ACA health insurance in Texas

The Health Insurance Marketplace is a service that helps people shop for and enroll in health insurance. The federal government operates it at HealthCare.gov for most states, and Texas is one of them, so in Texas the Marketplace is HealthCare.gov.

Every Marketplace plan follows Affordable Care Act rules, and plans are grouped into metal tiers so they are easier to compare. The Marketplace application also checks whether your household can get help paying premiums, based on your expected income for the year. Our guide to how ACA premium tax credits work explains the calculation, and the metal tier guide explains Bronze, Silver, Gold and Platinum.

Texas does not run its own exchange. For plan year 2027, CMS lists Texas as a federally facilitated Marketplace state, so applications, plan comparisons and enrollment go through HealthCare.gov or a certified agent working with it.

In practice, that means Texans follow HealthCare.gov's Open Enrollment calendar shown on this page, not a separate state calendar, and use HealthCare.gov's help resources: its call center at 1-800-318-2596, its Find Local Help tool, and agents certified to sell Marketplace plans in Texas.

Most people enroll or change Marketplace plans during the annual Open Enrollment Period. Outside that window, you generally need a life change, such as losing other coverage, moving, getting married or having a baby, that opens a Special Enrollment Period.

Special Enrollment Periods have their own deadlines and may ask for documents, so it helps to act soon after the life change. Our guide to ACA Special Enrollment Periods walks through the common triggers, and health insurance between jobs covers one of the most common situations.

If you lose job-based health coverage, you may qualify for a Special Enrollment Period on HealthCare.gov. The window covers coverage you lost in the past 60 days or expect to lose in the next 60 days, so you can start before your last day of coverage.

You may also be able to keep the plan you had at work. Federal COBRA lets you continue it for 18 months, and Texas law requires some group plans to let you keep the plan for another six months after COBRA coverage ends, which TDI calls state continuation. Either way, you pay the premium. When COBRA coverage ends, HealthCare.gov gives you 60 days to enroll in a Marketplace plan through a Special Enrollment Period. This applies when COBRA runs out or is no longer available. If you cancel COBRA on your own before it ends, you generally have to wait for Open Enrollment unless another life event qualifies you.

A licensed agent can help you compare continuing your work plan with a Marketplace plan before you decide. Our guide to health insurance between jobs covers the decision step by step, and if you are starting your own business, see health insurance for the self-employed.

Texas children might be able to get coverage from Children's Medicaid or the Children's Health Insurance Program (CHIP). One application covers both programs, and you can apply for Medicaid and CHIP any time of year, not only during Open Enrollment.

You can apply with the state directly: TDI points families to the Texas Health and Human Services website or 1-877-543-7669 (877-KIDS-NOW). A HealthCare.gov application also checks for these programs. If it looks like anyone in your household may be eligible for Medicaid or CHIP, HealthCare.gov securely sends your information to the state, and the state contacts you about enrollment.

The Texas Department of Insurance warns that some websites or salespeople use the words gold, silver or bronze to make plans sound like HealthCare.gov plans when they are not. If you want a Marketplace plan, confirm that is what you are buying.

Two checks help. Ask the company to confirm the plan is a HealthCare.gov plan, and call the TDI Help Line at 800-252-3439 to ask whether a company is licensed. TDI also points out that health plans don't go on sale, so there is no need to decide in a hurry. Our metal tier guide explains what the real Marketplace tiers mean.

If you have a problem with a health insurance company or policy, the Texas Department of Insurance Help Line at 800-252-3439 is the state's consumer contact, open from 8 a.m. to 5 p.m. Central time. Questions about the Marketplace application itself go to HealthCare.gov.

A licensed agent who is certified with the Marketplace can help you fill out the application, estimate your household income for the year, compare the plans offered where you live, and finish enrollment. There is no obligation to enroll.

An agent can also help you check whether your doctors and prescriptions work with a plan before you choose it, and can help again at renewal time. Start with our ACA health insurance overview, or go back to the Texas state guide.