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Texas Health Insurance Consumer Guide
This guide was developed to assist you in choosing the right health insurance plan for you and your family. The coverage options found in Texas’s ACA Marketplace may be a good choice for many consumers, and we will guide you through the options below.
Texas uses the federally run health insurance exchange HealthCare.gov for residents to purchase its ACA Marketplace plans. The Marketplace provides access to health insurance products from private insurers.
The federal government helps pay for insurance through an advance premium tax credit if you buy coverage from the exchange. Depending on your income and other circumstances, you may also get help to lower your monthly insurance premium (the amount you pay to enroll in the coverage) and possibly your out-of-pocket expenses.
Dental coverage in Texas
Hoping to improve your smile? Dental insurance may be a smart addition to your health coverage. Our guide explores dental coverage options in Texas.
Texas’s Medicaid program
Texas has not expanded Medicaid eligibility under the Affordable Care Act (ACA). As a result, Texas has the biggest coverage gap in the country, impacting an estimated 771,000 residents.1 The number of Medicaid beneficiaries in Texas has grown to more than 5 million people.2
Medicare coverage in Texas
Over 4.5 million people are enrolled in Medicare plans in Texas.3 Use our guide to learn about Medicare, Medicare Advantage, and Medigap coverage available in Texas as well as the state’s Medicare supplement (Medigap) regulations.
Short-term coverage in Texas
As of 2023, there were at least six insurers selling short-term health insurance plans in Texas.4
Frequently asked questions about health insurance in Texas
Who can buy Marketplace health insurance?
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 and how it compares with the cost of the second-lowest-cost Silver plan in your area – which depends on your age and location. In addition, to qualify for financial assistance with your Marketplace plan you must:
- Not have access to affordable health coverage through your 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.
When can I enroll in an ACA-compliant plan in Texas?
In Texas, you can sign up for an ACA-compliant individual or family health plan from November 1 to January 15 during open enrollment.5
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 1.6
Outside of open enrollment, a qualifying 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.
How do I enroll in a Texas Marketplace plan?
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.7
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.
How can I find affordable health insurance in Texas?
Texas uses the federally run exchange for individual market plans, so residents who buy their own health insurance enroll through HealthCare.gov.
In the Texas marketplace, nearly nine out of ten eligible enrollees who purchased health plans saved money on premium payments amounting to an average savings of $539/month. With the help of these subsidies, enrollees paid premiums of $43/month on average.8
The Affordable Care Act provides income-based advance premium tax credits (subsidies) that offset your premium payments to help keep your expenses down. People with household incomes below 250% of the federal poverty level also qualify for cost-sharing reductions (CSR) that may reduce your deductibles and out-of-pocket expenses when you buy a Silver plan. Between the premium subsidies and cost-sharing reductions, you may find that an ACA plan is the cheapest health insurance option for you.
How many insurers offer Marketplace coverage in Texas?
The Texas individual/family marketplace added three new insurers in 2023: Cigna, Imperial Insurance Companies, and Ascension Personalized Care. Texas has 15 insurers offering exchange plans for 2023:9
- Aetna CVS Health (expanded into 18 additional counties for 2023)
- Ascension Personalized Care (new for 2023)
- Blue Cross Blue Shield of Texas
- Celtic/Ambetter (Ambetter from Superior Health Plan)
- Cigna (new for 2023)
- Imperial Insurance Companies (new for 2023)
- Moda Health Plan
- Community Health Choice
- Scott & White Health Plan
- UnitedHealthcare of Texas
In most Texas counties, at least three insurers are offering health plans on the exchange in 2023.10
Are Marketplace health insurance premiums increasing in Texas?
Texas’ individual market insurance companies have proposed changes to 2024 average rates as follows:9
Texas’ ACA Marketplace Plan 2024 Proposed Rate Increases by Insurance Company
|Superior Health Plan/Ambetter||4.93%|
|Blue Cross Blue Shield of Texas||-0.24%|
|Community First Insurance Plans||9.47%|
|Community Health Choice||6.90%|
|Baylor Scott & White Health Plan||1.80%|
|Ascension Personalized Care (US Health and Life Insurance)||13.40%|
|Imperial Insurance Companies||2.97%|
Source: Texas Rate Review Submissions9
**As of 2019, Scott & White Health Plans acquired FirstCare
How many people are insured through Texas’s Marketplace?
Enrollment is far higher in the Texas marketplace in 2023 than in any previous year: During the 2023 open enrollment period, more than 2.4 million people enrolled in private plans.8
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.11
What health insurance resources are available to Texas residents?
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.Footnotes
- “How Many Uninsured Are in the Coverage Gap and How Many Could be Eligible if All States Adopted the Medicaid Expansion?” KFF.org, March 31, 2023
- “Medicaid & CHIP Enrollment Data Highlights” Medicaid.gov, April 2023
- “Medicare Monthly Enrollment" CMS.gov, April 2023.
- “Availability of short-term health insurance in Texas” healthinsurance.org, Jan. 11, 2023
- “When can you get health insurance?” HealthCare.gov, 2023
- “A quick guide to the Health Insurance Marketplace®” HealthCare.gov, Accessed August, 2023
- “Entities Approved to Use Enhanced Direct Enrollment” CMS.gov, April 28, 2023
- “2023 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2023
- “Texas Rate Review Submissions” HealthCare.gov, 2023
- 2023 Qualified Health Plans, CMS.gov, Oct. 26. 2022
- “Health Insurance Marketplaces 2023 Open Enrollment Report” CMS.gov, Accessed August 2023
- “ASPE Issue Brief (2014) ASPE, 2015
- Health Insurance Marketplaces 2015 Open Enrollment Period: March Enrollment Report, HHS.gov, 2015
- “HEALTH INSURANCE MARKETPLACES 2016 OPEN ENROLLMENT PERIOD: FINAL ENROLLMENT REPORT” HHS.gov, 2016
- “2017 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2017
- “2018 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2018
- “2019 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2019
- “2020 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2020
- “2021 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2021
- “2022 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2022