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From wide-open plains and Gulf Coast beaches to bustling cities like Houston and Dallas, Texas remains a desirable place to live, and understanding your health insurance options here is key to protecting your health and finances.
As of 2025, the uninsured rate in Texas remains one of the highest in the country, but state and federal programs continue to expand access. If you’re currently without coverage, here’s what you need to know about getting insured in Texas.
Health Insurance Options in Texas
Texas offers a range of health insurance options tailored to residents’ needs, depending on age, income, employment, and family size. Here are the most common coverage types available:
Employer-Sponsored Insurance
Many Texans receive health insurance through their employer. If your workplace offers coverage, this is usually the most cost-effective and convenient option.
ACA Marketplace Plans (Healthcare.gov)
The Affordable Care Act (ACA) allows individuals and families to buy health insurance through the federal Marketplace. These plans offer essential health benefits, free preventive care, and protection for preexisting conditions.
Individuals and families without employer coverage can shop for insurance through Healthcare.gov. If you don’t have employer coverage, you may qualify for subsidies to lower your premiums. Use our ACA Subsidy Calculator to check your eligibility.
Starting this year, the Centers for Medicare & Medicaid Services (CMS) is requiring income verification to confirm eligibility for premium subsidies. As part of this effort, CMS will reduce the ACA subsidies by $5 per month for individuals who are automatically re-enrolled in fully subsidized plans without verified eligibility.
ACA Plan Types
ACA marketplace plans are available in four tiers: Bronze, Silver, Gold, and Platinum, each with distinct coverage levels. Plans also vary by provider networks and out-of-pocket expenses, so be sure to compare carefully to find what best fits your needs.
- Bronze: Low monthly premiums, higher out-of-pocket costs; ideal for minimal healthcare usage.
- Silver: Moderate costs; eligible for cost-sharing reductions (CSRs).
- Gold: Higher monthly premiums with lower out-of-pocket costs; best for frequent healthcare users.
- Platinum (if available): Highest premiums, lowest out-of-pocket costs.
Metal Tier Breakdown:
| Metal Tier | Insurance Company Pays | Consumer Pays |
|---|---|---|
| Bronze | 60% | 40% |
| Silver | 70% | 30% |
| Gold | 80% | 20% |
| Platinum | 90% | 10% |
Medicaid
Texas Medicaid provides free or low-cost coverage for eligible low-income residents. Benefits typically include preventive care, hospital visits, maternity care, prescriptions, and more.
Eligibility includes:
- Adults caring for children
- Pregnant women
- Adults 65 and older
- Adults with qualifying disabilities
Visit YourTexasBenefits.com to learn more and apply.
Student Health Insurance
College students in any state have multiple health insurance options, including staying on a parent’s plan until age 26, enrolling in a school-sponsored plan, or applying for coverage through the ACA Marketplace. Depending on your income and location, you may also qualify for Medicaid, CHIP, or low-cost catastrophic or short-term plans—making Texas student health insurance accessible and flexible for a wide range of needs.
Children’s Health Insurance Program (CHIP)
Known as CHIP in Texas, this program offers low-cost health insurance to children under 19 in families that earn too much for Medicaid but can’t afford private insurance. CHIP provides coverage for doctor visits, dental care, prescriptions, and more.
Medicare
Medicare plans are available for Texas residents aged 65+ and younger individuals with qualifying disabilities. Options include:
- Medicare Advantage (Part C)
- Medicare Advantage is an alternative to Original Medicare offered by private insurers to those enrolled in Parts A and B. These plans often include extra benefits and cost protections but typically require using a specific network of providers.
- Prescription Drug Plans (Part D)
- Medicare Part D provides prescription drug coverage for anyone with Medicare, helping pay for medications and many vaccines. Offered by private insurers, these plans vary in cost and coverage and can be joined during specific enrollment periods.
- Medicare Supplement (Medigap)
- Medicare Supplement plans, or Medigap policies, help cover the out-of-pocket costs that Medicare Part A and Part B don’t pay. Since Original Medicare (Parts A and B) lacks an out-of-pocket maximum, these plans can limit your expenses for medical services.
COBRA Coverage
If you’ve recently lost employer-based health insurance, COBRA lets you temporarily continue that coverage—typically at full cost. This option helps bridge the gap until other insurance begins.
Short-Term Plans
Short-term medical (STM) plans offer flexible, low-cost coverage for up to four months, ideal for healthy individuals in transition. However, STM plans aren’t guaranteed issue, lack subsidies, and may exclude key benefits like maternity, mental health, and pre-existing conditions, making them less suitable for long-term or comprehensive needs.
Explore all non-ACA health plans that may fit your needs and lifestyle.
Enrollment Periods in Texas
Open Enrollment for 2026 Coverage:
November 1, 2025 – January 15, 2026
During this time, all eligible residents can apply for, renew, or change their marketplace health plans.
Special Enrollment Period (SEP)
If you experience a qualifying life event (QLE), you may enroll outside the open enrollment window. Examples include:
- Job loss
- Marriage or divorce
- Birth or adoption
- Moving to a new area
- Changes in income
You typically have 60 days from the event to enroll.
Health Insurance Providers in Texas
As of 2025, these insurers typically offer individual and family plans.
- Blue Cross Blue Shield of Texas
- Oscar Health
- Molina Healthcare
- Ambetter from Superior HealthPlan
- Aetna CVS Health
- UnitedHealthcare
- Cigna Healthcare
Plan availability may vary by county or ZIP code.
Understanding Health Insurance Costs
When selecting a health insurance plan, it’s important to understand common cost terms:
- Premium: The monthly payment to maintain coverage
- Deductible: The amount you pay before insurance begins covering services
- Copayment (Copay): A flat fee for specific services like doctor visits
- Coinsurance: Your share of costs after meeting the deductible
- Out-of-Pocket Maximum: The most you’ll pay in a year for covered services
- In-Network vs. Out-of-Network: Choosing providers in your plan’s network helps reduce costs
Understanding health insurance doesn’t have to be overwhelming. This glossary offers clear definitions of key terms—from agents to costs like copayments, coinsurance, and deductibles—to help you make confident coverage decisions.
Bottom Line
Health insurance in Texas offers a wide range of options—from employer-sponsored coverage and Marketplace plans to Medicaid, CHIP, and Medicare. By exploring your options and enrolling during the appropriate window, you can secure reliable health coverage that protects your well-being and fits your lifestyle.
Need help choosing a plan?
Need help choosing a plan? Use our ACA Subsidy Calculator to see if you are eligible for ACA plan financial aid or speak with a licensed insurance agent about all your options.
