Premiums went up this year. That doesn't mean you have to overpay.
Enhanced federal subsidies expired at the end of 2025, and premiums rose across the board for 2026. We compare plans across every major Texas carrier — on and off the Marketplace — to help you find real coverage at the best price available to you.
*This is the maximum any ACA-compliant plan is legally allowed to charge in 2026 — not a typical amount. Most plans, including many we offer, set a meaningfully lower cap. We’ll show you the actual out-of-pocket limit for any plan you’re considering.
Skip the headache of shopping the Marketplace alone
Free guidance from an agent who actually explains your options — not a call center.
Skip the confusing terms and endless plan filters — we walk you through it directly.
We work with many top carriers, on and off the Marketplace, to find what actually fits.
Our guidance is free — your premium is the same whether you enroll with us or alone.
We’re still here year to year — for claims questions, renewals, and life changes.
Bronze, Silver, Gold & Platinum — What's the Difference?
Comprehensive plans are categorized into four metal tiers based on premium and cost-sharing. The plan structure (HMO or EPO) is a separate choice from the tier — in Texas, these are the two structures available for individual coverage. Click a tab to learn more.
Health Maintenance Organization (HMO)
- Provider networkIn-network only (except emergencies)
- Referral needed for specialistsYes, from your PCP
- Typical premiumThe lower of the two structures
Exclusive Provider Organization (EPO)
- Provider networkIn-network only (except emergencies)
- Referral needed for specialistsNo referral required
- Typical premiumSlightly higher than HMO
HSA-Eligible (High-Deductible) Plans
- Available withHMO or EPO plan structures
- Tax advantageContributions are tax-free
- Best forLower premiums, building tax-advantaged savings
On-Exchange or Off-Exchange — Which Is Right for You?
Both follow ACA rules and include the same essential health benefits. The real difference comes down to subsidies and plan structure.
On-Exchange (the Marketplace)
Purchased through HealthCare.gov. If you qualify based on income, this is the only way to receive a premium tax credit. Guaranteed coverage regardless of pre-existing conditions. In Texas, Marketplace plans are HMO or EPO only.
Off-Exchange (Private Carrier)
Purchased directly from an insurance company. Same ACA consumer protections and essential benefits — but no subsidy eligibility, regardless of income.
Every ACA-compliant plan (on or off exchange) must cover these 10 Essential Health Benefits:
- Ambulatory patient services
- Emergency services
- Hospitalization
- Maternity & newborn care
- Prescription drugs
- Mental health & substance use disorder services
- Rehabilitative & habilitative services
- Pediatric services, including dental & vision
- Preventive & wellness services
- Lab services
Both on-exchange and off-exchange ACA-compliant plans can only be purchased during the annual Open Enrollment Period (Nov 1 to Dec 15th)
This applies whether you buy through the Marketplace or directly from a private carrier — any plan that carries ACA protections (guaranteed coverage regardless of pre-existing conditions, the 10 essential health benefits) follows the same enrollment calendar, on or off exchange.
Outside that window, you may still be able to enroll if you qualify for a Special Enrollment Period, typically triggered by:
- Losing other health coverage (job loss, aging off a parent’s plan, COBRA running out, losing Medicaid/CHIP)
- A change in household (marriage, divorce, having or adopting a child, a death in the family)
- Moving to a new address that changes your plan options
- A change in income or household size that affects your subsidy eligibility
- A change in immigration or citizenship status
Where Do You Stand on Subsidies?
A quick, rough orientation — then get your real, subsidy-adjusted quote in the next step.
Health Insurance, Quickly Explained
When can I enroll in a health plan?
Open Enrollment for 2027 Marketplace coverage runs November 1 – December 15, 2026 — note this window recently shortened under a new federal rule (it previously ran through mid-January). Enroll by December 15 for coverage starting January 1. Outside this window, you’ll need to qualify for a Special Enrollment Period.
What qualifies me for a Special Enrollment Period?
Common qualifying events include a change in marital status, a new dependent, moving to an area where your current plan isn’t available, losing other coverage (including a COBRA qualifying event), or becoming eligible for Medicare or Medicaid.
Am I required to have health insurance?
There’s currently no federal tax penalty for not having health insurance. A small number of states have their own individual mandate with a state-level penalty — Texas does not.
Why did my premium go up so much this year?
Enhanced federal premium subsidies that had been in place since 2021 expired at the end of 2025, and Congress did not renew them. As a result, average Marketplace premiums rose more than 25% nationally for 2026. If you’re feeling that increase, it’s worth having us re-shop your options — there may be a better fit at a lower cost.
Do I really need health insurance?
Nearly 70% of personal bankruptcies are tied to medical bills from an unexpected illness or accident. If a full ACA plan doesn’t fit your budget, non-ACA options like short-term health insurance can provide a lower-cost safety net — see our Supplemental Health Plans page for those options.
Health insurance plan availability, premiums, and subsidy eligibility vary by household income, ZIP code, and carrier. Pathway Health Insurance Experts, Inc. represents multiple carriers both on and off the Marketplace; we do not offer every plan available in your area. For full Marketplace plan details and subsidy eligibility, visit HealthCare.gov.
Let's find a plan that actually fits your budget
A quick call is all it takes to compare your real options — on and off the Marketplace — at no cost to you.