Open Enrollment Period in Texas

• Annual Open Enrollment: November 1 – January 15

• This is the time to:

  • Enroll in a new plan

  • Renew existing coverage

  • Switch between plans

Special Enrollment Period (SEP)

Outside of Open Enrollment, you may qualify for a Special Enrollment Period if you experience:

• Marriage or divorce

• Birth or adoption of a child

• Moving to a new ZIP code

• Loss of other health coverage

• Release from incarceration

Types of Health Insurance Plans Available in Texas

Plans are organized by metal tiers:

• Bronze: Lowest premiums, highest out-of-pocket costs

• Silver: Balanced costs, eligible for CSR

• Gold: Higher premiums, lower costs at time of care

• Platinum: Highest premiums, lowest deductibles/copays

Plan Formats:

• HMO: Requires referrals, limited networks, lower cost

• PPO: No referrals needed, broader networks, higher cost

• EPO: In-network only, no referrals, mid-range cost

Catastrophic Plans are available to Texans under 30 or those with a hardship exemption.

Eligibility for Subsidies and Cost Assistance in Texas

• Premium Tax Credits: Available for households earning 100% to 400% of the federal poverty level (FPL)

• Cost-Sharing Reductions (CSR): Only available with Silver plans for households earning under 250% of the FPL

• Medicaid in Texas: Texas has not expanded Medicaid, limiting eligibility for low-income adults

• CHIP (Children’s Health Insurance Program): Available for children and pregnant women in moderate-income families

How to Compare and Choose a Plan in Texas

When comparing plans, consider:

• Monthly premium vs. out-of-pocket maximums

• Access to doctors and hospitals (check if your provider is in-network)

• Prescription drug coverage (formularies vary)

• Specific needs for maternity care, mental health, or chronic conditions

Tips:

• Self-employed Texans may benefit from a Silver plan with CSR

• Families should explore whether children qualify for CHIP

• Retirees under 65 should compare premium vs. deductible trade-offs carefully

Top Insurance Providers on the Texas Marketplace

Major insurers on the Texas exchange may include:

• Blue Cross and Blue Shield of Texas

• Ambetter from Superior HealthPlan

• Molina Healthcare of Texas

• Oscar Health

• Cigna

• UnitedHealthcare (limited areas)

Availability varies by county — for example, some carriers serve metro areas like Houston and Dallas, while others serve rural parts of Texas.

Navigating Texas’s Online Enrollment Portal

To enroll, go to HealthCare.gov. You’ll need:

• Household income details

• Information on household members

• Employer and current insurance info (if applicable)

Need help? Use the local assistance tool to find licensed agents or certified enrollment navigators in Texas.

Alternatives to the Marketplace in Texas

If Marketplace coverage isn’t right for you, consider:

• Short-term health insurance: Coverage up to 364 days (renewable); may not include essential benefits

• Off-exchange private plans: Direct from insurers (no subsidies available)

• Faith-based health-sharing ministries: Allowed in Texas but not regulated like insurance

Common Mistakes to Avoid During Enrollment

• Not updating your income during the year

• Forgetting to remove old household members or dependents

• Choosing a plan based only on price, not network or benefits

• Missing the enrollment deadline

• Overestimating or underestimating your income for subsidies

Texas-Specific Health Programs or Initiatives

• No Medicaid Expansion: Texas has not expanded Medicaid under the ACA

• CHIP Perinate Program: Covers prenatal and delivery costs for pregnant women who don’t qualify for Medicaid

• Healthy Texas Women: Offers women’s health and family planning services for low-income Texans

• Telehealth Access Expansion: Many Marketplace plans now include virtual care options