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.

Toggle ConAlabama uses the federally facilitated health insurance marketplace, so residents use HealthCare.gov 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.tent

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., Healthcare.gov) 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.