Individual health coverage · Texas · 2026
Health coverage options in Texas —
ACA plans, Health Shares, DPC, and more.
Texas has the highest uninsured rate of any state — 16.7% of residents lack coverage. With no state Medicaid expansion, no state-run exchange, and 2026 ACA premiums up 34.7%, the individual coverage decision matters more here than almost anywhere else. This page covers what each option costs in Texas, who qualifies for subsidies, and where the real trade-offs are.
ACA plans in Texas
What ACA plans cost in Texas in 2026
Texas uses the federal exchange at HealthCare.gov — there is no state-run marketplace. For 2026, 16 insurers participate in the Texas marketplace, offering HMO and EPO plans. No PPO plans are available on-exchange in Texas — a significant limitation for people who want provider flexibility.
The 2026 benchmark silver premium for a 40-year-old in Texas is $661/month — up 34.7% from 2025, one of the largest increases nationally. For households below the 400% FPL subsidy cliff ($62,600 for a single adult), subsidies can significantly reduce this cost. Above the cliff, you pay the full amount.
| Annual income | % of FPL (single) | Full benchmark | Estimated subsidy | Your est. monthly cost |
|---|---|---|---|---|
| $20,000 | 128% FPL | $661/mo | ~$628/mo | ~$33/mo |
| $30,000 | 192% FPL | $661/mo | ~$511/mo | ~$150/mo |
| $40,000 | 256% FPL | $661/mo | ~$395/mo | ~$266/mo |
| $50,000 | 320% FPL | $661/mo | ~$286/mo | ~$375/mo |
| $62,600 | 400% FPL | $661/mo | ~$141/mo | ~$520/mo |
| $63,000+ | Above cliff | $661/mo | $0 | $661/mo |
Estimates for a single adult, age 40. Subsidy calculated using IRS Rev. Proc. 2025-25 applicable percentage table and 2025 HHS poverty guidelines. Actual subsidy depends on exact income, household size, and county. Source: KFF.org · IRS Rev. Proc. 2025-25. Use the comparison tool for your specific ZIP, age, and income.
Texas does not have Medicaid expansion
If your income is below 100% FPL ($15,650 for a single adult), you fall into the coverage gap in Texas. You earn too much for Texas Medicaid but too little for ACA marketplace subsidies. ACA subsidies start at 100% FPL — below that threshold, no subsidy is available and Texas Medicaid eligibility for working-age adults without children is extremely limited. This gap affects an estimated 588,000 Texans. Source: MoneyGeek, March 2026.
Texas ACA marketplace — key 2026 facts
Texas enrolls through HealthCare.gov only — no state exchange. 16 insurers for 2026 (Aetna exited; Harbor Health joined). HMO and EPO plans only — no PPO available on-exchange. Open enrollment: November 1 – January 15. Coverage begins January 1 for plans selected by December 15, February 1 for plans selected December 16–January 15. Source: healthinsurance.org.
2026 Texas benchmark — key numbers
Benchmark premium — age 40
$661/mo
Premium increase vs 2025
+34.7%
Subsidy cliff — single adult
$62,600/yr
No-subsidy-zone below 100% FPL
$15,650/yr
No Medicaid expansion — coverage gap below 100% FPL. Source: KFF.org 2026
Subsidy Subsidy cliff — Texas
A single adult in Texas earning $62,500 receives an estimated $141/mo subsidy — paying ~$520/mo for ACA coverage. At $63,000 — just $500 more in annual income — the subsidy drops to $0 and the full $661/mo applies. This sharp cliff is why many Texans above the threshold explore Health Shares and other alternatives. Use the comparison tool to see your specific numbers.
Alternatives to ACA plans in Texas
How Health Shares, DPC, and STM compare in Texas
| Coverage type | Typical monthly cost | What it covers | Key limitation | Enrollment |
|---|---|---|---|---|
| ACA plan (unsubsidized) | $661/mo (age 40) | Full ACA coverage — pre-existing, mental health, maternity | No PPO on-exchange · HMO/EPO only · high deductibles | Nov 1–Jan 15 |
| Health Share | $150–$350/mo est. | Major medical after Annual Unshared Amount | Not insurance · pre-existing often excluded · voluntary sharing | Year-round |
| DPC + Health Share | $230–$480/mo est. | Unlimited primary care (DPC) + major medical (Health Share) | Pre-existing often excluded · not regulated as insurance | Year-round |
| Direct primary care only | ~$92/mo avg | Unlimited primary care — no major medical | Must pair with other coverage for hospitalizations | Year-round |
| Short-term medical | $95–$165/mo est. | Major medical for temporary gap — 3–4 month terms | Pre-existing excluded · not MEC · terms limited | Year-round |
Why the Health Share + DPC combination is especially relevant in Texas
Texas has the highest uninsured rate in the country, the largest unsubsidized ACA premium burden of any major state, and a large self-employed and gig economy population in Dallas, Houston, Austin, San Antonio, and across rural counties. For Texans above the 400% FPL cliff earning $63,000–$150,000, the gap between what unsubsidized ACA costs ($661/mo) and what a Health Share + DPC combination costs ($230–$480/mo) is the widest it has been in years. The combination does not replace ACA coverage for people with pre-existing conditions or subsidy eligibility — but for healthy, self-employed Texans above the cliff, it is the most financially compelling alternative available.
Short-term medical in Texas
Yes. Short-term medical insurance is available in Texas. Texas state law allows initial terms up to 364 days. Following the August 2025 federal non-enforcement announcement, carriers resumed offering longer-duration plans — as of early 2026, at least 6 insurers offer STM in Texas with total durations up to 36 months available, though individual carrier limits vary. STM excludes pre-existing conditions, does not count as ACA minimum essential coverage, and losing it does not trigger an ACA Special Enrollment Period. It is best suited for short coverage gaps between other plans. Source: healthinsurance.org Texas STM tracker.
Initial term allowed
up to 364 days
Maximum total duration
up to 36 months total including renewals
ACA marketplace — 2026 carrier & plan guide
Texas marketplace carriers, plans, and pricing
The table below shows every carrier offering ACA marketplace plans in Texas for 2026, what metal tiers they offer, their network type, and estimated starting premium for a 40-year-old before subsidy. Availability varies by county — verify at healthcare.gov for your specific ZIP code.
Carriers — 2025
16
marketplace insurers
Carriers — 2026
15
▼ 1 fewer than 2025
National average
9.0
insurers per state 2026
2026 notable changes: Aetna exited end of 2025; Harbor Health joined. No PPO plans on-exchange — PPO available off-exchange only from BCBSTX, Cigna, UHC. Source: KFF — Insurer Participation 2026.
Premiums are estimates for a 40-year-old non-smoker before any subsidy. ⚠ carriers are participating in 2026 but have announced exit after the 2026 plan year — 2027 coverage will need to be selected from remaining carriers. Carrier count and county availability vary. Always verify at healthcare.gov for your ZIP code.
See your exact costs for Texas — enter your income and ZIP
The comparison tool calculates your ACA subsidy, benchmark premium, and how alternatives compare — for your specific age, income, and Texas ZIP code.
Texas health coverage — common questions
Individual health coverage in Texas — questions people ask most
Does Texas have its own health insurance marketplace?
No. Texas uses the federal exchange at HealthCare.gov — there is no state-run marketplace. Texas is one of the largest states to rely entirely on the federal exchange. The Texas Department of Insurance regulates carrier rates and network adequacy, but enrollment runs through CMS-operated HealthCare.gov. 16 insurers participate in the Texas marketplace for 2026, offering HMO and EPO plans only — no PPO plans are available on-exchange.
What is the 2026 ACA benchmark premium in Texas?
The 2026 benchmark silver premium for a 40-year-old in Texas is $661/month — up 34.7% from 2025, one of the largest increases nationally. Premiums are age-rated: younger adults pay less, older adults pay more. For a 60-year-old, the benchmark premium is significantly higher. If your household income is between $15,650 and $62,600 (100%–400% FPL for a single adult), you likely qualify for a premium tax credit that reduces this cost. Use the comparison tool to calculate your specific subsidy. Source: KFF.org 2026.
Does Texas have Medicaid expansion?
No. Texas has not expanded Medicaid under the ACA. This means that working-age adults without children generally do not qualify for Texas Medicaid regardless of income. Combined with the ACA subsidy cliff at 100% FPL, this creates a coverage gap: individuals earning below $15,650/year (100% FPL for a single adult) are too low-income to qualify for ACA marketplace subsidies but do not qualify for Texas Medicaid. An estimated 588,000 Texans fall into this gap — the largest of any state.
Are Health Shares available in Texas?
Yes. Health Shares are available to Texas residents year-round with no open enrollment requirement. Texas has a large Health Share population driven by the state’s high uninsured rate, large self-employed sector, and significant number of residents above the ACA subsidy cliff. Health Shares are not insurance and are not regulated by the Texas Department of Insurance — they operate under contract law and are subject to Texas Attorney General oversight. Pre-existing conditions are typically excluded or subject to waiting periods. See the Health Shares guide for a full explanation.
What are the best health coverage options for self-employed Texans?
It depends on your income. If your projected MAGI is between $15,650 and $62,600 (single adult, 2026), an ACA plan with a subsidy is almost always the most cost-effective option — the subsidy can reduce your premium to well below the unsubsidized rate. If your income exceeds $62,600, you face the full $661/month benchmark premium with no assistance. At that income level, a Health Share paired with a DPC membership is a common alternative — total monthly cost typically $230–$480, depending on age and the Annual Unshared Amount chosen. Note that self-employed Texans can deduct their health insurance premiums — ACA premiums and Health Share contributions have different tax treatment. Consult a CPA for your specific situation.
Is short-term health insurance available in Texas?
Texas allows short-term medical insurance under state law that permits initial terms up to 364 days with renewals up to 36 months total. Following the August 2025 federal enforcement suspension, some carriers have begun offering longer terms in Texas again. STM premiums in Texas typically run $95–$165/month for a 40-year-old depending on deductible and carrier. STM excludes pre-existing conditions, does not satisfy ACA minimum essential coverage, and losing an STM plan does not trigger an ACA Special Enrollment Period. It is best suited for short coverage gaps — between jobs, before employer coverage starts, or after missing open enrollment. See the short-term medical guide for full details.