21.0% of under-65 residents in Smith County were uninsured in 2024 — about 41,733 people — which is modestly above the Texas average of 19.1% and makes it the 90th highest of the 254 counties in Texas. Close enough to the state figure that the county is not an outlier; far enough that coverage gaps here are a real feature rather than a rounding artifact.
Smith County against Texas, and against the counties we cover
| Smith County | Texas | Covered counties | |
|---|---|---|---|
| Uninsured, under 65 | 21.0% | 19.1% | 13.0% |
| Marketplace enrollees per 1,000 | 139 | — | 127 |
| Insurers selling here | 4 | 6 (median) | 5 |
| Individual plans offered | 61 | — | 84 |
State uninsured rate from the Census SAHIE series; the final column is the median across the 104 counties covered on this site. Enrollment density is CMS plan selections per 1,000 under-65 residents.
What you can actually buy here
4 insurers compete here. That is thin enough that switching carrier usually means switching hospital system too, and wide enough that the premiums genuinely differ. Both things are worth checking before either is dismissed. Between them they offer 61 plans, about 15 for each insurer, which is a normal-sized list to work through once you know which network you need. The count is unchanged from last year, so the networks you compared previously still stand.
27,596 marketplace plan selections were recorded in Smith County for 2026, or 139 per thousand under-65 residents — above the 127 typical of the counties covered here. Enough people locally have done this that the process is not unfamiliar territory. 4,101 of them were new consumers and 23,495 were renewals — a 15% new share, close to the national pattern. Roughly one in six enrollees here arrived within the year.
Nearest counties on coverage
The counties we cover in Texas whose uninsured rate sits closest to Smith County. Worth a look if you are comparing across a county line or moving.
| County | Uninsured | Insurers | Enrollees |
|---|---|---|---|
| Jefferson County | 20.3% | 6 | 29,547 |
| Johnson County | 19.6% | 6 | 18,398 |
| Harris County | 22.8% | 9 | 731,300 |
| Nueces County | 19.1% | 4 | 37,566 |
| Tarrant County | 18.9% | 9 | 236,647 |
| Kaufman County | 18.7% | 3 | 15,607 |
Everything that applies in Texas · How COBRA works · Work out your COBRA premium · After a job ends
Common questions
How many people are uninsured in Smith County?
About 41,733 people under 65, out of 198,975 in that age group — 21.0%, the 90th highest of the 254 counties in Texas. The Texas average is 19.1%. Census Bureau estimates for 2024, the most recent published.
How many health insurers sell in Smith County?
4 insurers offer individual marketplace plans in Smith County for 2026, unchanged from the year before, and between them they sell 61 individual medical plans. The median across the counties covered on this site is 5 insurers and 84 plans.
How many people in Smith County buy marketplace coverage?
27,596 plan selections for 2026 — 4,101 new consumers and 23,495 renewals. That works out at 139 per thousand under-65 residents, against a median of 127 across the counties covered here. New consumers are the group most likely to have lost a job during the year.
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.
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.
Sources
- U.S. Census Bureau, Small Area Health Insurance Estimates, 2024 (released August 2026)
- Centers for Medicare & Medicaid Services, 2026 Marketplace Open Enrollment County-Level Public Use File
- Centers for Medicare & Medicaid Services, 2026 Service Area Public Use File
- Centers for Medicare & Medicaid Services, 2026 Plan Attributes Public Use File
- U.S. Department of Labor, FAQs on COBRA Continuation Health Coverage for Workers