The Medicaid situation
Texas is one of 10 states that has not expanded Medicaid under the ACA. Traditional Medicaid in Texas has very strict eligibility: it covers children, pregnant women, and some parents with extremely low incomes (generally under about 17% FPL for parents). Childless adults are essentially ineligible regardless of income.
This creates the coverage gap. If you earn less than 100% FPL ($15,960 for a single person for 2027 coverage) and don't fall into one of the narrow Medicaid categories, you make too little for marketplace subsidies and too much for Medicaid. An estimated 770,000 Texans fall into this gap.
For everyone else between 100% and 400% FPL, the marketplace is the primary path to coverage.
What plans cost in 2027
Texas marketplace premiums jumped significantly for 2026, when carriers increased rates by an average of 33% before subsidies. They are rising again for 2027. KFF puts Texas's average benchmark Silver premium for a 40-year-old at $737 a month for 2027, up from $661 in 2026 (about 11.5% higher).
Premiums after subsidies tell a different story for many people. Most Texas marketplace enrollees in recent years have had incomes below 200% FPL, and at that level the tax credit absorbs much of the increase. Silver plans with cost-sharing reductions are often the best value for that income group.
The enhanced subsidies expired after 2025 and were not extended. For 2027 there is no premium tax credit above 400% FPL (about $63,840 for a single person or $86,560 for a household of two), so people above that line pay full price.
Open Enrollment for 2027 coverage runs from November 1, 2026, through January 15, 2027, on HealthCare.gov. Enroll by December 15 for coverage that starts January 1.
Major carriers in Texas (2027)
Thirteen insurance brands sell 2027 marketplace plans in Texas, though availability varies a lot by county. Major insurers include:
- Blue Cross Blue Shield of Texas is the largest carrier with the broadest network. Available in most counties.
- Wellpoint (an Elevance Health company) and UnitedHealthcare both offer plans in the major metros and some smaller markets, such as Lubbock.
- Ambetter (Centene) is available in many Texas counties and often has competitive pricing, though networks can be narrower.
- Oscar Health operates in the DFW, Houston, Austin, and San Antonio markets. Known for a user-friendly app and virtual care.
- Community Health Choice serves the Houston metro area.
- Regional and newer options include Antidote Health (new for 2027, in markets such as San Antonio and El Paso), Harbor Health, Imperial Insurance Companies, Community First (San Antonio), Sendero Health Plans (Austin), CHRISTUS Health Plan, and Molina Healthcare (in counties including Dallas).
Notable changes for 2027: Baylor Scott & White Health Plan and Cigna left the Texas marketplace. If you had one of their plans in 2026, you need to pick a new one. Aetna left at the end of 2025.
Key cities
Houston
Houston (Harris County) is one of the most competitive marketplace areas in Texas. For 2027, eight insurers sell plans there, including Community Health Choice, BCBS, Oscar, Ambetter, Wellpoint, and UnitedHealthcare, with more than 100 plans to choose from.
Dallas-Fort Worth
The DFW metro has strong carrier competition as well. BCBS, Oscar, Ambetter, Wellpoint, UnitedHealthcare, and Molina are among the 2027 options in Dallas County.
San Antonio
Bexar County has more choices for 2027 than any of the other big metros listed here: nine insurers, including BCBS, Ambetter, Oscar, UnitedHealthcare, Wellpoint, Community First, and newcomer Antidote Health.
Rural Texas
Rural counties often have only one or two carriers. Premiums are typically higher due to less competition and higher provider costs. BCBS is the most common option in rural areas. In Central Texas, McLennan County (Waco) has just BCBS and Ambetter for 2027 after Baylor Scott & White's exit.
Estimate your subsidy
Subsidy Estimator
Enter your info below to get a rough estimate of your monthly premium tax credit for a 2027 marketplace plan.
Resources for Texans
- HealthCare.gov for plan shopping and enrollment (Texas uses the federal marketplace)
- Call 2-1-1 (Texas Health and Human Services) for help finding local enrollment assisters
- Benefits.gov to check eligibility for other programs
- Community health centers provide care on a sliding fee scale if you fall in the coverage gap