Before you start

Texas residence
Income information for subsidy eligibility
An SSN or ITIN for marketplace applications
A qualifying life event, if enrolling outside the annual window

Step-by-step

1
Treat employer coverage as part of the offer, not a perk
Enrol within your new-hire window, typically 30 days from your start date. In a state without Medicaid expansion, the employer plan is doing far more work than it would in New York or California — compare the deductible and out-of-pocket maximum between offers, not just salary.
Via employerWho: YouFirst 30 days of employment
2
Without an employer plan, use HealthCare.gov
Texas does not run its own exchange, so you enrol through the federal marketplace. Open enrolment for 2026 plans ran from 1 November 2025 to 15 January 2026. Outside that window you need a qualifying life event.
OnlineWho: You
3
Check your subsidy eligibility honestly
Marketplace subsidies phase in above a floor set by the federal poverty level. In expansion states Medicaid catches people below that floor; in Texas it largely does not. Run your actual expected income through the HealthCare.gov estimator before assuming you are covered either way.
OnlineWho: You
4
Register with a primary care physician
Your PCP gates specialist access in most plans. Confirm network status with the practice directly rather than trusting the insurer directory, which is frequently out of date, and do it before you are ill.
OnlineWho: You
5
Learn the urgent care versus emergency room distinction
An ER visit for something a clinic could treat can cost thousands even with insurance. Urgent care handles fractures, stitches and infections far more cheaply. Free-standing emergency rooms are common in Texas and often bill at hospital ER rates despite looking like clinics — check the signage carefully.
In personWho: You
6
If uninsured, look at Central Health and CommUnityCare
Travis County runs a hospital district and a federally qualified health centre network providing sliding-scale primary care for county residents. It is not insurance and it will not cover a hospital admission, but it is the local safety net and it is underused.
In personWho: You

Documents you’ll need

Proof of Texas residence
Income documentation for subsidy eligibility
SSN or ITIN
Immigration documents for marketplace eligibility categories
Evidence of losing prior coverage, if using a special enrolment period

Things most newcomers don’t know

Texas's decision not to expand Medicaid creates a real coverage gap.

In expansion states, Medicaid covers adults up to 138% of the federal poverty level and marketplace subsidies take over above that. Texas did not expand, so adult Medicaid is limited largely to parents at very low incomes, people with disabilities and pregnancy coverage. The result is a band of working people who qualify for neither — and the highest uninsured rate in the United States.

Source: HealthCare.gov — Medicaid expansion and the coverage gap

Free-standing emergency rooms look like clinics and bill like hospitals.

Texas has an unusual density of free-standing ERs in suburban retail settings. They resemble urgent-care clinics but are licensed as emergency departments and bill at emergency rates, producing four-figure bills for minor complaints. Read the sign: 'emergency' in the name means emergency pricing.

Source: Texas Department of Insurance — free-standing emergency rooms

The deductible is what actually surprises newcomers.

US plans commonly require you to pay the first several thousand dollars of care each year before the insurer contributes. Someone from a national health service reads 'I have insurance' as 'I am covered', then gets a $2,800 bill for a scan. Read the deductible and the out-of-pocket maximum before the premium.

Source: community-reported

Losing job-based coverage opens a special enrolment window.

You do not have to wait for annual open enrolment if you lose employer coverage, move to Texas, marry or have a child. Each triggers a limited special enrolment period, typically 60 days. People who don't know this go uninsured for months unnecessarily.

Source: HealthCare.gov — dates and deadlines

Common mistakes to avoid

Accepting a Texas job offer without health insurance and assuming a marketplace plan will be cheap.
Missing the 30-day new-hire enrolment window.
Walking into a free-standing emergency room thinking it is an urgent-care clinic.
Choosing on premium alone and hitting a five-figure deductible.
Assuming Medicaid is a fallback — in Texas, for a working-age adult without children, it usually is not.

Some of this may be out of date. Spotted something inaccurate? Help us keep it right for the next newcomer.