Health insurance in Texas

Reviewed September 4, 2026 · 2026 federal data

Source: CMS Marketplace Open Enrollment Public Use Files and US Census Small Area Health Insurance Estimates, 2026 release. Figures cover the under-65 population.

Where you enroll

Texas uses the federally facilitated marketplace, so you enroll at HealthCare.gov on the federal calendar — the dates are here.

Texas has a coverage gap

Texas has not adopted the Medicaid expansion. That creates a specific and badly-known problem: the premium tax credit was written on the assumption that everyone below 100% of the poverty guideline would be covered by an expanded Medicaid, so the credit does not start until 100%. In a state that did not expand, an adult below that line qualifies for neither.

In practice that means an adult in Texas earning under $15,960 a year — roughly $1,330 a month — may be offered no help at all, while someone earning slightly more gets a substantial subsidy. It is the one part of this system where earning less can leave you worse off.

Texas's uninsured rate is 19.1% of under-65 residents, or 5,023,981 people. Some of them are in this gap.

Texas is several markets, not one

Texas is not one market. Its counties range from 1 insurer to 10 — a gap of 9. Someone at one end of the state is shopping in a genuinely different market from someone at the other, at the same age and the same income.

7 counties in Texas have just one insurer selling on the exchange. In those, comparison shopping is not really available and the benchmark plan is whatever the single company filed. No county in Texas changed its number of insurers since the previous plan year.

Heavy marketplace use

4,171,965 Texas residents selected a marketplace plan for 2026. Against the state's under-65 population that is 159 per thousand, well above the 26-state median of 79, and 2nd highest of the 26 states on this site.

Of those, 764,301 — 18% — were new rather than renewing, which is an unusually high share of first-time buyers (2nd of 26).

The spread inside Texas

Harris County is the largest county we publish here, with 4,296,879 under-65 residents; Potter County is the smallest, with 91,283. Harris County has 9 insurers offering 121 plans, and Potter County has 4 offering 54.

The widest choice in Texas is in Dallas County — 10 insurers, 138 plans. The narrowest is Wichita County, with 1 insurer and 19 plans. Same state, same rules, 119 more plans to choose from.

Uninsured rates range from 10.8% in Williamson County to 26.7% in Hidalgo County — 2.5 times as high, within one state.

The 43 largest counties in Texas

By under-65 population, covering 87% of the state's under-65 residents. Texas has 251 counties with complete federal data; we publish pages for the largest.

Source: CMS Marketplace Open Enrollment Public Use Files and US Census Small Area Health Insurance Estimates, 2026 release. "Per 1,000" is marketplace plan selections per thousand under-65 residents.

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