Most Texas residents can enroll in an Affordable Care Act marketplace plan through HealthCare.gov, but eligibility depends on your income, immigration status, and whether you have access to affordable employer coverage. Texas has not expanded Medicaid, which creates a unique gap that leaves over a million low-income adults without coverage options. Here’s how eligibility works in Texas specifically.
Basic Eligibility Requirements
To enroll in a marketplace plan in Texas, you need to meet three baseline criteria: you must live in Texas, you must be a U.S. citizen or have an eligible immigration status, and you cannot be incarcerated. You also cannot be enrolled in Medicare.
Eligible immigration statuses include lawful permanent residents (green card holders), refugees, asylees, holders of work permits, people with Temporary Protected Status, T-visa and U-visa holders, and many other categories of lawful presence. Citizens of the Marshall Islands, Micronesia, and Palau living in the U.S. also qualify. One notable exclusion: DACA recipients are not eligible for marketplace coverage.
Income Limits and Premium Subsidies
Your household income determines whether you qualify for financial help paying your monthly premiums. In Texas, you generally need to earn between 100% and 400% of the federal poverty level to receive a premium tax credit. For 2025, those income thresholds look like this:
- Single person: $15,650 to $62,600 per year
- Family of 2: $21,150 to $84,600
- Family of 3: $26,650 to $106,600
- Family of 4: $32,150 to $128,600
- Family of 5: $37,650 to $150,600
You can still buy a marketplace plan if you earn more than 400% of the poverty level, but you would pay the full premium without subsidies. Enhanced subsidies introduced during the pandemic temporarily removed the upper income cap, but those provisions are subject to congressional renewal, so check HealthCare.gov for the most current rules when you apply.
If your income falls below 250% of the poverty level (about $39,125 for a single person), you may also qualify for cost-sharing reductions that lower your deductibles and copays. These only apply if you choose a Silver-tier plan. The savings can be substantial: someone receiving this benefit might face an annual out-of-pocket limit of around $3,350, compared to roughly $10,150 for someone on a Silver plan without the reduction.
The Texas Coverage Gap
This is the single most important thing to understand about ACA eligibility in Texas. Because Texas has not expanded Medicaid, adults without children (and many parents) earning less than 100% of the federal poverty level, roughly $15,650 a year for a single person, fall into what’s known as the coverage gap. They earn too much to qualify for Texas Medicaid, which has extremely strict eligibility rules, but too little to qualify for marketplace subsidies.
About 1.148 million uninsured adults in Texas currently fall into this gap. Texas Medicaid for parents kicks in only at about 15% of the poverty level, which is just a few thousand dollars a year. Childless adults without a disability generally don’t qualify for Texas Medicaid at all, regardless of how little they earn. If you’re in this situation, you won’t be eligible for subsidized marketplace coverage, and there is no state-level program to fill the gap.
Employer Coverage and the Affordability Test
If your employer offers health insurance, you can still buy a marketplace plan, but you typically won’t qualify for subsidies unless your employer’s coverage fails the affordability test. In 2025, employer coverage is considered unaffordable if your share of the premium for employee-only coverage exceeds 9.02% of your household income. If it crosses that threshold, you become eligible for marketplace subsidies instead.
This calculation uses household income, not just your individual salary, which matters for families where both spouses work. It also looks only at the cost of covering the employee alone, not the cost of adding a spouse or children to the employer plan.
When You Can Enroll
Texas uses the federal marketplace at HealthCare.gov. Open Enrollment runs from November 1 through January 15 each year. If you miss that window, you can only enroll during a Special Enrollment Period triggered by a qualifying life event. The most common triggers include:
- Losing other health coverage (job loss, aging off a parent’s plan, losing Medicaid)
- Getting married
- Having or adopting a child
- Moving to a new area with different plan options
- Divorce or a court order affecting health coverage
Most qualifying events give you 60 days to enroll. For the birth or adoption of a child, coverage can be backdated to the date of the event itself, rather than starting the first of the following month.
Who Cannot Get Marketplace Coverage
A few groups are specifically excluded. People currently enrolled in Medicare cannot purchase a marketplace plan. Undocumented immigrants are ineligible, as are DACA recipients. People who are incarcerated do not qualify during their incarceration, though they can enroll through a Special Enrollment Period upon release.
If you’re eligible for Veterans Affairs health benefits or TRICARE, you can technically apply through the marketplace, but you generally won’t qualify for subsidies because those programs are considered minimum essential coverage. The same applies if you have access to affordable employer-sponsored insurance that meets minimum value standards.