Ambetter

Health insurance plans for individuals and families in Illinois.

Ambetter Health Insurance
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2025 Ambetter Provider Finder

2025 Formulary / Prescription Drug List

2025 Formulary Changes

Ambetter – Illinois Health Plans

 

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
  • Advocate Health Care, the largest health system in Illinois, is now an in-network provider!
  • Illinois is expanding into Henderson and Whiteside counties

About Ambetter

Ambetter is a good choice for anyone who qualifies for Cost Sharing reductions, as well as for people who are more concerned about their prescription drug coverage (more copays then similar Blue Cross plans) vs gaining access to a wide provider & hospital network. They also offer medical plans bundled with optional vision & dental plans.

 

About Premier:

Premier is Ambetter Health’s broadest provider network and is available in all Ambetter Health counties. Members can visit any in-network provider, no referrals needed! When searching the Ambetter Guide, choose “Premier” to locate in-network providers. Adult vision and adult dental buy-ups are available on many plans.

Ambetter plans are grouped by metal tier. Descriptions for each tier is as follows:

Bronze Plans – Compare Plans Here

Recommended if you:

  • Rarely use your coverage or see the doctor
  • Want a “just in case” plan
  • Prefer very low monthly premiums
  • Are okay with higher out-of-pocket costs

Silver plans – Compare Plans Here

Recommended if you:

  • See your primary care physician for preventive care every year
  • Don’t anticipate any major ongoing medical needs
  • Would like a premium that fits most budgets
  • Would like out-of-pocket expenses that fit most budgets

Gold plans – Compare Plans Here

Recommended if you:

  • Will use your coverage often
  • Have an ongoing medical condition that needs treatment
  • Want additional security and peace of mind
  • Are okay with higher monthly premiums
  • Prefer lower out-of-pocket costs

Ambetter Coverage Map

  • Bond
  • Calhoun
  • Clinton
  • Cook
  • DuPage
  • Greene
  • Grundy
  • Henderson (New in 2025)
  • Henry
  • Jersey
  • Kane
  • Kankakee
  • Kendall
  • Lake
  • Macoupin
  • Madison
  • Mercer
  • Monroe
  • Montgomery
  • Randolph
  • Rock Island
  • St. Clair
  • Washington
  • Whiteside (New in 2025)
  • Will

NEW Provider Networks:

Advocate Health Care – Illinois’ largest health system

  • Advocate Children’s Hospital
  • Advocate Christ Medical Centers
  • Advocate Good Samaritan Hospital
  • Advocate Shepard Hospital
  • Advocate Lutheran General Hospitals
  • Advocate South Suburban Hospitals
  • Advocate Trinity Hospital
 

2025 Provider Networks Highlights (partial list – find full list here)

Cook County

AMITA Hospital System

Endeavor Health: 

  • Evanston Hospital
  • Northwest Community Hospital
  • Northshore
  • Swedish Hospital

Rush Oak Park Hospital / Rush university Medical Center

Sinai Health Systems

Weiss Memorial Hospital

Cook County Health / John Stroger Hospital

Jackson Park Hospital & Medical Center

Dupage County

Endeavor Health

  • Edward-Elmhurst Health

UChicago Medicine Glen Oaks / Hinsdale

Ambetter

Lake County

Vista  Medical Center East

Madison, St. Clair, Monroe Counties (East St. Louis)

Hospital Sisters Health System (HSHS) SSM Hospital System

Saint Luke’s Hospital – St. Louis, MO

Will, Kane, Kankakee Counties

AMITA Health Systems

Rush Copley Medical Center

Rock Island, Henry, Mercer Counties (Quad Cities)

Genesis Medican Center Silvis

UnityPoint Health Trinity – Rock Island

2025 Plan Comparison – Our Top 3 Recommended Ambetter Plans

Plan HighlightsFocused Silver (Base)Complete Silver (Base)Everyday BronzeEveryday Gold
Plan InfoLowest cost Silver plan that includes copays for PCP, Specialist, Lab, Urgent Care & Generic Rx.$0 deductible at 87% and 94%.Features copays for office visits, generic and preferred prescriptions.Lowest cost Gold plan premium on the Core portfolio.
DEDUCTIBLE$6,300$6,000$8,450$750
MAX OUT OF POCKET$8,000$8,500$9,250$7,500
COINSURANCE50%40%50%35%
PCP VISIT$45$30$40$35
TELEHEALTH/VIRTUALNO CHARGENO CHARGENO CHARGENO CHARGE
SPECIALIST VISIT$100$60$90$55
LAB$50$40$50$35
PREFERRED GENERIC / GENERIC RX$3 / $25$3 / $20$3  /$30$3 / $15
PREFERRED RX$75$5550% AD$60
URGENT CARE / VIRTUAL URGENT CARE$60 / $0$60 / $0$50 / $0$35 / $0

 

Reasons to Choose Ambetter

  • My Health Pays: Members can earn up to $500 in rewards annually, which can reduce monthly premiums by up to $41 per month.
  • Teladoc Program with a $0 copay: At home, in the office or even on vacation. Get medical advice, a diagnosis or a prescription for non-emergency health issues when you need it
  • Affordable Health Plans: Ambetter is projected to have one of the lowest cost Silver plans available on the Marketplace for 2023 Open Enrollment.
  • Start Smart for your Baby: A program created to provide advice and resources for pregnant members and new parents
  • Health Management Programs
  • 24/7 Nurse Advice Line
  • Care Management
Bronze Plans

Bronze Plans

Recommended if you:

  • Rarely use your coverage or see the doctor
  • Want a “just in case” plan
  • Prefer very low monthly premiums
  • Are okay with higher out-of-pocket costs

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