Ambetter – Illinois Health Plans 2023


Ambetter - Illinois Health Plans 2023happyfamily
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2023 Ambetter Provider Network Highlights 

2023 Ambetter Provider Finder

For a complete list of Ambetter in-network providers, please visit here

Coverage Area: Cook County, DuPage County, Will, Kane, And Kankakee Counties, Lake County

Ambetter – Illinois Health Plans

Our Rating: Ambetter - Illinois Health Plans 2023

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 5 carriers in Illinois for 2023, and one of 3 who is covering Cook & DuPage counties. They are currently only offering Silver & Gold plans, which can only be enrolled on the exchange. They also offer 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.

*NEW NorthShore Hospitals include:** 

Evanston Hospital

Glenbrook Hospital

Highland Park Hospital

Skokie Hospital

Hospital List – Cook and DuPage Counties

Amita Hospital System

Edward Elmhust Hospitals

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

PlansEveryday Gold + Vision + Adult DentalCMS Standard SilverElite Bronze – HMO
PLAN SUMMARIESPlan SummaryPlan Summary Plan Summary
DEDUCTIBLE

$750 Individual

$1,500 Family

$5,800 Individual 

$11,600 Family

$0
MAX OUT OF POCKET

$7,500 Individual

$15,000 Family

$8,900 individual 

$17,800 Family

$8,700 Individual

$17,000 Family

NETWORKHMOHMOHMO
METAL LEVELGoldSilverBronze
PRIMARY CARE$35 Copay$40 Copay$45 Copay
SPECIALIST$55 Copay$80 Copay$115 Copay
GENERIC DRUGS$5 Copay / $15 Copay$20 Copay/ $20 Copay$5 Copay / $35 Copay
PREFERRED BRAND DRUGS$60 Copay$40 Copay$195
NON PREFERRED BRAND DRUGS50% Coinsurance$80 copay$250
SPECIALTY DRUGS50% Coinsurance$350 Copay50% coinsurance subject to Rx deductible

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