Texas Health Insurance: Marketplace, Private Plans & 2027 Changes
Shopping for health insurance in Texas? The individual market is changing significantly for 2027. Baylor Scott & White Health Plan and Cigna are leaving the individual Marketplace, while premiums are changing by very different amounts depending on the insurance company.
Texas will still have one of the country's largest and most competitive individual health insurance markets, with 14 Marketplace insurers expected for 2027. But your choices depend heavily on your ZIP code, and some areas have far fewer options than Houston, Dallas, Austin, or San Antonio.
We help self-employed workers, individuals, families, early retirees, and small business owners compare HealthCare.gov plans with other available private coverage while looking at premiums, deductibles, doctors, hospitals, prescriptions, networks, and total out-of-pocket exposure.
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Texas Health Insurance at a Glance
| Topic | What Texas Residents Should Know |
|---|---|
| Marketplace | Texas uses the federal Marketplace at HealthCare.gov. |
| 2027 Open Enrollment | November 1, 2026 through January 15, 2027. |
| January 1 Coverage | Select a Marketplace plan by December 15, 2026. |
| 2027 Marketplace Insurers | 14 participating insurers are expected, down from 16 in 2026. |
| Leaving for 2027 | Baylor Scott & White Health Plan and Cigna. |
| 2027 Rate Filings | Current filing analysis points to an overall increase of roughly 14% before subsidies, with large differences by insurer. |
| Marketplace Financial Help | Premium Tax Credits generally require household income between 100% and 400% of the federal poverty level, plus other eligibility requirements. |
| Texas Medicaid | Texas has not adopted ACA Medicaid expansion for the general adult population. |
| Coverage Gap | Some very low-income Texas adults may qualify for neither Medicaid nor Marketplace Premium Tax Credits. |
Baylor Scott & White Health Plan Is Leaving the Marketplace
Baylor Scott & White Health Plan has announced that it will discontinue its Individual & Family Marketplace plans after December 31, 2026.
Current members remain covered under their existing 2026 plan through the end of the coverage period, assuming premiums and other plan requirements are met.
If you currently use Baylor Scott & White doctors, hospitals, or specialists, the important question is whether those providers participate in the exact 2027 replacement plan you're considering.
Cigna Is Also Leaving Texas Individual & Family Medical Coverage
Cigna has announced that it will no longer offer Individual & Family medical insurance for 2027.
Cigna's Texas individual-market withdrawal affects people in several areas of the state who currently have individual medical coverage.
Existing 2026 Cigna medical coverage remains available through the end of 2026, but affected members will need replacement medical coverage for 2027.
Have Baylor Scott & White or Cigna? What to Check Before Switching
1. Your Doctors
Make a list of your primary care physician, specialists, and other providers you regularly use.
2. Your Hospital System
Hospital access can be one of the biggest differences between Texas individual plans.
Check the specific hospitals and facilities you want rather than relying only on the carrier name.
3. Your Prescriptions
Compare the exact medication, dosage, drug tier, pharmacy network, prior authorization rules, and prescription deductible.
4. The Full Cost
Compare premium, deductible, specialist costs, prescriptions, hospital cost sharing, and the annual out-of-pocket maximum.
Texas Uses HealthCare.gov
Texas does not operate its own state-based individual health insurance Marketplace.
Texas residents use the federally facilitated Marketplace at HealthCare.gov for ACA Marketplace coverage.
Marketplace Qualified Health Plans include protections such as:
- Coverage for pre-existing conditions
- ACA-required essential health benefits
- Preventive services
- Prescription drug coverage
- Hospital and emergency coverage
- Defined annual limits on covered in-network out-of-pocket costs
- No medical underwriting for eligibility
Texas Will Have 14 Marketplace Insurers for 2027
Texas is expected to have 14 participating Marketplace insurers in 2027, down from 16 in 2026 after Baylor Scott & White and Cigna exit.
Consumer-facing insurers and brands continuing in parts of Texas include:
Blue Cross Blue Shield of Texas
One of the largest individual-market insurers in Texas, with availability across a broad portion of the state.
Ambetter
Ambetter-branded Marketplace coverage is offered through more than one legal insurance entity in Texas.
Oscar
Oscar continues to participate in significant portions of the Texas individual Marketplace.
UnitedHealthcare
UnitedHealthcare continues offering individual coverage in Texas, with plan and county availability varying.
CHRISTUS Health Plan
CHRISTUS continues to offer individual coverage in its applicable Texas service areas.
Other Regional Insurers
Other Texas participants include regional carriers such as Community First, Community Health Choice, Sendero, Molina, Imperial, Moda, Wellpoint, and Harbor Health, depending on location.
Texas Health Insurance Rate Changes for 2027
Texas insurers have filed 2027 individual-market rates, and the increases vary substantially by insurance company and legal issuer entity.
A current analysis of the filings estimates an enrollment-weighted increase of approximately 14% across the Texas individual market before Marketplace subsidies.
Examples from current filings include:
| Insurance Company / Issuer | Current 2027 Filing |
|---|---|
| Celtic Insurance / Ambetter | About +4.6% |
| Blue Cross Blue Shield of Texas | About +8.8% to +9.9% by product |
| Oscar | About +9.6% |
| Superior HealthPlan / Ambetter | About +10.9% |
| CHRISTUS Health Plan | About +12.5% |
| Molina Healthcare of Texas | About +12.7% |
| Imperial Insurance Companies | About +12.8% |
| Community First Insurance Plans | About +14.2% |
| Harbor Health | About +14.6% |
| Wellpoint Texas | About +15.3% |
| Moda Health Plan | About +22.5% |
| Community Health Choice | About +27.2% |
| UnitedHealthcare of Texas | About +27.4% |
| Sendero Health Plans | About +31.1% |
| UnitedHealthcare Benefits of Texas | About +34.0% |
| Baylor Scott & White | Exiting individual Marketplace coverage |
| Cigna | Exiting individual medical coverage |
Your actual 2027 cost depends on your age, county, specific plan, tobacco rating where applicable, household information, and any Marketplace financial assistance for which you qualify.
Your Texas County Matters More Than the Statewide Carrier Count
Texas is a large and highly regional insurance market.
Someone shopping for coverage in Houston may see a completely different combination of plans from someone in Dallas-Fort Worth, Austin, El Paso, Lubbock, Corpus Christi, the Rio Grande Valley, or rural North Texas.
Texas has historically had some counties with many competing Marketplace insurers and some rural or north-central counties with very limited carrier choice.
Texas Provider Networks Can Be Very Different
Many Texas individual plans use HMO or EPO-style provider networks.
That can make network verification particularly important if you use a major hospital system, have several specialists, or travel regularly.
Before selecting a plan, check:
- Your primary care doctor
- Your specialists
- Your preferred hospital system
- Your regular prescriptions
- Your preferred pharmacy
- Nearby urgent care facilities
- Out-of-area non-emergency coverage
Can You Still Use Baylor Scott & White Doctors in 2027?
Potentially, yes.
Baylor Scott & White Health Plan leaving the Marketplace does not mean Baylor Scott & White doctors and hospitals disappear from every Marketplace network.
Baylor Scott & White has specifically said its health system will continue accepting Marketplace insurance.
Marketplace Financial Assistance in Texas for 2027
Eligible Texans can still receive federal Premium Tax Credits when purchasing qualifying coverage through HealthCare.gov.
The temporary enhanced Premium Tax Credit rules that applied through 2025 have ended.
Under the general rules now in effect, Premium Tax Credit eligibility generally requires household income between 100% and 400% of the federal poverty level, along with other eligibility requirements.
Based on the applicable 2026 federal poverty guidelines, 400% of the poverty guideline is approximately:
One-Person Household
Approximately $63,840 per year.
Family of Four
Approximately $132,000 per year.
Self-Employed Health Insurance in Texas
Texas has a large independent workforce, including oilfield and energy contractors, construction workers, truck drivers, owner-operators, real estate professionals, rideshare and delivery drivers, consultants, technology contractors, freelancers, and small business owners.
One of the biggest challenges for self-employed households using HealthCare.gov is estimating annual income.
Use Expected Net Self-Employment Income
Marketplace income calculations generally use expected net self-employment income after eligible business expenses rather than simply gross revenue.
Income Can Change Quickly
Oil and gas work, commissions, contracting, real estate, construction, seasonal work, and business ownership can create large income swings.
Update Significant Changes
If your income estimate changes materially during the year, update your Marketplace application rather than waiting until the next Open Enrollment.
Tax Planning Can Matter
Certain eligible retirement contributions, HSA contributions, and other tax adjustments can affect Adjusted Gross Income.
Talk with your tax professional about which deductions apply to your circumstances.
Marketplace Plans vs. Other Private Health Coverage in Texas
Texans may also encounter health insurance and health-benefit products sold outside HealthCare.gov.
They do not necessarily work the same way as ACA Marketplace major medical coverage.
HealthCare.gov Marketplace Plans
- ACA-compliant major medical coverage
- Coverage for pre-existing conditions
- ACA-required essential health benefits
- Defined annual out-of-pocket limits
- No medical underwriting for eligibility
- Premium Tax Credits for eligible households
Other Private Coverage
- May be available outside HealthCare.gov
- Some products use medical underwriting
- Pre-existing-condition rules may differ
- Benefits and exclusions can differ
- Provider networks may be structured differently
- Marketplace Premium Tax Credits generally cannot be used
Looking for PPO Health Insurance in Texas?
Network flexibility can matter for Texans who travel, work in multiple cities, own businesses in several states, drive professionally, or want access to providers outside a local health system.
Many Marketplace individual plans in Texas use HMO or EPO-style networks.
Some non-Marketplace plans may use PPO networks, but network breadth and coverage rules vary considerably.
Texas Medicaid and the Coverage Gap
Texas has not adopted the ACA Medicaid expansion for the general low-income adult population.
Instead, Medicaid eligibility depends on fitting into specific categories.
Texas Medicaid can cover qualifying people including:
- Children
- Pregnant women
- Certain parents and caretaker relatives
- People who are elderly
- People with qualifying disabilities
- People who qualify for certain long-term care programs
The Texas Medicaid Coverage Gap
Because Texas has not expanded Medicaid, some adults with very low incomes can fall into what is commonly called the Medicaid coverage gap.
Under the general federal rules, Marketplace Premium Tax Credits generally begin at 100% of the federal poverty level.
But Texas does not have a general Medicaid expansion category for all adults below that level.
Texas Medicaid and CHIP for Children
Families should not assume everyone in the household has to use the same type of coverage.
A parent might use HealthCare.gov or employer coverage while a child qualifies for Children's Medicaid or the Children's Health Insurance Program, commonly called CHIP.
CHIP is designed for children age 18 or younger in qualifying families that earn too much for Children's Medicaid but meet CHIP eligibility requirements.
Texas Open Enrollment for 2027
Texas follows the federal HealthCare.gov Open Enrollment schedule.
Open Enrollment for 2027 coverage runs from November 1, 2026 through January 15, 2027.
- November 1, 2026: Open Enrollment begins.
- December 15, 2026: Select a plan by this date for coverage beginning January 1, 2027.
- January 15, 2027: Open Enrollment ends. Coverage selected after December 15 generally begins February 1.
Leaving a Job or Losing Employer Health Insurance?
Losing qualifying employer-sponsored coverage can create a Special Enrollment Period through HealthCare.gov.
Depending on your situation, compare:
- COBRA continuation coverage
- A spouse's employer-sponsored plan
- A HealthCare.gov Marketplace plan
- Texas Medicaid or CHIP if eligible
- Other available individual coverage
COBRA may allow you to keep your existing employer coverage temporarily, but the monthly premium can increase substantially when the employer stops contributing.
Texas Health Insurance for Early Retirees
Retiring before age 65 can leave several years between employer health insurance and Medicare.
Depending on your circumstances, you may compare:
- HealthCare.gov Marketplace coverage
- COBRA
- A spouse's employer-sponsored plan
- Other available private coverage
Marketplace financial assistance makes income planning especially important because taxable retirement withdrawals, pensions, investment income, business income, and other income can affect household MAGI.
Small Business Health Insurance in Texas
Texas employers have several ways to approach employee health benefits.
Depending on the business, options may include:
Traditional Group Coverage
Employer-sponsored group health insurance where eligible employees participate in the company's group plan.
Level-Funded Coverage
Certain employers may qualify for level-funded arrangements that combine employer funding with stop-loss protection.
Underwriting, plan design, and refund provisions vary by carrier.
ICHRA
An Individual Coverage HRA can allow an employer to reimburse eligible employees for qualifying individual health coverage under applicable rules.
QSEHRA
Certain qualifying small employers that don't offer a group health plan can reimburse eligible workers for qualifying individual premiums and medical expenses.
A Unique Texas Rule for Very Small Businesses
Texas has an unusual small-group insurance rule that can matter for family-owned businesses.
Under Texas insurance law, a small-group carrier generally cannot deny two qualifying employees small-group status solely because those two employees are married.
Each spouse must qualify as an eligible employee rather than one simply enrolling as the other's dependent.
Business documentation, employee status, participation rules, and carrier requirements still apply.
How We Help Texas Residents
Self-Employed & 1099 Workers
Oilfield and energy contractors, construction workers, truck drivers, owner-operators, real estate professionals, rideshare drivers, technology contractors, consultants, freelancers, and other independent workers.
Baylor Scott & White & Cigna Members
If your existing individual plan is ending, we can help compare replacement coverage and recheck doctors, hospitals, prescriptions, networks, and costs.
Individuals & Families
We compare premiums, deductibles, provider networks, prescriptions, Marketplace assistance, and other available options.
People Paying Full Price
If you don't qualify for Marketplace Premium Tax Credits, we can compare full-price Marketplace coverage with other available options.
Early Retirees
We help people who need coverage before Medicare compare Marketplace coverage, COBRA, spouse coverage, and other available options.
Small Business Owners
We can discuss traditional group coverage, level-funded arrangements, ICHRAs, QSEHRAs, and additional employee benefits.
Serving Clients Across Texas
We work with Texas residents by phone and video, so you don't need to live near a local insurance office.
Dallas, Fort Worth, Arlington, Plano, Frisco, McKinney, Irving, Denton and surrounding communities
Houston, Katy, Sugar Land, The Woodlands, Pasadena, Pearland and surrounding communities
Austin, Round Rock, Georgetown, Waco, Temple, Killeen and surrounding communities
San Antonio, New Braunfels, Corpus Christi, Laredo and surrounding communities
McAllen, Edinburg, Mission, Brownsville, Harlingen and surrounding communities
El Paso, Lubbock, Amarillo, Midland, Odessa and surrounding communities
Tyler, Longview, Beaumont and surrounding communities
We work with clients throughout Texas's rural counties by phone and video
Official Texas Health Insurance Resources
HealthCare.gov
Marketplace enrollment, Premium Tax Credits,
plan comparison, and Special Enrollment Periods.
Visit HealthCare.gov →
Texas Department of Insurance
Compare Texas health plans, review insurers,
provider networks, rates, and consumer information.
Visit Texas Department of Insurance →
Texas Health Plan Compare
Texas Department of Insurance comparison information
for locally available health plans.
Compare Texas Health Plans →
Texas Medicaid & CHIP
Eligibility and application information for
Medicaid and children's coverage.
Visit Texas Medicaid & CHIP →
Common Questions About Texas Health Insurance
Does Texas use HealthCare.gov?
Yes. Texas uses the federally facilitated Marketplace at HealthCare.gov for individual and family Marketplace coverage.
Is Baylor Scott & White leaving the Texas Marketplace?
Yes. Baylor Scott & White Health Plan says its Individual & Family Marketplace plans will end after December 31, 2026.
Is the Baylor Scott & White health system closing?
No. The insurance-plan exit is separate from the Baylor Scott & White health system.
Baylor Scott & White says its providers will continue accepting Marketplace insurance plans. Check whether your specific doctors and hospitals are included in the replacement plan you're considering.
Is Cigna leaving Texas individual health insurance?
Yes. Cigna says it will no longer offer Individual & Family medical plans for 2027.
How many Marketplace insurers will Texas have in 2027?
Texas is expected to have 14 participating Marketplace insurers in 2027, down from 16 in 2026.
The number actually available to you depends on your county and ZIP code.
How much are Texas health insurance premiums increasing in 2027?
Current filing analysis points to an average unsubsidized individual-market increase of roughly 14%.
Carrier filings vary substantially, so your actual change can be much higher or lower.
When is Texas Open Enrollment for 2027?
Open Enrollment runs from November 1, 2026 through January 15, 2027.
Select a plan by December 15 for coverage beginning January 1, 2027.
Can I still see my Baylor Scott & White doctor?
Possibly. Baylor Scott & White providers may participate in networks offered by other 2027 insurance companies.
Verify the exact physician and plan before enrolling.
Does Texas have PPO health insurance?
PPO networks may be available through certain employer, small-group, or non-Marketplace products, while many individual Marketplace products use HMO or EPO-style networks.
Always verify the exact network rather than relying only on the PPO label.
Did Texas expand Medicaid?
No. Texas has not adopted the ACA Medicaid expansion for the general low-income adult population.
What is the Texas Medicaid coverage gap?
Marketplace Premium Tax Credits generally begin at 100% of the federal poverty level, while Texas does not provide Medicaid coverage to all adults below that income level.
Some very low-income adults can therefore qualify for neither program.
Can my children qualify for Medicaid or CHIP even if I don't?
Yes. Texas uses different eligibility rules for children than for adults.
A child may qualify for Children's Medicaid or CHIP even when the parents use Marketplace, employer-sponsored, or other coverage.
Can self-employed Texans use HealthCare.gov?
Yes. Self-employed Texans can purchase individual Marketplace coverage and may qualify for Premium Tax Credits if they meet the applicable requirements.
Can a husband-and-wife Texas business get small-group health insurance?
Texas has special small-group rules that can allow two qualifying employees who are married to be treated as eligible employees rather than denying group status solely because they are spouses.
Business documentation and other small-group eligibility rules still apply.
Can I get Texas health insurance outside Open Enrollment?
Possibly. Marketplace enrollment outside Open Enrollment generally requires a Special Enrollment Period after a qualifying event such as losing coverage, getting married, having a baby, or certain moves.
Medicaid and CHIP accept applications throughout the year for eligible Texans. Other types of coverage can have different enrollment rules.
Is private health insurance cheaper than HealthCare.gov?
It depends on the person and the type of coverage.
Some non-Marketplace products may have lower premiums for certain eligible applicants, but benefits, medical underwriting, exclusions, provider networks, and pre-existing-condition provisions can differ.
Compare the actual coverage rather than choosing based solely on the monthly premium.
Can you check whether my doctors and hospitals are in network?
Yes. Give us the names of your physicians, specialists, preferred hospitals, prescriptions, and pharmacy when we compare your options.
Can you help me if your office is in Arizona?
Yes. We are licensed in Texas and work with Texas clients remotely by phone and video.
Compare Your Texas Health Insurance Options for 2027
With Baylor Scott & White and Cigna leaving, 14 Marketplace insurers remaining, substantial differences in 2027 rate filings, and major county-by-county network differences, this is an important year to review your coverage.
We'll help you compare the available options, check your doctors, hospitals, and prescriptions, and understand the costs and coverage before you choose.
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