Alabama health insurance
● Alabama uses the federally subsidized health insurance market and enrolls through HealthCare.gov.
● Alabama's open enrollment for 2021 health insurance coverage will run out from November 1 to December 15, 2020. Outside of that window, you need a qualifying event to register.
● Short-term health insurance plans can be sold in Alabama with initial plan terms of up to 364 days.
● Two insurers offer coverage through Alabama's health insurance market.
● About 160000 enrolled in 2020 medical coverage through the Alabama exchange.
● Alabama continues to reject expansion of the ACA's Medicaid coverage.
● As of August 2020, there were 1,059,950 Alabama State residents enrolled in Medicare plans.
This page is intended to be an overview of health insurance resources in the state of Alabama, including information about the various types of health insurance coverage available. We've included a summary of the Alabama health insurance market and the open enrollment period that applies to individual market plans (both on and off the market). You'll also find a brief overview of Medicaid in Alabama, including the state's refusal so far to expand coverage under the ACA. We also addressed short-term health insurance and included links to a variety of health insurance resources for Alabama residents.
Alabama's health insurance market
Alabama uses the federally subsidized health insurance market, so residents use HealthCare.gov to enroll in exchange plans and receive financial assistance with their coverage (premium subsidies, which reduce monthly premium costs and cost-sharing reductions, which reduce deductibles, copay, and coinsurance fees; both types of subsidies were created as part of the Affordable Care Act , also known as Obamacare).
The market is used by individuals and families who need to get their own health insurance (most Americans get their coverage from an employer or government - Medicare or Medicaid - and therefore don't need to use the market in Alabama). People who purchase their health insurance include those who are self-employed, those who are employed in a small business that does not offer health benefits, and those who have been withdrawn before Medicare eligibility.
Two carriers - Blue Cross Blue Shield of Alabama State and Bright Health - offer plans through the exchange in Alabama. For 2021, BCBSAL proposed an average rate increase of 4.9% and Bright proposed average rate increases ranging from about 17 to 35%.
160429 people enrolled in personal market plans through the Alabama exchange during the open enrollment period for 2020 coverage, down nearly 18% from their peak enrollment in 2016. In most states that use HealthCare.gov, there has been an overall decline in the number of people enrolling in the plans through exchange since 2016.
Alabama, open enrollment period and dates
For 2021 coverage, Alabama's open enrollment period for 2021 medical insurance will run out from November 1, 2020 to December 15, 2020. The open enrollment period gives people the option to recently sign up for individual market coverage or renew existing coverage for next year or choose to switch to a different plan. It's also an opportunity for people to update their financial information with the exchange (HealthCare.gov) to ensure that premium subsidies for next year are based on accurate data.
The enrollment period open from November 1 to December 15 does not apply to employer-sponsored plans (employers set their own open enrollment windows), Medicare (there's a different open enrollment period for Medicare beneficiaries), or Medicaid/CHIP (enrollment continues year-round for eligible residents).
Outside of the open enrollment period, people with eligible events can change plans or sign up, depending on the circumstances.
Medicaid coverage in Alabama
Alabama state has not accepted federal funding to expand Medicaid under the ACA. An estimated 324,000 Alabamans would gain coverage if the state accepted federal funding to expand the program.
The federal government covers 90% of the cost of expanding Medicaid coverage in states that have accepted funding. But Alabama is among the minority of states that continue to reject Medicaid expansion. As a result, there are 134,000 Alabama residents living in poverty and don't have realistic access to health coverage (many of the people who would become eligible for expanding Medicaid plans are people with incomes between 100 and 138% of the poverty level, who are currently entitled to premium subsidies in the exchange; people with below-poverty income are currently in the coverage gap in Alabama State and any other state that hasn't expanded Medicaid).
Short-term health insurance in Alabama
Alabama has no state regulations for short-term health insurance plans, so the state is not in compliance with federal regulations, which were relaxed in 2018 by the Trump administration. This means that short-term health insurance plans can have initial terms of up to 364 days and a total duration – including renewal – up to 36 months.
How did Obamacare help Alabama?
While it may not see the nation's biggest improvements, Alabama is seeing improvements under the Affordable Care Act. According to U.S. Census data, the uninsured rate in Alabama in 2013 was 13.6%, and this had fallen to 9.1% by 2016 , even though it had increased to 10% by 2018. But it fell slightly, to 9.7% in 2019 (there was a nationwide increase in the uninsured rate under the Trump administration, which continued in 2019; Alabama countered this trend, with an uninsured rate falling from 2018 to 2019).
The uninsured national rate was 8.9% in 2018, but Alabama's refusal to expand Medicaid coverage leaves more than a hundred thousand residents without any realistic access to medical coverage and results in an uninsured rate that is significantly higher than it would otherwise be. A 2020 analysis by the Robert Wood Johnson Foundation estimated that if Alabama expanded Medicaid coverage, the state's uninsured rate would drop by 43 percent -- the biggest expected decline among all states that have not yet expanded Medicaid.
The vast majority (90%) Of Alabama residents who enrolled in qualified health plans (QHPs) through Alabama's health insurance market (i.e. Healthcare.gov) in 2020 received financial assistance to cover a significant portion of their premiums. Average premium subsidies in Alabama in 2020 amounted to $561 per month (covering most of the average premium of $691/month).
Alabama and the Affordable Care Act
In 2010, the Alabama congressional delegation opposed the health care reform law. Senators Jeff Sessions and Richard Shelby both voted no to the bill, while six Alabama representatives voted no in the House. Sessions was later appointed attorney general by President Trump, and a much-watched special election led Doug Jones - a Democrat - to win Sessions' former seat (Sessions resigned as attorney general in 2018 and announced in 2019 that he will return to the Senate in 2020 in an attempt to regain his old seat).
Shelby remains in the Senate, so the Alabama Senate delegation is divided now, with a Democrat and a Republican. In the House of Representatives, Alabama has six Republicans and a Democrat. All Alabama Republican representatives voted yes to the American Health Care Act, which was the 2017 legislation that would repeal much of the ACA. That bill eventually died when it failed to pass in the Senate.
At the state level, then-Governor Robert Bentley unscathed in advance that he would support a state-based health insurance exchange, but would eventually oppose the state legislature, which decided to cede control of the exchanges to the federal government. Bentley was replaced in 2017 by Governor Kay Ivey, who is strongly opposed to the ACA. The state has not accepted federal financing to expand Medicaid coverage under the ACA.
Is there a high-risk pool in AL?
Before the ACA reformed the individual health insurance market, coverage was underwritten in nearly every state, including Alabama. Since pre-existing conditions were a factor in eligibility for coverage, some people were unable to purchase a private plan or were only able to obtain it if they excluded their pre-existing conditions.
AHIP (Alabama Health Insurance Plan) was made in 1998 to offer applicants a coverage option if they were not eligible to purchase individual health insurance because of their medical history. But unlike risk pools in many other states, AHIP was only available to eligible HIPAA candidates, exiting a group plan with no more than a 63-day gap in coverage.
Under the ACA, all new health insurance policies have become a guaranteed issue as of January 1, 2014. Once private insurance companies could no longer refuse claimants or charge them higher premiums based on their medical history, it largely eliminated the need for high-risk pools, and MCHA stopped enrolling new members as of January 1, 2014. In March 2014, the Alabama Senate approved SB 123, allowing the AHIP to "cease operations after giving current participants enough time to exit the plan." In 2017, the AHIP website was no longer operational.
Medicare coverage and enrollment in Alabama
There were 1059950 Alabama residents enrolled in Medicare plans as of August 2020. Most were eligible because of age, but 22% of Alabama Medicare beneficiaries are under 65 and are eligible for Medicare due to a disability. Country, an average of 15% of Medicare beneficiaries are under 65; Alabama is tied to three other states that have the highest percentage of disabled Medicare beneficiaries.
Alabama Medicare recipients can choose to enroll in Medicare Advantage or Original Medicare plans - both options have pros and cons. 46% of Alabama beneficiaries were enrolled in Medicare Advantage in December 2020, compared to a national average of nearly 40%.
In 2018, about 35% of Alabama Medicare beneficiaries were enrolled in autonomous Medicare Part D plans, which provide coverage of prescription drugs. Most Medicare Advantage plans include Part D coverage, so most people who purchase autonomous Part D plans are enrolled in Original Medicare.
Alabama Health Insurance Resources
● Alabama Department of Insurance — Licensing and supervision of health insurance companies, agents, and brokers; can provide assistance to consumers who have questions or complaints about entities that the Department regulates.
● AIDS Alabama/Enroll Alabama — The federally funded Navigator organization in Alabama State
● Alabama State Health Insurance Assistance Program - A local service that provides enrollment assistance and advice for Medicare beneficiaries
● Alabama Medicaid Agency
● All Kids, Alabama
Health care reform legislation in Alabama
Recent Alabama health care reform legislation:
SB147 was signed by law and became ACT Number 2015-227 in May 2015. This legislation ensures that insurance executive compensation in Alabama State will be kept confidential. Therefore, it is not subject to open records requests, Freedom of Information Act (FOIA) requests, or subpoenas.
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