Types of Health Insurance Plans Available

Marketplace plans in Alabama are divided into four “metal” tiers:

Catastrophic Plans: Available to those under 30 or with a hardship exemption. These plans have low premiums and high deductibles, covering essential benefits after the deductible is met. They are best for healthy individuals who want protection against major medical events.

HMO vs PPO vs EPO Options:

• HMO (Health Maintenance Organization): Lower premiums, limited network, requires referrals for specialists.

• PPO (Preferred Provider Organization): Higher premiums, broader network, no referrals needed for specialists. Blue Cross Blue Shield is the only company offering PPOs in Alabama.

• EPO (Exclusive Provider Organization): Larger network than HMO, no out-of-network coverage except emergencies, usually lower premiums than PPOs. Ambetter is a leading EPO provider in Alabama.

Eligibility for Subsidies and Cost Assistance

Premium Tax Credits: Available to households with incomes between 100% and 400% of the federal poverty level, though recent federal changes have temporarily removed the upper limit. Most Alabama Marketplace enrollees receive premium subsidies, with significant average savings.

Cost-Sharing Reductions (CSR): For those with incomes up to 250% of the federal poverty level who select a Silver plan, CSRs lower out-of-pocket costs like deductibles and copays. Over two-thirds of Alabama Marketplace enrollees receive CSR benefits.

Medicaid/CHIP Eligibility: Alabama Medicaid is available for low-income residents, and ALL Kids (Alabama’s CHIP program) covers children under 19 in families with incomes too high for Medicaid but below 300% of the federal poverty level. Enrollment in Medicaid and ALL Kids is available year-round.

How to Compare and Choose a Plan in Alabama

When comparing plans, consider:

• Premiums: Monthly cost regardless of care usage

• Deductibles/Out-of-Pocket Maximums: What you’ll pay before coverage kicks in

• Provider Networks: Ensure your preferred doctors/hospitals are in-network

• Drug Formularies: Check if your medications are covered and at what cost

Tips:

• Self-employed: Deduct premiums on taxes; check for HSA-eligible plans.

• Families: Consider pediatric dental/vision and family out-of-pocket limits.

• Retirees: Marketplace coverage bridges the gap until Medicare at 65; public employees may access PEEHIP plans.

Top Insurance Providers on the Alabama Exchange

For 2025, three insurers offer Marketplace coverage in Alabama:

• Blue Cross Blue Shield of Alabama (statewide, only PPO option; most popular and highest-rated)

• UnitedHealthcare (offers no-deductible plans)

• Ambetter from Alabama (leading EPO provider)

Regional providers include Viva Health, which offers HMO and Medicare plans in select counties.

Navigating Alabama’s Online Enrollment Portal

How to Apply:

Go to the federal enrollment platform to create an account and start your application.

Enter household and income information to see eligibility for subsidies.

Compare available plans by premiums, coverage, and network.

Select a plan and complete enrollment.

Pay your first premium to activate coverage.

Where to Get Help:

• Use the federal “Find Local Help” tool for free, in-person assistance from Navigators or certified application counselors.

• Local brokers and community health centers also offer assistance.

Alternatives to the Marketplace

• Short-term health plans: Temporary coverage for gaps; not ACA-compliant and may exclude pre-existing conditions.

• Off-exchange private plans: Purchased directly from insurers; no subsidies available.

• Faith-based health-sharing ministries: May be available but are not insurance and lack ACA protections.

Common Mistakes to Avoid During Enrollment

• Failing to update income, which can affect subsidy eligibility and lead to tax repayment.

• Missing enrollment deadlines, resulting in loss of coverage or waiting until the next Open Enrollment.

• Choosing the wrong metal tier for your needs (for example, picking Bronze for low premiums, but facing high out-of-pocket costs if you need care).

State-Specific Health Programs or Initiatives

• Medicaid Expansion: Alabama has not expanded Medicaid under the ACA, so eligibility is more limited than in some states.

• ALL Kids (CHIP): Covers children under 19 in families with incomes up to 300% of the federal poverty level.

• PEEHIP: Public Education Employees’ Health Insurance Plan for retirees and employees in the education sector.

• Local Navigator Programs: Free enrollment help is available statewide.