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Losing health coverage in Texas

COBRA works the same in every state, but almost everything around it does not — enrollment dates, which products are legal, and what coverage actually costs here. This is what is specific to Texas.

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Texas has the highest uninsured rate in the United States at 19.1% — nearly one in five working-age residents, and almost six times Massachusetts. Texas has not expanded Medicaid, so the coverage gap is the widest in the country. It is also the largest state by county count at 254, spread across 27 rating areas, so what is available to you in rural West Texas bears little resemblance to Houston or Dallas. Texas ranks sixth on our exposure index despite a below-median layoff rate, purely on the strength of how many people here have no coverage to begin with.

What the numbers say about Texas

19.1%of under-65 residents uninsured — the highest of 51
12.5%of median monthly household income taken by a single COBRA premium — the 22nd lowest of 51
1.00%monthly layoff and discharge rate

Texas ranks the 6th highest of 51 on our State COBRA Exposure Index, which combines those three measures. Uninsured figures are 2024 Census estimates covering all 254 counties in the state.

What is different about Texas

Texas uses the federal marketplace at HealthCare.gov.

Open Enrollment for 2027 coverage runs from November 1, 2026 to January 15, 2027, the federal schedule. Enroll by December 15, 2026 for coverage starting January 1.

Short-term plans are available here, but they are not comprehensive coverage — typically medically underwritten, often excluding pre-existing conditions, and not minimum essential coverage. They can suit a short, defined gap such as a new employer’s waiting period. They are not a substitute for a marketplace plan.

Where plans are priced

Individual health plans are not priced statewide. Texas is divided into geographic rating areas, and the plans available to you — and what they cost — depend on which one your county falls into. Two households an hour apart can face a different list at a different price. This is why a national quote figure means very little, and why a licensed agent will ask for your ZIP code before anything else.

COBRA in Texas

COBRA is federal law, so it works identically in every state. If your employer had 20 or more employees you have 60 days to elect from the later of losing coverage or receiving your notice, then 45 days to make the first payment, and coverage reaches back to the day your old plan ended. You pay 102% of the full premium.

What varies by state is what happens when federal COBRA does not apply. If your employer had fewer than 20 employees, Texas may have its own continuation law — often called mini-COBRA — with different durations and eligibility. Ask about this specifically if you worked for a small employer, because it is easy to be told "you do not qualify for COBRA" and not be told about the state alternative.

How COBRA works in detail · COBRA compared with a marketplace plan · All your options after a job ends

The largest counties in Texas

Because plans are priced by rating area rather than statewide, the figures below differ between places that sit an hour apart. Each one has its own page with the local uninsured count, how many people bought marketplace coverage there, and how many insurers actually sell in it.

CountyUninsured, under 652026 plan selectionsInsurers
Bell County15.0%39,4254
Bexar County18.1%299,9509
Brazoria County15.2%39,3776
Brazos County17.3%18,4044
Cameron County26.6%78,8625
Collin County11.0%168,20710
Comal County12.5%15,5387
Dallas County24.2%452,07510
Denton County11.7%120,0198
Ector County24.4%36,5894
El Paso County23.7%135,3087
Ellis County16.1%25,5458
Fort Bend County13.0%147,5047
Galveston County15.4%38,7005
Guadalupe County14.6%14,1237
Harris County22.8%731,3009
Hays County14.9%20,4209
Hidalgo County26.7%210,6385
Jefferson County20.3%29,5476
Johnson County19.6%18,3986
Kaufman County18.7%15,6073
Lubbock County16.6%53,3345
McLennan County18.3%20,5023
Midland County17.0%26,7134
Montgomery County17.4%75,2048
Nueces County19.1%37,5664
Parker County16.3%14,3405
Smith County21.0%27,5964
Tarrant County18.9%236,6479
Travis County14.6%184,35510
Webb County26.2%51,7273
Williamson County10.8%63,54610

The 32 largest counties in Texas by population, covering 82% of the state's under-65 residents. Uninsured rates are 2024 Census estimates; plan selections and insurer counts are from the 2026 CMS public use files. Figures for every county in Texas — including those without their own page — are in the state data set.

Common questions

How much is health insurance in Texas?

There is no single answer, because Texas is split into geographic rating areas and prices differ between them. Your age, household size and income all change the figure too. What we can say concretely is that a full COBRA premium consumes about 12.5% of median monthly household income here, which is the 22nd lowest of 51 in the country — one reason so many people in Texas look for an alternative.

When is Open Enrollment in Texas?

November 1, 2026 to January 15, 2027 for 2027 coverage, following the federal schedule. Enroll by December 15, 2026 if you want coverage starting January 1.

Can I get short-term health insurance in Texas?

Yes, they are available in Texas. They are not comprehensive coverage — typically medically underwritten and not minimum essential coverage — so they suit a short, defined gap rather than an ongoing need.

What if my employer in Texas had fewer than 20 employees?

Federal COBRA would not apply, but Texas may have its own continuation law covering smaller employers. Durations and eligibility differ from federal COBRA. Ask specifically about state continuation — people are often told they do not qualify for COBRA without being told the state alternative exists.

Does losing my job in Texas let me buy insurance right away?

Yes. Losing job-based coverage opens a 60-day Special Enrollment Period for a marketplace plan, and only 30 days to join a spouse's or parent's employer plan. Medicaid has no window at all and can be applied for any day of the year.

Is Medicaid an option in Texas?

It is worth checking first either way, because there is no enrollment window and no premium, and eligibility is assessed on your current monthly income rather than your annual figure. Be warned, though: Texas has not expanded Medicaid. That leaves a coverage gap — adults earning too much for the state's restrictive Medicaid limits but too little to qualify for marketplace subsidies. Losing a job can drop you into that gap rather than out of it, which is exactly why it is worth finding out where you stand before you decide anything else.

Why does my premium differ from someone else in Texas?

Because plans are priced by rating area rather than statewide, and your age and household composition also matter. Someone in a neighboring county can genuinely face a different set of plans at different prices.

Is there a health insurance agent near me in Texas?

You do not need one physically nearby. Plans in Texas are sold and priced by county, and a licensed agent can look up exactly what is available in yours from anywhere. Calling (866) 821-1808 connects you with a licensed agency covering Texas.

Talk it through with a licensed agent

Which option is right depends on your state, your income and which doctors you need to keep. A licensed agent can walk through it with you in about eight minutes.

Call (866) 821-1808

Free to call, no obligation, and we never ask you for payment. CobraScout is paid by the agency that answers, not by you. TTY 711.

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