During the last decade, Texans have seen many changes in how we can get health insurance. Employer-sponsored health benefits still leads the way for most Texas families. But if you're part of the group that completes Open Enrollment for a marketplace plan, you are likely more confused about health coverage and the best way to pay for medical expenses.
The last couple of months have been a whirlwind for health insurance coverage with the fight over the enhanced marketplace subsidies. Texans on all sides of politics have some very strong opinions, but the bottom line is that health care costs, including premiums, are continuing to skyrocket.
One of the main questions that we have fielded over the last couple of weeks when Texas families see the prices for health coverage in 2026 is what happens if I choose not to carry family health coverage. We completely understand the question, but we need to talk about the legality and practicality of it all.
Prior to the passage of the Affordable Care Act almost 15 years ago, many people didn't give nearly as much thought to this question. Especially if they were young and relatively healthy. But when the landmark legislation was passed, words like personal mandate and ACA Compliant were introduced into the vernacular of Texans and it changed everything.
Those Without Health Insurance Are Not Penalized Financially
After initial full implementation of the Affordable Care Act (ACA), there was a penalty system put in place for those that chose to not have health insurance. In the first few years of the ACA, this penalty was fairly benign from a pocketbook standpoint as the fine paid was small. But by 2017, the fine had grown to a point that many people went looking for affordable health coverage options rather than just giving the government money. The penalty was put in place to force everyone in to the risk pool in an attempt to moderate premiums since all pre-existing conditions were covered without recourse. This all changed in 2018 as the laws were changed once again.
Since 2019, the tax penalty was eliminated for individuals who choose to go without health insurance. That meant there was no need to scramble and find a health plan or qualified health share plan to avoid the penalty.
But just like then, there can be ramifications for Texas families without health insurance. Can be.
Can I See A Regular Doctor Without Health Insurance?
Yes! Of course you can see a regular doctor without health insurance. You can find medical care in many places without health insurance coverage. But you also need to realize that many doctor's offices are not set up well to handle a cash pay patient.
In Texas today, there is a viable cash pay health care marketplace due to many individuals not having visits covered by a health insurance plan. Since many health share plans do not provide preventive care visits to their members and many Texas families are going without coverage, the ability to pay cash has expanded.
The places where a lack of family health coverage can become problematic are specialist care or emergency care. The cost to see a specialist or to be treated in an emergency room can be quite expensive to say the least.
So yes, you can see a doctor without a health plan. But factor those potential visits into your cost effective equation.
Can I Be Denied Help At The Hospital If I Don't Have Health Insurance?
We talked about emergency room and speciality care. They can be expensive, but going to a hospital is where the ability to get things done can become much more difficult. And most of us don't think something will happen to us. Even though it does.
If you show up at the Hospital with a life threatening situation and no health insurance, you will receive care. The medical debt may bankrupt you, but you will receive care. When the heart attack strikes, none of us ask questions other than are we going to be ok? Health care costs are an afterthought.
If you are diagnosed with a longer term need like cancer treatments, the process can become a bit sticky. Not having insurance and needing cancer treatments that may cost $200,000 puts you in a tough situation. Most of us don't have that much money just sitting around.
That's why we recommend Catastrophic Health Insurance to allow you to combat those scenarios. Using insurance that only kicks in for big things like Cancer is a different way to think. But a catastrophic health plan is very cost effective on premiums and medical bills.
How Can I Afford My Prescriptions Without Health Insurance?
Pharmacy benefits may be one of the trickiest things to navigate when looking at working outside our current health insurance system in Texas. And with prescription costs being what they are, it is definitely a concern.
If you don't have health insurance, there are a couple of different paths that you can take. Realize that none of them will include high dollar treatments without you paying out of pocket.
Insurance For Texans does have the ability to get you pharmacy benefits on a limited basis as one of those paths. It's a bit unusual, but possible.
We typically recommend leveraging Good Rx, Cost Plus Drugs, or comparison shopping between pharmacies. In many cases, especially for generic prescriptions, the cost is so low on a Good Rx coupon that paying for a benefit service doesn't make sense. My family used Good Rx frequently instead of the health insurance marketplace plan pharmacy benefits.
Anything Else To Consider?
Many Texans would rather go uninsured rather than buy coverage on the ACA Exchange. We get it. The loss of premium tax credits for 2026 coupled with the massive premium increases for those inferior plans hurts.
But our job is to make sure you understand the risks involved with that from a financial standpoint. We cannot predict when an accident, getting cancer, or anything health related will occur.
However, we can help you make sure that you are not sunk forever if something happens. Talk to one of our agents today about how to evaluate your options.
Click the button below to find out what you can do outside of the Exchange and an employer.