Health insurance in Alabama
Alabama did not expand Medicaid, so adults below $15,960 can fall through the gap entirely. 10.0% of under-65 residents are uninsured.
Source: CMS Marketplace Open Enrollment Public Use Files and US Census Small Area Health Insurance Estimates, 2026 release. Figures cover the under-65 population.
Where you enroll
Alabama uses the federally facilitated marketplace, so you enroll at HealthCare.gov on the federal calendar — the dates are here.
Alabama has a coverage gap
Alabama has not adopted the Medicaid expansion. That creates a specific and badly-known problem: the premium tax credit was written on the assumption that everyone below 100% of the poverty guideline would be covered by an expanded Medicaid, so the credit does not start until 100%. In a state that did not expand, an adult below that line qualifies for neither.
In practice that means an adult in Alabama earning under $15,960 a year — roughly $1,330 a month — may be offered no help at all, while someone earning slightly more gets a substantial subsidy. It is the one part of this system where earning less can leave you worse off.
Alabama's uninsured rate is 10.0% of under-65 residents, or 387,887 people. Some of them are in this gap.
If your income is near the line, it is worth getting the number right before you assume you do not qualify. Projected annual income is what counts, not last month's pay.
How much choice Alabama counties get
Counties in Alabama carry between 2 and 4 insurers, so competition is fairly even across the state without being uniform.
No county in Alabama is down to a single insurer. Since the previous plan year, 53 counties in Alabama gained an insurer and none lost one.
Heavy marketplace use
441,883 Alabama residents selected a marketplace plan for 2026. Against the state's under-65 population that is 114 per thousand, well above the 26-state median of 79, and 6th highest of the 26 states on this site.
Of those, 58,550 — 13% — were new rather than renewing, which is a fairly typical mix of new and renewing enrollees (17th of 26).
The spread inside Alabama
Jefferson County is the largest county we publish here, with 522,923 under-65 residents; Houston County is the smallest, with 86,755. Jefferson County has 4 insurers offering 54 plans, and Houston County has 3 offering 43.
The widest choice in Alabama is in Jefferson County — 4 insurers, 54 plans. The narrowest is Tuscaloosa County, with 2 insurers and 25 plans. Same state, same rules, 29 more plans to choose from.
Uninsured rates range from 7.1% in Shelby County to 11.3% in Houston County — 1.6 times as high, within one state.
The 12 largest counties in Alabama
By under-65 population, covering 64% of the state's under-65 residents. Alabama has 60 counties with complete federal data; we publish pages for the largest.
| County | Under 65 | Uninsured | Insurers | Plans | Per 1,000 |
|---|---|---|---|---|---|
| Jefferson County | 522,923 | 10.4% | 4 | 54 | 119 |
| Madison County | 344,068 | 8.3% | 4 | 52 | 104 |
| Mobile County | 325,164 | 9.8% | 3 | 43 | 155 |
| Baldwin County | 201,674 | 9.5% | 3 | 43 | 118 |
| Shelby County | 191,414 | 7.1% | 4 | 54 | 80 |
| Tuscaloosa County | 181,574 | 8.6% | 2 | 25 | 93 |
| Montgomery County | 172,864 | 9.8% | 2 | 30 | 95 |
| Lee County | 155,226 | 9.7% | 3 | 43 | 83 |
| Morgan County | 101,231 | 10.8% | 3 | 43 | 103 |
| Limestone County | 97,479 | 8.4% | 4 | 52 | 91 |
| Calhoun County | 88,698 | 10.3% | 2 | 25 | 129 |
| Houston County | 86,755 | 11.3% | 3 | 43 | 115 |
Source: CMS Marketplace Open Enrollment Public Use Files and US Census Small Area Health Insurance Estimates, 2026 release. "Per 1,000" is marketplace plan selections per thousand under-65 residents.
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