Exchange
HealthCare.gov
Federal exchange
Medicaid Expansion
❌ Not Expanded
Limited Medicaid eligibility
Avg. Benchmark Premium
$530/mo
Age 40, Silver plan
Texas ACA Health Insurance Overview
Texas has the largest uninsured population in the country and has not expanded Medicaid under the ACA. Despite this, over 2.4 million Texans enrolled through HealthCare.gov for 2025 coverage, making it the state with the second-highest marketplace enrollment. Approximately 93% of Texas marketplace enrollees receive premium tax credits, reflecting the state's lower median incomes and higher benchmark premiums.
Texas Income Limits for ACA Subsidies (2026)
ACA subsidy eligibility is based on the Federal Poverty Level (FPL). The table below shows key income thresholds for an individual in Texas. For a family, multiply by the household size factor (e.g., a family of 4 at 100% FPL ≈ $50,706/year).
| FPL Level | Annual Income (Individual) | Significance |
|---|---|---|
| 100% FPL | $15,650 | Minimum income for marketplace subsidy eligibility |
| 138% FPL | $21,597 | Would be Medicaid threshold if state expanded (not applicable) |
| 150% FPL | $23,475 | Below this threshold, $0-premium Silver plans are often available |
| 400% FPL | $62,600 | Traditional “subsidy cliff” — but the ARP extension through 2025 removed the cliff, capping premiums at 8.5% of income for all enrollees |
Based on 2025 Federal Poverty Guidelines used for the 2026 plan year. Alaska and Hawaii have higher FPL thresholds.
How ACA Subsidies Work in Texas
ACA subsidies in Texas are especially impactful because the state has not expanded Medicaid, leaving the marketplace as the primary path to affordable coverage. Your subsidy is based on income as a percentage of FPL — most Texans earning between 100% and 400% FPL qualify for substantial premium reductions.
How to Enroll in Texas
Texas uses the federal exchange at HealthCare.gov.
Visit HealthCare.gov during Open Enrollment to browse plans, compare premiums, and apply for subsidies. You can also call the marketplace helpline at 1-800-318-2596.
Medicaid in Texas
Texas has not expanded Medicaid.
Without Medicaid expansion, adults without dependent children may have very limited Medicaid eligibility. There may be a “coverage gap” for people who earn too much for traditional Medicaid but too little for marketplace subsidies. Check your state's Medicaid program for current eligibility rules.
Calculate Your Texas Premiums
See how the subsidy cliff affects your specific situation.
Open Calculator →See How the 2026 Subsidy Cliff Affects You
Enter your income and household size for a personalized premium comparison.
Calculate Your 2026 Premium Impact →Related Resources
⚠️ Disclaimer
This calculator provides estimates for educational purposes only. It is not a substitute for professional advice. Actual premiums, subsidies, and eligibility may vary based on your specific circumstances, location, and available plans. We are not licensed insurance agents or brokers. For official information, visit HealthCare.gov or contact a licensed insurance professional. This site is not affiliated with the U.S. government, CMS, or any insurance company.