Texas Health Insurance & Medical Costs
Complete guide to healthcare costs in Texas. Compare insurance premiums, understand ACA marketplace options, and find medical procedure prices.
About Healthcare in Texas
Major Cities: Houston, Dallas, Austin, San Antonio, Fort Worth
Marketplace: Texas uses the federal marketplace (HealthCare.gov). Subsidies available based on income. Open enrollment typically Nov 1 - Jan 15.
Quick Cost Overview
Single Person
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Couple
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Family of 4
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Explore Texas Healthcare Costs
Health Insurance Costs
Find detailed premium information for different household sizes and plan types.
ACA Marketplace
Learn about subsidies, income limits, and marketplace options in Texas.
Medical Procedure Costs
Understand out-of-pocket costs for common medical procedures.
Medical Procedure Costs in Texas
MRI Scan
Without insurance
ER Visit
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CT Scan
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Understanding Healthcare Costs in Texas
Texas has the highest uninsured rate in the nation at approximately 18%, with over 5 million Texans lacking health coverage. As a non-expansion state, Texas has a significant 'coverage gap' where adults earning between 0-100% of the Federal Poverty Level often don't qualify for either Medicaid or ACA subsidies. Despite this, Texas has a competitive ACA marketplace with relatively affordable premium options in many counties.
Texas Healthcare Landscape
Texas is home to some of the nation's largest and most renowned medical centers, including the Texas Medical Center in Houston (the world's largest), MD Anderson Cancer Center, and UT Southwestern Medical Center in Dallas. The state has a significant rural healthcare access challenge, with many counties designated as Health Professional Shortage Areas.
Regional Cost Variations
Healthcare costs in Texas vary significantly between urban and rural areas. Houston, Dallas, and Austin have higher costs due to concentration of specialty care and higher labor costs. However, competition in major metros often provides more pricing options. Rural Texas faces provider shortages that can increase costs for those who must travel for care. The Rio Grande Valley generally has lower costs but fewer provider options.
Key Factors Affecting Texas Healthcare Costs
- Urban vs. Rural: Healthcare costs in cities like Houston and Dallasare typically higher than rural areas, but rural areas often have fewer provider options.
- Insurance Market Competition: Texas has 4+ major insurance carriers competing in the marketplace, including Blue Cross Blue Shield of Texas and Oscar.
- Hospital Pricing: Hospital-based services typically cost 2-4x more than independent clinics and imaging centers for the same procedures.
- State Marketplace: Texas residents use HealthCare.gov for ACA enrollment, which may offer state-specific programs or extended enrollment periods.
Texas Insurance Shopping Tips
- Texas has robust competition on HealthCare.gov—always compare all available plans during Open Enrollment
- Oscar Health offers user-friendly technology and has expanded to most major Texas metros
- Ambetter (Centene) and Molina often have the lowest-cost Bronze and Silver plans in Texas
- If you're self-employed, your ACA premium may be tax-deductible as a business expense
- Many Texans qualify for $0 premium Bronze plans with the enhanced ACA subsidies—check eligibility
How to Save Money on Healthcare in Texas
- Texas freestanding emergency rooms (FSERs) charge hospital ER prices—use urgent care instead for non-emergencies
- Houston's Texas Medical Center has numerous imaging centers offering competitive cash prices
- Ask for 'self-pay' or 'cash pay' prices—many Texas providers offer 30-50% discounts for immediate payment
- Community health centers like CommUnityCare (Austin) and JPS Health Network (Fort Worth) offer sliding-scale fees
- Texas hospitals are required to provide itemized bills—always review for errors before paying
Quick Tips for Texas Residents
Check Subsidy Eligibility
Many Texas residents qualify for ACA subsidies but don't apply. Use HealthCare.gov to see if you qualify for premium tax credits.
Compare Imaging Centers
For MRIs, CT scans, and X-rays, independent imaging centers in Texas often charge 50-70% less than hospital-based facilities.
Know Your Medicaid Options
Texas's Medicaid program (Texas Medicaid) provides free or low-cost coverage for eligible residents. Income limits vary by household size.
Review Plans Annually
Insurance plans and carrier networks change yearly. During Open Enrollment, compare your current plan against new options in Texas's marketplace.
🏥Texas Medicaid (Medicaid in Texas)
Texas has one of the most restrictive Medicaid programs in the country. Texas did not expand Medicaid under the ACA, creating a 'coverage gap' for adults. Traditional Texas Medicaid primarily covers: pregnant women, children under 19, parents with very low incomes (typically under 14% FPL), and people with disabilities. CHIP covers children up to 200% FPL. Many adults earning minimum wage don't qualify for any public coverage.
Unique Texas Healthcare Programs
- Texas Women's Health Program provides family planning and preventive health services to low-income women
- Healthy Texas Women (HTW) offers 12 months of coverage for family planning and related services
- Texas CHIP Perinatal covers prenatal care for uninsured pregnant women regardless of immigration status
- Harris Health System (Houston) provides charity care to Harris County residents regardless of ability to pay
🚨Emergency Room Alternatives in Texas
Texas has seen a proliferation of freestanding emergency rooms that often charge full hospital ER prices. For non-life-threatening conditions, urgent care centers typically charge $100-$200 vs $1,000+ at FSERs. Retail clinics at CVS MinuteClinic, Walgreens Healthcare Clinic, and H-E-B offer care for $75-$150. Telehealth services are increasingly popular for minor conditions.
⚠️Important Coverage Gap Information
IMPORTANT: Texas did not expand Medicaid. Adults with incomes between 0-100% of the Federal Poverty Level who don't qualify for traditional Medicaid may fall into the 'coverage gap' and not qualify for ACA subsidies either. Options for uninsured Texans include: community health centers, charity care programs at non-profit hospitals, county hospital districts, and healthcare sharing ministries.
💰Price Transparency in Texas
Texas hospitals must provide charge information under federal price transparency rules. The Texas Department of Insurance allows consumers to compare health plan prices. However, Texas does not have state-specific price transparency laws beyond federal requirements. Always request a good-faith cost estimate before scheduled procedures.
Need More Detailed Information?
Explore specific cost breakdowns, subsidy calculators, and real-world examples for Texas.
Disclaimer: The cost ranges shown above are estimates based on publicly available data from CMS, state insurance filings, and hospital price transparency reports. Actual costs vary by provider, location within Texas, age, and individual circumstances. Always verify specific costs with your insurance carrier or healthcare provider before receiving services.
Sources & Disclaimer
Sources:
- HealthCare.gov — Official ACA marketplace information and plan data
- CMS Public Use Files — Federal marketplace enrollment and premium data
- KFF Health Reform Analysis — Independent analysis of marketplace premium trends
Last Updated: January 2026
Disclaimer: The information provided is for educational purposes only. Actual costs vary based on individual circumstances, location, age, plan selection, and other factors. Always verify current information with official sources or licensed professionals. This site does not sell insurance or provide medical advice and is not affiliated with any insurance company or healthcare provider.