Ambetter

What Ambetter does

Ambetter Health is the ACA Marketplace health insurance brand of Centene Corporation (NYSE: CNC), offering Qualified Health Plans (HMO, EPO, PPO, and POS) to individuals and families through the federal Health Insurance Marketplace and state-based exchanges across 29 states. The brand serves primarily under-insured and uninsured populations, with many members receiving federal premium tax credits based on income. Plans include essential health benefits, preventive care, mental health services, prescription coverage, and optional dental and vision add-ons. Beyond core underwriting, the platform bundles telehealth (Virtual 24/7 Care), a wellness rewards program (My Health Pays, up to $500 in rewards), chronic condition management for diabetes, asthma, and COPD, a 24-hour nurse advice line, care management coordination, and an ICHRA-compatible employer offering (Ambetter Health Solutions).

The technology stack comprises a digital insurance platform with online enrollment tools, a consumer mobile app, provider-finder functionality, and machine-readable JSON APIs for product, formulary, and provider network data. Distribution runs through state-specific websites, a multi-language licensed agent call center, and broker channels, with the brand operating through 28 wholly-owned Centene state subsidiaries (e.g., Celtic Insurance Company, Buckeye Health Plan, Home State Health). As of December 31, 2025, Ambetter serves over 5.5 million members, and the brand is run as a national platform with state-level licensing and local provider network contracting.

Revenue is generated through monthly subscription premiums from individual members and ICHRA-participating employers, with revenue risk correlated to ACA enrollment policy, federal premium tax credit availability, and the medical loss ratio dynamics of the Marketplace segment.

Name

Ambetter

Legal name

Ambetter Health (brand name used by Centene Corporation subsidiaries)

Website

https://ambetterhealth.com

Company type

Private

Founded year

2012

Operating status

Operating

Headcount range

101–250 employees

Short description

Ambetter Health is Centene Corporation's ACA Marketplace health insurance brand, offering Qualified Health Plans (HMO, EPO, PPO, POS) to over 5.5 million individuals and families across 29 states through federal and state-based exchanges, bundled with telehealth, rewards, and care management.

Ownership category

akta.pro rank

Product category

Health Insurance

NAICS

Direct Health and Medical Insurance Carriers (524114), Insurance Carriers (5241)

SIC

Accident & Health Insurance (6321)

akta.pro primary industry

ACA Marketplace (On-Exchange) Individual Plans (FSAIAEAA)

Keywords

• Health insurance plans
• ACA marketplace coverage
• Telehealth services
• Wellness rewards programs
• Dental and vision insurance

Headquarters

HQ city

St Louis

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2C

Offering type

Services

Cost components

Personnel, Operations, Marketing or Sales, Technology or R&D, Infrastructure, Others

Revenue model

1. Health Insurance Premiums: Ambetter Health generates revenue through monthly premium payments from members enrolled in its Qualified Health Plans offered on the ACA Health Insurance Marketplace. Many members receive premium tax credits based on income, which subsidize their coverage.
2. ICHRA Plan Offerings: Ambetter Health also offers individual health insurance plans compatible with Individual Coverage Health Reimbursement Arrangements (ICHRAs), allowing employers to provide health benefits allowances that employees can use to purchase individual coverage.

Pricing tiers

Go-to-market motion2 records

Distribution channels4 records

Marketing channels5 records

Core offering

Ambetter Health is the ACA Marketplace health insurance brand of Centene Corporation, offering Qualified Health Plans (HMO, EPO, PPO, and POS) to individuals and families across 29 states through the federal Health Insurance Marketplace and state-based exchanges. The plans cover essential health benefits including preventive care, mental health services, and prescription drugs, and are paired with member programs such as Virtual 24/7 Care telehealth, My Health Pays Rewards, care management, and a mobile app. Ambetter also sells ICHRA-compatible individual plans and a separate dental and vision offering, distributed through licensed agents, direct online enrollment, and employer channels.

Product overview

Ambetter Health is a health insurance brand offered by Centene Corporation through the Affordable Care Act (ACA) Health Insurance Marketplace and state-based exchanges across 29 states. The core product consists of health insurance plans (HMO, EPO, PPO, and POS types) providing essential health benefits, preventive care, mental health services, and prescription coverage. The product portfolio includes a rewards program (My Health Pays), telehealth services (Virtual 24/7 Care), health management programs for chronic conditions (diabetes, asthma, COPD), care management, a 24/7 nurse line, dental and vision insurance, maternity programs (Start Smart for Baby), member perks, and a mobile app. Ambetter also offers ICHRA (Individual Coverage Health Reimbursement Arrangement) plans for employers and provides the Ambetter Health Solutions sub-brand with additional employer-focused products in select states.

Differentiator

Problem solved

Functional benefit

Brands

• My Health Pays Rewards: A wellness rewards program that allows members to earn up to $500 for completing healthy activities such as eating right, moving more, saving smart, and living well. Rewards can be used for pharmacy cost share at Hy-Vee, Walmart, and mail order pharmacy.
• Virtual 24/7 Care
• Ambetter Perks
• Start Smart for Baby
• Ambetter Health Solutions

Products and services

• Ambetter Health Plans Health insurance plans sold to individuals and families on the ACA Health Insurance Marketplace across 29 states, including HMO, EPO, PPO, and POS product types covering essential health benefits, preventive care, mental health services, and prescription coverage.
• Ambetter Health ICHRA Plans

Quantifiable outcome

• Over 5.5 million members served in the individual ACA Marketplace as of 12/31/2025
• +1 more outcomes

Named customers1 record

Segments2 records

Ideal customer profiles2 records

Technology focussed No

API detail

Has API

Yes

API docs

API detail

Core technology

AI maturity

App detail

Integration4 records

Feature4 records

Partnerships

Four partnerships are on record, tiered minor and core.

• KABOOM!minorGTM or Marketing Partner · 30 January 2026Ambetter Health partnered with the nonprofit KABOOM! and the City of Hialeah to complete a new kid-designed playground at Southeast Park on January 30, 2026, with over 100 company volunteers assembling equipment, adding landscaping, and creating seating areas in a single day. This was the second collaboration between the three organizations following a 2019 playground build at Bucky Dent Park. The project aims to promote health, social connection, and safe outdoor recreation for local children.
• City of HialeahminorGTM or Marketing Partner · 30 January 2026The City of Hialeah collaborated with Ambetter Health and KABOOM! to build a new playground at Southeast Park, completed on January 30, 2026, as part of efforts to provide local children with opportunities for play, social connection, and safe outdoor recreation.
• Tampa Bay BuccaneersminorGTM or Marketing Partner · 17 December 2025Ambetter Health and the Tampa Bay Buccaneers launched a joint public service announcement titled 'Stay Healthy, Stay in the Game' encouraging Floridians to prioritize preventive care and routine screenings before year-end. The PSA featured Buccaneers players Jamel Dean, Devin Culp, and Graham Barton discussing the importance of knowing health metrics like blood pressure and cholesterol. The initiative targets under-insured and uninsured populations served through the federal Health Insurance Marketplace.
• Geisinger Health SystemcoreTechnology or Integration · 3 November 2025Ambetter Health expanded into nine additional counties in Pennsylvania for the 2026 plan year through a partnership with Geisinger Health System, offering comprehensive benefits, online enrollment, wellness rewards, and telehealth services to Pennie marketplace consumers.

Scale indicators3 records

Recent moves6 records

Expansion highlights5 records

Direct peers

• Oscar Health: Tech-forward ACA Marketplace individual health insurer selling plans on Healthcare.gov across more than 20 states, directly overlapping Ambetter's on-exchange core product, target customer (individual under-65 buyers), and digital-first distribution model.
• Molina Healthcare: Government-sponsored health insurer with a significant ACA Marketplace footprint alongside Medicaid and Medicare, structurally analogous to Ambetter/Centene with similar dual-eligible and low-income customer focus and state-by-state subsidiary model.

Emerging players

• Bright Health Group: Smaller ACA Marketplace-focused carrier that has narrowed its geographic footprint; competes with Ambetter on individual on-exchange plans and shared the same risk-bearing, technology-enabled model targeting individual buyers.
• Clover Health: Medicare Advantage-focused insurer with technology-driven member engagement; an adjacent peer to Ambetter in government-sponsored individual coverage, sharing the digital-first philosophy but with a different primary program (Medicare vs. ACA Marketplace).

Broad incumbents

• UnitedHealthcare: Largest U.S. health insurer offering individual ACA Marketplace plans in many of the same states as Ambetter, with much broader commercial, Medicare, and Medicaid portfolios; competes head-to-head with Ambetter in on-exchange geographies.
• Elevance Health (Anthem): Major Blue Cross Blue Shield licensee with large ACA Marketplace presence via Anthem Blue Cross plans across multiple states; competes directly with Ambetter in individual exchange markets and operates broader employer and government lines.
• Cigna Group: Large diversified health insurer with ACA Marketplace offerings (post-HealthSpring/Evernorth portfolio); competes with Ambetter on individual coverage while serving much larger employer and stop-loss segments.
• Kaiser Permanente: Integrated nonprofit payer-provider offering individual Marketplace plans in selected states, competing with Ambetter in the same on-exchange geographies but with a fundamentally different integrated care delivery model.
• CVS Health (Aetna): Vertically integrated payer-retailer offering ACA Marketplace individual plans through Aetna in select states; competes with Ambetter on individual coverage while leveraging pharmacy, PBM (Caremark), and MinuteClinic assets.

Regional players

• Blue Cross Blue Shield Association (state plans): Individual state Blue Cross Blue Shield plans (e.g., Florida Blue, Blue Shield California, BCBS NC) compete with Ambetter on a state-by-state basis in ACA Marketplace, often as the legacy market leader in their respective geographies.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks6 records

Key highlights7 records

Customer concentration

• Facebookfacebook.com/AmbetterHealthcare
• LinkedInlinkedin.com/company/ambetter-health-insurance

Compliance1 record

Revenue estimate

Valuation estimate

Number of profiles

Subsidiaries29 records

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Ambetter