Before you start

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

Step-by-step

1
Enrol in your employer's plan within the new-hire window
Typically 30 days from your start date, and missing it can mean waiting for the next open enrolment. In a non-expansion state with no county hospital underneath, this is the most important form you will fill in during your first month. Compare the deductible and out-of-pocket maximum, not just the premium.
Via employerWho: YouFirst 30 days of employment
2
Without an employer plan, use HealthCare.gov
Texas runs no state exchange, so individual plans are bought on the federal marketplace. Open enrolment runs on a fixed annual calendar; outside it you need a qualifying life event such as moving state, losing coverage, marriage or a birth. There is no state-run alternative if you miss it.
OnlineWho: You
3
Check Texas Medicaid and CHIP eligibility, but do not assume
Texas has not expanded Medicaid to low-income adults. Children's coverage through CHIP and Medicaid is considerably broader than adult coverage, so a family can find the children eligible and the parents not. Apply through Texas HHS and check each household member separately.
OnlineWho: You
4
Understand what the Collin County safety net actually is
There is no Parkland or JPS here. Under the Texas Indigent Health Care and Treatment Act, a county with no hospital district and no public hospital must operate a county indigent health care programme with its own eligibility rules and its own spending threshold. Find out what Collin County's programme covers and who qualifies before you need it, and identify the federally qualified health centres in the area, which charge on a sliding scale.
OnlineWho: You
5
Register with a primary care physician in month one
Do it while you are well. An established relationship is what gets you referrals and urgent slots later, and confirming the practice is in your network before the first visit avoids an out-of-network bill for a routine appointment.
In personWho: YouMonth 1
6
Learn the urgent care versus emergency room distinction
An emergency room visit for something a clinic could treat can cost thousands even when insured. Urgent care handles fractures, stitches and infections far more cheaply. Freestanding emergency rooms are common across north Dallas — they look like urgent care from the car park and bill like hospitals. Read the sign carefully.
In personWho: You
7
Plan for heat, allergy and ozone
Summer heat here is a genuine medical risk rather than a discomfort. North Texas has a long ragweed, grass and cedar allergy season, and the Dallas-Fort Worth area is designated in non-attainment for ground-level ozone — which is precisely why Collin County has the vehicle emissions programme. Ozone action days in summer matter if anyone in the household has asthma.
In personWho: You

Documents you’ll need

Proof of Texas residence
Income documentation for subsidies
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

Collin County has no public hospital district. Dallas and Tarrant do.

This is the difference nobody explains when comparing Plano with Dallas or Fort Worth. Parkland and JPS are large county-funded systems with financial-assistance programmes and emergency departments of last resort. Collin County funds neither; the statutory duty falls on a county indigent health care programme instead, which is narrower and less visible. In a state that never expanded Medicaid, that is the floor you are standing on.

Source: Texas Health and Safety Code Chapter 61

Texas has no Medicaid expansion, and that is the single biggest health difference from most US cities in this app.

In Iowa, Oklahoma, California, Michigan and Indiana an adult earning below the subsidy floor is covered by something. In Texas they are frequently covered by nothing at all. That makes an employer health plan a material part of a job offer rather than a benefit line, and makes a gap between jobs genuinely risky.

Source: Texas Health and Human Services / HealthCare.gov

The ozone designation and the emissions test are the same fact.

Dallas-Fort Worth has long been in non-attainment for ground-level ozone under federal air-quality standards, which is why Collin County sits inside the vehicle emissions inspection programme. If anyone in the household has asthma, this connects a bureaucratic annoyance to a real health consideration: summer ozone action days are worth watching here.

Source: Texas Commission on Environmental Quality

A freestanding emergency room is not an urgent care clinic.

Texas has an unusually large number of freestanding emergency departments in suburban retail parks and north Dallas is thick with them. They are licensed as emergency facilities and bill accordingly, and people walk into them for stitches thinking they are a clinic. Check whether the sign says 'emergency' before you walk in — the price difference is an order of magnitude.

Source: Texas Department of Insurance

Common mistakes to avoid

Assuming Collin County has a Parkland-equivalent public hospital. It does not.
Assuming Medicaid will catch you if income is low. In Texas, for an adult, it usually will not.
Missing HealthCare.gov open enrolment and finding Texas has no state fallback.
Missing the 30-day new-hire enrolment window at a new employer.
Walking into a freestanding emergency room for something urgent care handles.
Waiting until you are ill to find out what the county programme covers.

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