Me and my Family live in Texas. I work freelance and my wife is fulltime. For the past 6 months I've been on my wifes PPO employer plan along with our 2 year old son. It's open enrollment right now and considering she's paying a 1000 a month for all three of us I decided to look into private health insurance. A health broker/Agent reached out to me and presented me with a few plans and after going over some stuff with him we landed on a plan that was 472 a month for me and my son which offered 6 doctors visits a year, 2 specialist visits a year, a 100$ health insurance company pay towards every doctors visit after health insurance discounts and 200$ health insurance company paid towards specialist visits after health insurance discount and a 100,000 in life assurance. Pretty much I'll pay what ever is left over after the health discount and the health company payout towards the visit, so if a visit is 500 bucks, they will bring it down to 200 and then pay 100 of it and then I pay the rest, the idea is that I should have to pay next to nothing though but that's the idea. The health insurance company this is for is United Healthcare (things I've heard bad and good things about but their claims history has me a bit worried). I really don't go to the doctor myself, I just do a yearly checkup with bloodwork and that's about the extent of my health care, my sons a bit different as he's two but all of his check ups seem to be covered under this plan.

Going on this plan would bring my wifes monthly premium to 330$ instead of 1000$. That saves us over 200 dollars a month and apparently my wifes employer coverage isn't covering certain things for our son like teledoctor visits (we have a 3 minute video call with a doctor that her insurance wouldn't cover and it cost us 200 bucks so I'm not opposed to looking else where).

Does anyone have experience with a similar situation? Anyone seen or been on a private plan like this and if so what was your experience?

The annual window to sign up for health insurance through the Affordable Care Act opened Nov. 1, and many Texans are expected to pay more for coverage this year.

Enhanced premium tax credits that have helped ACA enrollees shave off the cost of their premiums are slated to expire at the end of the year.

The loss of the subsidies will have an outsized effect on Texas, where nearly 4 million people signed up for ACA coverage this year. Health policy organization KFF projects that Texans who use ACA tax credits will see premiums rise by an average of 115% or $456 per year.

Here’s what you should know about ACA health insurance and open enrollment for the next year.

What is ACA health insurance?

Often referred to as Obamacare, ACA is a marketplace where Americans and legal residents can purchase health coverage. While some states have their own marketplace to buy insurance, Texas does not and Texans interested in ACA coverage can purchase a plan in the federal marketplace through healthcare.gov.

The period to sign up for ACA health insurance opens Nov. 1 and ends Jan. 15, 2026. There are many websites that look similar or claim to be the official website to sign up for ACA health insurance, but HealthCare.gov is the only one run by the federal government.

You must be a U.S. citizen or national or lawfully present in the U.S. Incarcerated people also can’t buy ACA coverage. There is no income limit.

Who is eligible to purchase ACA health insurance?
You must be a U.S. citizen or national or lawfully present in the U.S. Incarcerated people also can’t buy ACA coverage. There is no income limit.

There are five tiers for plans: bronze, silver, gold, platinum, and catastrophic. The cost you pay varies by plan.

How can I apply for ACA insurance?
Open enrollment, or the period to sign up for ACA health insurance for next year, opens Nov. 1 and closes Jan 15. 2026.

There are many websites that look similar or claim to be the official website to sign up for ACA health insurance, but HealthCare.gov is the only one run by the federal government.

There are also options to enroll over the phone for free and through a physical application that is mailed in. Brokers and agents that work for health insurance companies that offer ACA plans can also help with signing you up for ACA coverage. Clinics and nonprofit organizations also have staff members, such as navigators, to help you sign up for ACA coverage and Medicaid or CHIP.

What are some terms I should know when shopping for health insurance?

• Premium: The amount you pay for your health insurance per month.

• Deductible: The amount you pay before your insurance starts to pay. After this you also pay either a copayment, a fixed amount for the health care service, or coinsurance, where you pay a percentage of the covered cost.

• Out-of-pocket maximum: The maximum amount of money you have to pay in a year before your health plan pays 100% of the covered benefits.

• Out-of-network provider: A provider whose services are not covered by your health insurance plan and you may end up paying the full price of the service.

• In-network provider: A provider whose services are covered by your plan. Even if the service is considered in-network, there may be a co-pay that you must pay for the service. plan.

• Insurer: The company supplying the insurance.

• Policy: A policy is a package of covered health care items and services that your health care plan will pay for.

• Claim: A bill submitted by the provider to the health insurance company so that the provider can be paid for the services that are covered by the plan. If you’ve paid the full cost of the service up front, you can also submit a claim to the insurance company for reimbursement.

• Beneficiary: You or the person who is enrolled in the health insurance plan.

I can't afford an ACA plan.

I've been on Pivot short term insurance, renewing every time, for 4 years now. I've never used it. I only have it for catastrophic emergencies.

I've heard hospitals in Texas will offer charity care for the uninsured. So if I have Pivot for an emergency, and Pivot won't pay, does this mean I'd be better off with NO insurance?

I earned about $45k last year but I'm self employed. I'm not able to work as much right now so my future earning will be much less... I can't really afford the $127/mo short term health insurance for much longer.

Thanks for any help.

Edit - I removed a line about subsidized plans because I don't want that to be the focus on this post. ACA is unaffordable to me regardless of subsidies, especially now that my income has decreased.

I need help weighing being uninsured vs short term insurance please.

I'm in a bit of a frustrating situation with my Marketplace Plan.

In the past, I used to work for a large corporation that gave me health insurance for a great rate. Anytime I wanted to book an appointment, I never had any problems doing so. Basically, every doctor I needed to see would take the insurance.

Now, I have transitioned into being self-employed. One of the downsides of doing so is having to find and pay full price for your health insurance. I have been buying the insurance from Marketplace the past few years, which honestly is pretty expensive. When I was working for the large corporation, I was paying about $80 a month. Now that I am self employed, I am paying $480 a month.

The price is a hard pill to swallow, but honestly that is not even the main problem. The MAIN problem is that anytime I try to make an appointment with any doctor, they will say "Oh, we take your plan carrier (for example, BCBS, aetnta, UHC), but we don't take the 'Marketplace' Plan."

Honestly, aside from me being frustrated and feeling like I am spending 5x more money to not be able to be seen by any provider, I am also desperate to find an option that will not put me in this position ever again.

Basically, I never want to buy a plan from the Marketplace EVER again. Is this possible? Or do I have to be employed with a corporation again to get health insurance that will actually be accepted?

I realize it might be too late to get a health insurance plan for this year. However, for 2026, I would like to prepare and have a plan lined up so I can get adequate healthcare coverage.

My brother moved from Oklahoma to Texas with my mom who has Dementia and Extreme COPD. She is uncapable of taking care of herself and needs 24/7 supervision so she doesn't walk off, burn the house down ect.... My brother gave up his 6 figure job to take care of her and they are living on a fixed income of aprox. $3,000 a month. So things are tight but manageable. In Oklahoma, they have "Sooner Care" which by brother easily qualified for. But in Texas we cannot find any such program. He has no income (of course) and is dependent on meds. He is really in need of his meds. Called 211 and Medicare, no chance. They basicly told him to go to a clinic close by who works on a slide scale. I can't believe there is no way to get him insured for less than $500 a month. If you have any tips or direction to point us in, our family would be extremely graetful.

I know next to nothing about the marketplace, I have been reading as much as I can, but every time I search a specific insurer/group by name, I get a litany of horror stories.

I qualify for a special sign up based on losing insurance when I moved, I'd rather pay a little more each month than have an unknown amount I owe at a later date, if that makes sense.

Is there a trick or rhyme or reason to whittling down what options are best? I mean, I have no idea what my usage of the services will be. So I can't really guesstimate there. I could be there every day, or I could go once a year or less, it all depends on what they find and how bad it is.

Any and all advice would be appreciated.

Thank you in advance.

Edit: To add if it makes a difference, I am Male/43 and I'm going to likely need a full work up to see where I am at health wise. I haven't been to a doctor in 7 years. I have zero doubt there isn't something going on with me health wise, covid did a # on me (even with the vaccine), and I have some lingering other issues that seem to effect my energy and feeling good any given day.

I have blue cross blue shield insurance. I thought it can cover all expenses during the visit to the doctor. However, i was told that insurance covered "some" part of my visit and therefore I was charged as well. And the strange thing is that nobody could explain to me what % of expenses should be covered by me/insurance, they just asked the bill.

So, im wondering if anyone can explain how does this thing work at all? Is there a way that I can know before going to the doctor how much i will be charged and how much my insurance will pay?

Would love any advice for the cheapest healthcare option for me. Right now I’m paying $340/mo with BCBS. I make $50k salary with commissions here and there, about $3400/month income. I’m interviewing for new jobs with higher salaries. I go to the Dr. Maybe once or twice per year - I rarely get sick.

I’m wondering if it’s possible to find great, affordable health insurance in Texas. I’m a native Houstonian, and I’ve worked in restaurants since graduating. Company plans are pretty rare in my industry. Are there affordable plans that won’t screw me if something happens?

Hello, one thing that scares me to death about the US is healthcare, I keep reading horror stories on the internet about people being denied when they’re most vulnerable even with good health insurance.

What’s the reality you see?

Is there a level of health insurance that is actually safe or this is a widespread issue?

I’m someone that would be going for 200k+ tech jobs, but even with that kind of money health issues can eat your money pretty fast, so I’d like to know how good it actually is once you have good insurance, can you actually trust it? How much a good insurance actually cost? (30yo).

Other than that, how’s the overall quality in Dallas and Austin?

Is there any insurance in TX that’s as good as Anthem Blue Cross? I’m moving to TX soon (from CA) and I’m not too worried but still a bit worried about finding proper insurance

I’ve read that the morons running Texas turned down ACA which makes it a bit harder

The obvious choice is to stay in California but my mom moved out to TX and I’m choosing to go live with her because of personal issues with living alone in CA

Looking to learn about any insurances that cover most if not all types of medical care, I just put down dental vision because that’s the one thing on my mind right now

I don’t know what to do. My health is gradually deteriorating, I can’t ignore my symptoms anymore.

About my household: I applied via healthcare. gov. I’m in Texas, Denton County(obv). I have a sibling, we’re both 19. Only he and I qualify. My parents don’t work enough to qualify for job benefits, and also don’t qualify for government sponsored healthcare.

After submitting the application, I was shown very expensive plans ( deductibles at $18,000, at $600 a month, or $0 deductible at $900 a month.) I don’t know, Maybe that amount is normal or even cheep to some of you. But the healthcare. gov ads on TV said “affordable healthcare plans:D!! As low as $10 a mo/ the average applicant saves up to $62737373 a month!!!!”

I can’t believe it. I told these mfs on my application: “yeah my brother and I are both full time students, working part time, and making less than $1k a mo/.” And they’re like: “yes ok. let’s provide plans that are both your yearly salary combined in deductibles and charge 2/3 of what you make ea. month in payments!! :D hm yes that’s rational!”

I’m shocked. I know healthcare is expensive, I’m no veteran to the uninsured game, but jeez. It’s all too much. My parents never bothered re applying for Medicaid since I was 13, only taking me to a cheep community clinics whenever I caught a flu and largely ignore my underlying medical conditions. Now I ’m over 18 with a plethora of issues that make my daily life miserable. I’ve acquired $5k in remaining ER bills and previous doctor visits debt, currently paying them off + student debt.

I am so lost. I don’t know what to do.

I go to the cheep clinics, tell them my sob story and they all say:

1. “we can’t treat that here, you need a specialist” then don’t bother suggesting affordable referrals.

2. or “apply at healthcare. Gov/ medicaid” then I don’t even fking qualify/ it’s too expensive anyways.

What am I supposed to do??

**. insert guess I’ll die meme 🤷. **

Also going to post this on r/fortworth , r/Texas, and r/healthinsurance for more visibility im desperate.

Texas is such a beautiful state. I'm so shocked at how crappy the health insurance is. All insurance options appear to have coinsurance. With coinsurance it can be very costly for someone who has a medical condition. Not to mention anyone who may be on a tight budget. Wow!

Hey folks. Self employed in (sigh) Texas. Trying to change/upgrade my Blue Cross plan (Blue Advantage HMO, not even a metal/medal level) cause it seems like nothing is covered ever. This is just for me, no fam, no kids etc. Looking at other BCBS plans or United Health Care, open to others if anyone has ideas). I'm finding all the info very confusing.

Where do I start? On each of those companies' sites, when I list all the docs I see, they come up as not covered on EVERY PLAN. But if you search another way on the BCBS website, it says they are indeed covered on the Bronze, Silver, Gold Advantage plans. Navigating the UHC site is so tough I can't even find another way to search. Is this info just totally unreliable; i.e. would I be better off literally calling all my docs and seeing what plans they take? If these sites can't be trusted to accurately tell me what docs are covered under various plans, can I assume the same about meds?

Also don't understand why some Silvers are more expensive than Golds in the same "family" (Advantage for instance on the UHC website).

Lastly, co-insurance. Is this the amount YOU pay after you've met your deductible but before you reach the out of pocket max, or is that the amount THE INSURANCE COMPANY pays? Other websites seem to suggest it's the amount YOU pay, but that makes no sense if co-insurance is listed as "0" on some plans, or the numbers seem to be more favorable on cheaper plans, cause that's too good to be true and not the world we live in. On the BCBS site the description literally says it could be either. Super unhelpful.

Yours Truly, Lost in Lone Star

Hello. I moved in in March. Just got my drivers license recently. I am currently unemployed attending a coding bootcamp. How do I apply for health insurance? Thank you!

healthcare.gov quoting $800 per month in Texas. Is that how much I'll pay or are there tax credits or something that help with premiums?

So I am currently working 40 hours a week making around 30K a year the place I work for does not really any kind of health insurance I am 23 years old in decent health single and not disabled so I just wanted to know based on these factors what are some good options to get decent health insurance I know its a long shot since our country sucks in this but if anyone has any kind of useful advice I want to know.

Hi everyone.

My company is new and growing but they will be getting a comprehensive benefits package within the next year. So they are shopping for good rates for all of their employees. I’m joking this new company so I will have to pay out of pocket but they will reimburse me 100% of what I pay.

Is there some good recommendations for bundled health and dental plan? I live in Texas. I previously had Blue Cross Blue Shield. Any suggestions would be great. Preferably PPO in network.

Premium payments under $250/month if possible. Thanks.

Health and dental. No vision required.

I’m living in Texas and self employed. The health insurance in TX is super expensive and only allow small business to have PPO. I heard California state allow PPO even for individual and cheaper insurance, true ? Especially for my case who’s 55, insurance is important. Thanks