Health insurance in Texas.

Under-65 and Marketplace coverage in Texas

Texas has the second largest Marketplace in the country, nearly everyone on it gets a subsidy, and the gap between subsidized and unsubsidized here is wider than almost anywhere.

Texas does not run its own exchange. Individual and family coverage goes through the federal Marketplace at HealthCare.gov, where 4,172,233 Texans selected a plan for 2026. Only Florida is larger.

Here is the number that shapes every conversation we have in this state: 92.9 percent of Texas enrollees receive a premium tax credit, and among those who do, the average net premium is about $41 a month. If you qualify for help in Texas, the exchange is close to unbeatable and we will tell you so plainly rather than steer you somewhere we earn more.

The other side of that is steep. The average credit in Texas is about $667 a month, and it does not taper. The enhanced credits that ran from 2021 through 2025 expired at the end of 2025, so the 400 percent of federal poverty level cliff is back in full. A few hundred dollars of income can be the difference between a credit worth thousands over the year and no credit at all.

You can see the result in who is actually enrolled. Only about 1.9 percent of Texas Marketplace enrollees are above 400 percent of poverty, against roughly 6.2 percent in Arizona. Households above that line have largely stopped buying exchange coverage in Texas. If that is you, the exchange is one option and often not the best one, which is exactly the situation we are built for.

• Your credit is calculated from your projected income for the coverage year, not last year's tax return. Anywhere near the cliff, the estimate is the single most important number you give us.
• Cost-sharing reductions only attach to Silver plans bought on the exchange. Roughly between 100 and 250 percent of poverty, Silver can beat a cheaper-looking Bronze plan badly on the deductible.
• Above the cliff, off-exchange deserves a serious look. With no credit to protect, the only question left is which plan gives you the most coverage for the money, and that question is not limited to HealthCare.gov.

The Silver trap, and why Gold is usually cheaper in Texas

In every one of Texas's 27 rating areas, the cheapest Gold plan costs less than the cheapest Silver plan. If you are paying full price, the popular choice is the wrong one.

This is the most useful thing on this page and almost nobody tells you.

Texas requires carriers to load the cost of cost-sharing reductions onto Silver premiums. That is good for people receiving a credit, because the credit is calculated from a Silver benchmark, so inflating Silver inflates the help. It is why subsidized Texans pay so little.

If you are not receiving a credit, that same loading works against you. We checked the published 2026 rates for a 40-year-old in all 27 Texas rating areas. In all 27, the cheapest Gold plan is priced below the cheapest Silver plan. Statewide the median cheapest Silver runs about $653 a month against roughly $587 for Gold.

Gold plans generally carry lower deductibles and lower out-of-pocket maximums than Silver. So an unsubsidized Texan who picks Silver because it sounds like the sensible middle is usually paying more for less. You can verify this yourself on HealthCare.gov in about five minutes, and we would rather you did.

This is not true everywhere. Run the same comparison in Arizona and Gold is more expensive than Silver in every rating area, the normal ordering. Texas is genuinely different, and it is different in a way that costs unsubsidized households real money every month.

• Receiving a credit? Silver is often still right, because cost-sharing reductions attach only to Silver and can be worth more than the premium difference.
• Paying full price? Compare Gold before Silver, every time. In Texas the ordering is inverted and the default choice is usually the worse deal.
• Bronze is the cheapest premium, not the cheapest year. Median cheapest Bronze runs about $427 a month, but the deductible is where it gets recovered.

Carriers and networks in Texas

Texas has 834 individual plans and far more choice than most states, but not one of them is a PPO and none of them run a national network.

Eighteen carriers sell individual medical plans on the Texas Marketplace for 2026, offering 834 distinct plans. That is more than four times Arizona's 199, so Texans genuinely do have choice. What they do not have is out-of-network freedom.

Zero of those 834 plans are PPOs. The breakdown is 549 HMO, 252 POS, and 33 EPO. If you have had a PPO through an employer, none of the plan types on the Texas exchange work the way you are used to.

The short version of the plan types: an HMO usually requires a referral to see a specialist and pays nothing out of network except emergencies. An EPO drops the referral requirement but still pays nothing out of network. A POS usually requires a referral but may pay something out of network at a worse rate. A PPO does neither and is the most flexible, which is why it costs the most, and why none are offered here.

One caution we will give you straight: on paper Texas has 252 POS plans that should pay something out of network, but the published federal plan data leaves the out-of-network deductible blank for every single one of them. We do not treat a POS plan as real out-of-network coverage until we have read that specific plan's summary of benefits. Neither should you.

Every one of the 834 is also flagged as a non-national network. If you travel often, split time between states, or have a child at school out of state, say so early. It changes the answer.

• Check your doctors before you check the premium. With no PPOs available, a network mismatch is not a minor inconvenience here, it is the whole bill.
• Blue Cross Blue Shield of Texas is the largest presence, at roughly two thirds of the plans on offer, with Ambetter, Oscar, Molina, Community Health Choice, Wellpoint and others competing by region.
• Plan availability is set by rating area, not by state. Texas has 27 of them, and what is offered in Houston is not what is offered in Lubbock.

No Medicaid expansion, and the largest coverage gap in America

Texas did not expand Medicaid. About 605,000 Texans fall into the resulting gap, roughly half of everyone in that gap nationwide.

Texas has not adopted the Affordable Care Act's Medicaid expansion, and the consequences are larger here than in any other state.

For adults, Texas Medicaid is close to unavailable. Parents and caretakers generally qualify only up to about 15 percent of the federal poverty level, the lowest threshold in the country. Adults without dependent children and without a disability are categorically ineligible at any income.

That creates the coverage gap: people who earn too much for Texas Medicaid and too little for a Marketplace subsidy, which generally begins at 100 percent of poverty. About 605,000 Texans are in that gap. Nationally the gap holds roughly 1.2 million people, so about half of them are in Texas. Two thirds are in a working family.

Texas also has the highest uninsured rate in the nation at 16.7 percent, roughly 5.1 million people. Some of them are in the gap. Many more are simply above the subsidy cliff and have concluded there is nothing for them. That second group usually has more options than they think, and finding them is the job.

If your income is near the bottom of the subsidy range, the projection you give the Marketplace matters enormously, and an honest one can be the difference between help and nothing at all. Talk it through before you file an estimate you are unsure about.

Private and short-term coverage in Texas

Short-term plans in Texas are currently written in four-month terms, which is shorter than several neighboring states, and the rules here move when the federal rules move.

Private coverage sold outside the Marketplace is a genuinely bigger part of the conversation in Texas than in most states, because so many Texans sit above the subsidy cliff with no realistic exchange option.

Texas does not set its own duration limit for short-term medical. State law defines short-term coverage by pointing directly at the federal regulation, so whatever the federal limit is at the time, that is the Texas limit. Under the current federal definition, a term runs up to three months with a total of up to four months. Carriers in Texas today commonly write consecutive terms to cover a longer stretch. What is available, and for how long, varies by carrier and changes when the federal rules change, so we will tell you what is actually being offered at the moment you ask rather than quoting a number from an article.

What matters more than the duration is what these plans are. Short-term and fixed-benefit plans are not ACA-compliant comprehensive coverage. They are medically underwritten, they can decline you, and they can exclude pre-existing conditions. They do not have to cover the ten essential health benefits.

For a healthy person bridging a defined gap, or for a household above the cliff comparing a full-price exchange plan against the alternatives, they can be the right answer and often run on broader networks than anything on the Texas exchange. For someone with an ongoing condition, they are usually the wrong answer and we will say so.

Two Texas protections worth knowing

Texas surprise-billing law covers ground ambulance, which federal law does not, and Texas state continuation can extend coverage past COBRA.

Surprise medical bills. Texas passed SB 1264 in 2019, and it applies to services provided from January 1, 2020 onward. It covers emergency care, out-of-network providers working at an in-network facility, and connected lab and imaging. Texas also added ground ambulance for services from January 1, 2024, which the federal No Surprises Act does not cover at all. Disputes go to mediation or arbitration between the provider and the health plan, with you left out of it.

The limit matters: Texas law reaches state-regulated plans. If your insurance card says DOI or TDI you are covered by it. Self-funded employer plans follow the federal process instead unless the employer opted in, in which case the card shows TXI.

Continuation after a job ends. Texas state continuation runs on top of federal COBRA rather than duplicating it. If you are not eligible for COBRA at all, Texas continuation can cover you for up to nine months. If you have exhausted COBRA, Texas can add six more months. That is a meaningfully longer runway than COBRA alone, and it is worth checking before assuming your only options are COBRA or nothing. It does not apply to self-funded employer plans.

Enrollment windows and deadlines in Texas

Open enrollment opens November 1. The closing date is genuinely unsettled this cycle, so we confirm the current deadline with you rather than printing one.

Texas uses the federal HealthCare.gov calendar. Open enrollment opens November 1 for coverage starting the following January. The closing date has been shifting under recent federal rule changes and litigation, so we confirm the live deadline with you rather than publishing a date that may not hold.

Outside open enrollment you need a qualifying life event to enroll. Losing job-based coverage, moving, marriage, divorce, birth or adoption, and certain income changes all open a special enrollment period, usually 60 days. Losing coverage also lets you enroll in the 60 days before a known end date, which is the cleaner play when you can see it coming.

Short-term and fixed-benefit plans do not follow that calendar and can generally be applied for any time of year, subject to medical underwriting.

• Do the free work early. Confirm your doctors, list your prescriptions, and build an honest income estimate before plans go on sale.
• Auto-renewing without re-shopping is the most expensive habit in this market. Your plan changes, the benchmark changes, and your credit is recalculated whether you look or not.

Where we serve in Texas

All 254 counties. Licensing is statewide, and the work happens by phone, video, and email, so nobody has to drive anywhere.

Apex Health Advisors is licensed across Texas, so where you live in the state does not limit whether we can help. We work with households in Dallas-Fort Worth, Houston, San Antonio, Austin, El Paso, the Rio Grande Valley, and the smaller communities in between.

Plan availability, though, is not statewide. Texas is divided into 27 rating areas and what is offered in one is not what is offered in another, sometimes dramatically so. Premiums for the same age and metal level vary by more than sixty percent between the cheapest and most expensive Texas rating areas. When we quote you, we quote your area, not a state average.

Everything is done by phone, video, and email. There is no office visit and no paperwork drop-off.

What working with us looks like

Independent, multi-carrier, licensed in Texas, and free to you, with a straight answer about what we can and cannot do.

We are an independent agency, not a captive of any one insurance company. That means we compare across the carriers we are appointed with and recommend what fits, including when the answer is a plan we do not earn much on, or no change at all.

Our help costs you nothing. There is no fee and no markup. The carrier builds the same commission into the premium whether you enroll through us, through another agent, or by yourself on HealthCare.gov. Working with a licensed agent does not raise your price.

What we will tell you plainly: if you qualify for a subsidy in Texas, the exchange is very likely your best option and we will help you get it. If you are above the cliff, we will lay out the exchange at full price alongside the private alternatives and show you the real tradeoffs on network and underwriting. And if we cannot help with something, we will say so rather than sell around it.