Health Insurance in Alabama

Medicaid in Alabama

Alabama has not expanded Medicaid under the ACA. Eligibility is restricted to very specific groups: children, pregnant women (up to 146% FPL), parents with very low incomes (about 18% FPL, or roughly $2,800 per year for a family of three), people with disabilities, and elderly individuals who qualify for both Medicare and Medicaid. Childless adults do not qualify for Medicaid at any income level.

This creates what is known as the coverage gap. An estimated 128,000 Alabamians earn too much for Medicaid but too little to qualify for marketplace subsidies (which start at 100% FPL in non-expansion states). A single adult earning $10,000 to $15,000 per year falls squarely in this gap: no Medicaid, and marketplace premiums that can be $300 to $500 per month without subsidy help.

Alabama's overall uninsured rate is about 8.4%, with roughly 417,000 residents lacking coverage. That ranks the state among the higher uninsured populations in the country.

What plans cost in 2026

Alabama marketplace premiums increased by an average of 21.1% for 2026 before subsidies, according to the Alabama Department of Insurance. The rate increases break down by carrier: Blue Cross and Blue Shield of Alabama went up 19.3%, UnitedHealthcare increased 20%, and Celtic Insurance Company increased 25%. Oscar Health is new to the state, so there is no prior year comparison.

The subsidy picture for 2026 is tough. In 2025, 98% of Alabama marketplace enrollees received premium tax credits. With the enhanced subsidies expired, many of those people now face significantly higher costs. Alabama Arise, a statewide advocacy organization, estimated that about 130,000 Alabamians who had been using ACA subsidies would not be able to afford the 2026 price increases.

Alabama had a record 477,838 marketplace enrollees for 2025 coverage. Early 2026 enrollment figures showed 449,399 sign-ups, already reflecting the impact of higher costs.

Carriers in Alabama (2026)

Four insurers offer individual marketplace plans in Alabama for 2026. The market is heavily concentrated around one carrier:

• Blue Cross and Blue Shield of Alabama controls over 90% of the individual health insurance market in the state. BCBSAL is headquartered in Birmingham and has the broadest provider network by far, covering virtually every hospital and most physicians in Alabama. For many Alabamians, especially those in rural areas, BCBS is the only realistic option because of its network reach.
• UnitedHealthcare is the second carrier, offering plans in select counties. UHC networks in Alabama are narrower than BCBS but can be a competitive option on price in the counties where they operate.
• Celtic Insurance Company is a Centene subsidiary that offers Ambetter-branded plans. Celtic had the steepest rate increase at 25% for 2026. Available in multiple Alabama counties with lower premiums but narrower networks.
• Oscar Health is new to Alabama for 2026, entering the Birmingham metro area (Jefferson, Shelby, and Walker counties). Oscar partners with hospitals like Grandview Medical Center and Crestwood Medical Center. This is the first new carrier to enter the Alabama marketplace in several years.

With only four carriers and BCBS holding a dominant position, Alabama has less marketplace competition than most states. In many rural counties, BCBS is the only available insurer.

Key regions

Birmingham metro

Jefferson County and the surrounding area have the best carrier competition in the state for 2026, now that Oscar has entered. UAB Hospital (University of Alabama at Birmingham) is a major academic medical center and is in the BCBS network. Check Oscar's provider list if you are considering their plans, as UAB may or may not be included. Grandview Medical Center and St. Vincent's are other major Birmingham facilities.

Huntsville and northern Alabama

Madison County (Huntsville) has seen rapid population growth from the tech and defense sectors. Huntsville Hospital, one of the largest public hospitals in the country, is the anchor facility. BCBS and UnitedHealthcare are the primary marketplace options. The growing population has attracted some employer-sponsored competition but the individual marketplace remains limited.

Mobile and the Gulf Coast

Mobile County is served primarily by BCBS. USA Health (University of South Alabama) and Providence Hospital are the major systems. Fewer carrier options here than in Birmingham. Premiums in the Mobile area tend to be somewhat lower than the statewide average because of lower regional healthcare costs.

Rural Alabama (Black Belt and Wiregrass regions)

Many rural Alabama counties have only one marketplace carrier: BCBS. The Black Belt region in particular faces challenges with hospital closures and physician shortages. Several rural hospitals have closed in recent years, partly because the state did not expand Medicaid. If you live in a rural county, verify that there are in-network providers within a reasonable driving distance before enrolling.

Estimate your subsidy

Alabama-specific things to know

The coverage gap is real. If you earn less than roughly $15,060 per year (100% FPL for a single person) and do not qualify for Medicaid through another category (disability, pregnancy, dependent children), you cannot get marketplace subsidies in Alabama. This is the direct result of the state not expanding Medicaid. Community health centers offer sliding-scale care for uninsured individuals, and some hospitals have charity care programs, but these are not a substitute for insurance.

BCBS dominance means less price competition. In states with more carriers, insurers compete on price, which tends to keep premiums lower. Alabama's market concentration around BCBS means less competitive pressure. If BCBS and one other carrier serve your county, compare carefully. Even a small premium difference can add up to hundreds of dollars per year.

Navigator help is available. Alabama has certified marketplace navigators and assisters who provide free enrollment help. Given the complexity of subsidy calculations for 2026, getting in-person or phone assistance can be worth it, especially if your income is near a threshold that affects your eligibility.

Resources

• HealthCare.gov for marketplace enrollment (Alabama uses the federal marketplace)
• Alabama Medicaid Agency for Medicaid eligibility and enrollment
• Alabama Arise for consumer advocacy and coverage assistance resources