Texas Health Insurance Guide

Health Insurance Overview in Texas

Texas has not expanded Medicaid and has the highest uninsured rate of any state in the nation — approximately 17-18% of Texans lack health insurance. Texas uses the federal HealthCare.gov marketplace, which has very high enrollment (over 3 million) despite the state's non-participation in expansion. Texas's marketplace is highly competitive in its major metro areas.

Average Health Insurance Costs in Texas

Marketplace Enrollment in Texas

Texas residents can enroll in individual and family health insurance plans through HealthCare.gov (Federal). Open enrollment runs November 1 – January 15 (federal marketplace).

Average Premiums by City in Texas

Medicaid in Texas

Texas has not expanded Medicaid. Traditional Medicaid (STAR program) covers very limited categories: children, pregnant women, the elderly, and people with disabilities. Adults without children generally do not qualify, leaving millions in the coverage gap.

Children's Health Insurance (CHIP) in Texas

CHIP covers children under 19 in families with incomes up to 201% of the federal poverty level.

What Makes Texas Unique

Texas has the largest uninsured population and highest uninsured rate in the nation. Despite this, Texas has among the highest marketplace enrollment in the nation due to its large population. The combination of the largest marketplace enrollment and the largest uninsured population illustrates both the marketplace's reach and the limits of marketplace coverage without Medicaid expansion.

ACA Subsidies: What Texas Residents Should Know

The enhanced subsidies first enacted in the American Rescue Plan expired at the end of 2025. For 2026, premium tax credits follow the original ACA rules: there is no credit above 400% (the “subsidy cliff”), and enrollees are expected to pay up to 9.96% of income toward the benchmark Silver plan. House in January 2026 but has not become law, so 2027 plans are being priced and subsidized under the same rules unless Congress acts.

What Texans Actually Pay in 2026 After Subsidies

The sticker premiums above are not what most Texas marketplace enrollees pay. Your net cost depends on two things: the price of the benchmark Silver plan for your age and county, and your income relative to the federal poverty level (FPL). For 2026 coverage, the credit is set so that you pay a fixed share of income toward the benchmark plan, and the government covers the rest.

Estimates use the 2026 applicable percentage table (IRS Rev. Proc. 2025-25), 2025 federal poverty guidelines ($15,650 for one person, $32,150 for four), this page’s benchmark estimates ($472/mo at age 40, $1,352/mo for a family of four), and the federal default age curve for age 60. Your county’s actual benchmark will differ — use HealthCare.gov for an exact figure.

Two patterns stand out. First, at the same income, an older enrollee gets a much larger credit, because the benchmark premium roughly doubles between 40 and 60 while the share of income you pay stays the same. Second, the credit disappears completely just above 400% FPL — which in 2026 is $62,600 for a single person and $128,600 for a family of four.

The 400% Subsidy Cliff Is Back

From 2021 through 2025, temporary federal rules capped benchmark premiums at 8.5% of income for everyone, including households above 400% FPL. Those rules expired at the end of 2025. For a 60-year-old Texan earning $65,000, that is the difference between paying roughly $460 a month under the old cap and roughly $1,000 a month now, with no credit at all.

Because the cliff is measured on modified adjusted gross income for the coverage year, households just above the line have legitimate ways to come back under it:

• Pre-tax retirement contributions (traditional 401(k), 403(b), or a traditional IRA where deductible) lower MAGI dollar for dollar.
• Self-employed Texans can reduce MAGI through SEP-IRA or solo 401(k) contributions and the self-employed health insurance deduction.
• Health savings account contributions, if you enroll in an HSA-eligible Bronze plan.

The credit is reconciled on your tax return. If your income ends up higher than you estimated when you enrolled, you may have to repay some or all of the advance credit, so update your income on HealthCare.gov when it changes.

The Texas Coverage Gap: Below 100% of Poverty

Marketplace credits start at 100% FPL ($15,650 for a single adult for 2026 coverage). In states that expanded Medicaid, adults below about 138% FPL qualify for Medicaid instead. Texas did not expand Medicaid, so a non-disabled adult without dependent children earning under $15,650 generally qualifies for neither — and Texas Medicaid’s income limit for parents is a small fraction of the poverty line.

Practical options for Texans in the gap:

• Check whether projected income for next year crosses 100% FPL. Eligibility is based on expected income for the coverage year, not last year’s return. Part-time or seasonal workers often qualify once realistic annual earnings are projected.
• Children and pregnant women have separate, higher eligibility through Medicaid and CHIP even when the parents do not qualify.
• Federally qualified health centers charge on a sliding scale by income regardless of insurance status.

2027 Open Enrollment in Texas

Texas uses HealthCare.gov. Open enrollment for 2027 coverage runs November 1, 2026 through January 15, 2027; CMS has confirmed those dates despite ongoing litigation over a proposal to shorten the window. To have coverage start January 1, you must enroll by December 15 — enrollments between December 16 and January 15 start February 1.

Insurers filed 2027 rates assuming the enhanced credits will not return, so if you are currently enrolled, do not let your plan auto-renew without comparing. Your benchmark plan, and therefore your credit, can change from one year to the next even if your income doesn’t.

Tips for Choosing Health Insurance in Texas

Texas residents earning 100%+ of the federal poverty level should check HealthCare.gov for subsidy eligibility — Texas metro areas have strong marketplace competition. CHIP covers children. Adults below the poverty level have very limited options. Texas's large community health center network serves uninsured patients on a sliding fee scale.

• Enroll during open enrollment (November 1 – January 15 (federal marketplace)) — missing the deadline means waiting until the next open enrollment unless you have a qualifying life event.
• Texas has not expanded Medicaid, so if your income falls below the federal poverty level you may fall into the coverage gap — a community health center or sliding-scale clinic can serve as a bridge until your income qualifies for marketplace subsidies.

Frequently Asked Questions

How much does health insurance cost in Texas per month for one person?

Before subsidies, a benchmark Silver plan for a 40-year-old in Texas is estimated at about $472 a month in 2026, and roughly twice that at age 60. After the premium tax credit, a single person earning $25,000 would pay about $97 a month toward the benchmark plan, and someone earning $40,000 about $286 a month. Above 400% of the poverty level ($62,600 for one person) there is no credit.

Did ACA subsidies expire in 2026?

The enhanced subsidies from the American Rescue Plan expired at the end of 2025. The original premium tax credits still exist for households between 100% and 400% of the federal poverty level, but people pay a larger share of income (up to 9.96% for 2026) and there is no credit above 400%. A House-passed extension from January 2026 has not become law.

What is the 400% FPL subsidy cliff for Texas in 2026?

For 2026 coverage, 400% of the federal poverty level is $62,600 for a single person and $128,600 for a family of four. Households above those incomes receive no premium tax credit and pay the full premium. Pre-tax retirement contributions, HSA contributions, and self-employed deductions can lower modified adjusted gross income below the line.

Why can’t some low-income Texans get marketplace subsidies?

Premium tax credits start at 100% of the federal poverty level. Texas has not expanded Medicaid, so non-disabled adults without dependent children earning below that level generally qualify for neither Medicaid nor marketplace credits. Children, pregnant women, and people with disabilities have separate eligibility.

When is open enrollment for 2027 health insurance in Texas?

November 1, 2026 through January 15, 2027 on HealthCare.gov. Enroll by December 15 for coverage starting January 1; enrollments after that start February 1.

The information on this page is provided for general informational purposes only and reflects estimated industry averages and program eligibility rules as of 2026. Health insurance premiums, Medicaid eligibility thresholds, marketplace options, and program rules change annually. Always verify current eligibility and enrollment options at the official HealthCare.gov (Federal) or by contacting a certified navigator or broker. Premium figures shown are approximations before subsidies — actual net premiums depend on individual income, household size, and plan selection.