Off-exchange commercial enrollment increased slightly in recent cycles, while enrollment in exchange plans continue to decline. The decline could be the result of an increase in the upper income limit for subsidy eligibility, given the fact the state has not expanded Medicaid. Bright Health, which entered Alabama in 2018, again participates on the exchange in 2021, though cedes tremendous market share to behemoth BCBS of Alabama. As the COVID-10 pandemic continues to spread across the state, the response from all the payers continue to evolve, waiving cost-sharing for COVID-19 testing, diagnosis, and telehealth services to offering virtual care management tools to members.

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