The One Thing Most Self-Employed Texans Don't Know
If you're self-employed in Texas and you want a PPO — a plan where you can see any doctor without a referral and access any hospital without prior authorization — the ACA marketplace at HealthCare.gov cannot help you.
As of 2026, all ACA marketplace plans in Texas are HMO or EPO. Every single one. PPO plans were phased out of the Texas marketplace years ago. This is unique to Texas — other states still have marketplace PPO options. If you're in Texas and you need a PPO, you must go off-exchange through a licensed independent broker.
This is not widely known. Most people looking for health insurance in Texas go straight to HealthCare.gov, don't see a PPO option, and assume PPO simply isn't available. It is available — just not through the marketplace.
What Is an HMO or EPO and Why Does It Matter?
An HMO (Health Maintenance Organization) requires you to choose a primary care physician (PCP) who manages your care and provides referrals to see specialists. If you go to a specialist or hospital outside your network without a referral, your plan typically covers nothing.
An EPO (Exclusive Provider Organization) is similar but without the PCP referral requirement. You can see any in-network specialist directly, but you are still strictly limited to in-network providers. No coverage outside the network except in emergencies.
A PPO (Preferred Provider Organization) lets you see any licensed doctor or go to any hospital in the country without a referral and without prior authorization. In-network visits cost less, but out-of-network care is still covered. For self-employed individuals — especially those who travel frequently, work across multiple cities, or have existing specialist relationships they want to keep — a PPO is often the only plan that makes practical sense.
Two Paths for Self-Employed Texans
Regardless of which plan type you want, you have two distinct paths:
Path 1: ACA Marketplace (HealthCare.gov)
The marketplace is the right choice if your net self-employment income is below approximately $62,600 per year (single adult, 2026). Below that threshold, you may qualify for a premium tax credit that can significantly reduce your monthly cost. The marketplace offers HMO and EPO plans from carriers including:
- Blue Cross Blue Shield of Texas
- Ambetter from Superior Health Plan
- Oscar Health
- UnitedHealthcare
- Molina Healthcare
Carrier availability varies by county. In some rural Texas counties, only one or two carriers participate in the marketplace.
Path 2: Private Off-Exchange Plan (PPO Available)
If your income is above the subsidy threshold, or if you simply need a PPO, a private off-exchange plan is the alternative. Private plans are not listed on HealthCare.gov — they're accessed directly through a licensed broker. They include true PPO options with nationwide network access, no referral requirements, and no income reporting.
Private plans are also fully tax-deductible for self-employed individuals under the same rules that apply to marketplace plans. The premium you pay reduces your adjusted gross income dollar-for-dollar.
When Each Path Makes More Sense
| ACA Marketplace (TX) | Private Off-Exchange (TX) | |
|---|---|---|
| Plan types offered | HMO and EPO only | PPO available (plus HMO options) |
| Best income range (single) | Under ~$62,600/yr | Over ~$62,600/yr |
| Federal subsidies | Yes, based on income | No |
| See any doctor/hospital | No — in-network only | Yes (PPO) |
| Referrals required | Yes (HMO) / No (EPO) | No (PPO) |
| Income reporting at tax time | Yes — reconcile with IRS | No |
| Self-employed deduction | Yes, 100% | Yes, 100% |
Houston (Harris County)
Houston is home to the Texas Medical Center — the largest medical complex in the world — including MD Anderson Cancer Center, Houston Methodist Hospital, Memorial Hermann, and HCA Houston Healthcare. These institutions are world-class, and many self-employed Houstonians specifically want to ensure they can access them.
With a marketplace HMO or EPO, your access depends entirely on whether your chosen carrier's network includes those specific facilities. A PPO gives you direct access to any of these systems without pre-authorization or referral restrictions — which matters especially if you have a complex health situation or travel frequently for work.
Harris County is one of the most competitive insurance markets in Texas, with multiple carriers participating in the marketplace. I serve all Harris County zip codes.
Dallas / Fort Worth (Tarrant & Dallas Counties)
The DFW metroplex is Texas's largest insurance market. Self-employed contractors, real estate professionals, consultants, and small business owners in DFW represent one of the largest concentrations of self-employed individuals in the state.
Major hospital systems in the DFW area include Baylor Scott & White Health, UT Southwestern Medical Center, Texas Health Resources, and Medical City Healthcare. As with Houston, a PPO gives you access to any of these systems without network restrictions.
Austin (Travis County)
Austin's tech economy and high concentration of freelancers, startup founders, and independent contractors make it one of the most active markets for self-employed health insurance in Texas. Travis County has strong marketplace carrier participation, but again — all marketplace plans are HMO or EPO.
Major Austin hospital systems include St. David's HealthCare, Ascension Seton, and Baylor Scott & White Austin. Many Austin tech workers who left W-2 jobs with employer PPO coverage are surprised to find no PPO option on the marketplace. I serve all Travis County zip codes and the Austin metro area.
San Antonio (Bexar County)
San Antonio has a large military population (TRICARE-eligible) but also a significant self-employed and small business owner population, particularly in healthcare, real estate, and food service sectors. Bexar County marketplace options include several carriers, but all are HMO or EPO.
Major hospital systems include University Health, Baptist Health System, and Methodist Healthcare System. I serve all Bexar County zip codes and the greater San Antonio area.
The Self-Employed Deduction in Texas
Texas has no state income tax, which simplifies the picture somewhat. Your health insurance premium deduction works entirely at the federal level:
- Deduct 100% of premiums on Schedule 1, Form 1040 (line 17)
- Reduces your Adjusted Gross Income dollar-for-dollar
- Applies to both marketplace and private off-exchange plans
- Cannot exceed your net self-employment income for the year
- Does not apply if you were eligible for an employer-sponsored plan through a spouse
At common self-employment income levels in Texas, this deduction can save $1,200–$3,000 or more in federal taxes annually depending on your bracket.
Open Enrollment and Special Enrollment in Texas
Texas uses the federal marketplace (HealthCare.gov). Open Enrollment runs November 1 through January 15 each year, with coverage starting January 1 for plans selected by December 15, and February 1 for plans selected between December 16 and January 15.
If you recently left a W-2 job, lost other coverage, moved to a new county, or had another qualifying life event, you have a 60-day Special Enrollment Period. Private off-exchange plans are not subject to Open Enrollment restrictions — you can enroll at any time.
How I Help Self-Employed Texans
I'm a licensed independent advisor (NPN #22052447) serving all 254 Texas counties. I compare both marketplace and private plan options for every Texas client and give you a straightforward recommendation based on your income, health situation, and the doctors and hospitals that matter to you.
My service is free. I'm compensated by carriers at the same rate regardless of which plan you choose, so I have no incentive to steer you toward any particular option.