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.

The Lonestar State offers various options for health insurance to fit your budget and health needs. You can qualify for financial help with Marketplace plans or coverage through low-income programs. 

• State Marketplace Plans: Essential health benefits/coverage differs by metal levels
  • Catastrophic Plans: Lower-cost emergency coverage available for those under the age of 30
• Medicaid: State/Federal healthcare program for those with lower income or certain disabilities
• Medicare: Federal healthcare program for those age 65 and older and those with certain disabilities

Explore these different types of major medical health insurance plans in Texas based on your health needs, budget, as well income, and age eligibility. 

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Texas ACA Marketplace

Texas offers affordable health insurance for individuals and families through Healthcare.gov Federal Marketplace Exchange.

NOTE: If you’re self-employed with no employees, you qualify as an individual. 

• Plans are available in four metal levels: bronze, silver, gold, and platinum.
  • Each metal plan covers a percentage of your healthcare costs, from 60% (bronze) to 90% (platinum), with bronze being the least expensive and platinum the most expensive.
  • Catastrophic plans are also available for individuals under the age of 30.
• All plans provide comprehensive coverage, including essential health benefits such as hospitalization, maternity care, prescription drugs, and preventive services.

Open enrollment is from [November 1 to January 15] each year for independent individual and family health insurance plans regulated by the Affordable Care Act (ACA). 

Subsidies For ACA Plans 

Obamacare (ACA) subsidies are financial aid to help pay for your monthly premiums based on your income and household size, not your employment status. So you can still qualify for savings on an Obamacare plan even if you’re unemployed or in between jobs. You can report your expected income from unemployment benefits when applying for coverage.

• Subsidies are available if the benchmark plan costs more than 8.5% of your income, with no cap on income level. 
• Our ACA subsidy calculator helps you determine your eligibility for healthcare subsidies based on your income, household size, and location. The tool also accounts for special cases like unemployment benefits.”

Catastrophic Texas Health Insurance for Financial Hardship

Catastrophic health insurance is typically for those under 30, but if you’re over 30 and facing financial hardship (e.g., eviction, high medical debt, or bankruptcy), you can qualify for a hardship exemption to purchase a catastrophic plan.

While not as comprehensive as standard Obamacare plans, catastrophic plans include all ACA essential health benefits. 

Plans for Self-Employed and Small Business Owners

Are you a self-employed freelancer, independent contractor, or small business owner in Texas looking for affordable health insurance? Here are some options. 

Self-Employed: If you run a business with no employees, you qualify for individual health insurance under the ACA. Use the ACA Marketplace to apply for Texas self-employed health insurance. The application will determine if you can get subsidies to lower your monthly premium, or if you qualify for free or low-cost coverage through Medicaid or CHIP, based on income and household size.

Small Business Owner: If you have at least one employee who is not a co-owner, business partner, or spouse, you can enroll yourself and your employees in the Small Business Health Options Program (SHOP) via Healthcare.gov. By buying small business health insurance through the SHOP Marketplace, you may qualify for the Small Business Health Care Tax Credit, which can cover up to 50% of your contribution toward employee premiums, or 35% if you’re a non-profit.

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Plans for Students in 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 qualify as coverage under the Affordable Care Act (Obamacare), meaning they offer the essential health benefits required.
• Parent’s Health Plan: Under the ACA, you can usually stay on your parent’s health plan until age 26. 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 typically ends on your 26th birthday.
• Texas Obamacare Insurance for Students: You can purchase your own Obamacare plan through Healthcare.gov. Keep in mind that you must enroll during the Open Enrollment Period unless you qualify for a Special Enrollment Period.

If You Qualify for Low-Income Coverage

Medicaid 

Medicaid is a state and federal program for low-income Texans, including adults caring for children, pregnant women, adults over 65, and adults under 65 with disabilities. See if you qualify. 

• Adults Caring for Children: Must live with and care for a blood relative or stepchild under 17, or under 18 if attending school full-time.
• Pregnant Women: Eligible during pregnancy and up to two months after childbirth.
• Adults 65 and Older: Must need 30+ days of continuous long-term care, have little or no money, and not own or be paying for items of high value (e.g., home, burial insurance, vehicle).

Texas CHIP: Provides low-cost health coverage to children up to 18 from families that earn too much for Medicaid but cannot afford private insurance. Costs are capped at $50 per year per family, usually less.

Texas Medicaid for Adults with Disabilities: For those with a disability expected to last at least one year, with limited income and assets. Recipients must pay a share of long-term care costs.

Medicare

There are several Medicare options available. The default is Original Medicare, which includes Part A (hospital) and Part B (medical) insurance, managed by the federal government. 

Many enrollees add plans sold by private insurance companies, such as Part D (prescription coverage), Medicare Supplement, and Medicare Advantage plans. These plans fill in gaps of coverage that Part A and B don’t cover. 

Short-Term Medical Plans

Short-term health insurance is meant to be temporary until you’re able to get coverage under a traditional plan. It’s available for up to 3 months with a 1-month extension. Unlike plans purchased through the Health Insurance Marketplace, short-term health insurance is not required to include the 10 essential health benefits outlined in the ACA, and it generally doesn’t cover preexisting conditions.

Next Steps

Whether you’re applying for health insurance in Texas for yourself or a family of four, make sure to review all your options. Examine what makes sense for your needs and budget.

Resources

• Health Insurance Marketplace (healthcare.gov)
  • Click here to apply for coverage, compare plans, and enroll. For questions, call 1-800-318-2596 (TTY: 1-855-889-4325).
• State Assistance
  • Click here to find a local navigator or certified application counselor to help you get health benefits coverage.
• Understanding Health Insurance
  • Click here for resources to better understand health insurance and the marketplace.

Article Sources

1. Medicare.gov. “Costs.” Medicare. Accessed June 12, 2024. https://www.medicare.gov/basics/costs.
2. Benefits.gov. “Medicaid.” Benefits.gov. Accessed June 12, 2024. https://www.benefits.gov/benefit/1640.
3. HealthCare.gov. “Self-Employed Coverage.” HealthCare.gov. Accessed June 12, 2024. https://www.healthcare.gov/self-employed/coverage/.
4. HealthCare.gov. “SHOP Marketplace Overview.” HealthCare.gov. Accessed June 12, 2024. https://www.healthcare.gov/small-businesses/choose-and-enroll/shop-marketplace-overview/.
5. HealthCare.gov. “College Students.” HealthCare.gov. Accessed June 12, 2024. https://www.healthcare.gov/young-adults/college-students/.