Texas health insurance, explained clearly

How health coverage works in Texas

Texas is a federally facilitated Marketplace state, which means residents shop for individual and family health plans through HealthCare.gov rather than a state-run site. Coverage can also come from an employer, a spouse's employer plan, or directly from an insurer outside the Marketplace in some cases. Plan availability, provider networks, and costs can vary significantly from one Texas county to another, especially between major metro areas and rural regions. Because the landscape shifts each plan year, it helps to review your options annually rather than assuming last year's plan is still the best fit.

Common plan types you'll encounter

Most individual and family health plans sold in Texas fall into a few structural categories, and understanding the difference matters before you choose one.

• HMO (Health Maintenance Organization): typically requires using in-network providers and getting referrals to see specialists.
• PPO (Preferred Provider Organization): usually offers more flexibility to see out-of-network providers, often at a higher cost share.
• EPO (Exclusive Provider Organization): generally requires in-network care but usually does not require referrals.
• Each carrier builds its own network, so the same plan type can look very different depending on which doctors and hospitals participate.

Urban vs. rural access in Texas

Texans in large metro areas like Houston, Dallas–Fort Worth, San Antonio, and Austin generally have more plan choices and larger provider networks to pick from. In smaller and rural Texas counties, the number of participating carriers and in-network providers can be more limited, which makes network fit an especially important consideration. Reviewing whether a preferred doctor or clinic actually participates in a given network is worth doing before enrolling, not after. We work with clients across the state by phone or virtual appointment, so location doesn't have to be a barrier to getting help.

Enrollment timing and what an agent does

Individual and family health plans generally follow an annual Open Enrollment Period, though certain life events such as losing other coverage, marriage, or having a baby may open a Special Enrollment Period. An independent agent doesn't work for one insurance company; instead, we help you compare available plan structures, explain terms like deductible and out-of-pocket maximum, and walk through the Marketplace application process with you. We do not have access to or ask for sensitive details like your Social Security number, diagnoses, or prescriptions during an initial conversation about your options.

Who this may help

• Texans who are self-employed or don't have access to employer-sponsored coverage
• Individuals between jobs who need to bridge a coverage gap
• Families comparing plan options during Open Enrollment
• Early retirees not yet eligible for Medicare
• Anyone who wants a second look at their current plan before renewal

Potential benefits

• May help you understand what plan types and networks are actually available where you live
• May give you a clearer view of how deductibles, copays, and coinsurance work together
• Can help you compare options side by side instead of researching alone
• May help identify whether you could qualify for savings on a Marketplace plan, subject to eligibility rules
• Ongoing support if your situation changes during the year

What to consider

• Plan availability and pricing vary by county and can change each plan year
• Not every provider or hospital participates in every network
• Enrolling outside the standard window generally requires a qualifying life event
• We cannot guarantee approval, specific costs, or eligibility for any plan
• Some plan features described here are general and may differ by carrier

How enrollment works

• Reach out by phone or request a callback to describe your general situation
• Talk through the plan types and general coverage categories that may apply to you
• Compare available options together without pressure to decide immediately
• Complete the application through the appropriate Marketplace or carrier channel
• Follow up with us if anything changes or you have questions after enrolling

Frequently asked questions

• Does Texas have its own health insurance exchange? No. Texas uses the federally facilitated Marketplace at HealthCare.gov rather than running a separate state exchange, so that is where most Texans shop for individual and family health plans.
• What's the difference between an HMO and a PPO in Texas? In general, HMO plans require you to use in-network providers and get referrals for specialists, while PPO plans typically allow more flexibility to see out-of-network providers, usually at a higher cost. The specifics depend on the carrier and plan.
• Can I get help even if I live in a rural part of Texas? Yes. We work with Texans statewide by phone or virtual appointment from our Austin office, so you don't need to live near us to get help comparing options.
• When can I enroll in a health plan in Texas? Individual and family plans are generally available during an annual Open Enrollment Period. Outside that window, you may qualify for a Special Enrollment Period after certain life events, such as losing other coverage.
• Will an agent ask for my Social Security number or health history right away? No. An initial conversation focuses on your general situation and the types of coverage that may be worth exploring. Sensitive information is only handled through secure, appropriate channels when actually needed for an application.
• Can you guarantee I'll qualify for a lower-cost plan? No. Eligibility for any savings or specific plan depends on factors set by the Marketplace or carrier, and we cannot guarantee approval or costs in advance.
• Does RGI Group have an office in my city? No. RGI Group has one office, in Austin, and serves Texas residents statewide by phone and virtual appointment. Paperwork can usually be completed electronically, so you do not need to travel to meet with us.
• Is there a cost to review my options with RGI Group? You do not pay RGI Group a separate fee to review coverage options. You are also free to enroll on your own through the official government resources linked on this page.
• Can we talk in Spanish? Yes. Appointments and follow-up can be handled in English or Spanish, whichever you prefer.
• Which plans and carriers are available to me? Availability depends on your county, eligibility, and the product you are looking at, and it can change from year to year. We can tell you what we are able to offer for your situation rather than promise a specific plan or price.
• What should I have ready for a first conversation? Your ZIP code, who needs coverage, the doctors or prescriptions that matter to you, and a general sense of your budget. Please do not send Social Security numbers, Medicare ID numbers, date of birth, income, diagnoses, or prescription details through this website.

Official resources

• HealthCare.gov — https://www.healthcare.gov (The federal Marketplace Texans use to shop for and enroll in individual and family health plans, since Texas does not run its own state exchange.)
• Texas Department of Insurance — https://www.tdi.texas.gov (The state regulator that oversees health insurers and HMOs licensed to sell coverage in Texas.)

Talk with a licensed Texas agent

Call or text (346) 888-8811. Office: 5900 Balcones Drive, Ste 100, Austin, TX 78731. Open 24 hours, 7 days a week. Licensed in Texas. Guidance available in English and Spanish.