Every Option Compared: Texas Health Coverage Choices for 2027

The short answer

If your income qualifies for a big Marketplace tax credit, start there. If you pay full price and everyone in your household is generally healthy, an alternative such as health sharing plus a primary care membership often costs less each month. It isn't insurance, and it has real limits. The table below shows where each option fits.

Your options at a glance

Why so many Texans are comparing

Texas has one of the largest Marketplaces in the country, with nearly 4.2 million plan selections for 2026, so the end of the extra tax credits hit hard here. Prices rose about 34.7% on average for 2026, and the average monthly cost for enrollees who get a credit rose from $57 to $89 (source). For 2027, insurers proposed increases averaging about 13.1%, from about 1% to 31% depending on the company. Baylor Scott & White and Cigna are leaving the Texas Marketplace at the end of 2026, so their members must choose a new plan (source).

Households earning more than 400% of the federal poverty level generally get no tax credit now. That's where most of our calls come from: self-employed people, oilfield and construction contractors and early retirees paying the full price.

Insurance options (we can't help you buy these)

A Marketplace plan

Texas uses the federal Marketplace, HealthCare.gov. It's the only place to get a federal tax credit on an individual plan. Open enrollment for 2027 plans runs November 1, 2026 to January 15, 2027; enroll by December 15 for coverage that starts January 1 (source). Check HealthCare.gov for the final deadline. ACA plans must cover pre-existing conditions and pregnancy, which makes them the right choice for many households.

Texas Medicaid and the coverage gap

Texas hasn't expanded Medicaid. Adults under 65 without minor children don't qualify at any income, and the limit for parents is very low, around 12% to 15% of the poverty line (source). Children can get coverage through Medicaid or CHIP, and pregnant women qualify at higher incomes. People with incomes too low for a Marketplace tax credit but who can't get Medicaid fall into what's called the coverage gap: about 570,000 Texans, by one estimate (source).

If that's you, check HealthCare.gov and Medicaid anyway, because the rules have exceptions, and look at community health centers, which charge on a sliding scale. Health sharing and a primary care membership aren't insurance, but they're one option some households in the gap choose. We'll be honest about whether it makes sense.

Short-term plans

Texas law allows short-term plans with an initial term under 12 months and up to 36 months in total, including renewals, though most plans sold in early 2026 ran three or four months (source). They're insurance, but they can turn you down or exclude pre-existing conditions. See short-term plans vs health sharing. A licensed agent can explain specific plans.

The alternatives (what we help with)

None of these is insurance. Each one does a specific job, which is why we usually pair them:

Direct primary care

A monthly membership with a primary care practice: visits, questions and follow-ups with no copay. Texas law says a direct primary care agreement is not health insurance and isn't regulated by the Texas Department of Insurance (source). A DPC membership doesn't pay for specialists, hospitals or emergencies, so it's never enough by itself. Read direct primary care in Texas.

Health care sharing

Members share each other's eligible medical bills under written guidelines. For each new illness or injury (a "Need"), you pay your Initial Unshareable Amount, and eligible costs above it can be shared. There's no provider network. It's built for big, unexpected bills, and it leaves out routine care, most ongoing prescriptions, dental and vision. Read how health sharing works in Texas.

Discount plans

Dental, vision and prescription discount plans give you reduced fees at participating providers. They don't pay providers. See dental savings plans.

How to choose: five questions

1. What would a Marketplace plan cost you after your tax credit? Check at HealthCare.gov. If it's low, that's hard to beat.
2. Does anyone have an ongoing condition they need paid for this year? If yes, insurance.
3. Is a pregnancy likely in the next nine months? If yes, insurance for now.
4. Could you pay the Initial Unshareable Amount, up to three times in a bad year? If not, choose a lower amount or reconsider.
5. Do you want a guarantee? Sharing is voluntary. If you need a contract that has to pay, buy insurance.

If your answers point to the alternatives, the next step is the price table. Or tell us about your household and we'll walk through it with you.

Common questions

Written and reviewed by Graham Kerswell. Last updated October 19, 2026. Facts and prices are checked against the sources named on this page.

Sources

• Texas Marketplace guide: 2026 and proposed 2027 rates, insurers, enrollment, open enrollment (healthinsurance.org, updated Aug 27, 2026)
• Texas Medicaid eligibility and the coverage gap (healthinsurance.org, updated Sep 17, 2026)
• Short-term health insurance in Texas (healthinsurance.org, updated Sep 17, 2026)
• Texas Occupations Code § 162.253, direct primary care is not insurance
• Texas Insurance Code ch. 1681, health care sharing ministries (§ 1681.001 criteria, § 1681.002 notice)