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Individual and Family

The American Rescue Plan's premium-cutting subsidies

Find out how the American Rescue Plan has reduced marketplace health insurance costs for Alabamans from Birmingham, to Mobile, Montgomery, and beyond, and how the Inflation Reduction Act has extended those subsidy enhancements. Enroll during open enrollment (November 1 to January 15 in most states) or during a special enrollment period if you experience a qualifying life event.

Learn about the Alabama marketplace

Short-term coverage in Alabama

Short-term health insurance plans in Alabama are allowed to have initial terms up to 364 days, and total duration – including renewal – of up to 36 months. Read more about short-term health insurance in Alabama.

View short-term plans in Alabama

Medicaid in Alabama

Alabama has not accepted federal funding to expand Medicaid under the ACA. An estimated 324,000 Alabamans would gain coverage if the state were to accept federal funding to expand the program. Read more about Alabama and Medicaid expansion.

Learn more about Medicaid in Alabama

Medicare enrollment in Alabama

There were nearly 1.1 million Alabama residents enrolled in Medicare as of August 2022. Read more about Medicare enrollment and eligibility in Alabama

View our Alabama Medicare enrollment guide

Flexible dental benefits. Fast approval.

Protect yourself from the soaring costs of dental procedures. Compare plan options to see premiums and deductibles that fit your budget.

Compare dental plans in Alabama

Frequently asked questions about health insurance
coverage options in Alabama

Alabama uses the federally facilitated health insurance marketplace, so residents use to enroll in exchange plans and to receive financial assistance with their coverage (premium subsidies, which reduce monthly premium costs, and cost-sharing reductions, which reduce deductibles, copays, and coinsurance expenses; both types of subsidies were created as part of the Affordable Care Act, also known as Obamacare).

The marketplace is used by individuals and families who need to obtain their own health insurance (most Americans get their coverage from an employer or from the government — Medicare or Medicaid — and thus do not need to use the marketplace in Alabama). People who buy their own health insurance include those who are self-employed, those who are employed by a small business that doesn’t offer health benefits, and those who have retired prior to Medicare eligibility.

The open enrollment period for individual/family health coverage runs from November 1 through January 15 in Alabama. You can learn more about open enrollment in our comprehensive guide.

Outside of that open enrollment period, residents generally need a qualifying event in order to enroll in coverage or make a change to their plan. But some people can enroll in plans through the exchange year-round, including Native Americans and subsidy-eligible applicants with a household income of no more than 150% of the poverty level. Medicaid enrollment is also available year-round to eligible applicants.

In Alabama, consumers may be able to buy affordable individual and family health insurance by enrolling through the ACA marketplace ( More than 90% of consumers who enrolled in 2022 coverage through received premium subsidies.

Alabamans may also find affordable coverage through Medicaid if they’re eligible. See Medicaid eligibility guidelines in Alabama.

Short-term health insurance is also a lower-cost coverage option in Alabama, where thirteen insurers offer short-term plans.

Three carriers – Blue Cross Blue Shield of Alabama, UnitedHealthcare, and Celtic – offer plans through the exchange in Alabama for 2023. But most areas of the state only have one or two insurers offering plans, as coverage areas are localized for UnitedHealthcare and Celtic (BCBSAL offers plans statewide).

Celtic is new for 2023, but Bright Health, which offered plans in the exchange in 2022, is not offering coverage for 2023. So the total number of participating insurers remained at three for 2023.

Three insurers offer 2023 coverage in Alabama’s exchange, but Celtic is new and thus did not have any applicable rate changes. For the two existing insurers, the average rate changes amounted to a slight decrease for Blue Cross Blue Shield of Alabama, and roughly a 15% increase for UnitedHealthcare.

But most exchange enrollees receive premium subsidies (premium tax credits) that offset some or all of the cost of their coverage. So the change in a person’s premium from one year to the next will also depend on how premium subsidies change, in addition to how the cost of their plan changes. 

219,314 people enrolled in private individual market plans through the Alabama exchange during open enrollment for 2022 coverage. This was a record high, as was the case in most states, with the enrollment increase driven in large part by the American Rescue Plan’s subsidy enhancements.

See a summary of how enrollment has changed in Alabama’s exchange over the years.

While it may not be seeing the nation’s largest improvements, Alabama is seeing improvements under the Affordable Care Act. According to US Census data, the uninsured rate in Alabama in 2013 was 13.6%, and that had fallen to 9.1% by 2016 — although it had increased to 10% by 2018. But it dropped slightly, to 9.7% in 2019 (there was a nationwide uptick in the uninsured rate under the Trump administration, which continued in 2019; Alabama bucked that trend, with an uninsured rate that decreased from 2018 to 2019).

The national uninsured rate was 8.9% in 2018, but Alabama’s rejection of Medicaid coverage expansion leaves more than a hundred thousand residents without any realistic access to medical coverage, and results in an uninsured rate that’s significantly higher than it would otherwise be. A 2020 analysis by the Robert Wood Johnson Foundation estimated that if Alabama were to expand Medicaid coverage, the state’s uninsured rate would drop by 43% — the largest projected drop among all of the states that have not yet expanded Medicaid.

The vast majority (97%) of Alabama residents who were enrolled in qualified health plans (QHPs) through Alabama’s health insurance marketplace (i.e., in 2022 received financial assistance to cover a significant portion of their premiums. Subsidies are larger and more widely available than they were prior to 2021, thanks to the American Rescue Plan. And those subsidy enhancements have been extended through 2025 by the Inflation Reduction Act

In 2010, Alabama’s entire Congressional delegation opposed the health reform law. As of 2022, Alabama’s Senators are Republican, and in the House of Representatives, Alabama has six Republicans and one Democrat.

All of Alabama’s Republican Representatives voted yes on the American Health Care Act, which was the 2017 legislation that would have repealed major portions of the ACA. That bill ultimately died when it failed to pass in the Senate.

At the state level, then-Governor Robert Bentley indicated early on that he would support a state-based health insurance exchange, but ultimately sided with the state legislature, which decided to cede exchange control to federal government. Bentley was replaced in 2017 by Gov. Kay Ivey, who is strongly opposed to the ACA. The state has not accepted federal funding to expand Medicaid coverage under the ACA. 

Alabama has not accepted federal funding to expand Medicaid under the ACA. Alabama’s state legislature is heavily dominated by GOP lawmakers, most of whom oppose Medicaid expansion. An estimated 324,000 Alabamans would gain coverage if the state were to accept federal funding to expand the program.

The federal government covers 90% of the cost of Medicaid coverage expansion in the states that have accepted the funding. But Alabama is among the shrinking minority of states that continue to reject Medicaid expansion. As a result, there are 127,000 Alabama residents who live in poverty and have no realistic access to health coverage (many of the people who would become eligible for Medicaid plans under expansion are people with income between 100% and 138% of the poverty level, who are currently eligible for premium subsidies in the exchange; people with income below the poverty level are currently in the coverage gap in Alabama and any other state that hasn’t expanded Medicaid).

Read more about Alabama’s Medicaid expansion.

Alabama doesn’t have state regulations for short-term health insurance plans, so the state defaults to the federal regulations, which were relaxed in 2018 by the Trump administration. That means short-term health insurance plans are allowed to have initial terms up to 364 days, and total duration – including renewal – of up to 36 months.

Read more about short-term health insurance in Alabama.

There were 1,080,882 Alabama residents enrolled in Medicare plans as of August 2022. Most were eligible due to age, but 18% of Alabama Medicare beneficiaries are under the age of 65 and eligible for Medicare due to a disability. Nationwide, an average of 12% of Medicare beneficiaries are younger than 65.

Alabama Medicare recipients can opt to enroll in Medicare Advantage plans or Original Medicare — both options have pros and cons. Nationwide, about 46% of Medicare beneficiaries have private Medicare Advantage coverage, but Alabama is one of the states where a majority of beneficiaries have selected Medicare Advantage. Nearly 55% of Alabama Medicare beneficiaries have Advantage coverage, while only about 45% were enrolled in Original Medicare as of 2022. 

Read more about Medicare enrollment in Alabama, including the state’s rules for Medigap plans.

Learn more about how the Medicare open enrollment period works.

Recent Alabama legislation related to healthcare reform:

  • SB147 was signed into law and became Act Number 2015-227 in May 2015. This legislation ensures that insurance executive compensation in Alabama will be kept confidential. As such, it is not subject to open records requests, Freedom of Information Act (FOIA) requests, or subpoena.
  • HB249 was enacted in 2021. This legislation caps insulin copays at $100 for state-regulated health plans in Alabama (note that self-insured health plans are not regulated at the state level, and the majority of people with employer-sponsored health coverage are on state-regulated plans).

Before the ACA reformed the individual health insurance marketplace, coverage was underwritten in nearly every state, including Alabama.  Because pre-existing conditions were a factor in eligibility for coverage, some people were unable to purchase a private plan at all, or were only able to get one that excluded their pre-existing conditions.

The Alabama Health Insurance Plan (AHIP) was created in 1998 to give applicants an option for coverage if they were ineligible to purchase individual health insurance because of their medical history.  But unlike risk pools in many other states, AHIP was only available to applicants who were HIPAA eligible, coming off of a group plan with no more than a 63-day gap in coverage.

Under the ACA, all new health insurance policies became guaranteed issue starting on January 1, 2014. Once private insurance companies could no longer reject applicants or charge them higher premiums based on their medical history, it largely eliminated the need for high risk pools and MCHA stopped enrolling new members as of January 1, 2014.  In March 2014, the Alabama Senate passed SB 123, allowing AHIP to “cease operations upon allowing current participants enough time to transition out of the plan.” By 2017, the AHIP website was no longer operational.

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