How health insurance works in Alabama
Alabamians buying their own coverage have two markets: HealthCare.gov (healthcare.gov), where plans from Blue Cross and Blue Shield of Alabama, Ambetter, Oscar, and UnitedHealthcare are guaranteed-issue and priced on income, and the private shared-network market, where PPO plans on Cigna, Aetna and PHCS PPO are underwritten and priced on age and health.
Medicaid is not expanded in Alabama. Alabama has no state individual mandate.
What it costs
Full-price marketplace plans for a 40-year-old in Birmingham commonly run $550–$850 a month in 2026; with a subsidy, often under $300. Private PPOs for the same healthy person run roughly $320–$480. Alabama has a state income tax, so the self-employed health premium deduction reduces both federal and state taxable income.
The Alabama picture
Alabama didn't expand Medicaid and one Blue Cross carrier dominates the marketplace, so self-employed people above the subsidy line often see very few choices — and few PPO options.