Ambetter Health Plans - TEXAS
What’s New in 2025
- Bronze | Silver | Gold (Core) Network is now the Premier Network. Plans will continue to be grouped in metal tiers.
- Newly released Ambetter Health App was launched in July 2024 for members
- Ambetter Virtual Access (AVA) plans are no longer available (you can find old plan information at the bottom of the page)
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.
Ambetter Premier Silver:
The best value and the most balance between your monthly premium payments and out-of-pocket expenses. 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
Ambetter Premier Gold:
Peace of mind for all your healthcare needs. 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
Ambetter Value (HMO)
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.
The Good
- Member resources
- Unique features
- My Health Pays
- Dental and vision
Member Resources
Ambetter members are given access to an online portal, through which they can make all their payments, view their plan benefits, and take care of logistics like obtaining a member ID card. The member portal offers extra features too, such as providing reminders for members when they are due for another doctor’s visit or allowing them to take a health risk assessment to determine which steps they can take to live healthier. There’s also a section for member news alerts and, of course, social media accounts with Ambetter that members can connect to. If you’re looking to get an Ambetter plan, you can view their health plans by first selecting the state you live in and then selecting a metal type for the plan tier you’re most interested in.
From there, your options open up to several different plans with varying prices and benefits. Members can track their claims 24/7 through the online portal, as well as connect with member services or a nurse hotline at any hour of the day. The subsidy estimator in the online account also helps members see how much they would receive for reimbursement for a treatment with their benefits. Admittedly, many of the resources available to members do not extend far beyond the basic ones supplied by other health insurance companies. Nonetheless, Ambetter’s online portal and customer service mediums do make members’ experience more convenient and secure.
Unique Features
Ambetter provides more than just logistical tools for members. Many of the extra features they offer also send the message that they want their members to get healthier and stay healthier. These tools include a 24/7 nurse hotline that members can access for questions and medical needs. There are also health-promoting programs such as the StartSmart for Your Baby program, which provides support for expecting mothers. Ambetter has support for members coping with behavioral health issues, chronic illnesses, and similar struggles as well. My Health Pays is a rewards program offered by Ambetter, and through it members can be reimbursed for gym memberships and even earn back money for getting a wellness exam or a flu shot. This money can then be used toward a copay or monthly premium down the road.
My Health Pays
Members earn rewards for taking charge of their health! Use reward points to shop for special items at the online My Health Pays Rewards Store or convert
them into dollars to spend on healthcare-related items. It’s your choice! Use your rewards to help pay for:
- Monthly premium payments
- Doctor copays
- Deductibles / Coinsurance
- Utilities (gas, electric, water)
- Telecommunications
- Transportation, education, rent, childcare
There are many ways to earn with our My Health Pays program:
- Ambetter Health Onboarding
- Annual Wellness Exam and Preventive Screenings
- Health Management
- Online Activities
$0 copay
For virtual urgent care visits including mental and behavioral health on most plans
24/7 Nurse Line
Customers have 24/7 access to a nurse and can contact this healthcare professional for sudden medical concerns and other questions. Round-the-clock support like this adds reassurance to members’ experience.
Dental and Vision
Dental and vision coverage are available with Ambetter, but the benefits and availability of each are entirely specific to the state you live in and the type of plan you’ve signed up for. Dental coverage, for example, is not available in Texas, but vision insurance is. Dental coverage includes exams, cleanings, and screenings, overall, and vision benefits include yearly eye exams and glasses or contacts.
The Bad
- Types of plans offered (HMO, EPO – no PPO or HSA plans)
- Service areas
- Service areas
- Access to plan information
Types of Plans Offered
It’s somewhat difficult to access specific information about the types of health plans Ambetter has. Their website primarily just explains the metal tiers for their plans, as well as how essential health benefits are covered by every plan. But to find out what kinds of plans these are (such as HMO, PPO, etc.), not to mention what prices and benefits you qualify for, you’ll have to contact a representative. Up front, it’s important to know that Ambetter is part of the Health Insurance Marketplace (HIM). It’s Centene’s option for HIM plans, which is intended for people who don’t have health insurance and maybe don’t qualify for typical plans. In HIM territory, Medicare isn’t an option, for example, because if you qualify for Medicare, that’s the legal option for you to get rather than taking advantage of a plan like Ambetter’s. Medicaid and CHIP are HIM plans, though. Ambetter has PPOs, HMOs, and EPOs.
They don’t offer HSAs though. They’ve divided their plans into three metal tiers: Bronze, Silver, and Gold. All three of these tiers cover “essential health benefits,” Ambetter’s term for services like preventative and emergency care, therapy, behavioral health help, medications, maternity, and hospitalization. But the difference in the tiers comes in the costs for premiums and out-of-pocket expenses. Bronze plans have the lowest premiums but the highest OOP costs, and Gold has the highest premiums but the lowest OOP costs. Silver, of course, is the in the middle.
No Mobile App
Unlike many of its competitors, Ambetter doesn’t have a mobile app. Some companies provide this for members to access their accounts right from their phones, making communication and logistics much easier. Ambetter hasn’t provided this yet, making account management slightly less convenient than with other companies.
Access to Plan Information
Ultimately, it’s kind of hard to find specific information about the health plans at Ambetter. The company doesn’t provide enough assistance with truly understanding HIM plans, knowing which types are available up front, and comparing the costs of these plans in one place.
Ambetter Texas Coverage Map
2025 Texas Coverage Map
Ambetter Premier plans are available in all of the counties below. Ambetter VALUE plans are available in the bolded/underlined counties.
- Andrews
- Aransas
- Armstrong
- Atascosa
- Austin
- Bandera
- Bastrop
- Bell
- Bexar
- 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
- Lavaca
- Lee
- Leon
- Liberty
- Limestone
- Llano
- Madison
- Mason
- Matagorda
- Maverick
- McCulloch
- McLennan
- Medina
- Menard
- Milam
- Mills
- Mitchell
- Montague
- Montgomery
- Nacogdoches
- Navarro
- Nueces
- Oldham
- Orange
- Palo Pinto
- Panola
- 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
- Willacy
- Williamson
- Wise
- Wood
- Zapata
Ambetter Silver
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 | Deductible (Ind / Fam) | Out of Pocket Max (Ind / Fam) | PCP / Specialist | Virtual 24/7 Care | Urgent Care | Labs Outpatient | Preferred Generic Rx | Generic Rx |
| Complete Silver | $6,000 / $12,000 | $8,500 / $17,000 | $30 / $60 | No charge | $60 | $30 | $3 Copay per prescription |
$20 Copay per prescription |
| Standard Silver | $5,000 / $10,000 | $8,000 / $16,000 | $40 / $80 | No charge | $60 | 40% | $20 Copay per prescription |
$20 Copay per prescription |
| Focused Silver | $6,300 / $12,600 | $8,000 / $16,000 | $40 / $85 | No charge | $60 | $50 | $3 Copay per prescription |
$15 Copay per prescription |
| Clear VALUE Silver | $6,500 / $13,000 | $6,500 / $13,000 | $50 / $100 | No charge | $50 | $25 | No charge after deductible |
No charge after deductible |
| Focused VALUE Silver | $6,300 / $12,600 | $8,000 / $16,000 | $40 / $85 | No charge | $60 | 50% | $3 Copay per prescription |
$15 Copay per prescription |
| Standard Silver VALUE | $5,00 / $10,000 | $8,000 / $16,000 | $40 / $80 | NA | $60 | 40% | $20 Copay per prescription |
$20 Copay per prescription |
Ambetter Gold
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 | Deductible (Ind / Fam) | Out of Pocket Max (Ind / Fam) | PCP / Specialist | Virtual 24/7 Care | Urgent Care | Labs Outpatient | Preferred Generic Rx | Generic Rx |
| Complete Gold | $1,450 / $2,900 | $7,500 / $15,000 | $15 / $35 | No charge | $35 | $15 | $3 Copay per prescription |
$15 Copay per prescription |
| Everyday Gold | $750 / $1,500 | $7,000 / $14,000 | $35 / $55 | No charge | $35 | $35 | $3 Copay per prescription |
$15 Copay per prescription |
| Standard Gold | $1,500 / $3,000 | $7,800 / $15,600 | $30 / $60 | NA | $45 | 25% | $15 Copay per prescription | $15 Copay per prescription |
| Complete VALUE Gold | $1,450 / $2,900 | $7,500 / $15,000 | $15 / $35 | No charge | $35 | $15 | $3 Copay per prescription |
$15 Copay per prescription |
| Standard Gold VALUE | $1,500 / $3,000 | $7,800 / $15,600 | $30 / $60 | NA | $45 | 25% | $15 Copay per prescription | $15 Copay per prescription |
Ambetter Value HMO
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:
- Bexar
- Collin
- Dallas
- Denton
- Fort Bend
- Harris
- Montgomery
- Rockwall
- Tarrant
- Travis
- Williamson
Ambetter Premier
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.
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 Account
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!
Plan Brochures
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]
DISCONTINUED for 2025 - Ambetter Virtual Access (HMO)
Ambetter Virtual Access (HMO)
Recommended if you:
- Prefer connecting with your doctor virtually
- Don’t already have a preferred PCP
- Want $0 virtual visit copays
- Don’t mind a referral being needed to visit a hospital or specialist
Our Ambetter Virtual Access plans provide you with a full virtual primary care experience. Ambetter Virtual Access members are assigned a Teladoc Primary Care Provider (PCP). The Teladoc PCP can order labs, imaging, write prescriptions, and make referrals for on-the-ground care as needed. To see a specialist, members will simply request a referral from their Virtual Access PCP. Learn More about Ambetter Virtual Access Plan.
Ambetter Virtual Access (HMO)
- 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
- Ability to connect with experts regardless of physical location
- 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
Recommended if you:
- Prefer connecting with your doctor virtually
- Don’t already have a preferred PCP
- Want $0 virtual visit copays
- Don’t mind a referral being needed to visit a hospital or specialist
DISCONTINUED PLANS:
| Plan Name | Deductible | Out of Pocket Max | PCP / Specialist | Virtual 24/7 Care | Urgent Care | Labs Outpatient | Preferred Generic Rx | Generic Rx |
| Ambetter Virtual Access Silver (Virtual PCP selection required) | $5,700 | $7,400 | $40 / $100 | No charge | $60 | $50 | $3 Copay per prescription |
$25 Copay per prescription |
| Standard Ambetter Virtual Access Silver (Virtual PCP selection required) |
$5,900 | $9,100 | $40 / $80 | $40 | $60 | 40% after ded | $20 Copay per prescription |
$20 Copay per prescription |
DISCONTINUED PLANS:
| Plan Name | Deductible | Out of Pocket Max | PCP / Specialist | Virtual 24/7 Care | Urgent Care | Labs Outpatient | Preferred Generic Rx | Generic Rx |
| Ambetter Virtual Access Gold (Virtual PCP selection required) | $950 | $8,700 | $20 / $45 | No charge | $30 | $20 | $3 Copay per prescription |
$15 Copay per prescription |
| Standard Ambetter Virtual Access Gold (Virtual PCP selection required) |
$1,500 | $8,700 | $30 / $60 | $30 | $45 | 25% after ded | $15 Copay per prescription | $15 Copay per prescription |
Ambetter Virtual Access Plan options are offered in the following areas:
- Andrews
- Aransas
- Armstrong
- Atascosa
- Austin
- Bandera
- Bastrop
- Bell
- Bexar
- 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
- Lavaca
- Lee
- Leon
- Liberty
- Limestone
- Llano
- Madison
- Mason
- Matagorda
- Maverick
- McCulloch
- McLennan
- Medina
- Menard
- Milam
- Mills
- Mitchell
- Montague
- Montgomery
- Nacogdoches
- Navarro
- Nueces
- Oldham
- Orange
- Palo Pinto
- Panola
- 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
- Willacy
- Williamson
- Wise
- Wood
- Zapata
Find What Plans Your Doctor Accepts
Find Every Plan In Your Area Calculate Your Subsidy Live Chat Our Agents Apply On Or Off the Exchange Apply in Under 5 Minutes
Ambetter Coverage Map
