ALABAMA · 67 COUNTIES · 2027 FILINGS · SEPTEMBER 2026
What does employer health coverage cost in Alabama?
Alabama insurers filed the 4th steepest marketplace increase in the country for 2027: 23.9%.
Employer group plans asked for 14.0%. The good news Alabama employers have that most states don't: a PPO is filed in every one of the 67 counties, so a move to marketplace plans doesn't cost your people their out-of-network coverage.
Alabama, by the filings
What did insurers actually file for Alabama?
Every figure below comes from the filings insurers submitted to regulators. 2027 numbers are requested, not approved. Approvals land in October.
| Alabama | Figure | What it tells you |
|---|---|---|
| 2027 requested change, marketplace plans | +23.9% +11.6% to +35.1% across 4 insurers | 4th steepest in the country. The national median is 15.3%. |
| 2027 requested change, employer group plans | +14.0% +7.2% to +17.8% across 4 insurers | Group asked for 9.9 points less than marketplace here. |
| 2026 approved change | +20.1% marketplace +11.6% group | Compounded with 2027, that's roughly 33% to 49% on top of 2025. |
| Lowest cost silver plan, age 40, typical county | $634 per month $583 to $669 across counties | The number a CHOICE Arrangement contribution has to cover to pass the IRS affordability test. |
| Counties with a PPO or POS plan filed | 67 of 67 | Out-of-network coverage is purchasable everywhere in the state. In 18 states it isn't purchasable anywhere. |
| Typical county, lowest cost silver by plan type | $634 HMO · $657 PPO | A PPO costs about $23 per month more here. In most states the gap is far wider. |
| Marketplace vs group cost per member per month, 2026 | $825 marketplace $626 group | Group plans cost less per member here. Alabama is not one of the 22 states where marketplace wins on price. |
| Insurers competing per county | 1 to 4 | At least one Alabama county has a single insurer, so there's no competition on price there. |
What it means for an Alabama employer
Your renewal is going to be ugly. What are you allowed to change about it?
A 23.9% request on top of 20.1% approved last year is the kind of number that ends up as a benefit cut or a cost shift onto staff. Neither is the only option.
The Alabama-specific read: group plans asked for 14.0% while marketplace plans asked for 23.9%, and group already costs less per member per month here. So a CHOICE Arrangement is not the obvious lever in Alabama the way it is in Ohio or New Mexico. What Alabama does have is a PPO filed in all 67 counties, which means if you do move people to marketplace plans, they keep out-of-network access. That's not true in 18 states.
Where the money actually is at these rates: not the plan type, the design changes inside it. Sourcing 2,000+ medications at a $0 copay for the whole household. Unlimited virtual primary and behavioral care so a $0 visit replaces an urgent care trip. A supplemental layer that pays the employer back every pay period instead of adding a line item.
Those have landed at $2,000+ per employee per year in real client projects, with about $988 per employee per year in new cashflow on top of that and independent of it. About $100K per year for every 50 people. $0 upfront, billed out of savings, live in 30 to 45 days. Same broker, same doctors, same cards.
Compare the 12 plan designs · All 50 states and DC · PPO availability by county · Benchmark your cost
Results vary by group size, plan design, and utilization.
Where these Alabama numbers come from
Rate changes are the midpoint of what each insurer requested in Alabama, from the CMS rate review service, pulled September 17, 2026. 2027 figures are proposed and still under review; regulators can trim them before approvals land in October. County premiums are the lowest cost plan per metal level for a 40-year-old non-smoker before any subsidy, from the CMS marketplace plan and rate files for plan year 2026, covering all 67 Alabama counties.
The marketplace versus group cost comparison uses the 2026 average premium per member per month from the insurers' own filings on both sides, weighted by enrollment. It is an average across each plan's enrolled mix, not a same-metal, same-plan-type quote. PPO availability counts every plan filed in every Alabama county and asks whether any of them is a PPO or POS; HMO includes EPO and PPO includes POS, because the split that matters is whether a doctor outside the network is covered at all.
Nothing here is a quote.
