Alabama Health Insurance Consumer Guide

To enroll in private health coverage through the Marketplace in Alabama (HealthCare.gov), you must:³

• Live in Alabama and be lawfully present in the United States
• Not be incarcerated
• Not have Medicare coverage 

So most people are eligible to enroll in Marketplace coverage. But qualifying for financial assistance (premium subsidies and cost-sharing reductions) depends on your income and also has some additional parameters. To qualify for financial assistance with your Marketplace plan you must:

• Not have access to affordable health coverage offered by an employer. If you’re eligible to enroll in an employer-sponsored plan but it seems too expensive, you can use our Employer Health Plan Affordability Calculator to see if you might qualify for premium subsidies in the Marketplace. 
• Not be eligible for Medicaid or CHIP.
• Not be eligible for premium-free Medicare Part A.⁴
• If married, file a joint tax return⁵ (with very limited exceptions)⁶
• Not be able to be claimed by someone else as a tax dependent.⁷

You can sign up for an ACA-compliant individual or family health plan in Alabama between November 1 and January 15 during the annual open enrollment period. 

To have your coverage take effect on January 1, you need to complete your enrollment by December 15. If you apply between December 16 and January 15, your coverage will take effect on February 1.

Outside of the open enrollment window, you may be eligible to enroll or make a plan change if you experience a qualifying life event, such as giving birth or losing other health coverage. And some people can enroll year-round even without a specific qualifying event.

Enrollment in Alabama Medicaid and ALL Kids (CHIP) is available year-round, so if you’re eligible for either program, you can enroll anytime.

To enroll in an ACA Marketplace (exchange) plan in Alabama, you can: 

• Visit HealthCare.gov – the health insurance Marketplace website – to compare the available health plans, determine subsidy eligibility, and select the plan that best meets your needs . 
• Enroll in Marketplace coverage with the help of licensed agents, navigators, or certified application counselors.⁸
• Enroll via an approved enhanced direct enrollment entity.⁹ 

You can also call HealthCare.gov’s contact center by dialing 1-800-318-2596 (TTY: 1-855-889-4325). The call center is available 24 hours a day, seven days a week, except for holidays.

You may find affordable health insurance coverage in Alabama by enrolling through HealthCare.gov. This is especially true if you qualify for premium tax credits (subsidies), and most Alabama enrollees are subsidy-eligible.

As of early 2024, 98% of Alabama Marketplace enrollees were receiving premium subsidies. These premium subsidies saved enrollees an average of about $657/month. After subsidies were applied, the average enrollee’s monthly cost was about $64/month. ¹⁰

(The numbers above are based on effectuated enrollment in early 2024. The chart below is different because it measures some different metrics and also uses data from all enrollments submitted during the open enrollment period for 2024 coverage.)

If your household income isn’t more than 250% of the federal poverty level, you may also qualify for cost-sharing reductions (CSR). These subsidies can make your deductible and other out-of-pocket expenses smaller than they would otherwise be, as long as you select a Silver-level plan. As of 2024, more than two-thirds of the people with Marketplace coverage in Alabama were receiving CSR benefits. ¹⁰

Source: CMS.gov ¹¹

If you’re eligible for APTC and CSR benefits you can utilize both as long as you select a Silver-level plan (APTC can be used with plans at any metal level, but CSR benefits are only available on Silver plans). 

Depending on your income and circumstances, you may find that you’re eligible for free or low cost health coverage through Alabama Medicaid or ALL Kids (CHIP). Check to see if you meet the criteria for these programs in Alabama.

Three private insurers offer coverage through the Alabama Marketplace.¹² All three have filed rates and plans for 2025 Alabama Marketplace coverage, and two of the three have proposed an average rate reduction.¹³

The following average rate changes have been proposed for 2025 by Alabama’s individual/family health insurers, including two overall rate reductions:

Source: RateReview.HeathCare.gov¹⁴ and Alabama Department of Insurance¹⁵

Keep in mind that these average rate changes are for full-price (unsubsidized) plans. However, very few enrollees pay full price. Nearly all (98%) of Alabama’s Marketplace enrollees were receiving premium tax credits in 2024 that covered some or all of their monthly premium costs.¹⁰

These subsidies are adjusted to match changes in the benchmark plan (the second-lowest-cost Silver plan) in each area. And as a result of the American Rescue Plan and the Inflation Reduction Act, the subsidies are larger and more widely available than they used to be. This will continue to be the case through 2025¹⁶ (it could be extended past that, but only with an act of Congress).

But if the benchmark (second-lowest-cost Silver) plan premium decreases from one year to the next, premium subsidies in that area will also decrease. So it’s important to comparison shop during open enrollment, even if your plan’s pre-subsidy premium is going down.

For perspective, here’s a summary of how average unsubsidized premiums have changed over time in Alabama’s individual/family health insurance market:

• 2015: Average increase of 3%¹⁷
• 2016: Average increase of 24.4%¹⁸
• 2017: Average increase of 36%¹⁹
• 2018: Average increase of 17.9%²⁰
• 2019: Average decrease of 2%²¹
• 2020: Average increase of 3.3%²²
• 2021: Average increase of 5.1%²³
• 2022: Average increase of 6.7%²⁴
• 2023: Average increase of 0.42%²⁵
• 2024: Average (unweighted) decrease of 3.7%²⁶

During the open enrollment period for 2024 coverage, 386,195 people enrolled in private plans through Alabama’s health insurance Marketplace.²⁷

This was by far a record high, dwarfing enrollment in previous years (see chart below). Before 2024, the highest enrollment had come in 2023, when 258,327 people enrolled through Alabama’s Marketplace.²⁸ 

The sharp increase in enrollment in recent years is due in large part to the subsidy enhancements created by the American Rescue Plan and Inflation Reduction Act, which have made coverage more affordable than it used to be.

The enrollment growth in 2024 was also partially driven by the “unwinding” of the pandemic-era Medicaid continuous coverage rule. Medicaid disenrollments resumed in the spring of 2023, and by April 2024, more than 93,000 Alabama residents had transitioned from Medicaid to a Marketplacen plan during the unwinding process.²⁹

Source: 2014,³⁰ 2015,³¹ 2016,³² 2017,³³ 2018,³⁴ 2019,³⁵ 2020,³⁶ 2021,³⁷ 2022,³⁸ 2023,³⁹ 2024⁴⁰

HealthCare.gov
The Marketplace in Alabama, where residents can enroll in individual/family health coverage and receive income-based subsidies. You can reach HealthCare.gov at 800-318-2596.

Alabama Department of Insurance
Licenses and regulates health insurance companies, agents, and brokers; can provide assistance to consumers who have questions or complaints about entities the Department regulates.

AIDS Alabama/Enroll Alabama
The federally-funded Navigator organization in Alabama.

Alabama State Health Insurance Assistance Program
A local service that provides assistance and enrollment counseling for Medicare beneficiaries and their caregivers. 

Alabama Medicaid Agency and ALL Kids (Alabama’s Children’s Health Insurance Program)