Ambetter

Health insurance plans for individuals and families in Illinois.

2024 Ambetter Provider Network Highlights

2024 Ambetter Provider Finder

Coverage Area: Bond County, Calhoun County, Clinton County, Cook County, DuPage County, Greene County, Grundy County, Henry County, Jersey County, Kane County, Kankakee County, Kendall County, Lake County, Macoupin County, Madison County, Mercer County, Monroe County, Montgomery County, Randolph County, Rock Island County, St. Clair County, Washington County, Will County

Ambetter – Illinois Health Plans

Ambetter Health is changing their plan names for 2023. Members may see a new plan name, but they still have the same great coverage and benefits they’ve come to expect from Ambetter Health. Please refer to the 2023 Plan Name Reference Guide to view the Ambetter Health name changes.

Ambetter is one of 7 carriers in Illinois for 2024, and one of 6 companies covering Cook & DuPage counties. They also offer medical plans bundled with optional vision & dental plans.

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.

Lowest Premium Bronze: Standard Expanded Bronze

Lowest Premium Silver: Clear Silver

Lowest Premium Gold: Standard Gold

Lowest Cost Silver w/ Copays: Focused Silver

Ambetter Bronze

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

Ambetter Silver

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

Ambetter Gold

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

Hospital List – Cook and DuPage Counties

*NEW in 2024* RUSH MEDICAL Systems

Amita Hospital System

Evanston Hospital

Glenbrook Hospital

Highland Park Hospital

Skokie Hospital

Northwest Community Hospital**

Swedish**

Sinai Health System

Louis A. Weiss Memorial Hospital

Saint Bernard Hospital

Swedish Covenant Hospital

**(Members can use the Primary Care Providers (PCP) and Specialty Providers at this location for their medical care.)

2023 Plan Comparison – Our Top 3 Recommended Ambetter Plans

Plan Highlights	Focused Silver (Base)	Complete Silver (Base)	Everyday Bronze	Everyday Gold
Plan Info	Lowest 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
COINSURANCE	50%	40%	50%	35%
PCP VISIT	$45	$30	$40	$35
TELEHEALTH/VIRTUAL	NO CHARGE	NO CHARGE	NO CHARGE	NO 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	$55	50% 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