Key Features of the Texas Insurance Marketplace

The insurance marketplace in Texas, often referred to as the health insurance exchange, is a platform where individuals, families, and small businesses can shop for and enroll in affordable health insurance plans. This marketplace was established under the Affordable Care Act (ACA), commonly known as Obamacare.

Key Features of the Texas Insurance Marketplace:

  1. Open Enrollment Period:
    • The marketplace has an annual open enrollment period during which people can enroll in a health insurance plan.
    • For 2023, the open enrollment period was from November 1, 2022, to January 15, 2023. Dates can vary each year.
  2. Special Enrollment Periods:
    • Outside the open enrollment, special enrollment periods are available for those experiencing qualifying life events, such as marriage, birth of a child, or loss of other health coverage.
  3. Plan Categories:
    • Plans are categorized as Bronze, Silver, Gold, and Platinum, based on the percentage of costs they cover.
  4. Premium Tax Credits and Cost-Sharing Reductions:
    • Many Texans qualify for subsidies to help lower their monthly premiums and out-of-pocket costs based on their income and family size.
  5. Coverage for Essential Health Benefits:
    • All plans cover essential health benefits including emergency services, maternity care, mental health services, prescription drugs, and more.
  6. No Denial for Pre-existing Conditions:
    • Insurers cannot deny coverage or charge more due to pre-existing health conditions.

How to Access the Texas Insurance Marketplace

  • Online: The federal government’s website,, is the primary portal for the Texas insurance marketplace.
  • By Phone: Enrollment can also be done over the phone through the Marketplace Call Center.
  • In-Person Assistance: Navigators and certified application counselors are available in Texas to help with the enrollment process.
  • Through Insurance Agents: Licensed insurance agents can help individuals and businesses select and enroll in marketplace plans.

Choosing a Plan

When selecting a plan, consider factors such as:

  • Monthly premiums vs. out-of-pocket costs: Lower premiums often mean higher out-of-pocket costs and vice versa.
  • Network of Providers: Ensure your preferred doctors and hospitals are covered.
  • Prescription Drug Coverage: Check if your medications are covered under the plan’s formulary.

For Small Businesses

  • The Small Business Health Options Program (SHOP) is available for small businesses with 1 to 50 employees.
  • SHOP plans offer flexibility in coverage and contributions.


The Texas insurance marketplace is an essential resource for residents seeking affordable health insurance. With various plans and subsidies available, it provides options to meet different health needs and budgets. Understanding the enrollment process, plan categories, and available assistance can help Texans make informed decisions about their health insurance coverage.