explanation of Benefits.
- Pharmacy – Manage preferred pharmacy, prescription refills, mail order and more.
MyHealth Pays Rewards Activities
Ambetter Standard 2025 Rewards
•Wellbeing Survey
•Annual Well Visit
Comprehensive Diabetic Screenings
•Diabetes eye exam
•Diabetes kidney screening
•Diabetes HBa1c test
Quality Measures (6 rewards)
•Childhood immunizations – Child 0-1 years of age
•Vision screening – Child 2-20 years of age
•Cervical cancer screening – Women 21 – 49 years of age
•Breast cancer screening – Women 50+ years of age
•Cholesterol screening – Men 21 – 49 years of age
•Colorectal cancer screening – Men 50+ years of age
•High blood pressure screening – All
Online Activities
•Fun and easy activities that members can complete each month.
•Online activities take about ten minutes to complete
Ambetter Premier Summary
Ambetter Premier – EPO
With the Ambetter Health Premier Plan, you have the tools and resources needed to manage your health. Premier plans feature Ambetter from Superior HealthPlan’s broadest network of healthcare providers and hospitals. This gives you more options to choose from when you need care. With this plan, you don’t need referrals to see a specialist.
- Available in all Ambetter Health counties.
- Members can visit any in-network provider; no referrals needed.
- When searching Ambetter Guide, choose Premier to locate in-network providers.
- Adult vision and adult dental buy-ups are available on many plans.
- Ambetter Premier networks have reciprocity with other Premier networks, but not with any other Ambetter networks. CA and NY do not have reciprocity to one another or to any other Premier networks.
After you enroll, you may be assigned a Primary Care Provider (PCP). Your PCP is your main health care professional and should be your first choice for:
- Routine checkups
- Non-emergency medical care such as colds and fevers
- Managing health conditions like allergies and asthma
- Prescriptions
- Lab tests
- Imaging services like x-rays, ultrasounds or CT scans
You can view or change your PCP in your Online Member AccountExternal Link.
Your Premier plan offers balanced care for your whole health:
- Preventive care benefits, such as annual wellness exams and vaccinations, at no extra cost to you
- Psychotherapy and counseling
- Inpatient care
- and more!
Ambetter Premier Network Coverage (counties)
Ambetter Premier – Counties
Andrews
Aransas
Armstrong
Atascosa
Austin
Bandera
Bastrop
Bell
Blanco
Bosque
Brazoria
Brazos
Brewster
Brooks
Brown
Burleson
Burnet
Caldwell
Calhoun
Cameron
Camp
Carson
Castro
Chambers
Cherokee
Coke
Coleman
Collin
Collingsworth
Colorado
Comal
Comanche
Concho
Cooke
Dallam
Dallas
Deaf Smith
Delta
Denton
DeWitt
Donley
Ector
Edwards
El Paso
Ellis
Falls
Fannin
Fayette
Fisher
Fort Bend
Freestone
Frio
Galveston
Gillespie
Goliad
Gonzales
Gray
Grayson
Gregg
Grimes
Guadalupe
Hamilton
Hardin
Harris
Hartley
Hays
Henderson
Hidalgo
Hill
Hood
Houston
Hunt
Irion
Jack
Jackson
Jefferson
Johnson
Kendall
Kerr
Kimble
Kinney
Lampasas
Lee
Leon
Liberty
Limestone
Llano
Madison
Matagorda
Maverick
McCulloch
McLennan
Medina
Menard
Midland*
Mills
Mitchell
Montague
Montgomery
Nacogdoches
Navarro
Nueces
Oldham
Orange
Palo Pinto
Parker
Parmer
Potter
Rains
Randall
Real
Refugio
Robertson
Rockwall
Runnels
Rusk
San Jacinto
San Saba
Schleicher
Scurry
Sherman
Smith
Somervell
Starr
Sterling
Stonewall
Sutton
Tarrant
Tom Green
Travis
Trinity
Tyler
Val Verde
Van Zandt
Victoria
Walker
Waller
Webb
Wharton
Wheeler
Wise
Wood
Zapata
Ambetter Value HMO Summary & Network Coverage
Ambetter Value
Recommended if you:
- Want to use your primary care physician for all referrals
- Don’t mind your care being coordinated through a PCP
- Don’t mind needing referrals to see a specialist.
Ambetter’s Value Plans are affordably priced plans that feature specific health care providers and hospitals. Members on our Value plans will be assigned to a PCP within a Medical Group who will coordinate their care. These plans require referrals for most care outside of what the PCP can provide, such as seeing a specialist. Ambetter Value Plans are available in select counties in Texas and are in Silver and Gold plan metal levels. Learn more about Ambetter Value Plan.
Your Medical Group is an assigned group of providers. You will be assigned to a primary care provider (PCP) in your Medical Group to get care. This will ensure that the services you receive will be covered by your plan. Your PCP can help you with:
- Prescriptions
- Lab tests
- Imaging services, like x-rays, ultrasounds or CT scans
- Referrals for doctors other than a PCP, like a cardiologist, dermatologist or dietitian1
Note: If you need care beyond what your PCP provides, you will need to get a referral from your PCP for that care1. Without a PCP referral, your claims may be denied.
Ambetter Value plan options are offered in the following areas:
- Collin
- Dallas
- Denton
- Fort Bend
- Harris
- Hood
- Montgomery
- Rockwall
- Tarrant
- Travis
- Williamson
Ambetter Silver Plans Comparison
Ambetter Silver Plans
The best value and the most balance between your monthly premium payments and out-of-pocket expenses. Silver Care plans provide the best value and most balance between your monthly premium payments and out-of-pocket costs, especially if you’re eligible for financial assistance. Recommended if you:
- See your primary care physician for preventive care every year
- Don’t anticipate any major ongoing medical needs
- Want a monthly premium that fit most budgets
- Want Out-of-pocket expenses that fit most budgets
| Plan Name | Network | Deductible (Ind / Fam) | Out of Pocket Max (Ind / Fam) | PCP / Specialist | Urgent Care | Preferred Generic Rx | Generic Rx |
| Standard Silver | Premier EPO | $6,000 / $12,000 | $8,900 / $17,800 | $40 / $80 | $60 | $20 Copay per prescription | $20 Copay per prescription |
| Focused Silver | Premier EPO | $6,300 / $12,600 | $8,400 / $16,800 | $40 / $85 | $60 | $3 Copay per prescription | $15 Copay per prescription |
| Enhanced Diabetes Silver | Premier EPO | $5,000 / $10,000 | $8,650/ $17,300 | $30 / $50 | $50 | $3 Copay per prescription | $20 Copay per prescription |
| Standard Silver VALUE | Value HMO | $6,000 / $12,000 | $8,900 / $17,800 | $40 / $80 | $60 | $20 Copay per prescription | $20 Copay per prescription |
| Focused VALUE Silver | Value HMO | $6,300 / $12,600 | $8,400 / $16,800 | $40 / $85 | $60 | $3 Copay per prescription | $15 Copay per prescription |
Ambetter Gold Plans Comparison
Ambetter Gold Plans
Peace of mind for all your healthcare needs. You’ll have peace of mind for all your healthcare needs with Gold Care. Expect higher monthly premium payments to help limit your out-of-pocket costs later. Recommended if you:
- Will use coverage often
- Have an ongoing medical condition that needs treatment
- Want additional security and peace of mind
- Don’t mind higher monthly premiums
- Want lower out-of-pocket costs
Standard Cost Share Gold Plan Comparison (On-Exchange)
| Plan Name | Network | Deductible (Ind / Fam) | Out of Pocket Max (Ind / Fam) | PCP / Specialist | Urgent Care | Preferred Generic Rx | Generic Rx |
| Complete Gold | Premier EPO | $1,450 / $2,900 | $7,500 / $15,000 | $15 / $35 | $35 | $3 Copay per prescription |
$15 Copay per prescription |
| Everyday Gold | Premier EPO | $800 / $1,600 | $7,250/ $14,500 | $35 / $55 | $45 | $3 Copay per prescription |
$15 Copay per prescription |
| Standard Gold | Premier EPO | $2,000/ $4,000 | $8,200/ $16,400 | $30 / $60 | $45 | $15 Copay per prescription |
$15 Copay per prescription |
| Complete VALUE Gold | Value HMO | $1,450 / $2,900 | $7,500 / $15,000 | $15 / $35 | $35 | $3 Copay per prescription |
$15 Copay per prescription |
| Standard Gold VALUE | Value HMO | $2,000/ $4,000 | $8,200/ $16,400 | $30 / $60 | $45 | $15 Copay per prescription | $15 Copay per prescription |
Plan Brochures - ALL
Ambetter Premier
Gold
Silver
Ambetter Value
Gold
Silver
Pharmacy Resources
Ambetter from Superior HealthPlan is committed to providing appropriate, high quality, and cost effective drug therapy to all Ambetter from Superior HealthPlan members. Ambetter works with providers and pharmacists to ensure that medications used to treat a variety of conditions and diseases are covered. Ambetter covers prescription medications and certain over-the-counter (OTC) medications when ordered by a practitioner. The pharmacy program does not cover all medications. Some medications require prior authorization (PA) or have limitations on age, dosage, and maximum quantities. Choosing a pharmacy Ambetter has a variety of convenient in-network pharmacies. These include: HEB, CVS and Walmart, as well as many independent pharmacies in your area. To find a network pharmacy near you, use the Find a Provider Tool and follow these steps:
- Enter your zip code or address, or click Use my Current location.
- Click Detailed Search and select Pharmacy from the Type of Provider drop-down menu.
- If you are looking for a specific pharmacy like Home Infusion Therapy or Long Term Care, select that under the Specialty drop-down menu. Otherwise, you can skip this step.
- If you need help finding a pharmacy, please call Member Services at 1-877-687-1196. Relay Texas/TTY users should call 1-800-735-2989.
More on Ambetter’s pharmacy program. To find the cost of your medications please use the Drug Cost Tool. Use the Preferred Drug List to find more information on the drugs that Ambetter covers.
Contact Us
Phone: (312) 726-6565 Email: [email protected]
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