Both On-exchange and Off-exchange commercial enrollment increased slightly in recent cycles. This could be the result of a decrease in the unemployment rates in the state. UnitedHealth has entered the Alabama exchange, which it had left in 2016. Bright Health, which entered Alabama in 2018, again participates on the exchange in 2022, though cedes tremendous market share to behemoth BCBS of Alabama. As the COVID-19 pandemic continues to improve, the cost-sharing, diagnosis, and telehealth services have come back to pre-COVID levels.