If you live in Texas and need health insurance, the Affordable Care Act (ACA) Marketplace may be your best option for 2026 coverage. Texas uses the federal marketplace at HealthCare.gov with 16 private insurers offering plans across the state. Whether you qualify for financial help depends on your household income, family size, and a few other factors.
This guide walks you through everything you need to know about ACA eligibility in Texas for 2026, including exact income limits, how subsidies work, and what to do if you fall into the coverage gap.
Check your eligibility now with our free screener
What You Need to Know About 2026
A major change hit ACA Marketplace plans in 2026. The enhanced premium tax credits from the Inflation Reduction Act expired at the end of 2025. These enhanced credits had removed the income cap for subsidies and made premiums more affordable for millions of people. Without them, the original ACA subsidy rules are back in place for 2026.
That means premium subsidies are now limited to households earning between 100% and 400% of the Federal Poverty Level (FPL). If you earned above 400% FPL, you no longer qualify for any subsidy. If you received subsidies in 2025, your 2026 premiums may be noticeably higher.
2026 Income Limits for ACA Subsidies in Texas
Your eligibility for financial assistance on the Marketplace depends on your Modified Adjusted Gross Income (MAGI) and household size. Below are the 2026 Federal Poverty Level guidelines used to determine eligibility.
Minimum and Maximum Income for Premium Tax Credits
| Household Size | Minimum Income (100% FPL) | Maximum Income (400% FPL) |
|---|---|---|
| 1 person | $15,960/year | $63,840/year |
| 2 people | $21,640/year | $86,560/year |
| 3 people | $27,320/year | $109,280/year |
| 4 people | $33,000/year | $132,000/year |
| 5 people | $38,680/year | $154,720/year |
| 6 people | $44,360/year | $177,440/year |
Source: 2026 Federal Poverty Level guidelines from the U.S. Department of Health and Human Services
To qualify for premium tax credits in Texas, your income must fall between 100% and 400% of FPL. If your income is below 100% FPL, you may fall into the coverage gap (more on that below).
Cost-Sharing Reduction (CSR) Income Limits
If your income is at or below 250% of FPL and you choose a Silver plan, you also qualify for cost-sharing reductions. These lower your deductibles, copays, and out-of-pocket maximums.
| Household Size | CSR Threshold (250% FPL) |
|---|---|
| 1 person | $39,900/year |
| 2 people | $54,100/year |
| 3 people | $68,300/year |
| 4 people | $82,500/year |
CSR benefits only apply when you select a Silver-level plan. If you pick Bronze or Gold, you will not receive cost-sharing reductions even if your income qualifies.
Who Can Buy ACA Marketplace Coverage in Texas?
To be eligible for a Marketplace plan through HealthCare.gov, you must:
- Live in Texas
- Be a U.S. citizen or be lawfully present in the United States
- Not currently be incarcerated
- Not be enrolled in Medicare
To qualify for premium subsidies and cost-sharing reductions, you must also:
- Have a household income between 100% and 400% FPL
- Not have access to affordable employer-sponsored health coverage
- Not be eligible for Medicaid or CHIP
- File a joint tax return if married
- Not be claimed as a tax dependent by someone else
The Texas Coverage Gap
Texas has not expanded Medicaid under the ACA. This is one of the most important things to understand about health coverage in the state. Because Texas did not expand Medicaid, adults without dependent children generally do not qualify for Medicaid regardless of how low their income is.
This creates a "coverage gap" that affects an estimated 570,000 or more Texans. If your income falls below 100% of the Federal Poverty Level (below $15,960 per year for an individual), you likely do not qualify for Medicaid and also do not qualify for Marketplace premium subsidies. That puts you in a difficult spot with limited affordable options.
If you are in the coverage gap, consider these alternatives:
- Community health centers: Federally Qualified Health Centers provide care on a sliding fee scale based on your ability to pay. Find one at findahealthcenter.hrsa.gov.
- County programs: Some Texas counties offer local indigent health care programs.
- Call 2-1-1 Texas: Dial 2-1-1 to connect with local resources and assistance programs in your area.
Texas Medicaid does cover some specific groups even without expansion, including pregnant women (up to 198% FPL), children (at various income thresholds), and elderly or disabled adults who meet strict income limits. Parents with dependent children may qualify at very low income levels (approximately 12% FPL). You can apply for Medicaid through YourTexasBenefits.com.
How to Apply for ACA Coverage in Texas: Step by Step
Step 1: Gather Your Information
Before you start, have the following ready:
- Social Security numbers for everyone in your household
- Immigration documents (if applicable)
- Employer and income information (pay stubs, W-2s, or tax returns)
- Information about any employer-sponsored health coverage available to you
- Current health plan policy numbers (if switching plans)
Step 2: Check Your Eligibility
Use our free benefits screener to get a quick estimate of the programs you may qualify for, including ACA subsidies, Medicaid, CHIP, and more.
Step 3: Create a HealthCare.gov Account
Visit HealthCare.gov and create an account. You will need an email address and to set up a username and password.
Step 4: Complete Your Application
Fill out the Marketplace application with your household and income information. The system will determine whether you qualify for:
- Premium tax credits (to lower your monthly premium)
- Cost-sharing reductions (to lower out-of-pocket costs on Silver plans)
- Medicaid or CHIP (you may be directed to those programs instead)
Step 5: Compare Plans and Enroll
Once you see your results, compare plans across the four metal tiers: Bronze, Silver, Gold, and Platinum. Pay attention to:
- Monthly premium (after any tax credit is applied)
- Deductible amount
- Copays and coinsurance
- Provider network (check that your doctors are included)
- Prescription drug coverage
Step 6: Pay Your First Premium
Your coverage does not start until you pay your first monthly premium. Set up payment directly with your insurance company after enrolling.
Other Ways to Enroll
You do not have to go through HealthCare.gov alone. You can also:
- Work with a licensed insurance agent or broker at no extra cost
- Get free help from a Navigator or certified application counselor
- Call the HealthCare.gov help center at 1-800-318-2596 (available 24/7 except holidays)
Open Enrollment and Special Enrollment Periods
Open Enrollment for 2026 Coverage
For 2026, open enrollment ran from November 1, 2025 through January 15, 2026. If you signed up by December 15, your coverage started January 1, 2026. Applications submitted between December 16 and January 15 have a February 1 start date.
Important note for 2027: Starting in the fall of 2026, the open enrollment period will be shorter, ending on December 15 instead of January 15. All plans selected during that window will take effect January 1, 2027.
Special Enrollment Periods
If you missed open enrollment, you may still be able to sign up through a Special Enrollment Period (SEP) if you experienced a qualifying life event in the past 60 days, such as:
- Losing other health coverage (job loss, aging off a parent's plan, Medicaid loss)
- Getting married or divorced
- Having or adopting a baby
- Moving to a new area with different plan options
- Changes in household income that affect eligibility
Visit HealthCare.gov to report your qualifying event and see if you can enroll outside of open enrollment.
Silver Loading: A Texas Strategy That Helps You Save
Texas requires health insurers to add a 40% load to Silver plan premiums (as of 2026) to account for the cost of cost-sharing reductions. While that sounds like a bad thing, it actually works in your favor if you are shopping on the Marketplace.
Here is why: premium tax credits are calculated based on the cost of the benchmark Silver plan. When Silver plan premiums are inflated, your tax credit gets larger. That means Bronze and Gold plans often become much cheaper after subsidies are applied. In some cases, Gold plans end up costing less per month than Silver plans, while offering lower deductibles and better coverage.
If your income qualifies you for CSR (at or below 250% FPL), stick with a Silver plan to get those extra savings on out-of-pocket costs. If you do not qualify for CSR, compare Gold plans carefully because they may be a better deal in Texas.
Other Programs You May Qualify For
ACA coverage is just one piece of the puzzle. Depending on your situation, you might also be eligible for:
- SNAP (food stamps): Helps with grocery costs. Texas uses a gross income limit of 165% FPL.
- CHIP: Covers children in families earning too much for Medicaid but not enough for affordable private insurance.
- WIC: Nutrition assistance for pregnant women and children under 5.
- LIHEAP/CEAP: Help with energy bills if your income is at or below 150% FPL.
- Lifeline: A $9.25 per month discount on phone or internet service.
Use our free screener to check your eligibility for all of these programs at once.
For a full overview of Texas programs, visit Texas Benefits Overview.
Frequently Asked Questions
Can I get ACA coverage in Texas if I do not have a Social Security number?
Lawfully present immigrants can apply for Marketplace coverage, even without a Social Security number. You will need to provide your immigration document information during the application process.
What if my income changes during the year?
Report income changes to HealthCare.gov as soon as possible. If your income goes up or down, your subsidy amount may change. Failing to report changes could mean you owe money back at tax time or miss out on savings you deserve.
Is there a penalty for not having health insurance in Texas?
The federal individual mandate penalty was reduced to $0 starting in 2019. Texas does not have a state-level penalty for being uninsured. However, going without coverage means you are responsible for the full cost of any medical care you receive.
Can I use the Marketplace if my employer offers insurance?
Yes, but you will only qualify for subsidies if your employer's coverage is considered unaffordable (costs more than a set percentage of your household income (check HealthCare.gov for the current threshold) for the lowest-cost self-only plan) or if it does not meet minimum value requirements.
What happens if I am in the coverage gap?
If your income is below 100% FPL and you do not qualify for Medicaid, you fall into the coverage gap. You can still purchase a Marketplace plan at full price, but you will not receive financial assistance. Look into community health centers, county programs, and dial 2-1-1 for local resources.
When is the next open enrollment for Texas?
Open enrollment for 2027 coverage is expected to begin November 1, 2026 and end December 15, 2026. This is a shorter window than previous years.
Take the Next Step
Finding affordable health insurance in Texas can feel overwhelming, especially with the recent changes to subsidy rules. The good news is that millions of Texans still qualify for significant financial help through the Marketplace.
Use our free screener to check what you qualify for. It takes just a few minutes and covers ACA subsidies along with 10+ other federal and state programs. You might be leaving money on the table.
For help enrolling, call HealthCare.gov at 1-800-318-2596 or find a local Navigator or insurance broker who can walk you through the process at no cost.
