Texas health insurance Marketplace guide

To qualify for health coverage through the Texas Marketplace, you must:

• Live in Texas
• Be lawfully present in the United States
• Not be incarcerated
• Not be enrolled in Medicare

Eligibility for financial assistance (premium subsidies and cost-sharing reductions) depends on your income. In addition, to qualify for financial assistance with the cost of your Marketplace plan you must:

• Not have access to affordable health coverage offered by an employer. If your employer offers coverage but you feel it’s too expensive, you can use our Employer Health Plan Affordability Calculator to see if you might qualify for premium subsidies in the Marketplace.
• Not be eligible for Medicaid or CHIP.
• Not be eligible for premium-free Medicare Part A.⁷
• If married, file a joint tax return.⁸
• Not be able to be claimed by someone else as a tax dependent.⁸

In Texas, you can sign up for an ACA-compliant individual or family health plan from November 1 to January 15 during open enrollment.⁹

If you need your coverage to start on January 1, you must apply by December 15. If you apply between December 16 and January 15, your coverage will begin on February 1.¹⁰

Starting in the fall of 2026, for coverage effective in 2027 and future years, open enrollment will be shorter, ending on December 15, and all plans selected during open enrollment will take effect on January 1.

Outside of open enrollment, a special enrollment period (typically linked to a specific qualifying life event) is necessary to enroll or make changes to your coverage.

If you have questions about open enrollment, you can learn more in our comprehensive guide to open enrollment. We also have a comprehensive guide to special enrollment periods.

To enroll in an ACA Marketplace plan in Texas, you can:

• Visit HealthCare.gov, the Texas health insurance marketplace.

• Purchase individual and family health coverage with the help of an insurance agent or broker, a Navigator or certified application counselor, or an approved enhanced direct enrollment entity.¹¹

• Get a quote from a licensed third-party agency using the quoting feature below. 

• Talk directly with a licensed third-party agent or broker at 866-553-3223

You can also call HealthCare.gov’s contact center by dialing 1-800-318-2596 (TTY: 1-855-889-4325). The call center is available 24 hours a day, seven days a week, but it’s closed on holidays.

Texas uses the federally-facilitated exchange for individual market plans, so residents who buy their own health insurance enroll through HealthCare.gov.

Across the nearly 4 million Texas residents who enrolled in Marketplace coverage during the open enrollment period for 2025 coverage, 95% were receiving advance premium tax credits (premium subsidies) that paid an average of $541/month toward their premium costs. Across all enrollees, including the 5% who paid full price, this reduced the average net premium to about $57/month.¹²

Source: CMS.gov¹²

In addition to premium subsidies, the Affordable Care Act also includes cost-sharing reductions (CSR), which help to reduce out-of-pocket costs on Silver-level plans for people with household income up to 250% of the poverty level.¹³

Between the premium subsidies and cost-sharing reductions, you may find that an ACA plan is the cheapest health insurance option for you.

And as noted above, Texas requires health plans to charge higher premiums for Silver-level plans⁴⁵ (to account for the loss of federal CSR funding, but in a uniform manner).

The result is that it’s common to see Gold plans priced lower than Silver plans. If you’re not eligible for CSR, this can make a Gold plan a particularly good value in Texas.⁶ (If you are eligible for CSR, you’ll want to carefully consider Silver plans, as you’ll forfeit your CSR benefit if you don’t select a Silver plan.)

Texas has not expanded Medicaid under the ACA, so there is still a coverage gap in the state. An estimated 570,000 people are in the coverage gap in Texas, which means they earn less than the poverty level, are not eligible for Medicaid (due to lack of Medicaid expansion in Texas), and are also not eligible for subsidies in the Marketplace because their income is under the poverty level.¹⁴

As a result of the Affordable Care Act, federal law only allows a self-employed married couple to purchase small group health insurance if there is at least one additional employee. Even if both spouses work for their business, they aren’t considered two separate employees (and thus eligible for group health coverage, which requires at least two employees) under federal law. But Texas law is different, and takes precedence in this case. In Texas, a small group insurer must issue coverage to any group of two or more employees, even if the group only has two employees who are married to each other.¹⁵

So if you and your spouse are self-employed together, you can consider Texas small group plans as well as individual market plans. Marketplace subsidies are not available for small group plans, but you might find that there are factors that make the small group plans preferable (such as the provider network or the option to purchase a PPO plan), especially if you’re not eligible for Marketplace subsidies due to your income.

The Texas individual/family Marketplace has 16 participating insurers offering coverage for 2026 (coverage areas differ from one insurer to another). This is the same as 2025, but with some changes: Aetna is no longer offering coverage after the end of 2025 (as is the case in all states where Aetna offered Marketplace coverage in 2025), and Harbor Health joined the Texas Marketplace for 2026.¹⁶

Enrollees with 2025 Aetna coverage were able to select a new plan during the open enrollment period that began November 1, 2025.

There was a similar change for 2025, when the number of participating insurers stayed at 16,¹⁷ but there was one newcomer (Wellpoint)¹⁸ and one carrier that exited at the end of 2024 (Ascension/U.S. Health & Life).¹⁹

In most Texas counties, at least three insurers offered health plans on the exchange in 2025, although some counties in the north-central part of the state only had plans available from one insurer. But there were also numerous counties where five or more insurers offer Marketplace plans.²⁰

As of late 2025, neither CMS nor the Texas Department of Insurance had published a Marketplace coverage area map for 2026. But the HealthCare.gov plan comparison tool confirmed that there are still several counties in north-central Texas where Blue Cross Blue Shield of Texas is the only insurer offering plans for 2026.²¹

In the Texas individual/family health insurance market, the following average premium changes were approved for 2026,²² amounting to an average rate increase of almost 35%, before any subsidies are applied:²³ 

Source: RateReview.HealthCare.gov and Texas SERFF²⁴ 

* Aetna/CVS notified policyholders in mid-2025 that the carrier would no longer offer coverage in the individual market after the end of 2025.²⁵ Policyholders can select new 2026 coverage during open enrollment, and have until Dec. 31, 2025 to pick a new plan that will take effect Jan. 1, 2026 (the regular deadline to apply for Jan. 1 coverage is Dec. 15, but that’s not applicable if a person’s plan is ending altogether and not available for renewal).

Although the weighted average rate increase in Texas is almost 35% for 2026, that’s calculated before subsidies are applied. But net (after-subsidy) premiums are increasing by a much larger percentage, as Congress failed to extend the subsidy enhancements that were scheduled to expire at the end of 2026.

Congress could still take action on this in 2026 (potentially with a retroactive effective date), but as of January 1, 2026, the subsidy structure reverts to what it was prior to 2021. This means subsidies won’t cover as much of the premium as they did between 2021 and 2025, and it also means that the “subsidy cliff” is back, preventing people from getting a subsidy if their household income is more than 400% of the federal poverty level.

Prior to the 2023 plan year, Texas did not have an effective rate review program, so the federal government reviewed insurers’ rate proposals in Texas. But that changed as of the 2023 plan year, and the Texas Department of Insurance now handles rate review for individual/family health plans.²⁶

For perspective, here’s an overview of how full-price (pre-subsidy) premiums have changed in the Texas individual/family market over the years:

• 2015: Average increase of 5%²⁷
• 2016: Average increase of 15.8%²⁸
• 2017: Average increase of 34%²⁹
• 2018: Average increase of 32.5%³⁰
• 2019: Average increase of 2.3%³¹
• 2020: Average decrease of 1.4%³²
• 2021: Average increase of 7.4%³³
• 2022: Average rate increase of 3%³⁴
• 2023: Average increase of 4.9%³⁵
• 2024: Average increase of 5.3%³⁶
• 2025: Average increase of 5.8%³⁷

Enrollment spiked again in 2025 in the Texas Marketplace, for the fourth year in a row (see chart below). Nearly 4 million Texas residents enrolled during the open enrollment period for 2025 coverage.³⁸

The surge in enrollment during these years is likely due to the American Rescue Plan (ARP). Under the ARP, ACA’s premium subsidies are more significant and widely available.³⁹ The ARP’s subsidy enhancements were extended through 2025 by the Inflation Reduction Act. But these subsidy enhancements will expire at the end of 2025 unless Congress takes action to extend them again. If that happens, subsidies will be smaller in 2026, and some people will lose their subsidies altogether.

The 2024 enrollment spike was also likely driven by the “unwinding” of the COVID-related Medicaid continuous coverage rule that had been in place from 2020-2023. By April 2024, CMS reported that nearly 650,000 Texas residents transitioned from Medicaid to a Marketplace plan during the unwinding process. ⁴⁰

Source: 2014,⁴¹ 2015,⁴² 2016,⁴³ 2017,⁴⁴ 2018,⁴⁵ 2019,⁴⁶ 2020,⁴⁷ 2021,⁴⁸ 2022,⁴⁹ 2023,⁵⁰ 2024,⁵¹ 2025³⁸

HealthCare.gov
800-318-2596

Texas Health Plan Compare (a service of the Texas Department of Insurance)

State Exchange Profile: Texas
The Henry J. Kaiser Family Foundation overview of Texas’ progress toward creating a state health insurance exchange.