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Gold 80 Ambetter HMO (2026) is a Gold-tier ACA Marketplace health insurance plan with a health maintenance organization network structure. Gold plans generally have a higher actuarial value than Silver and Bronze plans, meaning the plan is designed to pay a greater share of covered essential health benefit costs on average across a standard population. Actual premiums, deductibles, copayments, coinsurance and out-of-pocket limits depend on the specific plan and service area. Members should review the applicable 2026 policy documents before enrolling.
Gold-tier coverage with benefits and cost-sharing defined by the official 2026 policy
This plan may suit Marketplace members comparing Gold-tier coverage and an HMO provider network. Before choosing it, confirm the monthly premium after any eligible financial assistance, deductible, primary-care and specialist visit costs, hospital cost-sharing, prescription formulary, referral requirements and annual out-of-pocket maximum. Verify that preferred providers and facilities are in-network for the exact plan and service area. Do not rely on benefit amounts from another Ambetter plan or state.
Centene Corporation
Key Insights
Founded
1984
Centene Corporation was established 42 years ago and has built strong credibility over time, backed by its long-standing presence in the market.
Claims Experience
0% CSR, calculated as a 3-year average
Centene Corporation settles 0% of all claims it receives.
Network Hospitals
140+
Centene Corporation has a network of 140+ hospitals, ensuring wide accessibility and convenience for policyholders.
Gold-tier ACA plans are designed to pay a higher average share of covered essential health benefit costs than Silver and Bronze plans across a standard population.
Actual member costs depend on the policy, covered service and provider network.
The HMO structure generally directs members to participating providers for routine covered care.
Check the exact provider directory and network rules before receiving care.
Eligible in-network preventive services may be covered without cost-sharing under applicable ACA requirements.
Diagnostic and follow-up services may have different cost-sharing rules.
Covered primary-care visits are subject to the plan benefit schedule and applicable network and cost-sharing rules.
Confirm the actual copayment and whether the deductible applies in the official 2026 documents.
Covered specialist services are subject to plan rules, including any applicable referral or prior-authorization requirements.
Verify referral requirements and specialist costs before scheduling care.
Separate vision coverage may be available to eligible Ambetter members. Vision benefits may help with eligible eye-care services according to the applicable supplemental policy.
Confirm availability for this exact plan and state, additional premium, provider network, covered services and benefit limits before publishing this as an available option.
Conditions or treatments that the policy clearly says it will not cover.
Insurer
Centene Corporation plans and claim process
It is a Gold-tier ACA Marketplace health insurance plan with an HMO network structure. Exact benefits depend on the specific 2026 policy and service area.
Gold plans generally have an actuarial value near 80%, meaning they are designed to pay about 80% of covered essential health benefit costs on average across a standard population. This is not a promise to pay 80% of each member’s bills.
The premium depends on the specific plan, service area, household details and any applicable financial assistance. Obtain a verified quote to confirm the amount.
Disclaimer: Premium amounts are indicative and may vary based on age, health, and plan selected. Ratings and figures are based on publicly available company disclosures and state insurance department filings. Finzony is not an insurance broker or agent. Verify all details on the official Centene Corporation website before purchasing.
Contact Details
314-725-4477
Headquarters: Centene Plaza, 7700 Forsyth Boulevard, St. Louis, Missouri, 63105, United States
Official Website
centene.com
Visit the official Centene Corporation website for plan brochures, premium quotes and policy services.
The aforementioned ratios have been averaged over three years (FY24-FY26)
The deductible is the amount a member may need to pay for eligible services before the plan pays for many covered services. Check the official 2026 Summary of Benefits and Coverage for the exact amount.
It is the plan-specific annual limit on eligible covered out-of-pocket spending. Confirm the limit and which expenses count toward it in the official plan documents.
Eligible preventive services may be covered without cost-sharing when they meet applicable ACA requirements and plan terms.
Specialist care is subject to the plan network and any referral requirements. Confirm the rules before scheduling an appointment.
Routine non-emergency out-of-network care may have limited or no coverage under an HMO. Review the policy for exceptions and applicable emergency-care protections.
Covered medicines are subject to the applicable formulary, drug tier, pharmacy network and cost-sharing rules. Check the formulary for each medication.
Covered hospital services are subject to policy terms, medical-necessity requirements, network rules and the benefit schedule. Consult the official 2026 documents for exact costs.
Eligible Marketplace enrollees may qualify for premium tax credits depending on applicable rules and household circumstances. Check the Marketplace application for an eligibility determination.
Review the official 2026 Summary of Benefits and Coverage, Evidence of Coverage or policy document, provider directory and prescription formulary for the specific service area.