Centene / Ambetter claim denial rate: 18.6%

Centene / Ambetter issuers selling on HealthCare.gov reported denying 17,062,275 of 91,545,854 in-network claims in 2024 across 22 filings in 19 states. The pooled rate for every issuer in the file is 18.7%. 21.0% of 35,239 internal appeals were overturned.

18.6%

in-network denial rate, 2024 claims

+5.0 pp

change from 2023 (13.6%)

21.0%

of 35,239 appeals overturned

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Three years, pooled

Claims year	Filings	In-network claims	Denied	Denial rate	Appeals	Overturned	External reviews
2022 (PY2024 file)	24	83,588,857	12,263,372	14.7%	16,963	57.5%	835
2023 (PY2025 file)	23	74,514,928	10,152,809	13.6%	16,904	48.8%	212
2024 (PY2026 file)	22	91,545,854	17,062,275	18.6%	35,239	21.0%	710

Every Ambetter filing, by state (2024 claims)

Sorted by reported denial rate. Filings under 1,000 claims are shown but not ranked. Each row links to the issuer's report card with the plan list and the year-over-year detail.

State	Issuer (as CMS prints it)	Denial rate	Prior year	Claims	Appeals	Overturned
Delaware	Celtic Insurance Company	28.2%	n/a	24,728	n/a	n/a
Michigan	Meridian Health Plan of Michigan, Inc.	27.7%	18.5%	3,404,769	844	n/a
Ohio	Oscar Buckeye State Insurance Corp.	26.5%	18.9%	1,276,642	18,709	25.1%
Oklahoma	Celtic Insurance Company	24.0%	21.3%	1,824,797	446	n/a
Texas	Superior Health Plan	22.2%	15.3%	5,807,390	1,083	57.4%
North Carolina	Ambetter of North Carolina Inc.	21.5%	15.3%	4,295,438	1,238	n/a
Alabama	Celtic Insurance Company	21.4%	17.0%	1,644,320	377	n/a
Ohio	Buckeye Community Health Plan	19.5%	14.4%	3,673,782	333	59.5%
Louisiana	Ambetter Health of Louisiana, Inc.	19.1%	n/a	1,704,183	289	n/a
Kansas	Celtic Insurance Company	19.0%	13.5%	3,865,491	1,121	1.8%
Tennessee	Celtic Insurance Company	18.9%	15.3%	8,726,180	2,600	n/a
Missouri	Celtic Insurance Company	18.8%	13.4%	5,919,313	n/a	n/a
Arizona	Health Net of Arizona, Inc.	18.6%	13.1%	3,202,241	502	2.8%
South Carolina	Absolute Total Care, Inc	18.3%	14.7%	8,043,578	1,299	n/a
New Hampshire	Celtic Insurance Company	17.6%	12.1%	759,938	31	58.1%
Texas	Celtic Insurance Company	16.3%	11.7%	16,238,521	3,010	61.2%
Arkansas	Celtic Insurance Company	16.1%	12.4%	8,079,882	1,813	0.0%
Mississippi	Ambetter of Magnolia Inc.	16.0%	13.7%	11,374,142	1,147	0.0%
Arkansas	QualChoice Life & Health Insurance Company, Inc.	15.6%	12.4%	1,680,519	397	0.0%
Florida	Centene Venture Company Florida	n/a	n/a	0	n/a	n/a
Indiana	Coordinated Care Corporation Indiana	n/a	n/a	0	n/a	n/a
Nebraska	Celtic Insurance Company	n/a	n/a	0	n/a	n/a

If Ambetter denied your claim

The rules, the filing window and the next level depend on the plan you hold, not on the brand: the Centene / Ambetter page carries the table for every plan type Ambetter administers. A denial can be appealed; the plan must give you its file and the criteria it applied.

Questions

What is Centene / Ambetter's claim denial rate?

In the CMS Transparency in Coverage file for plan year 2026, the 22 Centene / Ambetter issuer filings on HealthCare.gov reported denying 17,062,275 of 91,545,854 in-network claims received in 2024: 18.6%, against a pooled rate of 18.7% for all issuers in the file. The figure includes duplicate, administrative and eligibility denials and covers Marketplace plans only.

Does Ambetter's denial rate vary by state?

Yes. Among filings with at least 1,000 claims, Celtic Insurance Company (Delaware) reported 28.2% and QualChoice Life & Health Insurance Company, Inc. (Arkansas) reported 15.6%. Each state filing is a separate legal entity with its own claims operation.

How often are Ambetter appeals successful?

21.0% of the 35,239 internal appeals reported by Centene / Ambetter issuers in 2024 were decided in the member's favour. Members appealed 2.1 of every 1,000 denials. External reviews: 710 requested, 262 reversed the insurer.

Is this Ambetter's denial rate for employer or Medicare plans?

No. The CMS file covers individual and small-group Marketplace plans sold on HealthCare.gov in 32 states. Employer plans, Medicare Advantage and Medicaid are not in it. Use it as a comparison across insurers under the same rules, not as your own plan's number.

Other carriers

Method and limits

Reporting lag: the CMS public-use file for a plan year reports claims from two plan years earlier (the PY2026 file carries 2024 claims). These are not this year's figures.
In-network only: the denial rate is in-network claims denied divided by in-network claims received. Out-of-network claims are shown separately where the issuer reported them.
"Denied" is broad: CMS counts every denial, including administrative denials, duplicate submissions, ineligibility, incorrect billing and partial denials, not only medical-necessity decisions.
Issuer level: CMS reports the counts once per issuer per state and repeats them on every plan row; plan-level counts, where present, list denials only, so no per-plan rate is computed.
Coverage: only issuers on the federally facilitated marketplace (HealthCare.gov states) report to this file. Employer plans, Medicare and Medicaid are not included.
No inference of intent: a higher rate can reflect the issuer's mix of claims, its billing rules or its membership as much as its coverage decisions. Compare with the state median and read the N.
Issuer filings are mapped to Centene / Ambetter by the issuer's legal name (conservative brand matching); a filing that is not obviously Ambetter's is left out rather than guessed.

Source: CMS Transparency in Coverage Public Use File (Health Insurance Exchange PUFs). Download: CSV · methodology. Cite: Apellica Insurer Denial Report Cards, Centene / Ambetter, plan years 2024, 2025, 2026, generated 2026-09-14. CC BY 4.0.