ACA vs Medicaid in Texas: What’s the Difference and Which One Is Right for You?
ACA vs Medicaid in Texas: What’s the Difference and Which One Is Right for You?
If you're looking for affordable health insurance in Texas, you've probably come across two main options: Medicaid and the ACA Marketplace. But how do you know which one you qualify for—or which one is right for your situation?
You're not alone. This is one of the most common questions we hear from individuals and families trying to get the coverage they need without breaking the bank. Let’s clear up the confusion once and for all with a simple, side-by-side breakdown.
🩺 What Is Medicaid in Texas?
Medicaid is a state and federally funded program that provides free or low-cost health coverage to low-income individuals, families, seniors, pregnant women, and people with disabilities.
Unlike many other states, Texas has not expanded Medicaid under the Affordable Care Act. This means eligibility is more limited here than in other states.
✅ Who Qualifies for Medicaid in Texas?
In Texas, you must meet both income and categorical requirements to qualify. That means you must fall into a specific group and earn below a certain income level.
Here’s a breakdown of who typically qualifies:
Children under 19 in low-income households
Pregnant women
Parents or caretakers with very low income
Seniors and people with disabilities
Certain legal immigrants and refugees
🏥 What Is ACA Health Insurance (Marketplace Coverage)?
The ACA Marketplace (also known as Obamacare) offers health insurance plans to anyone who doesn’t have coverage through work, Medicare, or Medicaid. It’s open to all income levels, though financial help is available based on how much you make.
If you make too much for Medicaid, you may qualify for Premium Tax Credits and Cost-Sharing Reductions (CSRs) that make ACA plans very affordable.
🔍 Medicaid vs ACA in Texas: Side-by-Side Comparison
❗ Common Misconceptions
“I have a low income, so I automatically get Medicaid.”
➡️ Not in Texas. Unless you’re pregnant, a child, or disabled, low-income adults often don’t qualify due to Texas’s non-expansion status.
“If I don’t qualify for Medicaid, I’m out of options.”
➡️ Wrong again! Many people who fall into the “coverage gap” qualify for $0 premiums through ACA subsidies depending on their income and household size.
“Marketplace plans are expensive.”
➡️ Not always. With Premium Tax Credits, many families pay under $100/month—or even $0—for full ACA coverage.
📝 How to Apply for Medicaid or ACA Coverage in Texas
🟦 To apply for Medicaid in Texas:
Or call 2-1-1 for help
🟧 To apply for ACA Marketplace plans:
Use their calculator to check for subsidy eligibility
Enroll during Open Enrollment (Nov 1 – Jan 15) or if you have a life change (job loss, birth, marriage, etc.)
💬 Final Thoughts: Which One Is Right for You?
If you're a parent with very low income or are pregnant, Medicaid may offer the best free coverage—but only if you meet Texas’s strict limits.
If you’re an adult without dependents or you don’t qualify for Medicaid, there’s a good chance the ACA Marketplace is your best option. Thanks to recent policy changes, more Texans than ever before now qualify for low-cost or even free ACA plans.
At Pereyda Financial, we help you compare both options and walk you through the application process, so you get the coverage you qualify for—without the confusion.
📞 Reach out today for a free consultation (915) 265-5387 and let us help you find the plan that fits your needs and budget.
