Texas Health Insurance Cost Report 2026
A statewide look at ACA Marketplace pricing patterns and carrier competition across Texas's 25 largest cities, compiled from the same county-level data used throughout this site.
Reviewed by Cameron Erwin, Licensed Texas Insurance Agent (TDI License #3498689)
Statewide snapshot
These figures track statewide averages before premium tax credits are applied -- most Texans who shop the Marketplace qualify for some level of subsidy based on household income and size, which can bring the effective monthly cost well below these sticker figures. See our statewide cost and subsidy guide for how premium tax credits are calculated.
What actually drives the price difference between cities
Texas doesn't price ACA Marketplace plans statewide -- pricing and carrier availability are set by rating area, which generally aligns with county boundaries. Two shoppers with identical ages and incomes can see meaningfully different premiums and plan choices depending on which county they live in, driven mainly by how many carriers are actively competing for business in that specific rating area.
As a general pattern across this data, Texas's largest metro areas -- Houston, Dallas-Fort Worth, Austin, and San Antonio -- tend to see deeper carrier competition, which typically clusters more plans toward the lower end of the statewide price range. Smaller and more rural markets often have fewer competing carriers, which can mean less price pressure and, in some cases, higher typical premiums for a comparable plan. Markets with a dominant local economic driver -- a major military installation, a concentrated energy sector, or a large hospital system -- also see carrier and network decisions shaped by that specific economic base, independent of city size alone.
City-by-city carrier and market notes
The notes below summarize the carrier and market dynamics specific to each city's rating area, drawn from the detailed guide for each city and county elsewhere on this site.
| City | County | Market tier | What shapes pricing here |
|---|---|---|---|
| Houston | Harris County | Major metro | As the anchor of the nation's fourth-largest metro economy, Houston has some of the deepest ACA Marketplace carrier competition in Texas, giving shoppers a genuinely wide field to compare rather than one or two default options. |
| San Antonio | Bexar County | Major metro | San Antonio is one of Humana's historic strongholds in Texas, and CHRISTUS Health Plan's strong local hospital network gives shoppers here a distinct carrier mix compared to North Texas or Houston. |
| Dallas | Dallas County | Major metro | Dallas sits at the center of one of the fastest-growing metro economies in the country, with carrier competition to match one of the state's largest Marketplace enrollment bases. |
| Austin | Travis County | Major metro | Austin's rapid population growth has attracted increasing carrier interest in both ACA Marketplace and Medicare Advantage plans, though it's worth comparing network breadth carefully given how spread out the metro has become. |
| Fort Worth | Tarrant County | Major metro | Fort Worth shares much of North Texas's carrier landscape with Dallas, though pricing and network makeup should still be confirmed by ZIP code rather than assumed identical. |
| El Paso | El Paso County | Major metro | El Paso's border-region market tends to have a narrower carrier field than Texas's largest metros, making it worth comparing network access carefully before enrolling. |
| Arlington | Tarrant County | Major metro | Arlington's position between Dallas and Fort Worth gives shoppers here access to the same broad North Texas carrier field as its larger neighbors. |
| Corpus Christi | Nueces County | Mid-size market | Corpus Christi's carrier field is smaller and more regional than Texas's largest metros, shaped by the area's energy, manufacturing, and service-based economy. |
| Plano | Collin County | Major metro | Plano's concentration of corporate offices and professional services firms has made competitive group benefits more of a norm here, which also shapes the broader local Marketplace and Medicare Advantage carrier field. |
| Laredo | Webb County | Mid-size market | Laredo's carrier field tends to be narrower than in Texas's largest metros, with pricing and network options shaped by the city's trade- and logistics-driven economy. |
| Lubbock | Lubbock County | Mid-size market | Lubbock anchors the South Plains region, where shoppers typically have fewer plan options locally than in Texas's largest metros and benefit from comparing carriers carefully. |
| Irving | Dallas County | Major metro | Irving's dense concentration of corporate headquarters sits alongside the same deep North Texas carrier network available throughout the Dallas-Fort Worth metro. |
| Garland | Dallas County | Mid-size market | Garland shares the same broad carrier access as the rest of the Dallas-Fort Worth metro, generally without the added cost pressures of the urban core. |
| Frisco | Collin County | Major metro | Frisco's fast-growing population has attracted growing carrier interest, with many residents weighing individual Marketplace coverage against employer options for the first time as the area grows. |
| McKinney | Collin County | Mid-size market | McKinney's growth mirrors greater Collin County, one of the more competitive suburban Medicare Advantage and Marketplace carrier markets in the state. |
| Killeen | Bell County | Mid-size market | Killeen's Marketplace shoppers often need to weigh coverage alongside TRICARE eligibility, given the city's close ties to Fort Hood (Fort Cavazos) and its large military-connected population. |
| Pasadena | Harris County | Mid-size market | Pasadena sits within Houston's industrial corridor and draws on much of the same deep carrier competition as greater Houston. |
| McAllen | Hidalgo County | Mid-size market | McAllen anchors the Rio Grande Valley, a market with real carrier competition though generally more limited than Texas's largest metros. |
| Mesquite | Dallas County | Mid-size market | Mesquite is part of the greater Dallas-Fort Worth metro, giving shoppers here access to the same broad carrier field as the rest of North Texas. |
| Midland | Midland County | Mid-size market | Midland's carrier field is closely tied to the Permian Basin energy economy, which shapes both staffing patterns and coverage priorities for local shoppers and small employers alike. |
| Waco | McLennan County | Mid-size market | Waco sits between Dallas and Austin, with a Marketplace carrier field that blends steady local demand with growing spillover from both larger metros. |
| Carrollton | Dallas County | Mid-size market | Carrollton shares the same deep carrier competition available throughout the Dallas-Fort Worth metro. |
| Denton | Denton County | Mid-size market | Denton's large university population adds a younger age mix to the local shopper base, which can affect typical premium pricing alongside North Texas's broad carrier field. |
| Round Rock | Williamson County | Mid-size market | Round Rock benefits from its position just outside Austin, with shoppers here often comparing the same carriers active in the greater Austin market. |
| Pearland | Brazoria County | Mid-size market | Pearland is part of the greater Houston metro, giving shoppers here access to the same deep carrier competition found throughout the Houston area. |
Methodology & sourcing
Statewide premium figures reflect typical 2026 plan year ACA Marketplace pricing patterns before subsidies. City and county-level carrier notes are drawn from publicly available carrier service-area filings and this site's own ongoing county-by-county research, and are updated as carrier participation and market conditions change from one plan year to the next. These figures are general patterns, not a quote -- your actual premium depends on your specific age, household size, income, and the exact plan and carrier you choose. This report is not affiliated with HealthCare.gov, CMS, or the Texas Department of Insurance.
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