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 under $5,000 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 $500 to $700 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 2027
Premiums are going up again for 2027. The Alabama Department of Insurance approved the following average rate increases, before subsidies, effective January 1, 2027: Blue Cross and Blue Shield of Alabama 19.9%, UnitedHealthcare 27.5%, Celtic Insurance Company (Ambetter) 11.4%, and Oscar 33.8%. Because BCBS covers most of the market, its increase is close to what a typical enrollee will see. This comes on top of increases of roughly 20% for 2026.
For a concrete example, the benchmark Silver plan for a 40-year-old in Jefferson County (Birmingham) costs about $737 per month before subsidies in 2027, up from about $652 in 2026, based on HealthCare.gov plan data. In Madison County (Huntsville) it is about $750, and in Mobile County about $670.
The enhanced premium tax credits expired after 2025 and were not extended, so the 2027 subsidy rules are the original ACA ones. If your household income is between 100% and 400% FPL ($15,960 to $63,840 for a single person), you can still get a premium tax credit, and the credit grows when the benchmark premium rises. Above 400% FPL there is no subsidy at all, so you pay the full price.
Higher costs are already showing up in enrollment. Alabama had a record 477,838 marketplace enrollees for 2025, and early 2026 enrollment figures showed 449,399 sign-ups. 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.
Carriers in Alabama (2027)
The same four insurers offer individual marketplace plans in Alabama for 2027. 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.
- UnitedHealthcareoffers plans in more than half of Alabama's counties. UHC networks in Alabama are narrower than BCBS, and its 27.5% increase for 2027 is one of the larger ones, so compare prices carefully if you are renewing a UHC plan.
- Ambetter of Alabama (Celtic Insurance Company, a Centene subsidiary) had the smallest approved increase for 2027 at 11.4%. It is available in many Alabama counties, with lower premiums but narrower networks.
- Oscar Health entered Alabama for 2026 in a handful of counties around Birmingham and Huntsville. For 2027 it expanded to 18 counties, including Houston County (Dothan). Oscar also had the largest approved increase, 33.8%, so a plan that was cheap in 2026 may not be the cheapest option now.
With only four carriers and BCBS holding a dominant position, Alabama has less marketplace competition than most states. In some rural counties, such as Wilcox County in the Black Belt, BCBS is the only available insurer.
Key regions
Birmingham metro
Jefferson County and the surrounding area have the best carrier competition in the state, with all four insurers available. 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. All four marketplace carriers sell plans in Madison County for 2027, though BCBS still has the broadest network.
Mobile and the Gulf Coast
Mobile County has three carriers for 2027: BCBS, UnitedHealthcare, and Ambetter. USA Health (University of South Alabama) and Providence Hospital are the major systems. Premiums in the Mobile area tend to be somewhat lower than in Birmingham or Huntsville.
Rural Alabama (Black Belt and Wiregrass regions)
Many rural Alabama counties have only one or two marketplace carriers. 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
Subsidy Estimator
Enter your info below to get a rough estimate of your monthly premium tax credit for a 2027 marketplace plan.
Alabama-specific things to know
The coverage gap is real. If you earn less than $15,960 per year (100% FPL for a single person, the figure used for 2027 coverage) 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.
Open Enrollment dates. Open Enrollment for 2027 runs from November 1, 2026, through January 15, 2027, on HealthCare.gov. Enroll by December 15 for coverage that starts January 1. If you enroll between December 16 and January 15, coverage starts February 1.
Navigator help is available. Alabama has certified marketplace navigators and assisters who provide free enrollment help. With rates and subsidy rules both changing again for 2027, getting in-person or phone assistance can be worth it, especially if your income is near a threshold like 400% FPL.
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