Ambetter vs. Cigna Insurance

Cigna has the edge over Ambetter thanks to its wide variety of available coverage types, its gigantic network that extends to several countries around the world and the nationwide availability of its Medicare prescription drug plans. Still, even though Cigna will be the better option for many shoppers, Ambetter does have a leg up when it comes to the availability of its Marketplace health insurance plans.

Read on for more Ambetter vs. Cigna insurance comparisons that can help you decide whether either of these companies could be a good fit for you.

Ambetter History

Ambetter was founded in 2014 with a specialized focus on selling Marketplace health insurance plans.^[1] Its parent company is Centene Corporation, which started out as a nonprofit Medicaid plan in 1984 and later acquired the Medicare-focused company Wellcare in 2020 to complement its existing slate of insurance products.^[2][3]

Click here to read our full Ambetter review.

Cigna History

Cigna as it exists today was born in 1982 out of the merger of two longstanding health insurance providers: the Insurance Company of North America (INA), which was formed in 1792, and the Connecticut General Life Insurance Company, which was formed in 1865.^[4]

Cigna and its predecessors have played a prominent role in many aspects of American history. For example, INA paid out claims to help rebuild large parts of Chicago and San Francisco after they were impacted by natural disasters in the late 1800s and early 1900s. Today, Cigna’s reach extends beyond the United States to numerous countries around the world.^[4]

Click here to read our full Cigna review.

Ambetter vs. Cigna: A Quick Glance

Ambetter Pros and Cons

Cigna Pros and Cons

Ambetter vs. Cigna: Plan Structures

Cigna offers significantly more plan structures than Ambetter, allowing it to act as a one-stop shop for just about any common health insurance need in certain states. Due to its focus on selling Marketplace plans, Ambetter generally doesn’t offer employer group, Medicaid or Medicare plans, which are the three most common types of health insurance and collectively account for how the overwhelming majority of Americans receive coverage.^[5]

That said, Ambetter does partner with Superior HealthPlan to provide Medicare Advantage coverage for its plan members in Texas but Ambetter doesn’t offer this kind of coverage anywhere else in the country.^[6]

Ambetter vs. Cigna: Plan Availability

While Cigna technically beats Ambetter in terms of the number of states it operates in, Ambetter offers Marketplace coverage in more states than Cigna. Cigna operates in all 50 states, the District of Columbia and Puerto Rico but it only offers Medicare Advantage plans in 29 states plus D.C. and only offers Marketplace plans in 14 states.^[7][8]

You may want to note that Cigna previously sold Affordable Care Act (ACA) Marketplace coverage in Kansas and Missouri but opted to discontinue this product in those states beginning in 2024.^[9] Meanwhile, Ambetter operates and sells Marketplace health plans in 29 states.^[10]

Ambetter vs. Cigna: In-Network Providers

Ambetter and Cigna’s networks cannot be easily compared since Ambetter has not publicly disclosed the size of its network. However, you may want to note that Ambetter’s parent company, Centene, was sued in 2018 for misrepresenting the size of its network to prospective Ambetter policyholders.^[11] Meanwhile, Cigna’s network extends across the globe and includes close to 1.7 million health care providers in total as of 2021.^[12]

Ambetter vs. Cigna: Cost

Ambetter and Cigna don’t publish their average health insurance premiums, so you will need to find a plan that matches your specific needs to get an idea of how much you might have to pay for coverage. In general, the average monthly premiums for private Marketplace benchmark plans and Medicare Advantage plans are $477 and $18.50, respectively.^[13][14]

Remember that insurance carriers like Ambetter and Cigna that sell coverage through the Health Insurance Marketplace can only consider the following factors when calculating your premiums:^[15]

• Age
• Location
• Tobacco use
• Whether you have an individual or family plan
• Plan tier

The tier of a health plan indicates whether it comes with higher premiums or higher out-of-pocket costs whenever you receive medical services. If you’re willing to pay higher deductibles, copays and coinsurance in exchange for lower upfront premiums, you may want to opt for a bronze or silver plan. Conversely, if you need medical care regularly and would prefer to budget for higher premiums rather than higher out-of-pocket costs, a gold or platinum plan may be a better fit for you.^[16]

Ambetter vs. Cigna: Coverage Limits

Coverage limits can also differ significantly depending on the type of care you receive and the details of your health plan, making it hard to specifically compare Ambetter and Cigna on this metric. Nevertheless, it is worth noting that neither insurer is allowed to limit coverage for the following essential health benefits:^[17][18]

• Ambulatory patient services
• Emergency services
• Hospitalization
• Pregnancy, maternity and newborn care
• Mental health and substance use disorder services
• Prescription drugs
• Rehabilitative and habilitative services and devices
• Laboratory services
• Preventive and wellness services and chronic disease management
• Pediatric services (including dental and vision care for children)

Ambetter vs. Cigna: Policy Management

Both Ambetter and Cigna allow policyholders to manage their coverage through an online account or over the phone, while Cigna also allows plan members to manage their policies through the myCigna mobile app.

Meanwhile, Ambetter offers the Wellframe mobile app, which allows members to access telehealth services but doesn’t actually allow them to manage the details of their insurance plans.^[19] Both companies’ apps are well-rated for the most part, although the myCigna app does have mediocre reviews on Google Play.

Ambetter vs. Cigna: Medical Loss Ratio

Like all health insurance companies, Ambetter and Cigna are required to adhere to the medical loss ratio (MLR) standards established by the ACA. MLR refers to the percentage of an insurance company’s revenue from premiums that goes back to its plan members in the form of coverage for treatments and other investments intended to improve the customer experience.

At the end of each year, insurance providers that sell individual and small group health insurance must issue prorated rebates to their policyholders if they failed to maintain an average MLR of 80% across the previous three years. Insurers in the large group market must maintain a three-year rolling average MLR of 85% to avoid paying out rebates.^[24]

Centene Corporation’s three-year rolling average MLR is 87.73% as of the end of 2023 and the company has not announced any MLR rebates for Ambetter plan members in 2024.^[25][26] Similarly, Cigna has not announced any MLR rebates for this year and maintained an average MLR of 82.33% from 2021 to 2023.^[27][28]

Ambetter vs. Cigna: Enrollment Process

You will generally need to sign up during open enrollment between November 1 and January 15 to get a Marketplace health insurance plan from either Ambetter or Cigna.^[29] If you are interested in enrolling in a Medicare Advantage plan, you should instead keep the following Medicare open enrollment deadlines in mind:^[30]

To sign up for health coverage outside of these dates, you will generally need to qualify for a special enrollment period. These are typically triggered by major life events that can significantly affect your health insurance needs such as the following:^[31]

• Getting married, divorced or separated
• Giving birth to or adopting a child
• Changing or losing your job
• Moving to a new home
• Losing your existing health coverage due to the death of a family member
• Aging out of your parents’ health plan by turning 26
• Becoming a United States citizen
• Leaving prison

Ambetter vs. Cigna: Policyholder Experience

Neither Ambetter nor Cigna has particularly good reviews on online review platforms like Best Company and the Better Business Bureau. Despite that, Cigna earned the No. 1 spot in New Jersey in a J.D. Power study that measured customer satisfaction among commercial health insurance companies.^[32]

^{*rating applies to Centene Corporation as a whole}

How To File Claims With Ambetter and Cigna

You shouldn’t need to file your own insurance claim with Ambetter or Cigna if you go to an in-network health care provider since the provider will usually file a claim for you. However, if you do need to file a claim yourself, then you can submit your claim information electronically through your myCigna account or fill out and mail a claim form to the specific branch of Ambetter that operates in your region.^[37][38]