The house is finally quiet for the night, but Mark and Emily are still at the kitchen table with papers spread everywhere. Open Enrollment always feels stressful, but this year something feels heavier.
Their renewal notice is sitting right in front of them. The new premium for their ACA plan pushes their family budget past the breaking point. They also discover their preferred doctor in Austin is still not part of the HMO network. The frustration is real, and the clock is ticking.
They need coverage that starts January first. They do not have the luxury of waiting due to a chronic condition that needs care. Like many Texas families, they feel stuck between deadlines, rising premiums, and confusing options. They are not alone.
Across the state, families are trying to figure out what to do before the open enrollment period cutoff dates hit. Every year there are people who miss the deadlines, and end up with giant bills from medical care that they needed during a gap in health coverage.
Right now, Texans have two hard dates they must understand.
- December 15, 2026
- December 27, 2026
The first date is the cutoff for Health Insurance Marketplace Plans. The second is the cutoff date for Private Health Plans.
The bottom line is simple. If you need New Year’s Day coverage, you must act now. Here are the three things every Texan needs to know before the deadlines pass.
1. ACA Marketplace Plans Must Be Selected by December 15 To Start January 1
This is the rule that does not change. If you want an ACA Marketplace plan to begin on January first, your application or renewal must be completed by December 15th. The system does not bend for late decisions or last minute struggles with the website. If you miss the deadline, your family has until January 15 for a plan to begin February 1st.
That one month gap without a health insurance plan leaves families exposed to risk. An accident, a sudden illness, or a hospital stay in January can create financial fallout that takes years to fix. Most Texans cannot afford that kind of exposure. This is why the December fifteenth cutoff exists and why it matters more than people realize. If you plan to stay on the health insurance marketplace, you must finalize the plan by December fifteenth. Waiting will cost you.
2. Texans Still Have Until December 27 To Secure Private Coverage
Let's face it. If you are like Mark and Emily and not receiving premium tax credits (Subsidies) this year, the price of health insurance coverage on the exchange is outrageous! For families who cannot justify the cost of an ACA HMO plan, the good news is that options still exist.
Several private health insurance solutions can be activated as late as December 27th and still begin on January first. This gives Texans an extra twelve days if they decide that ACA plans are too expensive or too restrictive. Which most of them are.
Private PPO plans, catastrophic plans, and hybrid health plans continue to grow in popularity because they allow families to step off the ACA exchanges treadmill. These health plans provide real coverage, predictable benefits, and often far wider access to doctors and hospitals.
For families that missed the ACA deadline or simply refuse to pay inflated premiums for inferior coverage options, these private plans provide a valuable alternative. They offer flexibility for Texans who want meaningful coverage without feeling trapped by an HMO structure.
The best news is that your family can also enroll in these plans any time of year without needing a special enrollment period. That means Texans can get affordable health coverage when they need it regardless of an open enrollment season. Just make a selection by the 27th of a month for it to be effective on the first of the next month.
3. Income Matters
Here is the reality many Texans are discovering. The Advanced Premium Tax Credits from the COVID era are not going to be in place for 2026. The political debate over "how to fix" the Affordable Care Act has raged since the legislation was passed. And we've yet to see a solid plan to fix it. While we have a lot of opinions about this, we try to focus our energy on helping Texans like Mark and Emily rather than discussing the politics of the situation.
The harsh truth is that ACA health plans without strong subsidies become overpriced HMO products with very limited networks and high out of pocket costs. Many Texas families are paying too much for too little access if your family is making a modest living. Private PPO plans have become a better option for these households because the pricing is manageable and the networks and the benefit options are significantly broader.
A family earning $65,000 or more rarely receives enough subsidy to justify staying with ACA health coverage. Once they see the full cost of the plan and compare it to the flexibility and simplicity of private PPO options, the decision usually becomes clear.
- They want freedom to choose their doctors.
- They want control over where they receive care.
- They want predictable medical bills and the ability to plan ahead.
Private PPO plans offer exactly that.
This does not mean ACA plans are bad for everyone. Texans with lower incomes or specific medical needs may still find value in the health care tax credits and structure of the ACA system. But for middle income earners, the ACA has become too expensive to make sense.
How Texas Families Should Evaluate Their Options Before Time Runs Out
Choosing the right plan begins with understanding your situation. Every family should ask these questions before enrolling.
- Do your preferred doctors and hospitals accept the plan?
- What will your total out of pocket exposure be in 2026 if something major happens?
- Does your family's income qualify you for meaningful subsidies?
- Does the plan match the way you actually use healthcare throughout the year?
The right plan is the one that protects you financially AND gives you access to the care you trust.
How Insurance For Texans Helps Families Make This Decision
Sorting through the ACA Exchange, private PPO options, catastrophic plans, and hybrid solutions can feel overwhelming. There is a lot of jargon, confusing documents, paperwork, and open enrollment period decisions that have to be made in a timely fashion. This is why our team at Insurance For Texans steps in.
Our experienced health insurance agents compare ACA and private plans side by side. We break down the networks. We look at drug plans. We highlight the true cost of health care, not just the monthly premium. We explain the rules and the risks in plain language.
We help you see what works, what does not, and why one plan may be a better fit than another. Texans are tired of trying to decode health insurance on their own. We make the conversation simple, personal, and focused on what your family actually needs.
The Bottom Line
Time is running out. Texans must select an ACA health plan by December 15th if they want coverage to begin on January 1, 2026. If an ACA plan is not the right fit, private plans remain available year round. Middle income families will often find better value, wider network access, and lower risk by moving to a private PPO plan.
This is not the moment to wait. Your family deserves coverage that works and a plan that will protect your financial future.
Click the button below to compare ACA and private PPO plans and secure the right coverage before the deadlines pass.