Texas Health Insurance

Everything is bigger in Texas and so are the number of health insurance choices. You won’t have any problem finding the right Texas health insurance plan to meet your needs.

Buying Health Insurance in Texas

There are two paths to health insurance for Texans: private and government-funded. Deciding which works best for you depends on factors, such as your age, income, health condition, or whether or not you own a business.

• Private Health Insurance Plans: These include comprehensive health insurance plans regulated by the Affordable Care Act (known as Obamacare), short-term health plans, Medicare Advantage plans, and Medicare Supplement plans. 

• Government-funded Health Insurance: This includes Original Medicare, Medicaid, CHIP coverage, TRICARE military insurance, and VA Health Insurance.

Buying Texas Health Insurance if You’re Under 65 

If you’re under 65 and don’t qualify for Medicare, your best option for affordable insurance may be an Obamacare plan. You may also consider another type of comprehensive low-cost plan that doesn’t qualify for ACA subsidies (like a catastrophic health plan) if you are under the age of 30. Depending on your income, Medicaid could serve as an option. (See below for more information). 

Texas Health Coverage If You’re Low-Income, Unemployed, Or In Between Jobs

You can get access to low-cost or free health insurance in Texas through several plans: Obamacare, short-term, or catastrophic. You can also get coverage from a government-funded program, such as Medicaid or the Children’s Health Insurance Program (CHIP). 

Texas Health Coverage If You Have a Disability or Chronic Illness

You may have frequent doctor visits and/or higher medical expenses if you have a disability or chronic condition. So your cheapest option for Texas disability health insurance may be a government-funded program or a special type of private Medicare plan.

Texas Health Insurance Facts

• Texans who got an unsubsidized ACA benchmark plan paid an average of $436 per month in 2021.
• Fourteen companies sell individual and family plans on the federal health insurance marketplace in 2022.
• 1.3 million Texas enrolled in an ACA plan in 2021.
• 4.3 million enrolled in Medicare or Medicare Advantage in 2020.

Texas and Medicare

Medicare offers affordable health insurance for Texans age 65 or older. About 2.5 million Texas residents enrolled in Original Medicare as of 2020.²⁰ Original Medicare includes Part A hospital insurance and Part B medical insurance. There are also Medicare plans sold by private insurance companies. You can find your Medicare options below. 

Why Buy a Texas Medicare Advantage Plan?

Nearly 1.7 million Texans enrolled in Medicare Advantage, which is an alternative way to get Medicare Part A and Part B benefits.¹⁹ Here are some highlights of Medicare Advantage plans:

• Offers Extra Benefits: Medicare Advantage plans offer extra benefits Original Medicare doesn’t cover. Many plans include prescription drug coverage and other benefits, such as dental, vision, and hearing care.
• Expanded Benefits Starting in 2020: In 2020, Texas Medicare Advantage plans can offer even more benefits, including adult daycare, in-home caregiver support, and access to safety devices.
• Affordable: You can find many Medicare Advantage Prescription Drug Plans (MA-PDs) in the $20 monthly range for coverage effective 2020.⁵ There are also plans available for as low as $0 per month.*
• Many Chances to Enroll or Change Plans: You can enroll during your Initial Enrollment Period, which lasts a full seven months—from three months before the month you turn 65, through your birthday month, and then three months after your birthday month.  You get an opportunity each year to switch your Medicare coverage during the annual Open Enrollment Period from October 15 to December 7. You can also switch to a different Medicare Advantage plan or leave your plan and return to Original Medicare during the Medicare Advantage Open Enrollment Period from January 1 to March 31.

*You must continue to pay your Medicare Part B premium (most people get premium-free Part A)⁶ when you enroll in Medicare Advantage. The Part B premium is $148.50 in 2021.⁷

When Buying Texas Medicare Supplement Insurance May Be Right For You

With Medicare Supplement, you pay a flat monthly premium in exchange for the plan covering some to all of your Medicare Part A and Part B out-of-pocket costs (copays, coinsurance, deductibles, etc.).

A Texas Medicare Supplement plan may be right for you if:

• You Need Frequent Medical Care: Medicare Supplement (also Medigap) helps cover the costs of your copay, coinsurance, and deductible each time you visit your doctor or are admitted to the hospital.
• You Have Health Problems: You can buy Medigap without going through a health screening during your Medigap Open Enrollment Period (OEP). This is a 6-month period that starts when you turn 65 and enroll in Medicare Part B. You can’t be charged more for a policy because of your health (unless you’re under 65) if you enroll during this time. Outside of your Medigap OEP, companies can deny you coverage because of your health.
• You Travel Out of State or Overseas Often: Standard Medigap plans can be used at any provider across the country that accepts Medicare. Some plans even pay up to 80% of the approved costs for the emergency care you receive in a foreign country.²¹ 
• You Want Access to Multiple Options to Fit Your Needs and Budget: Texas offers a multitude of standard Medigap plans.

There are more than 60 carriers that offer Medicare Supplement plans in Texas. Here’s a list of Texas Medicare Supplement insurance companies. 

Texas Medicare If You’re Under 65 And Have a Disability or Chronic Illness

Medicare is a federal government program that’s generally for people 65 and older. But if you’re under 65, you can get Medicare Part A and Medicare Part B if one of the following applies to you:

1. You have a disability: You automatically get Medicare Part A and Part B after you receive disability benefits from Social Security or the Railroad Retirement Board (RRB) for 24 months.
2. You Have ALS: You get Medicare Part A and B during the first month you receive disability benefits if you have Amyotrophic Lateral Sclerosis, or Lou Gehrig’s disease.
3. You Have Permanent Kidney Failure (End-Stage Renal Disease): You sign yourself up for Medicare through Social Security. It’s best to enroll in both Medicare Part A and Part B to get the full benefits available for ESRD. Once you enroll, your coverage usually begins the first day of the fourth month of dialysis treatment.

You may be eligible for Medicare Part A at a $0 monthly premium if you receive disability benefits for 24 months or you have ESRD.⁶ Medicare Part B has a standard monthly premium, which is $148.50 in 2021.⁷ If you qualify for low-income status in Texas, you can get financial assistance to pay your premium (and any deductibles or copays) through a Medicare Savings Program. 

Texas Medicare Advantage Special Needs Plans

If you’re looking for the best private Texas health insurance for chronic conditions, a Medicare Advantage Special Needs Plan (SNP) may be the way to go. SNPs offer unique benefits, such as a care coordinator or primary care physician (PCP) to help manage your healthcare. You also have access to doctors who specialize in your condition and can get prescription drug coverage.

You typically can’t enroll in Medicare Advantage if you have End-Stage Renal Disease (ESRD). However, you may be able to buy a Medicare Special Needs Plan for ESRD if one is available where you live.¹⁶

There are three types of Texas Medicare Advantage Special Needs Plans:¹⁷

• Chronic Condition SNP: These plans serve people with specific conditions. Not all plans are alike so you should make sure your condition is covered before enrolling.

• Dual-Eligible SNP: You can enroll if you qualify for both Medicare and Medicaid. 

• Institutional SNP: You must live in a nursing facility or need nursing care at home to qualify. 

As of 2019, Texas has more than 500 contracts offering Medicare Special Needs Plans—making Texas the third-largest provider of Medicare SNPs.¹⁸ Dual-eligible SNPs are the most common in Texas followed by chronic condition SNPs. 

How Much Does Texas Health Insurance Cost?

The average monthly premium for Obamacare Texas health insurance costs $436 in 2021.¹ How much you pay for coverage will vary based on factors such as where you live, the plan type you choose, and the insurance company offering the plan. For 2020,  a 21 year old in Dallas, TX earning $35,000 (274% of the federal poverty level) could get an Obamacare silver plan for $351 before subsidies and $145 after.²

Average Marketplace Premiums

Metal Level (Average Cheapest Plan)	2019	2020	2021
Bronze	$313	$295	$301
Silver	$422	$418	$420
Benchmark (Second cheapest silver plan)	$444	$432	$436
Gold	$496	$471	$429

What is the Cheapest Texas Health Insurance Plan?

Among the cheapest Texas health insurance you can buy is an Obamacare bronze plan. Obamacare subsidies (known as premium tax credits) can help you access metal plans at a low monthly cost. Metal plans come in bronze, silver, gold, and platinum. Bronze plans are often the cheapest.

The lowest-cost bronze plan could cost nothing after subsidies. In 2018, more than 1 million uninsured Texans qualified for a bronze plan with no monthly premium.³

Other Cheap Health Insurance Plans in Texas 

• Short-Term Health Insurance: Short-term health plans don’t count as qualified insurance under the Affordable Care Act, but they usually cost half of major medical coverage. In 2021, a short-term plan for a 30-year-old woman in San Antonio costs about $67 a month.⁴
• Catastrophic Health Plans: Catastrophic health insurance premiums are usually much lower than other ACA-regulated plans, while their deductibles (what you pay before benefits kick in) are very high. Catastrophic plans are designed to protect you from high out-of-pocket costs in case of a major accident or illness. 
• Medicare Advantage Zero-Premium Plans: You can find Medicare Advantage plans for as low as $0 per month through several Texas insurance companies.⁵ You may qualify to enroll in a zero-premium plan if you’re 65 or under 65 and have a disability.*

*You must continue to pay your Medicare Part B premium (most people get premium-free Part A)⁶ when you enroll in Medicare Advantage. The Part B premium is $148.50 in 2021.⁷

Texas Medicaid

Medicaid is a jointly-funded state and federal government program available to low-income Texans. This includes adults caring for children, pregnant women, adults over 65, and adults under 65 with a disability (see further below for more on this group).

• An Adult Caring for a Child: You must meet two criteria to get coverage through Medicaid. First, you must care and live with a child who is your blood relative or stepchild. Second, the child must be under 17 or 18 if attending school full time. 
• Pregnant Women: Low-income pregnant women in Texas can get Medicaid during pregnancy and up to two months after childbirth. 
• Adults Ages 65 and Older: You must meet three conditions to qualify for Medicaid. First, you must need 30 or more days of continuous long-term care. Second, you have little or no money. Lastly, you don’t own or are paying for items over a certain value, such as a home, burial insurance, or a vehicle.

The chart below shows the maximum income you must make to qualify for Medicaid in Texas. You can visit Your Texas Benefits to apply for Medicaid.

Texas Medicaid Maximum Annual Income Level as of 2021⁹

1 person	$25,503
2 people	$34,492
3 people	$43,481
4 people	$52,470
5 people	$61,460
6 people	$70,449
7 people	$79,438
8 people	$88,427
For households with more than 8 people, add	$8,989

Texas CHIP Health Insurance for Low-Income Children and Pregnant Women

The Texas Children’s Health Insurance Program (CHIP) offers low-cost coverage to children (up to and including 18) whose families earn too much to qualify for Medicaid but cannot afford private health insurance. You pay no more than $50 a year to cover all your children, but most Texas families pay $35 a year or less for CHIP, depending on your monthly income.

If you’re pregnant, you and your unborn child can get health coverage through the Texas Children’s Health Plan. If you meet the Texas Children’s Health Plan’s income limits to qualify for coverage, you’ll get benefits like prenatal care and labor and delivery for your baby.

Texas Medicaid for Adults With Disabilities

Health insurance through the Texas Medicaid program may be right for you if you have a disability that’s expected to last for at least one year. You qualify if you have limited income and assets (e.g. house, car, burial insurance) below a certain value. Medicaid expects you to pay your share of costs for long-term care.¹⁵

Texas Short-Term Health Insurance

Unlike Obamacare plans, short-term medical plans are not regulated by the ACA. They don’t provide comprehensive health insurance and can deny you coverage based on a preexisting condition. However, short-term health insurance may be ideal for situations where you’re temporarily uninsured, such as losing coverage from a former job or waiting for coverage to begin at a new job. 

Texas Catastrophic Health Insurance if You Experiencing Financial Hardship

Catastrophic coverage usually requires you to be younger than 30. But if you’re over 30 and experience hardship, such as eviction, high-medical debt, or bankruptcy, you can qualify for a hardship exemption to buy a catastrophic health plan.

Although these plans aren’t as comprehensive as standard Obamacare plans, they include all the ACA essential health benefits. Catastrophic plans are sold on Healthcare.gov’s individual Marketplace, so Texas open enrollment dates apply.

Plans for Self-Employed and Small Business Owners

You may prefer the freedom of being your own boss rather than having access to health insurance through an employer. But can you get affordable health insurance in Texas as a self-employed freelancer, independent contractor, or a small business owner? The answer is Yes!

• Self-Employed: You’re self-employed if you run a business that doesn’t have any employees.¹⁰ So you qualify for individual health insurance under the Affordable Care Act (ACA). You can use the ACA Marketplace to apply for Texas self-employed health insurance. 

Completing an application lets you know if you can get subsidies to lower your monthly premium, free or low-cost coverage through Medicaid, or the CHIP program. Income and household size determine eligibility for savings.

• Small Business Owner: You’re considered a small business owner if you have at least one employee who isn’t a co-owner, business partner, or spouse of an owner or partner.¹¹ If you have 1 to 50 employees, you can enroll yourself and your eligible employees in the Small Business Health Options Program (SHOP) through Healthcare.gov. 

If you buy small business health insurance through the SHOP Marketplace, you may qualify for the Small Business Health Care Tax Credit. It can amount to as much as half of your contribution toward employee premiums or 35% if you’re a non-profit.

Plans for Students

• Texas College Health Insurance: Enrolling in your school’s health plan is one of the best ways to get low-cost health insurance. Most plans count as qualifying coverage, which means they offer the essential health benefits required by the Affordable Care Act (Obamacare).¹² 

• Parent’s Health Plan: You can usually stay on your parent’s health plan until 26 under the ACA. You can enroll even if you don’t live with your parents, they don’t claim you as a dependent, or you leave school. Coverage usually ends on your 26th birthday. 

• Texas Obamacare Insurance for Students: You can buy your own Obamacare plan. Keep in mind that you must enroll during the Open Enrollment Period, unless you qualify for a Special Enrollment Period.

• Short-term Health Insurance: Short-term coverage can be an affordable option if you’re transitioning off your parent’s health insurance or student health plan. You can get coverage as fast as 24 hours from the time you enroll and pay for the plan. 

Military Health Insurance 

If you serve in active duty, have served as an officer, or are a family member of a service officer, you can find health coverage through government-funded programs like TRICARE or VA Health Care. These programs meet the requirements for qualified coverage under the ACA.

TRICARE: Active-duty soldiers get this health insurance from the Department of Defense. Coverage can begin after 30 straight days of active service.

VA Health Care: Military veterans who didn’t get a dishonorable discharge qualify for this coverage through the Department of Veteran Affairs.

If for some reason you don’t qualify for any type of military health insurance, you can still get qualified health insurance through Obamacare or through Medicaid or Medicare, if eligible. 

Who Can Get Military Health Insurance in Texas

You may qualify for military health insurance in Texas if you’re among the following:¹³

• Active duty officers and their families
• National Guard/Reserve members and their families
• Retired officers/Reserve members and their families
• Homeless veterans¹⁴
• Beneficiaries eligible or TRICARE and Medicare
• Former spouses
• Survivors
• Children
• Dependent parents and parents-in-law
• Medal of Honor recipients and their families
• Foreign Force members and their families

State Resources

Texas Department of Insurance
PO Box 12030
Austin, TX 78711-2030
Phone: (800) 252-3439
tdi.texas.gov

Texas Department of State Health Services
PO Box 149347, MC-1913
Austin, Texas 78714-9347
Phone: 888-963-7111
Email: customer.service@dshs.texas.gov
dshs.texas.gov