Health Insurance Carriers in Texas

Sixteen insurers offer ACA Marketplace plans somewhere in Texas for 2026 — though no single carrier is available in every county.

2026 ACA Marketplace carriers

Availability changes by county and by year. Confirm which carriers are active in your ZIP code before comparing plans.

HMO vs. PPO: which matters more in Texas?

Most Texas ACA plans are HMOs (Health Maintenance Organizations), which require you to use an in-network primary care provider and get referrals for specialists, in exchange for lower premiums. PPOs (Preferred Provider Organizations) cost more but allow more flexibility to see out-of-network providers without a referral.

HMO

  • Lower monthly premium
  • Requires in-network primary care provider
  • Referrals typically needed for specialists
  • Little to no out-of-network coverage

PPO

  • Higher monthly premium
  • No primary care provider requirement
  • No referral needed for specialists
  • Partial out-of-network coverage available

In large metro areas like Houston, Dallas-Fort Worth, and San Antonio, HMO networks are usually broad enough that the lower premium makes sense for most people. In more rural counties with fewer contracted providers, a PPO's flexibility can be worth the extra cost.

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