You do not have to have health insurance in Texas. The state has never passed an individual mandate, and the federal tax penalty for going without coverage has been $0 since 2019. No agency will fine you for being uninsured. What Texas does have is the highest uninsured rate in the country, and the bills from a single serious medical event can be crushing when you’re paying them yourself.
The Federal Penalty Is Gone
The Affordable Care Act’s individual mandate technically still exists in the law: you’re supposed to maintain “minimum essential coverage.” But the Tax Cuts and Jobs Act of 2017 dropped the penalty to $0 starting with the 2019 tax year, and it has stayed there.1Internal Revenue Service. Questions and Answers on the Individual Shared Responsibility Provision You don’t file anything, you don’t claim an exemption, you don’t owe anything.2HealthCare.gov. Exemptions From the Fee for Not Having Coverage
Texas Has No State Mandate
A handful of states filled the vacuum after the federal penalty went away. California, Massachusetts, New Jersey, Rhode Island, Vermont, and the District of Columbia all enforce their own individual mandates with tax penalties for uninsured residents. Texas is not among them and has never enacted one. State insurance law here regulates what plans sold in Texas must cover, not whether you have to buy a plan.3Texas Department of Insurance. Mandated Health Benefits
When Coverage Can Still Be Required
“Not legally mandated” is not the same as “never required.” Several situations effectively force the issue.
Your Employer or Their Plan
Businesses with 50 or more full-time equivalent employees have to offer affordable coverage under the ACA’s employer mandate, or the IRS penalizes the business. You still aren’t forced to enroll. Declining, though, means walking away from money your employer would have put toward your premium. It also disqualifies you from marketplace subsidies as long as the employer plan meets federal affordability standards.
College and University Enrollment
Many Texas public universities require health insurance to enroll, particularly for international students. The University of Texas System authorizes its institutions to require international students to maintain coverage as a condition of staying enrolled.4The University of Texas System. Rule 50402 – Student Health Insurance Requirements Texas A&M requires F-1 and J-1 international students to buy the system’s student health plan or receive an approved waiver.5The Texas A&M University System. Student Health Insurance State law also lets medical and dental school governing boards require health insurance for their students.6Texas Public Law. Texas Education Code Section 51.952 – Student Health Insurance
J-1 exchange visitors also fall under a federal rule requiring sickness and accident coverage for the entire program, with a minimum of $50,000 per accident or illness.7eCFR. 22 CFR 62.14 – Insurance
Court Orders in Family Cases
Divorce decrees and custody orders often make one or both parents responsible for maintaining health insurance on the children. Ignoring that obligation is contempt of court, and the consequences go well beyond what a premium would have cost.
What Going Uninsured Actually Costs in Texas
The penalty for being uninsured is not a fine anymore. It’s the bill.
As of 2024, 16.7 percent of Texans lack health insurance, and 21.6 percent of working-age adults do — both figures the highest in the country, and both roughly double the national average.8U.S. Census Bureau. Health Insurance Coverage by State – 2023 and 2024 A treat-and-release emergency room visit averaged about $610 for self-pay patients in 2021, and that’s the low end. Anything involving surgery, hospitalization, or a specialist can run to five or six figures fast.9Agency for Healthcare Research and Quality. Costs of Treat-and-Release Emergency Department Visits in the United States, 2021
Charity Care Is a Real Backstop
If you end up uninsured with a large hospital bill, nonprofit hospitals in Texas are required by federal and state law to run financial assistance programs. Under Texas law, hospitals must use an eligibility system tied to the federal poverty guidelines, and they cannot set the income threshold for financially indigent charity care above 200 percent of the federal poverty level.10Texas Department of State Health Services. Texas Health and Safety Code Chapter 311 – Powers and Duties of Hospitals In practice, patients at or below 175 percent of the federal poverty level qualify for free care at every nonprofit hospital in the state.
You can apply after treatment, not only before. Hospitals are required to have the program; they aren’t always eager to bring it up. If you get a bill you can’t pay, call billing and ask about the financial assistance or charity care application by name.
How to Get Covered If You Want To
Texas uses HealthCare.gov as its marketplace. More than 4.1 million Texans selected plans during 2026 open enrollment.11Centers for Medicare and Medicaid Services. Marketplace 2026 Open Enrollment Period Report – National Snapshot
Open Enrollment and Special Enrollment
Open enrollment runs November 1 through January 15.12HealthCare.gov. Get Health Insurance Answers From HealthCare.gov Marketplace Outside that window you generally have to wait until next year, unless a qualifying life event opens a 60-day special enrollment period. Qualifying events include losing existing coverage (job-based, Medicaid, CHIP, or aging off a parent’s plan at 26), getting married or divorced, having or adopting a child, moving to a new ZIP code or county, becoming a citizen, and leaving incarceration.13HealthCare.gov. Getting Health Coverage Outside Open Enrollment The 60 days run from the event, and if you’re losing coverage you can apply up to 60 days before the loss to avoid a gap.
Subsidies Changed in 2026
Premium tax credits still exist, but the enhanced subsidies in place since 2021 expired at the end of 2025 and were not renewed.14Congress.gov. Enhanced Premium Tax Credit and 2026 Exchange Premiums A household at 200 percent of the federal poverty level was expected to contribute about 2 percent of income toward the benchmark premium in 2025; in 2026 that jumps to 6.6 percent. Households above 400 percent of the federal poverty level are now ineligible entirely. If you received subsidies last year, expect your 2026 bill to be higher even if the plan hasn’t changed.
Catastrophic Plans
Catastrophic plans offer low premiums and high deductibles, covering essential benefits and preventive care but leaving most routine costs to you until you hit the deductible.15HealthCare.gov. Catastrophic Health Plans They were limited to people under 30. For 2026, CMS opened them to people 30 and older who qualify for a hardship or affordability exemption, including a new category for those whose income falls below 100 percent or above 400 percent of the federal poverty level and who therefore lost subsidy eligibility.
Medicaid and CHIP
Texas has not expanded Medicaid under the ACA. Adults without dependent children, and most low-income parents, do not qualify unless they’re pregnant, disabled, or fit another narrow category. Income limits sit well below the 138 percent of the federal poverty level used in expansion states.
Children have more room. CHIP covers kids 18 and under in families that earn too much for Medicaid but not enough to buy private insurance comfortably. The income limit for a family of four is $5,528 per month before taxes.16Texas Health and Human Services. Children’s Medicaid and CHIP Premiums are low, and you can apply any time; there is no limited enrollment window.