Health Insurance in Texas

The Medicaid situation

Texas is one of 10 states that has not expanded Medicaid under the ACA. Traditional Medicaid in Texas has very strict eligibility: it covers children, pregnant women, and some parents with extremely low incomes (generally under about 17% FPL for parents, which is roughly $2,700/year for a family of three). Childless adults are essentially ineligible regardless of income.

This creates the coverage gap. If you earn less than 100% FPL ($15,650 for a single person) and don't fall into one of the narrow Medicaid categories, you make too little for marketplace subsidies and too much for Medicaid. An estimated 770,000 Texans fall into this gap.

For everyone else between 100% and 400% FPL, the marketplace is the primary path to coverage.

What plans cost in 2026

Texas marketplace premiums jumped significantly for 2026. Carriers increased rates by an average of 33% before subsidies, driven partly by the expiration of enhanced premium tax credits and partly by rising medical costs.

But premiums after subsidies tell a different story. About 75% of Texas marketplace enrollees have incomes below 200% FPL, and at that level, subsidies absorb most of the increase. Every enrollee under 200% FPL still has access to at least one $0-premium Bronze plan in 2026. Silver plans with CSR are available at very low cost for the same income group.

For people above 400% FPL who lost their subsidy due to the cliff, the full-price increases are painful. A 50-year-old in Dallas might pay $700-$900/month for a mid-tier plan without any help.

Major carriers in Texas (2026)

The Texas marketplace has a large number of carriers, though availability varies by county. Major insurers include:

• Blue Cross Blue Shield of Texas is the largest carrier with the broadest network. Available in most counties.
• Molina Healthcare offers some of the lowest premiums in the state, particularly in urban areas. About 64,000 members.
• Ambetter (Centene) is available in many Texas counties and often has competitive pricing, though networks can be narrower.
• Oscar Health operates in the DFW, Houston, Austin, and San Antonio markets. Known for a user-friendly app and virtual care.
• Baylor Scott & White Health Plan is a regional HMO option in Central Texas tied to the Baylor Scott & White hospital system. Requested a 24% rate increase for 2026.
• Community Health Choice serves the Houston metro area with some of the most affordable options in the region.

Notable change: Aetna left the Texas individual marketplace at the end of 2025, affecting over 208,000 enrollees statewide. If you were on Aetna, you need to pick a new plan.

Key cities

Houston

Houston (Harris County) has some of the most competitive marketplace pricing in Texas due to multiple carriers competing. Community Health Choice, Molina, BCBS, Oscar, and Ambetter all offer plans. ZIP codes like 77001-77099 typically have 50+ plan options.

Dallas-Fort Worth

The DFW metro has strong carrier competition as well. BCBS, Oscar, Ambetter, and Molina are the primary options. Premiums tend to be slightly higher than Houston, but still below the state average.

San Antonio

San Antonio has fewer carriers than Houston or DFW. BCBS and Ambetter are the main options in Bexar County. Premiums are moderate compared to rural areas.

Rural Texas

Rural counties often have only one or two carriers. Premiums are typically higher due to less competition and higher provider costs. BCBS is the most common option in rural areas.

Estimate your subsidy

Resources for Texans

• HealthCare.gov for plan shopping and enrollment (Texas uses the federal marketplace)
• Call 2-1-1 (Texas Health and Human Services) for help finding local enrollment assisters
• Benefits.gov to check eligibility for other programs
• Community health centers provide care on a sliding fee scale if you fall in the coverage gap