Early Retiree Health Insurance in Texas
Retiring in Texas before 65 means buying your own coverage until Medicare starts, and premiums are highest in exactly those years: insurers can charge a 64-year-old up to three times what they charge a 21-year-old. Texas individual premiums are also set to rise 13.1% to 14.1% on average for 2027. How you draw retirement income can matter as much as which plan you pick.
Private health insurance in Texas
Most people I help in Texas end up on a private plan, not a Marketplace plan. Private, medically underwritten health insurance is priced on your age, zip code and health instead of your income, so a strong year never raises your premium and there is no tax credit to pay back in April.
Why people leave the Marketplace
- Premiums keep climbing. Texas Marketplace premiums are rising 13.1% to 14.1% on average for 2027.
- The subsidy cliff. Above 400 percent of the poverty level ($63,840 for one person, $132,000 for a family of four) you pay full price.
- Surprise tax bills. Underestimate your income and you repay the tax credit in April.
- Narrow networks. Many plans are local HMOs or EPOs that need referrals and cover little outside the area.
- High out-of-pocket costs. 2027 out-of-pocket maximums reach $12,000 per person and $24,000 per family.
- One window a year. Outside open enrollment you need a qualifying life event to enroll or switch.
What a private plan does differently
- Start any month. If approved, coverage can begin the first of next month, with no wait for open enrollment.
- Networks that travel. Many private plans use national PPO networks, which can give you in-network doctors outside Texas too. Networks vary by plan.
- Can cost less than full-price Marketplace plans for some healthy applicants above the subsidy line.
- Accident coverage the Marketplace does not offer. A private plan can be paired with accident coverage, a separate policy. What it includes varies by plan.
- Approval is based on health. You answer health questions, and acceptance is not guaranteed.
With a significant health condition, or income low enough for a large tax credit, a Marketplace plan can be the better fit, and I will tell you if it is. Either way you see both side by side.
Private plans are not ACA Marketplace plans. Benefits, exclusions and pre-existing condition rules differ by plan and by state, so review the plan details before you enroll.
Get a private plan quoteLearn more: coverage not based on income · how underwriting works · private vs Obamacare · PPO plans for individuals · switching from the Marketplace
Retiring early in Texas
About 3.4 million Texans were 55 to 64 in July 2025, roughly 10.8 percent of residents, according to Census Bureau estimates. Only Utah and North Dakota have a smaller share, because Texas skews young. The picture changes in retirement areas. In the Hill Country counties of Llano and Bandera, more than 15 percent of residents are 55 to 64 and close to a third or more are already 65 or older. Coastal Aransas County, around Rockport, looks much the same, and these are the places where early retirees most often need a bridge to Medicare.
Texas rules for the bridge to Medicare
Texas law gives families a longer bridge than federal COBRA alone. Under Insurance Code Section 1251.309, if a group plan lets a retiring employee keep coverage until Medicare, the same right must extend to that employee's dependents. A spouse who has been on the plan at least a year can continue for up to three years after the employee retires or dies. At 65, your six-month Medigap open enrollment begins with Part B. A 2025 Texas law opened Medigap to people under 65 only if they have end-stage renal disease or ALS.
The Texas market for 55-to-64-year-olds in 2027
Texas buyers use HealthCare.gov, and the state has the second-largest Marketplace in the country with about 15 insurers filing for 2027. Texas requires insured group plans to offer state continuation, nine months for people without COBRA rights and six more months after COBRA ends, at the group rate plus 2 percent, though self-funded employer plans are exempt. Texas defines short-term plans by the federal rule rather than its own limit. Final 2027 individual increases average about 13 to 14 percent, with small-group plans up about 17 percent, which makes individual coverage reimbursement worth a look for small Texas employers.
Other Texas rules to know
- Leaving a small employer: Texas requires insured group plans to offer state continuation for up to nine months to people not eligible for COBRA, or six more months after COBRA ends, at the group rate plus 2 percent. It does not apply to self-funded employer plans.
- Short-term plans: Texas defines short-term plans by reference to the federal rules, which set a three-month initial term and four months in total; federal agencies are not prioritizing enforcement of that limit while new rules are written.
- Where to enroll: Texas uses HealthCare.gov. Open enrollment for 2027 coverage runs November 1, 2026 to January 15, 2027. Private, medically underwritten plans can start the first of any month if approved.
- 2027 rates: individual plans 13.1% to 14.1% on average, small-group plans about 16.9%. See the Texas 2027 rate page.
Your income is partly your choice
The Marketplace credit is based on modified adjusted gross income. Early retirees often control it: Roth withdrawals and cash savings generally do not count, while traditional IRA withdrawals, Roth conversions and capital gains do. For 2027 the credit stops at 400 percent of the poverty level, $63,840 for one person and $86,560 for a couple. Plan withdrawals with that line in mind. General information, not tax advice — confirm with your CPA based on your specific entity structure.
Private plans for healthy retirees
A retiree above the line pays full price on the Marketplace. A healthy 55-to-64-year-old can may pay less with a private, medically underwritten plan, which is priced on health and can start the first of any month if approved. With a health condition, the Marketplace remains the guaranteed choice.
Planning the switch at 65
Your Medicare initial enrollment period runs seven months around your 65th birthday. Line up the end of your individual plan with the start of Medicare so you never pay for both or go without.
For 2027 the Marketplace credit stops at 400 percent of the poverty level: $63,840 for one person, $86,560 for two and $132,000 for a family of four. The out-of-pocket maximum for 2027 Marketplace plans is $12,000 for one person and $24,000 for a family. The full guide covers the rest.
Compare Texas plans
Licensed in Texas. Private plans priced first, Marketplace alongside when it fits. No fee.
Texas questions
Where do Texas residents enroll in 2027 coverage?
Texas uses HealthCare.gov. Open enrollment for 2027 coverage runs November 1, 2026 to January 15, 2027.
What continuation rights does Texas give after leaving a small employer?
Texas requires insured group plans to offer state continuation for up to nine months to people not eligible for COBRA, or six more months after COBRA ends, at the group rate plus 2 percent. It does not apply to self-funded employer plans.
How much are Texas premiums rising for 2027?
Individual-market premiums are set to rise 13.1% to 14.1% on average, and small-group plans about 16.9%.
What health insurance do people use if they retire before 65?
COBRA or state continuation for a while, a Marketplace plan, a private underwritten plan, or a spouse's employer plan. Many use COBRA briefly and then switch.
Do Roth IRA withdrawals count toward Marketplace income?
Qualified Roth withdrawals generally do not count toward the modified adjusted gross income used for the credit, while traditional IRA withdrawals do. General information, not tax advice — confirm with your CPA based on your specific entity structure.
Sources: www2.census.gov, www2.census.gov, statutes.capitol.texas.gov, capitol.texas.gov. Facts checked October 2026. See all Texas health insurance rules.
Early retirees in other states
Written by Frank Caballero, licensed health insurance agent in Texas and 30 other states, NPN 21032307.