Ranked 12 of 15 states · median $807/mo · CMS PY2026
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A 40-year-old nurse practitioner in Texas pays a median $807/month for a Silver plan before subsidies — 12th of 15 on cost. The cheapest plan in the state is $540 from Blue Cross and Blue Shield of Texas in Cameron. On median Silver premium, Texas ranks 12 of 15 for this occupation.
Patient-facing and on-your-feet work produces steady, predictable claims — routine visits, refills, physical therapy, the occasional urgent care. That profile is decided by copay design and by whether your providers are in network, not by the sticker premium, so carrier count sits alongside cost below.
Occupational context: Needlestick and infectious exposure; standing strain.
Two things get confused here constantly. Risk exposure decides what coverage you should buy. It does not decide what you are charged — Texas carriers rate on age, ZIP, tobacco and family size, full stop. A nurse practitioner with a bad back and a healthy 40-year-old office worker in the same county see the same number.
Premium is set by rating area, so a nurse practitioner in one Texas county can pay materially more than one an hour away. Six counties from across the state, cheapest Silver plan for a 40-year-old:
| County | Cheapest Silver @40 | Issuer | Deductible | Carriers |
|---|---|---|---|---|
| Crosby | $779 | Baylor Scott and White | $6,000 | 5 |
| Lamb | $779 | Baylor Scott and White | $6,000 | 3 |
| Camp | $784 | Ambetter from Superior HealthPlan | $6,000 | 3 |
| Goliad | $786 | Ambetter from Superior HealthPlan | $6,000 | 3 |
| Hall | $796 | Blue Cross and Blue Shield of Texas | $4,000 | 3 |
| Roberts | $796 | Blue Cross and Blue Shield of Texas | $4,000 | 3 |
The spread across just these six is $17/month — $204 a year for the same metal tier. Statewide the range runs $540 to $1,409. Coverage by County publishes all 254 Texas counties individually.
| Texas — network and cost | 2026 |
|---|---|
| Median Silver premium @40 | $807 |
| Cheapest Silver @40 | $540 — Blue Cross and Blue Shield of Texas (Cameron) |
| Most expensive Silver @40 | $1,409 |
| Carriers filing in the state | 15 — Ambetter from Superior HealthPlan, Baylor Scott and White, Blue Cross and Blue Shield of Texas, CHRISTUS |
| Plan types available | EPO, HMO, POS |
| Counties with only one carrier | 7 of 254 |
Texas has 15 carriers filing and 7 of 254 counties served by a single issuer. For a nurse practitioner with an established provider relationship, that carrier count is the number that decides whether you keep your doctor.
Source: CMS Plan Year 2026 Qualified Health Plan Landscape file. 13,013 plan records across 254 Texas counties. Full-price filed rates before premium tax credits — verify at enrollment.
Cheaper for the same coverage: Kansas ($765), Florida ($789), Utah ($805). More expensive: North Carolina ($828), Arkansas ($828), Nebraska ($875).
Side-by-side: Texas vs Florida · Texas vs Utah · Texas vs North Carolina · Texas vs Arkansas
This only matters if you can actually choose — you buy in the state where you live, not where you work. If you are a nurse practitioner who moved this year, that move is a qualifying life event and opens a special enrollment period.
If you file a Schedule C as a nurse practitioner, the categories that usually show up are: Malpractice insurance, licensing, DEA registration, CE. The health premium itself is normally an above-the-line deduction under IRC §162(l), which reduces AGI rather than requiring you to itemize. Your CPA should confirm it against your actual situation.
If your household income is above the subsidy range, ACA is not automatically the answer. There are other categories of coverage that may fit, and they work very differently. That is a conversation, not a web page.
The cheapest Silver plan for a 40-year-old in Texas is $540 per month from Blue Cross and Blue Shield of Texas, with a state median of $807. Both figures are full price before premium tax credits; most buyers pay less after subsidies.
It cannot happen on an exchange plan. Rating in Texas uses four inputs only: age, ZIP code, tobacco use and how many people are on the policy. Trade, injury history and pre-existing conditions are all excluded from pricing by law.
No. Only EPO and HMO and POS plans were filed for 2026.
Texas ranks 12 of 15 states covered here, at a median $807 per month. Indiana is cheapest at $558 and Nebraska is most expensive at $875.
Above the cliff. At this income a single-person household receives no premium tax credit for 2026 and pays the full premium.
This occupation is above the cliff in all 20 states reported.
What this figure is. It is the median annual wage BLS reports for Nurse Practitioners (SOC 29-1171) in Texas. BLS surveys wage and salary workers and excludes the self-employed, so it is a benchmark for the occupation in this state — not the income of a self-employed nurse practitioner. Premium tax credit eligibility is set by household modified adjusted gross income and household size, not by occupation, so treat this as a reference point rather than a determination of what you qualify for.
Why the cliff is back. The enhanced premium tax credits expired on 31 December 2025. For plan year 2026 the 400% FPL limit applies again, so household income above $62,600 ends premium tax credit eligibility outright.
This page compares states. For Texas specifically — county-by-county carriers, plan data and enrollment help — I publish that on Coverage by County, including a page written for Nurse Practitioners in Texas and a blog covering deductibles, subsidies and special enrollment.
One of Texas’s 15 carriers is leaving. Cigna exits the individual market entirely on January 1, 2027, so if you are a nurse practitioner covered by them the question is not whether you switch but whether you choose the switch yourself.
Rate filings for 2027 point to roughly a 15% median increase nationally, from −1% at one end to 54% at the other. Texas has not finalised, so treat exact local 2027 pricing as unavailable rather than unknown.
Enrollment opens November 1, 2026. Treat December 15 as the deadline: it guarantees January 1 cover on every marketplace, Texas included. Conflicting end dates get quoted because a 2025 rule shortened the window and a court vacated it in June 2026, appeal pending — enrol by the 15th and the argument is irrelevant to you.
One thing 2027 will not fix: no PPO is sold anywhere in Texas. All 254 counties offer HMO, EPO or POS only, so care outside the network is effectively emergency-only. If your work as a nurse practitioner crosses county lines, weigh that above the premium.
You already know you are changing plans — Cigna is leaving. The only real question is whether you pick the replacement or the marketplace picks it for you, and that is a much easier decision made in August than in the second week of December.
Give me a ZIP and I will tell you three things:
Coverage for Nurse Practitioners is priced county by county across Texas. Enter your ZIP and I will show you what is on the table.