Texas marketplace insurers are signaling higher 2026 premiums. Here’s how to lower costs—plan timing, private PPO options, and Rx strategy
Texas 2026 Health Insurance Premiums: What to Do Before Prices Jump | RKA
Texas • Premium Watch
Texas 2026 Health Insurance Premiums: What to Do Before Prices Jump
Fast take: Texas marketplace insurers have filed for notable premium increases for 2026. Costs are being driven by higher medical prices, utilization, and pricey drugs. If enhanced federal subsidies expire after 2025, some households could see larger net costs. Here’s how to prepare—and options to compare now.
Medical inflation & utilization: Providers and hospitals are charging more, and people are using more care.
High‑cost drugs: GLP‑1 medications and other specialty drugs are materially affecting trend.
Policy uncertainty: If enhanced ACA subsidies end after 2025, net premiums may rise for many families.
Moves to consider now
1) Audit your plan type
Check whether your current plan fits your usage. If you travel or work across state lines, a nationwide PPO may offer better access and predictable costs on the road.
2) Time your enrollment
Open Enrollment later this year sets your 2026 price. We can compare multiple options side‑by‑side—including marketplace plans and other eligible choices—so you don’t overpay.
3) Consider private PPO with medical underwriting
For healthy individuals and families, private, medically underwritten PPO options can offer lower premiums than unsubsidized ACA plans, broad nationwide PPO access, and predictable day‑to‑day costs. Eligibility depends on underwriting; we’ll pre‑screen quickly and confirm network access so you know if it’s a fit.
4) Rx strategy
Know your drug tiering and prior auth rules. When appropriate, ask about generics, patient assistance, or discount programs to lower out‑of‑pocket costs.
How RKA helps Texans
Plan matching: We compare options from major carriers and traveler‑friendly PPOs.
Cost projection: We estimate your annual cost with premiums + likely usage so you choose confidently.
Fast enrollment: We can place coverage quickly and help you avoid gaps.
Will 2026 marketplace prices impact my plan right away?
They typically apply starting January 1, 2026. The choices you make during Open Enrollment later this year will determine your 2026 costs.
Are there alternatives if I’m healthy and want lower premiums?
Depending on eligibility, some households may consider different plan structures. We’ll walk you through options that fit your needs and travel patterns.
Can RKA verify if my doctors are in‑network?
Yes—send us the names and we’ll confirm network status and expected costs before you enroll.
For education only; benefits and eligibility vary by carrier and state. Always review official plan documents.
Quick guide to COBRA vs Marketplace vs Private PPO—costs, networks, and when each wins. We’ll verify your doctors and show clear prices.
COBRA vs Marketplace vs Private PPO: What to Do Right After You Lose Employer Coverage
Laid off, new job, or between jobs? Here’s the fast, practical guide—costs, networks, deadlines, and how to decide in minutes. We’ll verify your doctors and show clear costs.
COBRA (keep your old plan)
Same network/benefits you already know.
Usually most expensive (you pay full premium + 2%).
Time-limited (18 months); retroactive if elected on time.
Good when in treatment and changing plans is risky.
Marketplace (Government)
May be cheapest if your income qualifies for credits.
Many plans are HMO/EPO; referrals are common.
Mid-year move allowed due to loss of coverage.
Credits reconcile at tax time—under-reporting income can create payback.
Private PPO (Licensed Access)
Nationwide PPO when eligible; keep specialists/hospitals.
Typically no referrals; fewer hoops.
Advance premium tax credits do not apply to Private PPOs.
Pricing = age, ZIP, benefits, and network.
Great when you travel or want doctor choice.
What tends to cost more—and why
Why COBRA is often pricey
You pay the entire employer premium + 2% admin fee.
Large-group plan designs can carry higher OOP maxes.
No income-based help.
How non-Marketplace Private PPO prices
Based on age, ZIP, network size, and benefits.
Good fits: provider choice, travel, specialist access, fewer referrals.
We verify your doctors before you switch.
How to decide in minutes
Pick COBRA if…
You’re mid-treatment and can’t risk network changes.
You can stomach short-term higher premiums.
You need exactly the same plan and doctors right now.
Pick Private PPO if…
You want nationwide PPO and typically no referrals.
You travel, use specialists, or dislike gatekeepers.
Credits don’t help you—or you prefer not to use them.
We’ll compare all three with your doctors and meds, then show clear side-by-side costs.
Want the best post-employer fit in your ZIP?
We’ll verify your doctors and meds, compare COBRA vs Marketplace vs Private PPO, and show clear costs. No pressure—just answers.
Generally 60 days from the notice. If elected in time, coverage can be retroactive to the loss date (you’d owe premiums).
Can I switch from COBRA to other coverage later?
Yes. Marketplace: during Open Enrollment (or another qualifying event). Private PPO: typically year-round if you’re eligible. We’ll time it so there are no gaps.
Do Private PPOs use ACA tax credits?
No. Private PPOs don’t use ACA advance premium tax credits (APTC). Marketplace plans do, and those credits reconcile at tax time—under-reporting income can create payback.
How do I know if my doctors are covered?
Send your provider list. We check your doctors against the specific plan network you choose so you know before you switch.
How do we start?
Share your doctors, prescriptions, and budget. We’ll map options and enroll you quickly and compliantly.
This overview is educational, not tax or legal advice. Availability varies by state and carrier. Eligibility and enrollment subject to plan terms.
Whether you’re on the road for work, chasing weekend getaways, or planning a cross‑country move, having reliable coverage that travels with you matters. Traveler‑friendly plans—often built on nationwide PPO networks—help you access urgent care, ERs, and a broad set of in‑network doctors across the U.S.
Tip: Before you go, add your plan ID card to your phone wallet and bookmark your carrier’s provider search. If you’re unsure about a facility, text or call us and we’ll verify network status for you.
Why traveler‑friendly health insurance?
If you spend time outside your home area, a PPO gives you flexibility without referrals and, on many plans, nationwide in‑network access. That can mean lower bills and faster check‑in when you need care away from home.
Key features frequent travelers value
1) Nationwide provider access
Tap into large, national networks so you can see in‑network providers in most cities and states, from urgent care to specialists.
2) Emergency & urgent care coverage on the road
Emergencies don’t wait. With the right plan, ER and urgent care visits while traveling are covered per your policy terms, with predictable cost sharing.
3) Help coordinating care
We’ll confirm network participation, estimate costs, and schedule appointments for you—so you focus on the trip, not the paperwork.
4) Options for international travel
Going abroad? Pair your domestic plan with short‑term travel medical for overseas emergencies and evacuation benefits.
How RKA Insurance Advisors helps
Plan matching: We compare traveler‑friendly PPO options across carriers in the 30+ states where we’re licensed.
Concierge verification: Message us a clinic name, and we’ll check network status and expected costs before you go.
Fast enrollment: Same‑day enrollments available in many cases; options exist year‑round depending on your situation.
Does PPO health insurance cover me while traveling out of state?
Yes. With a PPO network, members typically have nationwide access to participating providers for urgent care, ERs, and many outpatient services. Benefits depend on the plan; verify provider participation and any out‑of‑network cost sharing before you go.
Do I need separate travel medical insurance for international trips?
U.S. plans often have limited or no coverage abroad. For international travel, a short‑term travel medical policy can cover emergencies and evacuation. We’ll help you compare options.
What’s better for travelers: PPO or HMO?
PPOs offer broader, often nationwide networks and don’t usually require referrals—ideal for frequent travelers. HMOs tend to be regional and referral‑based; out‑of‑area care is typically emergency‑only.
How do I check if a provider is in‑network while traveling?
Use the carrier’s provider lookup or call member services. Or text/call us—we’ll verify and estimate costs.
Can I get short‑term coverage just for a trip?
Yes—short‑term medical or travel medical may fit. We’ll review dates, destinations, and needs to recommend the right fit.
Truckers need coverage that works in every state they drive. We compare ACA vs. private PPOs, verify doctors along your routes, model subsidies for variable income, and set up telehealth/Rx for life on the road.
Truckers Health Insurance (2025–2026): Simple, Road-Ready Options
Fast take: Trucking life crosses state lines—your coverage should too. We compare ACA Marketplace options (often with subsidies) against private, medically underwritten PPOs for eligible drivers, then confirm your doctors, pharmacies, and hospitals along the routes you actually run.
Need coverage that works in every state you drive?
We’ll estimate subsidies, check nationwide PPO access, verify your doctors, and show total annual cost—no pressure, just answers.
