Complete Guide to Teladoc Coverage with Ambetter Health:

What You Can and Cannot Do

In recent years, telehealth has transformed how people access healthcare—making it faster, more affordable, and incredibly convenient. For members of Ambetter Health's 2025 Standard Silver 94% HMO plan, this transformation comes to life through Teladoc, a robust virtual care service offering 24/7 access to licensed doctors, therapists, psychiatrists, and more.

This article offers a deep dive into Teladoc coverage under the Ambetter plan, compares it to what other major insurers offer, and provides a full table of what's included at little to no cost. Whether you're new to Teladoc or looking to get the most from your insurance, this guide will help you understand exactly what services are available, what’s not covered, and how to use the platform wisely.

Teladoc Health is a leading telemedicine provider offering virtual consultations for non-emergency medical conditions, mental health services, dermatology, and more. With board-certified doctors and licensed mental health professionals available via phone, video, or mobile app, Teladoc provides quick, safe, and effective healthcare solutions.

Ambetter's 2025 Silver 94% HMO plan includes broad coverage through Teladoc. Most services come at no cost to the member, making it a powerful tool for routine care.

Covered at Little/No Cost

• General Medical Consults (24/7): Unlimited $0 visits for minor illnesses like colds, fevers, flu, allergies, infections.
• Mental Health Therapy: $0 virtual therapy visits with licensed professionals (18+).
• Psychiatry: $0 psychiatric evaluations and medication management (excluding controlled substances; adults only).
• Dermatology: $0 consults via image upload for acne, rashes, skin infections.
• Prescriptions: Doctors can electronically send prescriptions to your local pharmacy (standard drug copays apply).

Limitations / Not Covered

• Emergencies: Chest pain, broken bones, or severe symptoms require in-person ER.
• Controlled Substances: Teladoc doctors do not prescribe narcotics or ADHD medications.
• Chronic Care Programs: Long-term disease management programs like Livongo are not included.
• Second Opinions: Specialist case reviews or second-opinion services are not part of this plan.
• Pediatrics Psychiatry: No psychiatric care available via Teladoc for those under 18.

Service Ambetter (Teladoc) Other Major Insurers (BCBS, Cigna, Aetna, UHC) 24/7 Virtual Urgent Care $0, unlimited Often $0-$20, varies by plan Mental Health Therapy $0, adults 18+ Covered, copay may apply Psychiatry $0, adults 18+ Covered, copay or coinsurance typically applies Dermatology Consult $0 Usually available, copay may apply E-Prescriptions Included (non-controlled) Included (non-controlled) Chronic Condition Management Not included Sometimes included in premium plans Second Medical Opinions Not included Rarely included unless employer-sponsored Virtual Primary Care Not included Some plans offer virtual-first options

Convenience

• Access care anytime, anywhere—24/7
• Available via app, website, or phone
• Average wait time under 10 minutes for medical consults

Broad Medical Services

• Diagnose & treat common illnesses
• E-prescribe medications
• Pediatric care included (except psychiatry)

Mental Health Support

• Licensed therapists for counseling
• Psychiatrists for medication management (adults only)
• Evening and weekend appointments available

Dermatology

• Upload photos for diagnosis
• Responses typically within 24-48 hours

No Cost Barriers

• Unlimited $0 visits under Ambetter plan
• No deductibles or copays for covered Teladoc services

Limitations to Be Aware Of

• Not for emergencies or complex procedures
• Cannot prescribe controlled medications
• No hands-on exams, imaging, or lab work
• Visit Summaries: After each visit, you can send a summary to your primary care provider.
• Multi-Language Access: Teladoc supports multiple languages and can arrange translation.
• Follow-up: Some issues may allow for free follow-up visits or clarifications.
• HIPAA-Compliant: All data and communications are secure and private.

Teladoc is a powerful benefit included in Ambetter's Silver 94% plan. From urgent medical needs to mental health support, it covers a wide range of services that can save you time and money. Compared to other major insurance providers, Ambetter offers one of the most comprehensive and cost-effective telehealth solutions in the market today.

Understanding the capabilities and limitations of Teladoc helps you make the most of your healthcare coverage. Use it smartly, and it could save you hundreds in healthcare costs while giving you quick, easy access to quality care.

Need help with coverage or Teladoc setup? Contact XactInsure today—we’ll walk you through it!