Texas Health Insurance Marketplace 2026: Coverage If You Earn Too Much for Medicaid

Texas did not expand Medicaid. That means most adults without children, a disability, or a pregnancy can't get Texas Medicaid at any income. If that's you, the Health Insurance Marketplace is usually your best option for real coverage.

Who the Marketplace Is For

• Adults who earn too much for Medicaid, or who don't fit a Medicaid group
• People whose job doesn't offer affordable health insurance
• Self-employed workers, gig workers, and small business owners
• Parents and pregnant women who lost Medicaid after it ended
• Lawfully present immigrants, including many who can't get Medicaid yet

How Texans Sign Up

Texas uses the federal Marketplace. You apply at HealthCare.gov or by calling the Marketplace at 1-800-318-2596. There is no separate Texas state website.

1. Make an account on HealthCare.gov.
2. Estimate your income for next year. Your help paying depends on this number, not last year's.
3. Compare plans. Look at the monthly cost, the deductible, and whether your doctors and pharmacy are in the network.
4. Pick a plan and pay your first month to turn your coverage on.

Help Paying for a Plan

Most people who sign up get a premium tax credit that lowers the monthly bill. It's based on your household income and size. People with lower incomes may also get cost-sharing reductions on Silver plans, which lower deductibles and copays.

The amount of help can change from year to year. HealthCare.gov shows your real price after you enter your income — so check before deciding you can't afford it.

The Texas "Coverage Gap"

Help paying for a Marketplace plan usually starts at the federal poverty level. Adults who earn less than that and don't qualify for Medicaid fall into what's called the coverage gap. If that's you, you still have options:

• Free and sliding-scale clinics — care based on what you can pay
• Healthy Texas Women — free women's health care for ages 18–44
• Emergency Medicaid — for emergency care, regardless of status
• County hospital programs, such as Harris Health's financial help program

When You Can Sign Up

• Open Enrollment: every year from November 1 to January 15. Sign up by December 15 for coverage starting January 1.
• Special Enrollment: you usually get 60 days to sign up after a life change — losing Medicaid or CHIP, losing job coverage, moving, getting married, or having a baby.
• Losing Medicaid? Don't wait. Apply on HealthCare.gov right after your denial or end-of-coverage letter. See our Medicaid renewal guide too.

Check Medicaid and CHIP First for Your Kids

Even if you don't qualify, your children or a pregnant family member might. Texas covers many more children and pregnant women than adults. See CHIP income limits, Pregnancy Medicaid, and Texas Medicaid eligibility.

What to Have Ready

• Social Security numbers (or immigration documents) for everyone applying
• Pay stubs, W-2s, or your best income estimate for next year
• Information about any job-based insurance offered to you
• Your current doctors and prescriptions, to check plan networks

Texas Health Help is a community nonprofit, not a government agency or insurance company. We don't sell plans. Prices, dates, and help amounts are set by HealthCare.gov and can change each year.