Education · Texas prescription savings

Lost your health insurance in Texas in 2026? How to keep affording your prescriptions

Last updated September 3, 2026 · Reviewed by the LowerScript editorial team · Español

The enhanced ACA Marketplace premium tax credits expired at the end of 2025, and Texas — which has not adopted Medicaid expansion — still saw 4,172,233 people sign up for 2026 Marketplace coverage, the second-highest total of any state (CMS). If you lost job-based coverage, you generally have 60 days to enroll in a new Marketplace plan. Whatever happens with your coverage, the cash price of your prescriptions is a separate question — it varies widely between nearby pharmacies, and comparing prices with a free discount card is one of the fastest ways to lower it.

What changed in 2026

The enhanced premium tax credits available since 2021 expired at the end of 2025: "when those enhancements expired at the end of 2025, premium payments rose sharply for many enrollees" (KFF). Despite that, Texas still recorded 4,172,233 cumulative 2026 Marketplace plan selections through HealthCare.gov — the second-highest state total in the country (CMS, 2026). Texas has also not adopted the ACA's Medicaid expansion: as of KFF's August 2026 tracking update, Texas remains one of 10 states that have not adopted expansion, with no implementation date and no adoption via ballot initiative.

If you lost job-based coverage

If you lose job-based health coverage, you generally need to apply for Marketplace coverage within 60 days to use the Special Enrollment Period (HealthCare.gov). COBRA is another option worth asking your employer about directly — it can let some people keep their employer plan temporarily, but the specific terms depend on your employer and plan, so ask your HR department directly rather than assuming a standard cost or length.

Texas Medicaid redetermination — a note on history

Texas ended its pandemic-era continuous Medicaid coverage protection on March 31, 2023, following a staggered redetermination schedule under a Texas HHSC operational plan. That was a 2023 process, not a 2026 event — if you're on Medicaid today, routine annual redetermination has been standard practice since 2024, so watch for renewal paperwork from HHSC and respond promptly to avoid a coverage gap.

What this means for your prescriptions

If you're now paying full retail price — no insurance, a high deductible, or a plan that doesn't cover a specific drug — there is no fixed cash price for most medications. The same drug in the same dose can cost very different amounts at pharmacies a few miles apart. Comparing the cash price before you fill, asking about the generic where one exists, and using a free discount card can meaningfully lower what you pay — with no enrollment, income test or waiting period. See how to lower prescription costs without insurance for more, or prescription help for the uninsured if you're between coverage right now.

Frequently asked questions

What happened to ACA subsidies in 2026?

The enhanced premium tax credits that had been in place since 2021 expired at the end of 2025. "When those enhancements expired at the end of 2025, premium payments rose sharply for many enrollees" (KFF).

Has Texas expanded Medicaid?

No. As of KFF's August 2026 tracking update, Texas is one of 10 states that has not adopted the ACA's Medicaid expansion, with no adoption date or ballot initiative pending.

How long do I have to enroll in a Marketplace plan after losing job-based coverage?

Generally 60 days from the date you lose job-based coverage, under the Special Enrollment Period. "You need to apply for Marketplace coverage within 60 days of losing your job-based coverage" (HealthCare.gov).

Does a discount card replace health insurance?

No. A discount card lowers the cash price of prescriptions but doesn't cover doctor visits, hospital care or other benefits. LowerScript is a discount card, not insurance, and can't be combined with Medicare on the same purchase.

Sources: KFF, What We Know So Far About 2026 ACA Marketplace Enrollment, Premiums, and Deductibles; HealthCare.gov, If You Lose Job-Based Coverage; KFF, Status of State Medicaid Expansion Decisions (August 2026); CMS, Marketplace 2026 Open Enrollment Period Report; Texas HHS, Continuous Medicaid Coverage Unwinding Operational Plan. Figures are dated to their source and update over time.

This page is general educational information, not medical, legal or insurance advice, and does not describe any individual's situation. It doesn't replace ACA Marketplace or Medicaid coverage for people who qualify. Never start, stop or change a medication without talking to your prescriber. LowerScript is a discount program, not insurance, and can't be combined with Medicare on the same purchase.

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