Country Guide
Best Health Insurance in Texas (2026)
Texas has the highest uninsured rate in the US. Compare top health insurance carriers, marketplace plans, and Medicaid options available to TX residents.
By Itai Varochik | Updated February 21, 2026
Top Exchanges in Texas
| # | Exchange | Best For | Fees | Type |
|---|---|---|---|---|
| 1 | Blue Cross Blue Shield of Texas | Largest provider network | $487/mo | — |
| 2 | Oscar Health | Tech-forward younger adults | $312/mo | — |
| 3 | Molina Healthcare | Medicaid and low-income coverage | $0/mo (Medicaid) | — |
| 4 | UnitedHealthcare | Employer group plans | $520/mo | — |
| 5 | Aetna | Flexible HMO and PPO plans | $445/mo | — |
Texas health insurance landscape
Texas has the highest uninsured rate of any U.S. state, with approximately 18% of residents lacking health coverage. The state has not expanded Medicaid under the ACA, leaving an estimated 1.4 million Texans in the coverage gap. Texas uses the federal marketplace (HealthCare.gov) and has over 2.4 million marketplace enrollees, making it the second-largest exchange market after Florida.
Coverage options comparison
| Plan tier | Monthly premium (single, age 40) | Deductible | Best for |
|---|---|---|---|
| Bronze | $320–$450 | $7,000–$8,700 | Young, healthy individuals |
| Silver | $420–$580 | $3,500–$5,500 | Subsidy-eligible families |
| Gold | $520–$700 | $1,000–$2,500 | Regular medical needs |
| Catastrophic | $230–$320 | $9,100 | Under-30 or hardship exemption |
Key Texas regulations
The Texas Department of Insurance (TDI) regulates health insurers but the state has no individual mandate penalty. Texas passed SB 1264 (2019), one of the strongest surprise billing protections in the country, which prohibits balance billing for emergency care and certain non-emergency services at in-network facilities. The law uses a median in-network rate benchmark and arbitration process to resolve payment disputes between insurers and out-of-network providers. Texas CHIP covers children in families earning up to 200% FPL with premiums of $0–$50/month depending on income.
How to save on Texas health insurance
- Apply for enhanced subsidies: Extended ACA subsidies through 2025 mean a family of four earning up to $124,000 may qualify for premium tax credits
- Choose Silver plans if subsidy-eligible: Cost-sharing reductions significantly lower deductibles and copays for households under 250% FPL
- Compare HMO vs. PPO carefully: Texas HMO plans from Blue Cross Blue Shield and Ambetter cost 20–35% less than comparable PPO plans
- Use Texas CHIP for children: Coverage costs $0–$50/month with comprehensive benefits including dental and vision
- Check for community health centers: Texas has 75 federally qualified health centers offering sliding-scale fees
- Consider faith-based health shares: While not insurance, health sharing ministries are popular in Texas and exempt from ACA requirements — but understand the limitations
The Medicaid gap challenge
Texas Medicaid eligibility for adults remains among the most restrictive in the nation — non-disabled, non-pregnant adults without dependent children do not qualify regardless of income. Parents qualify only if earning below approximately 15% FPL (roughly $3,300/year for a family of three). This leaves an estimated 1.4 million Texans earning too much for Medicaid but too little for marketplace subsidies. Safety-net hospitals, county indigent care programs, and community health centers serve as primary access points for this population.
Crypto Regulations in Texas
Texas has not expanded Medicaid, leaving 1.4 million in the coverage gap. TDI regulates health insurers but the state has no individual mandate. SB 1264 provides strong surprise billing protections using median in-network rate benchmarks and arbitration. Texas CHIP covers children up to 200% FPL. The state uses HealthCare.gov with 2.4M+ enrollees. Adult Medicaid eligibility is limited to approximately 15% FPL for parents.
Frequently Asked Questions
Why does Texas have so many uninsured residents?
Texas has the highest uninsured rate in the country, around 17 to 18 percent of the population, largely because the state did not expand Medicaid under the ACA. This leaves a significant coverage gap for adults earning too much for traditional Medicaid but too little for marketplace subsidies.
Can I get health insurance through the Texas marketplace?
Yes. Texas uses the federal marketplace at healthcare.gov. Open enrollment typically runs from November 1 to January 15. Residents who lose employer coverage or experience qualifying life events can enroll during a Special Enrollment Period.
Does Texas have Medicaid expansion?
No. Texas is one of the few remaining states that has not expanded Medicaid under the Affordable Care Act. Texas Medicaid is limited to specific groups including children, pregnant women, and certain low-income adults with disabilities. Many working-age adults in Texas fall into a coverage gap with no affordable options.
What is the cheapest health insurance option in Texas?
For residents who qualify, Medicaid or CHIP (for children) is free or very low cost. For marketplace shoppers, Bronze and Silver plans on healthcare.gov offer the lowest monthly premiums. ACA subsidies can significantly reduce costs for households earning between 100 and 400 percent of the federal poverty level.
What health insurance do Texas state employees use?
Texas state employees are covered by the Texas Employees Group Benefits Program (GBP), administered by the Employees Retirement System of Texas (ERS). The program offers several plan options including HealthSelect of Texas, a statewide PPO, and regional HMO plans in major metros.