Health Insurance in Texas

Texas uses the federally facilitated Marketplace at HealthCare.gov. Texas has among the largest Marketplace enrollment in the country, and it also has the highest uninsured rate of any state — a combination that means a large number of Texans are eligible for financial help they have never applied for.

With 254 counties, Texas has by far the most granular county-level variation of any state Mercy is licensed in. The gap between a major metro like Harris or Dallas County and a sparsely populated West Texas county can be the difference between a deep field of carriers and a very short list.

If you have moved between Texas metros, do not assume your prior plan follows you. A permanent move to a new coverage area is itself a qualifying life event, and it frequently changes both which plans exist and what they cost.

Texas premiums are set by your county's rating area, the ages of enrollees, household size, tobacco use, and metal tier. Because Texas spans such a wide range of markets, the same 45-year-old can see meaningfully different benchmark pricing in Austin, Houston, and a rural county.

Premium tax credits are calculated against the second-lowest-cost Silver plan in your specific county, which means the value of your subsidy is a local number, not a statewide one. In counties with strong carrier competition, the benchmark is lower — which lowers the subsidy but also lowers the plans it is applied against.

Texas has a very large population of self-employed workers, 1099 contractors, and energy-sector consultants with variable income. For these households, the income estimate on the application is the single highest-leverage input. Under-estimating can mean repaying credits at tax time; over-estimating means paying more each month than necessary. Report a realistic figure and update the Marketplace when income changes materially during the year.

Medicare runs on its own calendar, separate from the ACA Marketplace. Your Initial Enrollment Period is seven months long — the three months before the month you turn 65, your birthday month, and the three months after. Missing it can trigger Part B and Part D late enrollment penalties that last for as long as you hold the coverage.

After that, Medicare Open Enrollment runs October 15 through December 7 each year, when you can change between Original Medicare and Medicare Advantage or switch Part D plans. A separate Medicare Advantage Open Enrollment Period runs January 1 through March 31 for people already enrolled in an Advantage plan.

One window is easy to miss and hard to recover: your Medigap open enrollment is the six-month period beginning when you are 65 or older and enrolled in Part B. During those six months a Medicare Supplement insurer generally cannot use medical underwriting to deny you or raise your price. Outside it, in most states, they can.