2026 Health Coverage in Texas: What Actually Happened.

Last year, Texas insurers filed some of the steepest rate increases in years, and nearly every forecast pointed the same direction. Premiums up. Subsidies gone. Enrollment down.

Now that we are nearly half a year into 2026, it is worth setting the predictions next to the results. The gap between them is instructive, and for our market it is not what most people expected.

Here is the big picture, what the data actually shows, and what still has not been settled.

The 2026 individual market filings in Texas were built on a single assumption: that the enhanced federal premium tax credits would expire at the end of 2025.

Carriers initially requested an average increase near 24 percent. The Texas Department of Insurance later described the figure as roughly 33 percent, and the final approved statewide weighted average landed near 34.7 percent before subsidies. [1][2][3] For context, Texas individual market increases had not topped 4 percent in any year since 2018. [1]

Among the carriers confirmed in Rating Area 7, which covers Bexar and the surrounding counties where I live and work, the filed averages ran a wide spread: Blue Cross and Blue Shield of Texas at 39.4 percent on its Blue Advantage HMO, Superior HealthPlan (Ambetter Health) at 36.0 percent, UnitedHealthcare at 23.02 percent, and Community First Health Plans, at 17.58 percent. [4][5][6][7]

The predictions that accompanied those filings were uniformly grim. Analysts projected the subsidy lapse would push millions out of the market, raise average morbidity as healthier members left first, and more than double net premiums for many subsidized enrollees. [8]

The credits did expire on January 1, 2026. While the House passed a three-year extension on January 8 by a 230 to 196 vote, with 17 Republicans joining, the Senate has not enacted one, and earlier Senate efforts to extend the credits failed to reach the 60 votes needed. As of late May, the credits remain lapsed. [9][10][11]

On the national numbers, the forecasts are largely holding. Plan selections fell by more than a million to about 23.1 million, the sharpest single-year drop since the marketplaces launched. [12][13] The effects on cost were significant. The average marketplace deductible rose 37 percent, climbing more than $1,000 from $2,759 to $3,786, the steepest jump on record. Average net premium payments rose 58 percent, from $113 to $178 a month. [14]

The retention picture looks worse than the sign-up picture. KFF projects average monthly effectuated enrollment, meaning people who actually pay and keep coverage, could fall about 21.5 percent, from 22.3 million in 2025 to roughly 17.5 million in 2026. Wakely Consulting Group estimates a decline between 17 and 26 percent. A KFF survey in late February and early March found that 9 percent of 2025 enrollees had already become uninsured, and one in six returning enrollees were not confident they could afford coverage for the full year. [14][15]

This is where the story turns.

Texas did not contract. It set a record. Through the close of open enrollment on January 15, about 4.17 million Texans selected a marketplace plan, up roughly 5 percent from the 3.97 million who enrolled for 2025. Texas was one of only nine states to surpass its prior-year total, even as national enrollment fell. [16][17]

The reason is largely a state policy decision made years ago. A 2021 Texas law, Senate Bill 1296, structures the market so the state captures more value from federal subsidies than states without similar rules, which has kept both bronze and gold plans more affordable. For 2026, every eligible enrollee at or below 200 percent of the federal poverty level, roughly 3.1 million Texans, again had access to at least one zero-premium plan. [17]

The pain in Texas was concentrated, not absent. Approximately 125,000 enrollees reporting incomes above 400 percent of the poverty level, the group that lost subsidy eligibility entirely, absorbed the sharpest cost increases. [17]

I want us all to be careful here, because the most important number is the one we do not have yet.

Plan selections are not the same as people who keep their coverage. A record sign-up count includes automatic re-enrollments, and many of those enrollees may not realize their premium has changed until the first bill arrives. The measure that matters, effectuated enrollment, will not be reported by CMS until its early snapshot expected in July 2026, and even that may understate mid-year attrition. [18][14]

So the honest read in late May is this:

First, a headline rate increase is the start of the analysis, not the end. A 34.7 percent statewide average sat on top of a Texas market that grew, because subsidy structure and plan design did more to determine real affordability than the gross filed number.

Second, the local nonprofit posture matters. Community First filed the lowest increase among the carriers confirmed for our rating area, in a market where access carries real community weight.

Third, watch July. The effectuated data will tell us whether record sign-ups held as sustained enrollment, and that answer shapes both 2027 planning and providers' year-end financials. Remember: Payers can recoup payments for enrollees who lapse during the grace period, but providers cannot recoup the care already delivered, and the shortfall converts into self-pay balances and bad debt.

If you are reading these numbers differently, I would value the exchange. Getting this right serves all of us.

By the way, this is the kind of question I work through for providers in Mastering Managed Care. If it is useful, follow along.

[1] Initial average request near 24 percent; no Texas increase above 4 percent since 2018. Texas Tribune, August 21, 2025. https://www.texastribune.org/2025/08/21/texas-health-insurance-premiums-aca-tax-credit-expiration

[2] TDI described the average as roughly 33 percent. Newsweek, August 2025. https://www.newsweek.com/texas-health-insurance-cost-rise-2026-2113912

[3] Final approved statewide weighted average near 34.7 percent. ACA Signups, compiling SERFF, TDI, and the federal Rate Review database. https://acasignups.net/rate_changes/2026/tx

[4] Per carrier filed figures and ranges (BCBSTX, Superior, UnitedHealthcare, Community First). ACA Signups.https://acasignups.net/rate_changes/2026/tx

[5] BCBSTX coverage in all 254 counties. Texas Tribune, August 21, 2025.https://www.texastribune.org/2025/08/21/texas-health-insurance-premiums-aca-tax-credit-expiration

[6] UnitedHealthcare filing detail and 580,871 Texans covered. San Antonio Current, August 24, 2025.https://www.sacurrent.com/news/health-insurance-carriers-request-raising-aca-premiums-by-more-than-20-on-average-in-texas-38331688

[7] Community First Health Plans, the only local nonprofit health plan in Bexar County, and University Community Care Plan. Community First Health Plans. https://communityfirsthealthplans.com/blog/your-guide-to-the-health-insurance-marketplace-what-it-is-and-how-to-apply/

[8] Subsidy expiration as the leading driver in carrier filings. ACA Signups, carrier actuarial memos.https://acasignups.net/rate_changes/2026/tx

[9] Enhanced premium tax credits expired January 1, 2026. Congressional Research Service, Congress.gov.https://www.congress.gov/crs-product/R48290

[10] House passed a three-year extension on January 8, 2026, by 230 to 196 with 17 Republicans. Ballotpedia News, January 12, 2026. https://news.ballotpedia.org/2026/01/12/house-passes-three-year-extension-of-expanded-aca-subsidies/

[11] Senate extension efforts (S 3385) failed to reach 60 votes; no extension enacted. ASTHO, January 20, 2026.https://www.astho.org/communications/blog/2026/aca-enhanced-premium-tax-credits-legislative-developments-2025-2026/

[12] National plan selections fell about 5 percent to 23.1 million, the sharpest single-year drop. HFMA, April 3, 2026.https://www.hfma.org/payment-reimbursement-and-managed-care/aca-marketplace-enrollment-2026-decline/

[13] CMS 2026 Open Enrollment national snapshot, total plan selections. Centers for Medicare and Medicaid Services.https://www.cms.gov/newsroom/fact-sheets/marketplace-2026-open-enrollment-period-report-national-snapshot-2

[14] Deductibles up 37 percent; net premiums up 58 percent; effectuated enrollment projected down about 21.5 percent; 9 percent of 2025 enrollees already uninsured. KFF analysis and AJMC summary, May 2026.https://www.kff.org/affordable-care-act/what-we-know-so-far-about-2026-aca-marketplace-enrollment-premiums-and-deductibles/

[15] Wakely estimate of a 17 to 26 percent effectuated decline. Insurance Forums, May 2026. https://www.insurance-forums.com/health/aca-marketplace-deductibles-spike-enrollment-drops-after-subsidy-expiration/

[16] Texas reached about 4.17 million plan selections, up roughly 5 percent, one of only nine states to surpass 2025. Texas Tribune, January 13, 2026. https://www.texastribune.org/2026/01/13/texas-affordable-care-act-health-insurance-enrollment-record

[17] Record Texas enrollment, Senate Bill 1296, zero-premium plans for enrollees at or below 200 percent FPL, and 125,000 enrollees above 400 percent FPL most affected. Texas 2036, January 13, 2026. https://texas2036.org/posts/texas-aca-enrollment-hits-record-high-in-2026-surpassing-last-year/

[18] Effectuated enrollment early snapshot expected July 2026; plan selections do not equal sustained coverage. KFF, February 5, 2026. https://www.kff.org/affordable-care-act/aca-marketplace-enrollment-is-down-in-2026-but-all-of-the-data-isnt-in-yet/

Kevin W. Barron, MBA, FHFMA, FACHE is a nationally recognized healthcare contracting and payer relations executive with over 30 years of experience in healthcare finance. He is an author, speaker, and mentor to emerging leaders in healthcare finance. Follow Kevin on LinkedIn or subscribe to his weekly newsletter at https://www.KevinWatsonBarron.com

Disclaimer: This article is provided for general informational and educational purposes only. It reflects my personal views and observations based on professional experience in healthcare finance, managed care, payer relations, and revenue cycle operations. It should not be interpreted as legal, financial, regulatory, actuarial, or reimbursement advice. The content is not intended to represent the official position of my employer, any payer, provider, professional association, or other organization with which I may be affiliated. Readers should consult their own legal, financial, compliance, actuarial, or operational advisors before making decisions based on the issues discussed. Any references to payers, providers, regulations, market trends, or reimbursement practices are intended for discussion and education only and should not be construed as a statement about any specific contract, negotiation, patient matter, or confidential business arrangement.