Welcome to your Ambetter Health Premier Plan.

Get started here to get the most out of your coverage and benefits. 
 

  

With the Ambetter Health Premier Plan, you have the tools and resources needed to manage your health.

Premier plans feature Ambetter from Meridian's broadest network of healthcare providers and hospitals. This gives you more options to choose from when you need care. With this plan, you don't need referrals to see a specialist.

After you enroll, you may be assigned a Primary Care Provider (PCP). Your PCP is your main health care professional and should be your first choice for:

  • Routine checkups 
  • Non-emergency medical care such as colds and fevers
  • Managing health conditions like allergies and asthma
  • Prescriptions
  • Lab tests 
  • Imaging services like x-rays, ultrasounds or CT scans 

You can view or change your PCP in your Online Member Account. 

Your Premier plan offers balanced care for your whole health:

  • Preventive care benefits, such as annual wellness exams and vaccinations, at no extra cost to you
  • Psychotherapy and counseling
  • Inpatient care
  • and more! 

 

   

Getting Started

You can easily manage your healthcare and get the most out of your Premier plan. Here are some useful things you can start with:

Create Your Online Member Account

Access your health information 24/7. All members 18 years or older need to create their own Online Member Account.

To set up your account:

  1. Go to Member.AmbetterHealth.com.
  2. Register with your member ID or Social Security number.
  3. Verify your account through email.

Your member account helps you:

  • Find in-network care
  • View or change your PCP
  • Manage your benefits
  • See the details of your plan
  • Access your digital ID Card
  • Set payment preferences


Download the Ambetter Health Mobile App

To access your health plan details on the go, download the Ambetter Health mobile app from the app page or search for “Ambetter Health” in your app store. To start using the app, sign in with your Online Member Account login and password. 

Your Ambetter Health app has all the useful features of the member account. Additionally, you can contact member support directly through the app, quickly open your digital ID Card in the app or save it to your device wallet.
 


Review Your Plan Documents

  • Member Welcome Packet. It includes your Member ID Card and helpful information about your plan and resources that are available. Your Welcome Packet is mailed to you after you make your first premium payment.
  • Digital ID Card. Access your digital ID Card anytime. You can view and download your digital ID Card in your Online Member Account 24–48 hours after your payment. You can also find it in the Ambetter Health mobile app. 
  • Evidence of Coverage (EOC). This is your “member contract”. In it you can find all the details about your Ambetter Health plan benefits and covered services. Log in to your Online Member Account and select “Email” under “Communication Preferences” to access this document digitally.

Explore Your Ambetter Health Premier Network

Find doctors, pharmacies and health services in your area that meet your needs. Search for in-network care using the Ambetter Guide: 

  • Go to Guide.AmbetterHealth.com.
  • Select your state.
  • Select the coverage year.
  • Select your county.
  • Choose the Premier network and click Set Network.

Schedule your Wellness Check

View your PCP and schedule your first appointment right away. Your PCP will be your first choice when you need medical care. You can change your PCP but check to make sure that the PCP is in-network to avoid additional costs.

A wellness check normally includes:

  • A comprehensive history appropriate for your age and gender
  • Physical examination
  • Counseling or anticipatory guidance
  • Interventions to reduce risk factors
  • Ordering of appropriate immunizations, labs and screenings

Watch this video on how to find a provider that meets your needs using the Ambetter Guide. 

Activate Your My Health Pays® Rewards*

My Health Pays is a rewards program that pays you for the healthy decisions you’re already making every day.  

Benefits 

With your Premier plan, you have access to all essential benefits and much more. Ambetter Health offers free health and wellness services, pharmacy home delivery, and access to exclusive discounts and rewards. 

Essential Benefits and So Much More

You are covered with Essential Benefits. All health plans offered on the Health Insurance Marketplace include certain items or services. They are known as Essential Health Benefits (EHBs). Ambetter Health covers you on these essential medical care and wellness services: 

  • Emergency Care
  • Outpatient or Ambulatory Care
  • Preventive & Wellness Care
  • Maternity & Newborn Care
  • Pediatric Care
  • Mental Health & Substance Abuse Care
  • Laboratory Services
  • Prescription Drugs
  • Therapy Services
  • Hospitalization

Virtual 24/7 Care**

Virtual 24/7 Care gives you easy access to care for non-emergency issues. You can get medical advice, a diagnosis or a prescription using your mobile phone, tablet or computer. With 24-hour access, you can choose to receive immediate care or schedule a virtual appointment. Virtual 24/7 Care treats the same issues as your PCP. You can get help with colds, flu, pink eye, anxiety or depression. You can also get prescriptions for your medication or refills. Before you start using Virtual 24/7 Care, you will need to set up your account. 

24/7 Nurse Advice Line

Not sure where to go for care? Call our 24-hour nurse advice line at 1-833-993-2426 (TTY Relay 711) It is a cost-free service connecting you to a registered nurse who can help you find a doctor or learn where to go for care. They can help answer health questions including what to do for a sick child and whether you should go to the ER or see your PCP.

My Health Pays® Rewards Program*

Our My Health Pays® program is available to Ambetter Health members. It’s a rewards program that pays you for the healthy decisions you’re already making each and every day. Completed your annual wellness screening? You get points for that. Want to learn new ways to be healthy? You can get rewards for that, too. And the best part, you can turn those rewards into dollars for your everyday needs like utilities, groceries, and more.

Earn up to $500 in rewards*. Visit the My Health Pays page to learn more.

Ambetter Health Member Perks

The Ambetter Member Perks Program is available exclusively to Ambetter Health members. The program is brought to you by Abenity. As an Ambetter Health member, you can now enjoy healthy discounts to help you be well, stay well, and save smart. Start enjoying all the discounts available to you including restaurants, computers, hotels, retailers, and more! Ambetter Member Perks. The benefits you deserve!

Prescription & Mail Order Pharmacy Benefits

Order your medications through Express Scripts® Pharmacy Home delivery to save you time and money. You can get a 90-day supply of your maintenance medications. It will be delivered safely on your schedule, right to your door.

Where to go for care

With the Premier plan, you have many options to support your physical and mental health. If your injury is minor and not life threatening, like a sprain or a cold, call your Primary Care Provider (PCP). If you can't wait for an appointment with your PCP, consider one of the options below. Have a question about your prescriptions, refills, over-the-counter medicine, or side effects? Your local pharmacist can also help you at no cost over the phone or in person.

   Virtual 24/7 Care

Virtual 24/7 Care is a great option for urgent care around the clock. If you cannot get in with your PCP fast enough or it's after your PCP's hours, Ambetter Health's Virtual 24/7 Care is here to help. Use it whenever and wherever works best for you. 

Before you start using Virtual 24/7 Care, set up your account at AmbetterTelehealthMI. 

You can reach Virtual 24/7 Care providers by phone or video when you need medical care, a diagnosis or a prescription. Choose to receive immediate care or schedule an appointment for a time that fits in your schedule.  

Get help with:  

  • Colds, flu and fevers 
  • Rash and skin conditions
  • Respiratory infections, ear infections or pink eye
  • Stress, anxiety, depression or grief 

   24/7 Nurse Advice Line

Our free nurse advice line makes it easy to get answers to your health questions. Staffed by licensed nurses, it runs 24 hours a day, 7 days a week. You don't even have to leave home! Call 1-833-993-2426 (TTY Relay 711) if you have questions about: 

  • Urgent care 
  • Your health, medications, or a chronic condition 
  • Whether you should go to the emergency room (ER) or see your PCP 
  • What to do for a sick child 
  • How to handle a condition in the middle of the night 
  • Accessing our online health information library 

   Urgent Care

Urgent Care is for when you have an injury or illness that must be treated within 24 to 72 hours and is not life threatening. Go to an urgent care clinic if you need care and your PCP is unable to see you. You do not need an appointment. Consider Urgent Care for small wounds, simple sprains and broken bones, ear infections, and urinary tract infections.   

Be sure to choose an in-network urgent care center to save on costs. Use the Ambetter Guide to find urgent care near you.

   Emergency Room (ER)

If you have a life-threatening injury or illness, do not wait! Call 911 or go directly to the ER. A medical emergency is a sudden illness or condition that could result in serious harm to you and needs care right away. For example, bleeding that will not stop, severe pain, chemical poisoning, drug overdose or thoughts of harming yourself or others. Choose other care options if your injury is minor to maximize your benefits and lower your costs. Consider all your options before going to the ER.  

Watch the video to learn more about your choices for care when you are sick or hurt. 

   988 Suicide and Crisis Lifeline

The 988 Lifeline provides confidential help when you need it quickly. To connect:  

988 can help you or a family member with mental health, drug use, or suicidal concerns. Contact 988 if you have thoughts of hurting yourself or others.  

Health Insurance 101

Know these health insurance terms to make the most out of your Ambetter Health Premier Plan. 

Network 

A health insurance network is a group of doctors, hospitals, clinics, and other healthcare providers. These providers are part of your plan.

  • In-network (INN) providers partner with your health plan. When you use their services, your plan typically covers a larger portion of costs, and you pay less. 
  • Out-of-network (OON) providers are not part of your network. If you see a doctor who is out of your network, you may have to pay more. Some plans may cover a smaller portion of the cost, but many do not cover out-of-network services at all. That is why it is best to stay in-network. 

Primary Care Provider (PCP) 

Your Primary Care Provider (PCP) is your main point of contact for care. This can be a doctor, a physician assistant, or a nurse practitioner. 

See your PCP for wellness and sick visits, checkups, vaccinations, or for mental wellness. Your PCP can assess your symptoms, give you initial treatment, help you with your medication and refer you to a specialist when it is necessary. 

As a Premier plan member, you may be assigned a PCP. You can view or change your PCP in your Online Member Account.

Why is it good to have a PCP? 

  • Your PCP gets to know you and your medical history. This helps you get care that's right for you. 
  • Your PCP handles your preventive care. Regular checkups, screenings and vaccinations can help prevent health issues. 
  • If you have diabetes, asthma or another chronic condition, your PCP keeps track of it and helps you get consistent care. 

Premium

A Premium is a fixed fee you will pay each month for your health insurance plan. 

Copay 

A copay (or copayment) is a set fee you pay for a doctor visit or prescription. You typically pay it during your visit. 

Copays are common for these medical services: 

  • Doctor or specialist visit 
  • Urgent care visit 
  • Emergency room (ER) visit
  • Prescriptions 

Not all health plans have copays. Usually, plans with a high deductible do not have copays for doctor visits or prescription drugs. You can find your copay information on your Member ID Card.

 

Deductible 

A deductible is the money you need to pay for the covered services you are using before your plan starts to pay. Before you reach your deductible, you are responsible for the full costs of your care. Deductibles reset every year. 

Most health plans have a deductible, but the amounts can vary. A plan with a higher monthly premium often has a lower deductible. Lower monthly payments generally mean a higher deductible. 

Your deductible may also depend on where you go for care. Typically, you pay less when you get care from a doctor who is in your network. 

Coinsurance 

Coinsurance is a type of cost-sharing. Usually, coinsurance begins once you pay your deductible. Coinsurance is as a percentage that you need to pay for covered services. It is a smaller portion of the full cost, and your insurance covers the rest. 

Maximum Out of Pocket (MOOP)

This is the maximum amount of money you can pay for covered services in a year. Once you reach this limit, your plan typically covers the full cost of covered services for the rest of the year. 

  

Frequently Asked Questions

A PCP is your Primary Care Provider. It is where you go for checkups, vaccinations or if you have fever or cold. Your PCP also cares about your ongoing issues like allergies, diabetes or asthma.

Go to the Ambetter Guide and select the Premier network. Use the search to find an in-network provider of your choice. Use the Ambetter Guide to find urgent care near you. 

You can access urgent care virtually or in person without a referral. 

  • For a virtual visit: Go to your online member account and select “Virtual 24/7 Care” on the right side of the homepage to schedule your visit. 
  • For an in-person visit: Find a nearby urgent care clinic using the Ambetter Guide. Go to Guide.AmbetterHealth.com, choose the Premier network and search for “Urgent Care.” 

No. As a Premier plan member, you can choose to see any in-network specialist. Your plan will cover this visit. To find a doctor in your network, use the Ambetter Guide. Be sure to select your state, plan year and the Premier network before searching. 

Your plan will cover the visit if the specialist is in your Premier network. To check this, use the Ambetter Guide. Be sure to select your state, plan year and the Premier network before searching. If the specialist is not in your network, choose another in-network specialist to avoid additional costs.

Most out-of-network services are not covered by your plan. You will have to pay in full for any out-of-network visits. The only exception is if you have a PPO Premier plan. To choose a doctor in your network, use the Ambetter Guide. Be sure to select your state, plan year and the Premier network before searching. 


Visit our Coverage Area Map to view the Michigan counties where the Ambetter Health Premier Plan is available. 

*Healthcare-related costs will vary by member and the plan in which you are enrolled. Funds expire immediately upon termination of insurance coverage. My Health Pays® rewards cannot be used for pharmacy copays.

Restrictions apply. Members must qualify for and complete all activities to receive $500 or more. Visit Member.AmbetterHealth.com for more details. Your health plan is committed to helping you achieve your best health. Rewards for participating in a wellness program are available to all members. If you think you might be unable to meet a standard for a reward under this wellness program, you might qualify for an opportunity to earn the same reward by different means. Contact us at 1-833-993-2426 (TTY Relay 711). and we will work with you (and, if you wish, with your doctor) to find a wellness program with the same reward that is right for you in light of your health status.

**Cost sharing may apply when using Virtual 24/7 Care. Virtual 24/7 cost share does not apply to HSA plans until the deductible is met and is only applicable when used through the Virtual 24/7 program. Ambetter Health does not provide medical care. Medical care is provided by individual providers which are independent contractors and not agents of Ambetter Health.

Ambetter from Meridian is underwritten by Meridian Health Plan of Michigan, Inc., which is a Qualified Health Plan issuer in the Michigan Health Insurance Marketplace. This is a solicitation for insurance. ©2024 Meridian Health Plan of Michigan, Inc. All rights reserved.