Texas Health Insurance in 2026

Texas has the highest uninsured rate in the nation and has not expanded Medicaid, so its Marketplace is enormous — millions of Texans enroll through HealthCare.gov each year, many for under $50 a month after subsidies. Houston and Dallas–Fort Worth have some of the most carrier choice in the country.

Where you enroll. Texas uses the federal Marketplace, HealthCare.gov. Open Enrollment for 2027 coverage runs November 1, 2026 through January 15, 2027 — the shortened enrollment window proposed for this year was vacated by a federal court, so the usual dates apply.

Medicaid vs. subsidies. Because Texas has not expanded Medicaid, Texas Medicaid mostly covers children, pregnant women, some parents, and disabled or elderly residents. Working-age adults at or above 100% of the poverty level get help through Marketplace tax credits instead — and at lower incomes those credits can cover nearly the whole premium.

The biggest lever on your Texas premium is the ACA premium tax credit. It caps what you pay for a benchmark silver plan at a percentage of your income — the lower your income, the larger the credit — and the government pays the rest directly to your insurer.

If your income is under about 250% of the poverty level, look at Silver plans first: they come with cost-sharing reductions that shrink your deductible and copays, which no other tier gets. Our guide to Bronze vs. Silver vs. Gold walks through it.

One important change for 2026: the enhanced pandemic-era subsidies expired unless renewed, so the “400% cliff” may return for higher earners. That makes comparing plans with a licensed Texas agent more valuable than ever. Prefer to read up first? Start with our ACA health insurance overview or the subsidy calculator.