Texas Health Insurance Guide for 2027: ACA, Medicaid, Private PPOs, Dental, Vision, Employer Coverage & COBRA

Texas residents shopping for health insurance in 2027 have several very different options depending on household income, employment, health history, prescriptions, preferred doctors, age, and whether coverage is needed for an individual or a family.

For most Texans under age 65, the major coverage categories are:

• •ACA Marketplace plans through HealthCare.gov
• •off-Marketplace individual plans
• •private medically underwritten coverage
• •employer-sponsored health insurance
• •COBRA or Texas state continuation
• •Medicaid and CHIP
• •dental and vision coverage

The best option is rarely determined by premium alone. A proper comparison should also include deductible, out-of-pocket maximum, doctor network, prescriptions, subsidy eligibility, pre-existing-condition protection, and total expected annual cost.

For many Texans, especially self-employed people and small-business owners, it can also be valuable to compare ACA plans against private PPO-style options rather than assuming the Marketplace is the only route.

2027 Texas Open Enrollment dates

Texas uses the federal Health Insurance Marketplace at HealthCare.gov. For 2027 coverage, the key dates are:

After January 15, most people need a qualifying life event to enroll in or change an ACA Marketplace plan. Common qualifying events include losing employer coverage, getting married, having or adopting a child, certain moves, or losing Medicaid or CHIP coverage.

Does Texas use HealthCare.gov?

Yes. Texas does not operate its own state Marketplace. Texans who want ACA Marketplace coverage use HealthCare.gov.

During Open Enrollment, you can:

• •enroll for the first time,
• •renew your current plan,
• •switch carriers,
• •change metal levels,
• •update household income,
• •update household members,
• •and see whether you qualify for federal premium subsidies.

HealthCare.gov also allows consumers to preview plan prices based on ZIP code, household size, and estimated income before completing a full application.

ACA health insurance in Texas

ACA Marketplace plans are comprehensive major medical plans governed by Affordable Care Act rules. They cannot deny coverage or charge more because of:

• •diabetes,
• •cancer,
• •asthma,
• •heart disease,
• •autoimmune conditions,
• •pregnancy,
• •mental-health diagnoses,
• •prior surgeries,
• •or other pre-existing medical conditions.

ACA plans also cover the required essential health-benefit categories, including:

• •hospitalization,
• •emergency care,
• •physician services,
• •maternity,
• •mental-health and substance-use treatment,
• •prescription drugs,
• •lab services,
• •preventive care,
• •rehabilitative services,
• •and pediatric services.

For someone with significant medical conditions, expensive prescriptions, pregnancy needs, or strong subsidy eligibility, ACA coverage is often the first place to compare.

2027 ACA subsidies in Texas

Premium tax credits can reduce the monthly cost of Marketplace coverage. For 2027, subsidy eligibility again generally follows the traditional ACA framework, which means the temporary enhanced subsidies from recent years are no longer broadly available above the traditional income ceiling.

In practice, subsidy eligibility depends on:

• •household income,
• •household size,
• •age,
• •ZIP code,
• •the benchmark plan in the area,
• •and whether affordable employer coverage is available.

The Marketplace uses expected household income for 2027, not simply what was earned in 2026. That is especially important for:

• •self-employed Texans,
• •real estate agents,
• •commissioned salespeople,
• •contractors,
• •business owners,
• •and households with variable income.

HealthCare.gov recommends updating income and household information before renewing because subsidy amounts can change materially from one year to the next.

What if your income is too high for an ACA subsidy?

Higher-income Texans may receive little or no Marketplace assistance. That can make the full unsubsidized ACA premium expensive, especially for:

• •older adults under 65,
• •families,
• •self-employed households,
• •and small-business owners.

Someone paying the full Marketplace premium may want to compare:

• •unsubsidized ACA coverage,
• •off-Marketplace plans,
• •employer coverage if available,
• •spouse coverage,
• •or medically underwritten private options if eligible.

This is one of the situations where private PPO-style coverage can become especially relevant.

Texas ACA plan carriers

Carrier participation varies by county, and no single insurer is available everywhere. Texas has a broad individual market with carriers that may include:

• •Blue Cross and Blue Shield of Texas
• •UnitedHealthcare
• •Aetna
• •Baylor Scott & White
• •Ambetter/Celtic
• •and other regional or national insurers.

The Texas Department of Insurance maintains a list of companies offering individual health plans in the state. Because availability is ZIP-code and county specific, someone in Dallas may see a different set of plans than someone in Houston, Austin, San Antonio, El Paso, or rural Texas.

Blue Cross and Blue Shield of Texas plans

Blue Cross and Blue Shield of Texas is one of the most prominent individual-market carriers in the state. BCBSTX offers individual and family plan options that include HMO and broader-network plan designs, depending on the specific product and year. BCBSTX currently markets options such as:

• •Blue Advantage
• •Blue Advantage Plus
• •MyBlue Health

These are offered at Bronze, Silver, and Gold metal levels. BCBSTX also promotes statewide network access for certain products and describes PPO-style coverage as offering more flexibility and fewer referral restrictions than traditional HMOs.

For Texans who care about:

• •broad doctor access,
• •statewide coverage,
• •fewer referral requirements,
• •or more flexibility when traveling,

network design should be examined carefully before enrolling.

UnitedHealthcare ACA plans in Texas

UnitedHealthcare offers ACA Marketplace Individual & Family coverage in Texas. Plan availability depends on ZIP code and county, and UHC offers multiple plan designs and metal levels. Some UHC Marketplace products include lower-deductible designs, and certain plan structures may offer $0 medical deductibles.

Before enrolling, verify:

• •your primary-care doctor,
• •specialists,
• •preferred hospital,
• •prescription coverage,
• •referral rules,
• •and whether care outside the local network is covered.

Aetna individual health insurance in Texas

Aetna is active in the Texas insurance market and is listed by the Texas Department of Insurance as offering individual HMO coverage. Aetna is also widely present in Texas through employer-sponsored coverage, Medicare, Medicaid-related programs, dental, and vision.

Aetna availability for a particular individual-market ZIP code can vary, so consumers should confirm current 2027 options before assuming a specific Aetna plan is available.

Cigna in Texas for 2027

Cigna is an important carrier in Texas, but there is a major change for 2027. Cigna has stated that it will not offer Individual and Family medical plans for 2027, although its individual medical plans remain available for qualifying 2026 Special Enrollment Periods through the end of 2026.

Cigna remains relevant through:

• •employer-sponsored health coverage,
• •group PPO plans,
• •dental,
• •and other benefit products.

So someone searching for “Cigna health insurance Texas” in 2027 may still encounter Cigna through an employer or dental plan even though new individual-and-family medical plans are no longer offered for 2027.

Private PPO health insurance in Texas

Texas has a strong market for private health insurance outside the ACA Marketplace. Private PPO-style coverage can appeal to people who:

• •are generally healthy,
• •receive little or no ACA subsidy,
• •are self-employed,
• •own a small business,
• •want a broader national network,
• •travel frequently,
• •or need coverage outside Open Enrollment.

Some private plans may use large national PPO networks associated with major carriers such as:

• •UnitedHealthcare
• •Aetna
• •Cigna
• •Blue Cross Blue Shield-affiliated networks

However, the exact carrier, network, underwriting rules, and benefits depend on the specific product. It is important not to assume every plan using a well-known network name is an ACA major medical policy.

Private PPO vs. ACA in Texas

For many Texas households, this is the most important comparison.

Private plans may use medical underwriting and may not provide the same protections as ACA coverage. Before switching, verify:

• •pre-existing-condition rules,
• •maternity,
• •mental-health coverage,
• •prescription coverage,
• •deductible,
• •coinsurance,
• •provider network,
• •out-of-pocket exposure,
• •and lifetime or annual benefit limitations if applicable.

PPO vs. HMO vs. EPO in Texas

Texas shoppers often encounter several plan structures.

• •HMO — generally requires members to use in-network doctors, select a primary-care physician, and sometimes obtain referrals before seeing specialists. HMOs often have lower premiums but less flexibility.
• •PPO — generally provides more doctor flexibility, fewer referral requirements, and some out-of-network benefits. PPOs are often more expensive but can be attractive for people who travel, see specialists, or want access to providers outside a narrow local system.
• •EPO — often allows specialist access without referrals but generally provides little or no non-emergency out-of-network coverage.

BCBSTX explains that PPOs usually provide more flexibility than HMOs and permit out-of-network care at a higher cost.

Texas Medicaid

Texas has not adopted broad ACA Medicaid expansion for all low-income adults. That means Texas Medicaid remains heavily based on eligibility categories rather than simply income.

Potentially eligible groups include:

• •children,
• •pregnant women,
• •very low-income parents and caretaker relatives,
• •people with disabilities,
• •elderly residents,
• •and certain other qualifying groups.

Texas residents can apply for Medicaid through the state, and eligibility is determined based on income, household structure, age, disability status, pregnancy, and other program-specific rules.

Texas CHIP

Texas CHIP provides low-cost health coverage for children in families that earn too much to qualify for Medicaid but still meet CHIP eligibility requirements. CHIP can cover:

• •doctor visits,
• •hospital care,
• •prescriptions,
• •vaccines,
• •dental,
• •vision,
• •and other pediatric services.

Enrollment in Medicaid and CHIP is available year-round. HealthCare.gov also directs families who qualify for Medicaid or CHIP to those programs outside Marketplace Open Enrollment.

A Texas family may therefore use different coverage for different household members. For example:

Pregnancy and Medicaid in Texas

Pregnant women may qualify for Texas Medicaid under different income limits than non-pregnant adults. Pregnancy can also affect:

• •household size,
• •Medicaid eligibility,
• •CHIP Perinatal eligibility,
• •Marketplace planning,
• •and maternity-cost comparisons.

ACA plans cannot deny someone because they are pregnant and include maternity care as an essential health benefit. Private medically underwritten plans may treat pregnancy differently, so anyone pregnant or planning pregnancy should verify maternity coverage before choosing a non-ACA plan.

Prescription coverage in Texas

Prescription coverage can vary significantly between carriers and plans. Before enrolling, check:

• •whether the drug is on the formulary,
• •which tier it is on,
• •copay or coinsurance,
• •prior authorization,
• •step therapy,
• •quantity limits,
• •specialty-pharmacy requirements,
• •and whether the drug is subject to a separate deductible.

For high-cost drugs, this can be more important than the premium itself.

Specialty medications

Anyone taking an expensive specialty medication should compare plans very carefully. Examples include medications for:

• •cancer,
• •rheumatoid arthritis,
• •Crohn's disease,
• •ulcerative colitis,
• •multiple sclerosis,
• •psoriasis,
• •rare diseases,
• •HIV,
• •hepatitis,
• •and certain metabolic conditions.

Dental insurance in Texas

Dental coverage is commonly purchased separately from medical insurance. Texas residents may find dental plans through carriers such as:

• •Blue Cross and Blue Shield of Texas
• •UnitedHealthcare
• •Cigna
• •Aetna
• •other national and regional dental insurers

Dental benefits often include some combination of:

• •cleanings,
• •exams,
• •X-rays,
• •fillings,
• •crowns,
• •root canals,
• •implants,
• •dentures,
• •orthodontics,
• •and oral surgery.

Check:

• •waiting periods,
• •annual maximums,
• •deductibles,
• •in-network dentists,
• •major-service coinsurance,
• •and orthodontia coverage.

Cigna has confirmed that dental plans will continue for 2027 even though it is leaving the individual medical market.

Vision insurance in Texas

Vision coverage may be available as a standalone plan, through an employer, as an add-on, or bundled with certain health plans. Benefits may include:

• •routine eye exams,
• •glasses,
• •frames,
• •lenses,
• •contact lenses,
• •and discounts on additional eyewear.

UnitedHealthcare specifically notes that adult and pediatric vision options are available with some Texas ACA plans. Always verify whether vision is included in the medical plan, optional, or provided through a separate vision insurer.

Employer-sponsored health insurance in Texas

Employer coverage remains one of the most common sources of insurance in Texas. Employer plans may include:

• •PPOs,
• •HMOs,
• •EPOs,
• •high-deductible health plans,
• •HSA-compatible plans,
• •and self-funded employer plans.

Major carriers such as:

• •UnitedHealthcare,
• •Aetna,
• •Cigna,
• •and Blue Cross and Blue Shield of Texas

are widely used in the Texas employer market. Employer-sponsored coverage can be attractive because the employer often pays part of the premium. But employees should still compare:

• •employee-only premium,
• •spouse premium,
• •child premium,
• •family premium,
• •deductible,
• •HSA contribution,
• •prescriptions,
• •and network.

Sometimes employee-only coverage is inexpensive while family coverage is extremely costly.

Can small Texas businesses offer group health insurance?

Yes. Texas classifies employers with 50 or fewer employees as small employers for small-group health coverage purposes. Small-group plans must follow state and federal rules, including protections for employees with pre-existing conditions.

Texas says small-group premiums are primarily affected by:

• •employee ages,
• •tobacco use,
• •geographic region,
• •and plan design,

rather than the health status of individual employees. Insurance companies often require a minimum percentage of eligible employees to participate in the group plan. For some small-business owners, however, individual coverage for the owner and family can still be more cost-effective than establishing a full group plan.

Employer coverage and ACA subsidies

Having access to job-based insurance can affect Marketplace subsidy eligibility. If an employer offers coverage that meets federal affordability and minimum-value requirements, an employee may not qualify for an ACA premium tax credit even if they prefer a Marketplace plan.

Family members can sometimes have different eligibility depending on the cost of dependent coverage. That means a household may end up with:

• •employee on employer coverage,
• •spouse on ACA,
• •children on CHIP,
• •or another combination.

This can sometimes produce a lower total household cost than keeping everyone on a single employer plan.

COBRA in Texas

Federal COBRA applies mainly to employers with 20 or more employees. If you lose employer coverage because of:

• •job loss other than gross misconduct,
• •reduced hours,
• •divorce,
• •death of the covered employee,
• •or certain dependent-status changes,

COBRA may allow you to continue the same employer plan temporarily. Employees generally have 60 days to elect COBRA. The employee usually pays:

• •the employee portion,
• •the employer's former contribution,
• •plus up to a 2% administrative fee.

That is why COBRA can be much more expensive than the premium the employee remembers paying while employed. For many employees, COBRA lasts up to 18 months. Dependents may sometimes qualify for longer periods depending on the event.

Texas state continuation coverage

Texas has its own continuation rules in addition to federal COBRA. This is sometimes called Texas state continuation or informally “Texas Mini-COBRA.”

If someone is not eligible for federal COBRA, Texas state continuation may allow them to remain on certain fully insured group plans for up to 9 months. If someone uses federal COBRA first, Texas may allow an additional 6 months after COBRA ends, bringing total continuation to as much as:

• •24 months for the employee
• •42 months for certain spouses or dependents

depending on circumstances. State continuation generally does not apply to self-funded employer plans because those plans are governed primarily by federal ERISA law rather than Texas insurance law.

COBRA vs. ACA in Texas

Losing employer coverage usually creates a Marketplace Special Enrollment Period. That means someone leaving a job may be able to compare:

Private coverage may be worth comparing for a healthy person who receives little or no ACA subsidy. The Texas Department of Insurance explicitly recommends comparing continuation coverage with other available health-plan options after employment ends.

Short-term and alternative health plans in Texas

Texas residents may also encounter:

• •short-term health insurance,
• •fixed-indemnity plans,
• •limited-benefit plans,
• •hospital indemnity,
• •accident coverage,
• •and health care sharing arrangements.

These are not automatically substitutes for ACA major medical coverage. The Texas Department of Insurance warns that alternative plans may not cover all injuries, conditions, or medical services. Consumers should be particularly cautious about:

• •pre-existing-condition exclusions,
• •benefit caps,
• •prescription coverage,
• •maternity coverage,
• •mental-health benefits,
• •and how claims are paid.

Health insurance for self-employed Texans

Texas has a large population of:

• •independent contractors,
• •1099 workers,
• •real estate professionals,
• •consultants,
• •owner-operators,
• •freelancers,
• •and small-business owners.

Self-employed Texans commonly compare:

• •subsidized ACA plans,
• •unsubsidized ACA plans,
• •private medically underwritten options,
• •spouse employer coverage,
• •small-group insurance,
• •and HSA-compatible plans.

Income estimation is especially important because subsidy calculations are based on projected annual household income. If income changes during the year, HealthCare.gov recommends updating the application so subsidy amounts remain accurate.

Health insurance for Texas small-business owners

Small-business owners often have more flexibility than traditional employees. Depending on the business structure, household size, income, and employee count, possible options may include:

• •individual ACA coverage,
• •private PPO-style coverage,
• •spouse employer coverage,
• •small-group insurance,
• •QSEHRA arrangements,
• •ICHRA arrangements,
• •or other employer-funded structures.

For an owner with only a few employees, a full group plan may not always be the cheapest route. For a healthy owner who is paying a large unsubsidized ACA premium, private medically underwritten coverage may be worth comparing.

Texans who travel frequently

Texas is large, and many residents travel extensively for:

• •work,
• •oil and gas,
• •trucking,
• •aviation,
• •consulting,
• •sales,
• •or multi-state business ownership.

A narrow HMO can work very well locally but provide limited non-emergency access outside the service area. A broader PPO network may be more appropriate for people who:

• •travel regularly,
• •spend time in multiple states,
• •want specialist flexibility,
• •or need national provider access.

Always verify the network itself rather than relying only on the letters “PPO.”

What information should Texans gather before comparing health plans?

Before shopping, gather:

• •ZIP code
• •ages of everyone needing coverage
• •estimated household income
• •current premium
• •current insurance carrier
• •preferred doctors
• •preferred hospitals
• •specialists
• •prescription names and dosages
• •expected medical procedures
• •pregnancy plans
• •employer coverage details
• •COBRA offer if applicable
• •deductible already paid
• •anticipated travel needs

That allows a meaningful comparison between ACA, employer, COBRA, and private options.

What should you compare besides the monthly premium?

The monthly premium is only one part of health-insurance cost. Compare:

• •deductible
• •copays
• •coinsurance
• •out-of-pocket maximum
• •prescription deductible
• •specialist costs
• •hospital costs
• •emergency-room costs
• •provider network
• •referrals
• •maternity
• •mental health
• •specialty prescriptions
• •out-of-network benefits
• •subsidy eligibility

Frequently Asked Questions About Texas Health Insurance

Bottom line for Texas health insurance in 2027

Texas residents have several distinct health-insurance markets available. An individual with significant medical conditions or strong subsidy eligibility may be best served by an ACA Marketplace plan. A healthy self-employed Texan paying a high unsubsidized premium may want to compare private PPO options. Someone leaving a job may need to compare COBRA, Texas state continuation, ACA Special Enrollment, and private coverage. A low-income household may need to evaluate Medicaid and CHIP separately for adults and children. A business owner may need to compare individual coverage against small-group options.

For Texans who want to compare Marketplace plans and private PPO options without having their information sold to multiple lead companies, HealthNerd can help review both sides of the market.