To get health insurance in Texas, you apply through one of two places: Healthcare.gov for a private Marketplace plan (with income-based subsidies for most households), or YourTexasBenefits.com for Medicaid or the Children’s Health Insurance Program (CHIP). Texas does not run its own state exchange, so every individual and family Marketplace plan in the state is shopped and enrolled through the federal site.1Texas.gov. Texas Health Insurance Which door you use depends on your income, your household, and your immigration status.
Which Program Fits Your Situation
Start with income. Marketplace premium tax credits are available to households earning between 100% and 400% of the federal poverty level (FPL).2HealthCare.gov. Federal Poverty Level (FPL) For 2026, that runs from roughly $15,960 to $63,840 for a single person, or about $33,000 to $132,000 for a family of four.3HHS ASPE. 2026 Poverty Guidelines Enhanced subsidies in effect from 2021 through 2025 removed the 400% cap and boosted credit amounts, but they were set to expire after the 2025 plan year, and whether Congress extends them for 2026 is unresolved. Under the baseline rule, households above 400% FPL pay full price.
Texas has not expanded Medicaid, so adult Medicaid eligibility is narrow. You generally must be a parent or caretaker of a dependent child, pregnant, or have a qualifying disability, and the income limits are very low. A single parent with two children, for example, must earn no more than about $230 per month (roughly 10% of FPL) to qualify.4Texas Health and Human Services. Medicaid for Parents and Caretakers Children and pregnant women qualify at higher income thresholds.
CHIP covers children under 19 in families earning too much for Medicaid but who cannot afford private insurance. In Texas, the cutoff is 201% FPL, roughly $54,900 a year for a family of three.5Medicaid.gov. CHIP Eligibility and Enrollment CHIP is not free at every income level: depending on where you fall, you may owe an annual enrollment fee of up to $50 per family, plus copays from $3 to $35.6Texas Health and Human Services. CHIP
Immigration status also matters for Marketplace enrollment. U.S. citizens, lawful permanent residents, refugees, asylees, people with employment authorization, and holders of certain visas (H-1, H-2, student, U, and T among them) qualify.7HealthCare.gov. Immigration Status to Qualify for the Marketplace As of late 2025, DACA recipients are not eligible for Marketplace coverage, though court orders and legislation could shift that.8HealthCare.gov. Health Coverage for Lawfully Present Immigrants Without a qualifying status, your options are generally limited to plans bought directly from an insurer outside the Marketplace.
If You Fall in the Coverage Gap
Because Texas has not expanded Medicaid, many adults earn too much for Medicaid but too little for Marketplace subsidies, which do not start until 100% FPL. A single adult earning $10,000 a year is a common example. If you are in that gap, Texas has 71 Federally Qualified Health Centers running more than 700 service sites that provide primary, dental, mental health, and substance use care on a sliding fee scale and cannot turn you away for inability to pay.9Texas DSHS. Federally Qualified Health Centers (FQHCs) You can also buy a Marketplace plan at full price or check county indigent-care programs.
When You Can Enroll
Marketplace open enrollment runs November 1 through January 15.10Centers for Medicare and Medicaid Services. Marketplace 2026 Open Enrollment Fact Sheet Pick a plan by December 15 and coverage starts January 1; enroll between December 16 and January 15 and coverage starts February 1.11HealthCare.gov. When Can You Get Health Insurance Miss the window and you generally wait until next year unless a qualifying life event triggers a special enrollment period.
Qualifying events include marriage, the birth or adoption of a child, losing other health coverage, or a permanent move to a new zip code. Most special enrollment periods last 60 days from the event; losing Medicaid or CHIP gives you 90 days.12HealthCare.gov. Special Enrollment Opportunities
Medicaid and CHIP work differently. There is no annual enrollment window. You can apply through Your Texas Benefits any time of year.13Your Texas Benefits. Your Texas Benefits – Learn
What to Gather Before You Apply
Pull these together for every household member on the application:
- Social Security numbers for U.S. citizens, or immigration document numbers for non-citizens with qualifying status.
- Recent pay stubs, W-2s, or self-employment records showing current monthly income. If earnings have changed since your last tax return, use your best estimate for the coverage year.
- Employer name and address for each working household member, plus what the employer’s cheapest health plan costs you.
- Your most recent federal tax return (Form 1040).
The Marketplace calculates subsidies from your modified adjusted gross income (MAGI), which includes wages, tips, self-employment income after expenses, unemployment, and Social Security benefits (including the non-taxable portion).14HealthCare.gov. What’s Included as Income It also picks up untaxed foreign income and tax-exempt interest.15HealthCare.gov. Modified Adjusted Gross Income (MAGI) Child support and Supplemental Security Income do not count. Because subsidies are based on projected income, report income and household changes to the Marketplace as they happen, not at year end. If you don’t, credits will keep paying out on old numbers and you’ll owe the difference at tax time.16HealthCare.gov. Reporting Income, Household, and Other Changes
If your employer offers coverage, you can still qualify for Marketplace subsidies, but only if that plan is too expensive or falls short of minimum value standards. For 2026, employer coverage counts as unaffordable if your share of the cheapest available plan’s premium exceeds 9.96% of household income.17HealthCare.gov. If You’d Like to Change to a Marketplace Plan Have that premium figure ready when you apply.
How to Submit Your Application
For a Marketplace plan, you can:
- Apply online at Healthcare.gov by creating an account and completing the guided application.
- Call the Marketplace at 1-800-318-2596 (TTY 1-855-889-4325), open 24/7.18HealthCare.gov. Contact Us
- Request a paper application by phone and mail it to the federal processing center.
- Use the “Find Local Help” tool on Healthcare.gov to work with a certified navigator, agent, or broker at no cost.19HealthCare.gov. Find Local Help
For Medicaid or CHIP, apply at YourTexasBenefits.com, visit a Texas Health and Human Services office, or call 2-1-1.13Your Texas Benefits. Your Texas Benefits – Learn The Your Texas Benefits site has a prescreening tool that flags which programs you may qualify for before you commit to a full application.
Choosing a Marketplace Plan
Marketplace plans come in four metal tiers based on how costs split between you and the insurer.20HealthCare.gov. Health Plan Categories: Bronze, Silver, Gold and Platinum Bronze plans cover about 60% of costs on average, with the lowest premiums and highest out-of-pocket costs. Silver covers about 70%. Gold covers about 80%. Platinum covers about 90%, with the highest premiums and lowest costs at the point of care. The tier reflects cost sharing, not the quality of care or network size.
If your income is low enough, picking a Silver plan unlocks cost-sharing reductions that lower your deductibles, copays, and coinsurance. These reductions can push a Silver plan’s effective coverage to somewhere between 73% and 94%, depending on income.21HealthCare.gov. Cost-Sharing Reductions Cost-sharing reductions only work on Silver plans. Premium tax credits still apply to any tier.
After You Apply
Marketplace applicants usually get an Eligibility Determination Notice almost immediately after submitting online. It shows the plans you qualify for, your premium tax credit amount, and whether you qualify for cost-sharing reductions. From there, you pick a plan and confirm enrollment before the applicable deadline. If you disagree with the decision, you have 90 days from the notice date to appeal, and late requests are accepted with an explanation.22HealthCare.gov. How to Appeal a Marketplace Decision
Texas Medicaid takes longer. Applications can run up to 45 days, or longer if a disability determination is required. If the state asks for missing information, response deadlines are tight: typically 39 days from your application date for most applicants, or 84 days when disability is involved, with possible 90-day extensions.23Texas Health and Human Services. B-6400, Processing Deadlines Check your mail and Your Texas Benefits account so you don’t miss a request.
Taxes If You Got Marketplace Subsidies
If you took advance premium tax credits during the year, you have a year-end reconciliation to complete. By January 31, the Marketplace mails you Form 1095-A showing the premiums and credits paid on your behalf.24Internal Revenue Service. About Form 1095-A, Health Insurance Marketplace Statement You then file IRS Form 8962 with your return to reconcile the credits you received against what your final income actually qualifies you for.25Internal Revenue Service. Instructions for Form 8962
If your income came in higher than you projected, you owe some of the excess credit back. Repayment is capped by income and filing status below 400% FPL, but at 400% FPL or higher, there is no cap and you repay the full excess.26Internal Revenue Service. Instructions for Form 8962 If your income came in lower, you may get an additional credit that adds to your refund. Filing Form 8962 is mandatory whenever advance credits were paid; skipping it can delay your refund or trigger IRS follow-up.