The One Thing Most Self-Employed Texans Don't Know
If you're self-employed in Texas and you want a PPO — a plan where you can see any doctor without a referral and access any hospital without prior authorization — the ACA marketplace at HealthCare.gov cannot help you.
As of 2026, all ACA marketplace plans in Texas are HMO or EPO. Every single one. PPO plans were phased out of the Texas marketplace years ago. This is unique to Texas — other states still have marketplace PPO options. If you're in Texas and you need a PPO, you must go off-exchange through a licensed independent broker.
This is not widely known. Most people looking for health insurance in Texas go straight to HealthCare.gov, don't see a PPO option, and assume PPO simply isn't available. It is available — just not through the marketplace.
What Is an HMO or EPO and Why Does It Matter?
An HMO (Health Maintenance Organization) requires you to choose a primary care physician (PCP) who manages your care and provides referrals to see specialists. If you go to a specialist or hospital outside your network without a referral, your plan typically covers nothing.
An EPO (Exclusive Provider Organization) is similar but without the PCP referral requirement. You can see any in-network specialist directly, but you are still strictly limited to in-network providers. No coverage outside the network except in emergencies.
A PPO (Preferred Provider Organization) lets you see any licensed doctor or go to any hospital in the country without a referral and without prior authorization. In-network visits cost less, but out-of-network care is still covered. For self-employed individuals — especially those who travel frequently, work across multiple cities, or have existing specialist relationships they want to keep — a PPO is often the only plan that makes practical sense.
Two Paths for Self-Employed Texans
Regardless of which plan type you want, you have two distinct paths:
Path 1: ACA Marketplace (HealthCare.gov)
The marketplace is the right choice if your net self-employment income is below approximately $63,840 per year (single adult, 2026). Below that threshold, you may qualify for a premium tax credit that can significantly reduce your monthly cost. The marketplace offers HMO and EPO plans from carriers including:
- Blue Cross Blue Shield of Texas
- Ambetter from Superior Health Plan
- Oscar Health
- UnitedHealthcare
- Molina Healthcare
Carrier availability varies by county. In some rural Texas counties, only one or two carriers participate in the marketplace.
Path 2: A Private Plan With a PPO Network
If your income is above the subsidy threshold, or if you simply need a PPO, a private off-exchange plan is the alternative. Private plans are not listed on HealthCare.gov — they're accessed directly through a licensed broker. They give you access to a nationwide PPO network (UnitedHealthcare or PHCS), with no referrals and no income reporting. They are built for healthy people who don’t need maternity, substance-use or ongoing mental-health coverage: medically underwritten, not ACA coverage, and paying set amounts for covered care, so Daniel walks through exactly what a plan pays before you buy.
Premiums for health coverage are deductible for the self-employed, marketplace or private: for a private plan that means the premium for its medical coverage. Any life insurance or income benefit bundled into a package is not deductible, so your tax preparer should use the medical figure.
When Each Path Makes More Sense
| ACA Marketplace (TX) | Private Off-Exchange (TX) | |
|---|---|---|
| Plan types offered | HMO, EPO and POS (no PPO) | PPO network: UnitedHealthcare or PHCS |
| Best income range (single) | Under ~$63,840/yr | Over ~$63,840/yr |
| Federal subsidies | Yes, based on income | No |
| Out-of-network coverage | Only POS plans pay part; HMO and EPO pay nothing outside emergencies | Pays set amounts in or out of network; network rates stretch them further |
| Referrals required | Yes (HMO) / No (EPO) | No (PPO) |
| Income reporting at tax time | Yes — reconcile with IRS | No |
| Self-employed deduction | Yes, 100% | Yes, for the medical coverage in the plan |
Houston (Harris County)
Houston is home to the Texas Medical Center — the largest medical complex in the world — including MD Anderson Cancer Center, Houston Methodist Hospital, Memorial Hermann, and HCA Houston Healthcare. These institutions are world-class, and many self-employed Houstonians specifically want to ensure they can access them.
With a marketplace HMO or EPO, your access depends entirely on whether your chosen carrier's network includes those specific facilities. A PPO network lets you see providers in these systems without a referral, which matters if you travel for work; Daniel checks which of them are in a plan’s network before you choose.
Harris County is one of the most competitive insurance markets in Texas, with multiple carriers participating in the marketplace. All Harris County zip codes are covered.
Dallas / Fort Worth (Tarrant & Dallas Counties)
The DFW metroplex is Texas's largest insurance market. Self-employed contractors, real estate professionals, consultants, and small business owners in DFW represent one of the largest concentrations of self-employed individuals in the state.
Major hospital systems in the DFW area include Baylor Scott & White Health, UT Southwestern Medical Center, Texas Health Resources, and Medical City Healthcare. As with Houston, Daniel checks which of these systems are in a private plan’s PPO network before you choose.
Austin (Travis County)
Austin's tech economy and high concentration of freelancers, startup founders, and independent contractors make it one of the most active markets for self-employed health insurance in Texas. Travis County has strong marketplace carrier participation, but again — all marketplace plans are HMO or EPO.
Major Austin hospital systems include St. David's HealthCare, Ascension Seton, and Baylor Scott & White Austin. Many Austin tech workers who left W-2 jobs with employer PPO coverage are surprised to find no PPO option on the marketplace. All Travis County zip codes and the Austin metro area are covered.
San Antonio (Bexar County)
San Antonio has a large military population (TRICARE-eligible) but also a significant self-employed and small business owner population, particularly in healthcare, real estate, and food service sectors. Bexar County marketplace options include several carriers, but all are HMO or EPO.
Major hospital systems include University Health, Baptist Health System, and Methodist Healthcare System. All Bexar County zip codes and the greater San Antonio area are covered.
The Self-Employed Deduction in Texas
Texas has no state income tax, which simplifies the picture somewhat. Your health insurance premium deduction works entirely at the federal level:
- Deduct 100% of premiums on Schedule 1, Form 1040 (line 17)
- Reduces your Adjusted Gross Income dollar-for-dollar
- Applies to both marketplace and private off-exchange plans
- Cannot exceed your net self-employment income for the year
- Does not apply if you were eligible for an employer-sponsored plan through a spouse
At common self-employment income levels in Texas, this deduction can save $1,200–$3,000 or more in federal taxes annually depending on your bracket.
Open Enrollment and Special Enrollment in Texas
Texas uses the federal marketplace (HealthCare.gov). Open Enrollment runs November 1 through January 15 each year, with coverage starting January 1 for plans selected by December 15, and February 1 for plans selected between December 16 and January 15.
If you recently left a W-2 job, lost other coverage, moved to a new county, or had another qualifying life event, you have a 60-day Special Enrollment Period. Private off-exchange plans are not subject to Open Enrollment restrictions — you can enroll at any time.
How a Licensed Agent Helps Self-Employed Texans
Health Advisory is a licensed independent advisor (NPN #22052447) serving all 254 Texas counties. A licensed agent compares both marketplace and private plan options for every Texas client and gives you a straightforward recommendation based on your income, health situation, and the doctors and hospitals that matter to you.
The service is free. Health Advisory is paid by the insurance company you choose, never by you, and your premium is the same either way.