The Alabama Health Insurance Marketplace
Alabama’s health insurance exchange is operated by the federal government with health plans sold by two familiar insurers: Humana and Blue Cross and Blue Shield of Alabama. The exchange, or marketplace, is a resource for the uninsured created by the Affordable Care Act, in which private health plans can offer residents reasonable coverage through tax credits. The cities and small towns of Alabama now have access to more coverage options as individual health plans on and off the exchange are guaranteed issue, meaning you can’t get turned down. On the exchange, however, you have the option of reduced costs, making insurance more manageable for your budget. Coverage through the marketplace also includes a set of mandatory benefits, featured in each plan. Residents are also required to obtain some sort of health insurance under the health law known as Obamacare, and the marketplace makes it possible for more Alabamans to get covered.
Your local Alabama marketplace plans must include subsidies to lower costs for eligible members, which is another helpful feature. A majority of individuals applying for coverage on the exchange qualify for reduced premiums and cost sharing, including those with income between 100-400 percent FPL. Another guarantee of marketplace plans is coverage for ten categories of essential health benefits, including hospitalization, maternity care, prevention and wellness, and prescriptions. If you still find coverage on the exchange too costly, find out if you qualify for Alabama Medicaid or All Kids, which cover a long list of services at little or no cost.
The marketplace in Alabama is a source of individual, family, and small group coverage at affordable prices. Our licensed agents can help you find a plan, determine your subsidy eligibility, and get you enrolled at 888 803 5917.
Every Alabama marketplace plan has an assigned “metallic” tier representing its level of coverage: bronze, silver, gold or platinum. These levels are designed to help you find the plan that best suits your needs, whether you prefer lower out-of-pocket costs, lower monthly premiums, or somewhere in between. A general guideline is that bronze and silver plans have more reasonable premiums, and gold and platinum plans offer more coverage, therefore charging higher premiums.
If you are a healthy Alabaman under age 30, you can also consider the marketplace’s catastrophic plans. These plans are designed for those who rarely visit the doctor, but still want to avoid the penalty for being uninsured. Catastrophic plans cover four office visits and preventive care at 100 percent, and emergency care at deductible. These plans cost slightly less than the bronze level plans, but are not subsidy eligible. Use the cost comparison tool below to view estimates of your rates across each plan type in Alabama.
Premium Tax Credit
One key element of the marketplace is financial assistance for Alabamans who earn between 100 and 400 percent of poverty. Lower income enrollees will receive the greatest amount of assistance, including help paying for monthly premiums and covered medical expenses. While it doesn’t offer the best coverage, select applicants may even qualify for a zero-premium bronze plan with their subsidy included. Marketplace applicants in Virginia earning between 100 and 250 percent of federal poverty qualify for a cost sharing subsidy to help pay for coinsurance, copays and deductibles. If you earn up to 400 percent of FPL, the government will provide you with a premium tax credit.
Subsidies are determined by income and family size, and the percentage of annual income the second lowest-cost silver plan in your region would consume. According to income, you can determine about how much of the premium you’ll be required to pay in the table below. The remainder is paid for by the tax credit. For a better illustration of how subsidies work, use the calculator at the bottom of this page.
As mentioned, only two Alabama insurers sell coverage in the marketplace, offering subsidized individual and small group plans. In every region, one or both of these carriers may provide plans. It should be mentioned that these plans feature smaller provider networks than non-marketplace plans. Reducing network size enables these companies to offer affordable plans. Before you decide on a plan, it’s best to check that your doctors are included in your plan’s network. If not, take a look at the off-exchange plans that can connect you with your providers of choice. Find out which plans cover your area at 888 803 5917.
- Blue Cross and Blue Shield of Alabama
Marketplace plans are required to include ten categories of benefits so that finding good coverage isn’t an obstacle. Deductibles, copayments and coinsurance may differ between plans and carriers. You’ll also find that every single service within each category isn’t necessarily covered. However, many types of care are included, such as preventive screenings, which are covered in full. We implore you to read the fine print of your plan, especially where it details benefits and exclusions, to be sure a service is covered.
Essential Health Benefits include:
- Preventive, wellness, and chronic disease management services
- Office visits
- Emergency care
- Prescription drugs
- Laboratory tests
- Maternity and newborn care
- Pediatric care, including dental and vision
- Rehabilitative and habilitative services and devices
- Mental health and substance abuse services, including behavioral health care
Small Business Health Options Program
In addition to individual market coverage, the exchange offers small group plans through the Small Business Health Options Program (SHOP) with subsidies for qualifying businesses. Alabama small business owners have access to insurance coverage for themselves and their full-time workers if they employ less than 50 people. The Small Business Health Care Tax Credit is offered to employers with up to 25 full-time employees who earn $50,000 per year each. As with individual coverage, larger tax credits go to those with smaller incomes. For businesses, the most you can receive is 50 percent of your premium contribution, awarded to companies with up to 10 full-time workers earning up to $25,000 each per year.
How to Apply
The Alabama marketplace is ready for your application during open enrollment. You can apply for coverage by contacting a licensed insurance agent at 888.803.5917. Other ways to apply include visiting a facility where navigators are staffed, such as food banks, libraries and health clinics. If you want to apply on your own, go to HealthCare.gov, the federal website for coverage. As it’s helpful to speak with a professional while committing to a year-long health plan, discussing your options with a licensed agent can ensure a smooth enrollment process. Already knowledgeable in the Alabama market, out agents are licensed to sell plans off the exchange and are certified to sell subsidized marketplace policies. With any application method, researching your options for affordable, reliable coverage is key in navigating the marketplace.
Compare Alabama Marketplace Plans
Below is a cost comparison tool providing a closer look at exchange plans in Alabama. These rates are calculated by average premiums released by insurers on the exchange. If you’re interested in one of the plans you find in your results, or to receive an accurate quote of premiums and subsidy eligibility, consult an agent at 888 803 5917.
*The above disclaimer pertains to the creator of this comparison tool, not East Coast Health Insurance, a licensed broker of insurance products.