Ranked 12 of 15 states · median $807/mo · CMS PY2026
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A 40-year-old therapist 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: Emotional load and burnout; sedentary strain.
This is background for choosing a plan, not for pricing one. Since 2014 every Texas exchange plan has been guaranteed issue and community rated: same age, same ZIP, same tobacco status means the same filed premium whether you are a therapist or an accountant. Occupation changes the shopping criteria, nothing else.
Premium is set by rating area, so a therapist 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 |
|---|---|---|---|---|
| Zapata | $649 | Ambetter from Superior HealthPlan | $6,000 | 3 |
| Van Zandt | $653 | CHRISTUS | $5,990 | 4 |
| Kenedy | $667 | CHRISTUS | $5,990 | 4 |
| Live Oak | $676 | CHRISTUS | $6,000 | 3 |
| Brazos | $688 | UnitedHealthcare | $6,000 | 4 |
| Tarrant | $688 | Ambetter from Superior HealthPlan | $6,000 | 8 |
The spread across just these six is $40/month — $477 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 therapist 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 therapist who moved this year, that move is a qualifying life event and opens a special enrollment period.
Self-employed Therapists in Texas typically deduct: Licensing, malpractice insurance, EHR software, supervision. Health premiums sit separately, above the line under IRC §162(l), and only when neither you nor a spouse could have joined an employer plan — eligibility disqualifies you even if you declined the coverage.
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.
No. Under the ACA, carriers cannot rate, decline, or exclude based on occupation or health history. Rates vary only by age, ZIP code, tobacco use and household size.
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.
Below the cliff. At this income a single-person household remains eligible for a premium tax credit in 2026.
This occupation sits above the cliff in 7 of the 20 states reported and below it in the other 13, so the answer changes with the state.
What this figure is. It is the median annual wage BLS reports for Marriage and Family Therapists (SOC 21-1013) 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 therapist. 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 Therapists 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 therapist 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.
The window opens November 1, 2026, and December 15 is the date worth writing down — it is what secures January 1 cover in Texas and everywhere else. You will find later dates quoted; they stem from a 2025 rule that was vacated in June 2026 and is under appeal.
There is still no PPO on the Texas marketplace — not in any of its 254 counties. Every plan is an HMO, EPO or POS, which for a therapist working across a wide area is the binding constraint, not price.
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:
There is no single Texas price. Enter your ZIP and I will pull what is filed in your county, then work out what help you qualify for.