Short answer: “private health insurance” in Texas means two different things. Every marketplace plan is sold by a private insurer; there are 15 of them for 2026, led by Blue Cross and Blue Shield of Texas in all 254 counties. They come with tax credits and no health questions. Separately, medically underwritten plans ask about your health, can turn you down and get no tax credit. In return, a healthy buyer can often pay less, and you can buy one in any month; many of these plans pay set amounts for covered care rather than whole bills. (Reviewed by Daniel Griffin, licensed independent advisor, NPN #22052447.)
Every Kind of Private Plan Sold in Texas
| Plan | Health questions? | Tax credit? | When you can buy |
|---|---|---|---|
| Marketplace plan (HealthCare.gov) | No | Yes, between 100% and 400% of the poverty line | Open Enrollment or a 60-day special window |
| The same ACA plan bought off the marketplace | No | No | Same windows |
| Medically underwritten private plan | Yes | No | Any month |
| Short-term plan | Yes | No | Any month; usually excludes pre-existing conditions |
| Health care sharing ministry | Yes | No | Varies; not insurance, so payment is not guaranteed |
Texas uses HealthCare.gov. Marketplace figures from the CMS Plan Year 2026 plan files.
Who Should Look Beyond the Marketplace
The marketplace is the right place for anyone with a real health history, and for anyone whose tax credit brings the price down. The case for a medically underwritten plan is narrower: a healthy household that gets little or no tax credit. For 2027 coverage there is no credit above 400% of the poverty line, which is $63,840 for one person and $132,000 for a family of four. Above that line a Texan pays full price, and in the median Texas county the 2026 benchmark Silver plan for a 40-year-old costs about $724 a month.
That describes many of the people who call Daniel: the self-employed, business owners, contractors, and families where one spouse’s job covers only the employee. For them, underwriting is the mechanism that lets good health lower the price. It is also why acceptance is never guaranteed.
At the other end, Texas has not expanded Medicaid. An adult earning under 100% of the poverty line usually gets neither Medicaid nor a marketplace tax credit, and needs to know that before paying for any plan.
Networks: The Texas Detail That Matters
Every 2026 marketplace plan in Texas is an HMO, EPO or POS; there is no PPO on the Texas marketplace. HMOs and EPOs pay nothing out of network outside an emergency. Whichever kind of plan you consider, ask which network it uses and check your doctors and hospital in that specific network, not just the insurer’s name.
Healthy, in Texas, and paying full price?
Send your ZIP code. Daniel checks your tax credit first, then compares your best marketplace plan with the private options for your county.
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How to Tell a Real Private Plan From Junk
- A licensed agent. Look up any agent’s license with the Texas Department of Insurance before you give them your details.
- A named insurance company on the application and the policy.
- Plan documents before you pay, including what is not covered.
- A straight answer to “what does this plan pay for a hospital stay or surgery, and what is left for me?” Discount cards and sharing ministries cannot give one.
Changes Coming for 2027
Cigna leaves the ACA individual market for 2027, including the 11 Texas counties where it sells marketplace plans. Open Enrollment runs from November 1, and choosing by December 15 gets you coverage from January 1. Medically underwritten plans are not tied to that calendar. Every insurer on the Texas marketplace · self-employed in Texas · marketplace vs private, compared.
Sources
- CMS, Qualified Health Plan Landscape file, individual market medical, plan year 2026, from data.healthcare.gov.
- HealthCare.gov, Lower costs on marketplace coverage: the tax credit income range.
- KFF, Status of state Medicaid expansion decisions.
- Texas Department of Insurance, tdi.texas.gov: agent license lookup.
Figures are full-price filed rates before tax credits, not quotes or offers of coverage. Medically underwritten coverage is not available in every state and acceptance depends on health history. Daniel Griffin is a licensed independent insurance agent, NPN #22052447, not tied to any single carrier and not affiliated with the U.S. government.