Health insurance in Smith County, Texas
4 insurers sell 61 marketplace plans here, and 21.0% of under-65 residents have no coverage at all.
Source: CMS Marketplace Open Enrollment Public Use Files and US Census Small Area Health Insurance Estimates, 2026 release.
Who sells here, and how much choice that gives
4 insurers sell marketplace plans in Smith County, offering 61 plans between them, roughly 15 each. The number has not changed since the previous plan year.
One in six has no coverage
21.0% of Smith County's 198,975 under-65 residents have no health coverage — 41,733 people. That is above the Texas rate of 19.1%, and puts Smith County in the top 10% of the 1,817 counties on this site (101st).
Some of those 41,733 are in the Texas coverage gap: under $15,960 a year, too little for a subsidy and no expanded Medicaid to fall back on.
The marketplace is used heavily here
27,596 Smith County residents selected a marketplace plan for 2026: 139 per thousand under-65 residents, 394th of 1,817. That is 1.8× the 78 per thousand typical here. 4,101 of them — 15% — were new rather than renewing.
Smith County against Texas
Smith County is the 24th largest of the 43 Texas counties we publish. Its uninsured rate runs 1.9 points higher than Texas overall and its 4 insurers sit between the state's 1 and 10. Marketplace use is close to the Texas rate.
| Smith County | Texas | Published median | |
|---|---|---|---|
| Uninsured, under 65 | 21.0% | 19.1% | 9.9% |
| Insurers selling | 4 | 1–10 | 4 |
| Plans offered | 61 | — | 57 |
| Selections per 1,000 | 139 | 159 | 78 |
| New rather than renewing | 15% | 18% | 15% |
Counties of a similar size nearby
| County | Under 65 | Uninsured | Insurers | Plans |
|---|---|---|---|---|
| Ellis County | 199,216 | 16.1% | 8 | 119 |
| Brazos County | 200,739 | 17.3% | 4 | 55 |
| Jefferson County | 194,962 | 20.3% | 6 | 91 |
| McLennan County | 219,047 | 18.3% | 3 | 44 |
Ellis County has 8 insurers against this county's 4 — a reminder that the county line, not the state line, is what decides your options.
Other Texas counties · Where the subsidy stops · Enrollment dates