Private Health Insurance in Texas
Private health insurance in Texas is coverage you buy directly, outside the ACA Marketplace, priced on your age, zip code and health instead of your income. With Texas Marketplace premiums rising 13.1% to 14.1% on average for 2027, more people who earn too much for a tax credit are pricing a private plan first. It is not the right fit for everyone, and the sections below explain how it works in Texas and when the Marketplace is the better call.
Who buys their own coverage in Texas
Texas has the biggest individual market on HealthCare.gov. CMS counted 4,172,233 Texans choosing a plan in the 2026 open enrollment, about 5 percent more than the 3,966,226 a year earlier, and roughly 764,000 of them were new to the Marketplace. About 93 percent qualified for an advance premium tax credit, which leaves about 7 percent paying the full price, up from about 5 percent in 2025 after the enhanced credits expired. Census figures for 2024 show about 40 percent of Texas households earn $100,000 or more, and many of them sit above the subsidy line.
How Texas regulates private plans
Texas polices fixed indemnity and other limited plans through outline-of-coverage rules. Under 28 TAC 3.3091, a limited benefit outline must say in capital letters that the policy pays less than the state minimum standard, and a supplemental policy must say it only adds to insurance already in force. Insurance Code Chapter 1681 says a qualifying health care sharing ministry is not in the business of insurance, and Chapter 1682 does the same for agricultural organization plans. Employers can pool coverage through health group cooperatives under Chapter 1501 or self-funded arrangements under Chapter 846, whose members must share a trade.
Protecting yourself when you buy in Texas
Texas Insurance Code section 1201.058 requires an individual accident and health policy to tell you that you may return it within 10 days of delivery for a refund of the premium, and a returned policy is treated as if it was never issued. The Texas Department of Insurance links to a search where you can look up an agent by name or license number. Its Help Line, 800-252-3439, answers questions and takes complaints on weekdays. The department warns that some sellers use labels like gold, silver or bronze to pass off plans as HealthCare.gov coverage.
The Texas Marketplace you would be comparing against
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.
Why people leave the Marketplace for a private plan
Marketplace premiums are rising again for 2027, and above 400 percent of the poverty level ($63,840 for one person, $132,000 for a family of four) there is no tax credit at all. Underestimate your income and you repay the credit in April. Many Marketplace plans are local HMOs or EPOs, out-of-pocket maximums reach $12,000 per person in 2027, and you can only enroll once a year without a qualifying event.
What a private plan does differently
A private, medically underwritten plan is priced on health, not income, so a strong year never raises the premium and there is nothing to pay back at tax time. If approved, it can start the first of any month, and many plans use national PPO networks that work when you travel.
The honest trade-offs
You apply and answer health questions, and approval is not guaranteed. Underwritten plans can decline an application or exclude a pre-existing condition, and benefits and limits differ from plan to plan. Private plans are not ACA Marketplace plans. If you have a significant health condition, the Marketplace is the guaranteed option, and I will tell you so.
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.
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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 is private health insurance?
Coverage you buy directly from an insurer outside the ACA Marketplace. Medically underwritten private plans are priced on age, zip code and health rather than income, and they can start the first of any month if you are approved.
Is private health insurance cheaper than the Marketplace?
Often for healthy people above the subsidy line, who pay full price on the Marketplace. Below the line, a Marketplace plan with a tax credit may be cheaper. The only way to know is to price both.
Can a private plan turn me down?
Yes. Underwritten plans can decline an application or exclude a pre-existing condition. The Marketplace has to accept everyone during open enrollment or a special enrollment period.
Sources: www.cms.gov, data.census.gov, tcss.legis.texas.gov, www.tdi.texas.gov, tdi.texas.gov. Facts checked October 2026. See all Texas health insurance rules.
Private plans in other states
Written by Frank Caballero, licensed health insurance agent in Texas and 30 other states, NPN 21032307.