Before you start

Alabama residence
Income information for subsidy eligibility
An SSN or ITIN for the marketplace application
A qualifying life event, if enrolling outside the annual open-enrolment window

Step-by-step

1
Enrol in your employer's plan within the new-hire window
Typically 30 days from your start date, and missing it can mean waiting for the next open enrolment. In a non-expansion state this is the most important form you will fill in during your first month. Compare the deductible and out-of-pocket maximum, not just the premium.
Via employerWho: YouFirst 30 days of employment
2
Without an employer plan, use HealthCare.gov
Alabama runs no state exchange, so individual plans are bought on the federal marketplace. Open enrolment runs on a fixed annual calendar; outside it you need a qualifying life event such as moving state, losing coverage, marriage or a birth. Moving to Alabama is itself a qualifying event — use it on arrival rather than waiting.
OnlineWho: You
3
Check Alabama Medicaid and ALL Kids eligibility, but do not assume
Alabama has not expanded Medicaid to low-income adults, so adult eligibility is narrow. Children's coverage through Medicaid and the ALL Kids CHIP programme extends considerably further up the income scale, so a household can find the children eligible and the parents not. Check each household member separately.
OnlineWho: You
4
Register with a primary care physician in month one
Do it while you are well. Alabama has a genuine physician shortage outside the metros and a stretched supply inside them, so establishing with a practice takes longer here than in a large coastal city — and being an established patient is what gets you an appointment later.
In personWho: YouMonth 1
5
Know where the federally qualified health centres are
In a state with no Medicaid expansion, the federally qualified health centres charging on a sliding scale are the practical safety net for anyone uninsured or underinsured. Find the ones near you before you need them; registering while healthy is far easier than doing it in a crisis.
In personWho: You
6
Learn the urgent care versus emergency room distinction
An emergency room visit for something a clinic could treat can cost thousands even when insured. Urgent care handles fractures, stitches and infections far more cheaply, and Birmingham has plenty of it. UAB's emergency department is a major trauma centre and should be used as one.
In personWho: You
7
Take the tornado plan seriously as a health matter
This is not a scare. Work out today where you shelter at home, at work and at your children's school — an interior room on the lowest floor, or a designated community shelter. Keep shoes, a torch and a helmet there: most tornado injuries come from debris and from walking through wreckage afterwards, and a bicycle helmet is the cheapest genuinely useful piece of safety equipment you can own in Alabama.
In personWho: You
8
Plan for heat and for a long allergy season
Birmingham summers combine high temperature with high humidity and the heat index rather than the thermometer is what matters. The tree pollen season here is long and severe — the metro sits in dense mixed forest — and newcomers frequently develop allergies they never had. Air conditioning is not optional and an air filter is a reasonable first purchase.
In personWho: You

Documents you’ll need

Proof of Alabama residence
Income documentation for subsidies
SSN or ITIN
Immigration documents for marketplace eligibility categories
Evidence of losing prior coverage, if using a special enrolment period

Things most newcomers don’t know

Alabama has no Medicaid expansion, and that is the single biggest health difference from Iowa, Oklahoma or California.

In Iowa, Oklahoma and California an adult earning below the subsidy floor is covered by something. In Alabama they are frequently covered by nothing at all. That makes an employer health plan a material part of a job offer rather than a benefit line, and makes a gap between jobs genuinely risky. Weigh it when comparing an Alabama salary to one elsewhere.

Source: HealthCare.gov

The clinical provision here is far better than the metro's size predicts.

UAB Hospital is one of the largest hospitals in the United States and Children's of Alabama is among the largest paediatric hospitals in the country — both in a metro of about a million. For anything complex you are better placed here than in most cities of this size, and considerably better than in a comparable metro without an academic medical centre. The gap is in access and insurance, not in capability.

Source: community-reported

Dixie Alley tornadoes come at night, in winter, hidden by rain.

This is the specific reason Alabama's tornado death toll is disproportionate. You cannot see one coming through the tree cover and the rain, they occur outside the spring season people expect, and they arrive when households are asleep. That makes the phone alert and a battery weather radio your entire warning system, and it makes silencing alerts the most dangerous ordinary decision available here.

Source: National Weather Service — Birmingham

Alabama ranks poorly on physicians per head and establishing as a new patient takes longer than newcomers expect. It is the cheapest thing you can do in month one and the thing people most reliably postpone — and it is what determines whether you can get a same-week appointment a year from now.

Source: community-reported

Common mistakes to avoid

Assuming Medicaid will catch you if income is low. In Alabama, for a working-age adult, it usually will not.
Missing HealthCare.gov open enrolment and finding Alabama has no state fallback exchange.
Missing the 30-day new-hire enrolment window at a new employer.
Silencing weather alerts, in a state where tornadoes arrive at night and unseen.
Waiting until you are ill to find a sliding-scale clinic.
Walking into an emergency department for something urgent care handles.

Some of this may be out of date. Spotted something inaccurate? Help us keep it right for the next newcomer.