Texas health insurance guide (2024)

To qualify for health coverage through the Texas Marketplace, you must:

• Live in Texas
• Be lawfully present in the United States
• Not be incarcerated
• Not be enrolled in Medicare

Eligibility for financial assistance (premium subsidies and cost-sharing reductions) depends on your income. In addition, to qualify for financial assistance with your Marketplace plan you must:

• Not have access to affordable health coverage offered by an employer. If your employer offers coverage but you feel it’s too expensive, you can use ourEmployer Health Plan Affordability Calculatorto see if you might qualify forpremium subsidiesin the Marketplace.
• Not be eligible for Medicaid or CHIP.
• Not be eligible for premium-free Medicare Part A.⁸

In Texas, you can sign up for an ACA-compliant individual or family health plan from November 1 to January 15 during open enrollment.⁹

If you need your coverage to start on January 1, you must apply by December 15. If you apply between December 16 and January 15, your coverage will begin on February 1.¹⁰

Outside of open enrollment, a special enrollment period (typcailly linked to a specificqualifying life event) is necessary to enroll or make changes to your coverage.

If you have questions about open enrollment, you can learn more in ourcomprehensive guide to open enrollment. We also have acomprehensive guide to special enrollment periods.

To enroll in an ACA Marketplace plan in Texas, you can:

• VisitHealthCare.gov, the Texas health insurance marketplace.

• Purchase individual and family health coverage with the help of an insurance agent or broker, a Navigator or certified application counselor, or an approved enhanced direct enrollment entity.¹¹

You can also call HealthCare.gov’s contact center by dialing 1-800-318-2596 (TTY: 1-855-889-4325). The call center is available 24 hours a day, seven days a week, but it’s closed on holidays.

Texas uses the federally run exchange for individual market plans, so residents who buy their own health insurance enroll through HealthCare.gov.

In the Texas marketplace, nearly nine out of ten eligible enrollees who purchased health plans for 2023 saved money on premium payments amounting to an average savings of $539/month. With the help of these subsidies, enrollees paid premiums of $43/month on average.¹²

Source: CMS.gov⁴

In addition to premium subsidies, the Affordable Care Act also includes cost-sharing reductions (CSR), which help to reduce out-of-pocket costs on Silver-level plans for people with household income up to 250% of the poverty level.¹³

Between the premium subsidies and cost-sharing reductions, you may find that an ACA plan is the cheapest health insurance option for you.

And as noted above, Texas requires health plans to charge higher premiums for Silver-level plans²(to account for the loss of federal CSR funding, but in a uniform manner).

The result is that it’s common to see Gold plans priced lower than Silver plans. If you’re not eligible for CSR, this can make a Gold plan a particularly good value in Texas.³(If you are eligible for CSR, you’ll want to carefully consider Silver plans, as you’ll forfeit your CSR benefit if you don’t select a Silver plan.)

Texas has not expanded Medicaid under the ACA, so there is still acoverage gapin the state. An estimated 772,000 people are in the coverage gap in Texas, which means they earn less than the poverty level, are not eligible for Medicaid (due to lack of Medicaid expansion in Texas), and are also not eligible for subsidies in the Marketplace because their income is under the poverty level.¹⁴

As a result of the Affordable Care Act, federal law only allows a self-employed married couple to purchase small group health insurance if there is at least one additional employee. Even if both spouses work for their business, they aren’t considered to be two separate employees (and thus eligible for group health coverage, which requires at least two employees) under federal law. But Texas law is different, and takes precedence in this case. In Texas, a small group insurer must issue coverage to any group of two or more employees, even if the group only has two employees who are married to each other.¹⁵

So if you and your spouse are self-employed together, you can consider Texas small group plans as well as individual market plans. Marketplace subsidies are not available for small group plans, but you might find that there are factors that make the small group plans preferable (such as the provider network), especially if you’re not eligible for Marketplace subsidies due to your income.

The Texas individual/family Marketplace has 16 participating insurers that offer coverage for 2024,¹⁶although plan participation varies from one area to another.

In most Texas counties, at least three insurers are offering health plans on the exchange in 2024, although some counties in the north-central part of the state only have plans available from one insurer. But there are also numerous counties where five or more insurers offering Marketplace plans.¹

In the Texas individual/family health insurance market, insurance companies have implemented the following average rate changes for 2024, applicable to full-price (pre-subsidy) premiums,¹⁶which amount to a weighted average rate increase of about 5.3%:¹⁷

Source: Texas Rate Review Submissions¹⁶

*Community First Health Plans policies are not available to new enrollees during the open enrollment period for 2024, as enrollments are suppressed due to network issues until May 2024. But existing CFHP policies are not affected, and will renew for 2024.

**FirstCare’s individual/family plans are no longer available in Texas as of 2024.¹⁸FirstCare was bought by Scott & White Health in 2019.¹⁹FirstCare enrollees have the option of switching to any available plan in their area for 2024, even if they’re automatically transitioned to a Scott & White plan.

Prior to the 2023 plan year, Texas did not have an effective rate review program, so the federal government reviewed insurers’ rate proposals in Texas. But that changed as of the 2023 plan year, and the Texas Department of Insurance now handles rate review for individual/family health plans.²⁰

For perspective, here’s an overview of how full-price (pre-subsidy) premiums have changed in the Texas individual/family market over the years:

• 2015: Average increase of 5%.²¹
• 2016: Average increase of 15.8%.²²
• 2017: Average increase of 34%.²³
• 2018: Average increase of 32.5%.²⁴
• 2019: Average increase of 2.3%.²⁵
• 2020: Averagedecreaseof 1.4%.²⁶
• 2021: Average increase of 7.4%.²⁷
• 2022: Average rate increase of 3%.²⁸
• 2023: Average increase of 4.9%.²⁹

Enrollment was far higher in the Texas marketplace in 2023 than in any previous year: During the 2023 open enrollment period, more than 2.4 million people enrolled in private plans.¹²And that came on the heels of a previous record high in 2022.³⁰

The surge in enrollment during these years is likely due to the American Rescue Plan (ARP). Under the ARP, ACA’s premium subsidies are more significant and widely available.³¹The ARP’s subsidy enhancements have been extended through 2025 by theInflation Reduction Act.

Source: 2014,⁵ 2015,⁶2016,⁷2017,⁸2018,⁹2019,¹⁰2020,¹¹2021,¹²2022,¹³2023,¹⁴ 2024¹⁵

HealthCare.gov
800-318-2596

Texas Health Plan Compare(a service of the Texas Department of Insurance)

State Exchange Profile: Texas
The Henry J. Kaiser Family Foundation overview of Texas’ progress toward creating a state health insurance exchange.