Ambetter

Health insurance plans for individuals and families in Illinois.

Ambetter Health Insurance
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2026 Ambetter Provider Finder

2026 Formulary / Prescription Drug List

2026 Formulary

Ambetter – Illinois Health Plans

 

What’s new in 2026

  • Start Smart for Your Baby – Every pregnancy is different. And each person is unique. What doesn’t change is  Ambetter’s commitment to your health and the health of your family. Ambetter’s program was created to support you when you need it. From pregnancy to delivery and after your baby is born. Find useful information about topics that are important to you. Plus, download and save helpful checklists and appointment info!

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 Are No Longer Being Offered For Plan Year 2026

    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 Programs: 

    MyHealthPays – The My Health Pays® program helps you focus on your total health. When you complete healthy activities, such as eating right, moving more, saving smart and living well, you can earn up to $500 in rewards! 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
    • Telecommunications
    • Transporation, Education, Rent, Childcare
    Restrictions may apply

    Ambetter Coverage Map

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

    Provider Network Highlights

    Cook County

    • Advocate Health Care
      – Advocate Childrens Hospital
      – Advocate Christ Medical Centers
      – Advocate Good Samaritan Hospital
      – Advocate Good Shepard Hospital
      – Advocate Lutheran General Hospitals
      – Advocate South Suburban Hospitals
      – Advocate Trinity Hospital
    • Endeavor Health:
      – Evanston Hospital
      – Northwest Community Hospital
      – Northshore
      – Swedish Hospital
    •  Rush University Medical Center
    • Sinai Health Systems
    • Prime Healthcare
    • Ascension Health

    DuPage County

    • Endeavor Health
      – Edward-Elmhurst Health
      – Northshore-Highland Park
    • Advocate Aurora Health
      – Advocate Condell
      – Advocate Good Samaritan
      – Advocate Good Shepard

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

    • Hospital Sisters Health System (HSHS)
    • SSM Hospital System
    • Saint Luke’s Hospital – St Louis, MO

    Rock Island, Henry, Mercer Counties (Quad Cities)

    ● Genesis Medical Center Silvis
    ● UnityPoint Health Trinity – Rock Island

    Will, Kane, Kankakee Counties

    • Rush Copley Medical Center

     

    2026 Plan Comparison – Our Top 3 Recommended Ambetter Plans

    Plan Highlights Focused Silver (Base) Complete Silver (Base) 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%. Lowest cost Gold plan premium on the Core portfolio.
    DEDUCTIBLE $6,300 $6,000 $750
    MAX OUT OF POCKET $8,000 $8,500 $7,500
    COINSURANCE 50% 40% 35%
    PCP VISIT $45 $30 $35
    TELEHEALTH/VIRTUAL NO CHARGE NO CHARGE NO CHARGE
    SPECIALIST VISIT $100 $60 $55
    LAB $50 $40 $35
    PREFERRED GENERIC / GENERIC RX $3 / $25 $3 / $20 $3 / $15
    PREFERRED RX $75 $55 $60
    URGENT CARE / VIRTUAL URGENT CARE $60 / $0 $60 / $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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