Catastrophic health insurance in Texas is an ACA marketplace plan with a very low monthly premium and a very high deductible, and for the 2026 plan year it’s available to anyone under 30 as well as Texans 30 and older who don’t qualify for premium tax credits or cost-sharing reductions. The plan covers the same essential health benefits as any other marketplace plan, but you pay nearly all non-preventive care yourself until you hit $10,600 for an individual or $21,200 for a family. Whether it’s the right choice depends almost entirely on whether you qualify for subsidies on a bronze plan instead.
Who Qualifies in Texas for 2026
Texas uses HealthCare.gov, so federal rules control eligibility. Three groups can enroll in a catastrophic plan for 2026:
- Anyone under age 30. No exemption or paperwork required.
- People 30 and older whose projected household income falls below 100 percent or above 250 percent of the federal poverty level, making them ineligible for premium tax credits or cost-sharing reductions. Under CMS guidance issued September 4, 2025, this qualifies as a hardship exemption.1CMS.gov. Guidance on Hardship Exemptions
- People of any age who have a qualifying hardship — homelessness, eviction, domestic violence, bankruptcy, natural disaster, and similar circumstances.2HealthCare.gov. Health Coverage Exemptions: Forms and How to Apply
Starting with the November 2025 open enrollment period, HealthCare.gov evaluates the income-based hardship exemption automatically from the application, so most consumers 30 and older no longer need to file a separate paper form.3CMS.gov. Expanding Access to Health Insurance: Consumers Gain Access to Catastrophic Health Insurance Plans A paper form is still an option — the applicant selects “Hardship 14” and briefly explains the circumstances.1CMS.gov. Guidance on Hardship Exemptions
What the Plan Actually Covers
Every catastrophic plan is ACA-compliant, so it covers the same ten essential health benefit categories as bronze, silver, and gold plans: hospitalization, prescriptions, emergency services, maternity care, mental health treatment, laboratory services, and the rest.4HealthCare.gov. Catastrophic Health Plans Preventive services — screenings, check-ups, immunizations — are free before you hit the deductible.
The plan also covers at least three primary care visits per year before the deductible applies.5KFF. What Is a Catastrophic Health Plan After that, you pay the full negotiated cost of any non-preventive care until you reach the annual deductible: $10,600 for an individual or $21,200 for a family in 2026.6KFF. Policy Changes Bring Renewed Focus on High-Deductible Health Plans Once you cross that number, the plan covers everything else for the year. The deductible and the out-of-pocket maximum are the same figure, so there’s no coinsurance middle ground.
What It Costs in Texas
Premiums vary by age, county, and insurer. In the Houston area, the cheapest 2026 catastrophic plan for a 45-year-old came in around $507 per month, with other options running as high as $647.7HealthInsurance.org. Catastrophic Plan For the same 45-year-old in Houston, bronze plans started around $423 per month.
That gap isn’t a mistake. Insurers were allowed to refile catastrophic plan rates in late September 2025 after CMS expanded eligibility, and in some markets premiums went up meaningfully to reflect the wider pool of potential enrollees.7HealthInsurance.org. Catastrophic Plan Check bronze premiums in your county before assuming catastrophic is the cheaper monthly bill.
The other cost fact matters more than the premium itself: premium tax credits cannot be applied to catastrophic plans. You pay the full listed premium.8HealthCare.gov. HSA Options If you qualify for a subsidy, a bronze or silver plan will almost always cost less per month and cover more per doctor visit.
HSA Eligibility Starting in 2026
Before 2026, no catastrophic plan was compatible with a Health Savings Account.6KFF. Policy Changes Bring Renewed Focus on High-Deductible Health Plans That changed with Section 71307 of the Working Families Tax Cuts legislation (Public Law 119-21), signed July 4, 2025, which treats every individual-market catastrophic plan as an HSA-eligible high-deductible health plan.9IRS. Working Families Tax Cuts
For 2026, HSA contributions cap at $4,400 for self-only coverage and $8,750 for family coverage.10HealthCare.gov. High Deductible Health Plan Contributions are pre-tax, grow tax-free, and can be withdrawn tax-free for qualified medical expenses. That combination is the strongest argument for choosing a catastrophic plan if you’re healthy, ineligible for subsidies, and have the cash to fund the account. Health economists have noted the tax benefit is worth much less to lower-income buyers who can’t spare money to contribute after paying an unsubsidized premium.11Forbes. Oz Pushes Catastrophic Health Plans, Which Critics Call Junk Insurance
How to Enroll
Texas residents shop for catastrophic plans on HealthCare.gov, the same federal marketplace they use for any other ACA plan. Open enrollment for 2026 began November 1, 2025. Outside that window, a qualifying life event may open a special enrollment period.
If you’re under 30, catastrophic plans will appear in your list of options automatically. If you’re 30 or older, HealthCare.gov reviews your projected income and, if you don’t qualify for tax credits or cost-sharing reductions, grants the hardship exemption and displays the plans.12HHS. HHS Expands Access to Affordable Catastrophic Health Coverage Catastrophic plans are offered in at least some parts of 36 states plus D.C. for 2026, but availability varies by county, and not every Texas county has one.7HealthInsurance.org. Catastrophic Plan
Catastrophic vs. Bronze Plan
For most Texas shoppers, the real decision is catastrophic or bronze. Both sit at the low-premium end of the marketplace, and both are HSA-eligible for 2026.13HealthCare.gov. Plans and Categories The differences that matter:
- Bronze plans cover roughly 60 percent of average healthcare costs. Catastrophic plans cover less; HHS has estimated their actuarial value at about 55 percent under updated 2027 rules, and they carry no formal actuarial value requirement.14Health Affairs. HHS Finalizes Sweeping Marketplace Changes
- Bronze plans can be bought with premium tax credits. Catastrophic plans cannot.8HealthCare.gov. HSA Options
- Both cover preventive care with no cost-sharing. Catastrophic adds three primary care visits before the deductible; bronze applies a standard cost-sharing split to a broader range of services from the start.
- Anyone can buy a bronze plan. Catastrophic requires being under 30 or qualifying for an exemption.
If you qualify for a subsidy, run the bronze numbers first. If you don’t qualify, and you’re healthy, and you want low fixed costs plus an HSA against a bad year, catastrophic is the plan that was designed for you.
The Risks You’re Taking On
The $10,600 individual deductible is more cash than many Americans have on hand. A chronic diagnosis, a serious injury, or an unexpected hospitalization can put you on the hook for the full deductible before the plan pays anything beyond the three primary care visits and preventive services.
Some health economists and members of Congress have called the expansion of catastrophic plans a push toward “junk insurance,” arguing that pulling healthy people into low-cost, high-deductible plans leaves sicker people in a smaller, more expensive risk pool and drives up premiums for everyone else.11Forbes. Oz Pushes Catastrophic Health Plans, Which Critics Call Junk Insurance The Trump administration, through CMS Administrator Dr. Mehmet Oz, has described the expansion as giving consumers “real choices.”15CMS.gov. HHS Expands Access to Affordable Health Insurance
Why Texans Are Looking at These Plans
Texas has the highest uninsured rate in the country. Census figures for 2024 put 21.6 percent of Texas adults and 13.6 percent of Texas children without coverage, roughly double the national average.16Texans Care for Children. Texas Has the Worst Uninsured Rate in the US Once Again The state has not expanded Medicaid, so most low-income adults don’t have that fallback unless they’re pregnant, severely disabled, or in a nursing home.
The enhanced ACA premium tax credits created by the American Rescue Plan Act and extended by the Inflation Reduction Act expired at the end of 2025 and were not renewed.17Brookings Institution. Why Are Expiring ACA Subsidies Raising Health Insurance Premiums Research from the Mosbacher Institute at Texas A&M projected that between 665,000 and 1.45 million Texans would lose marketplace coverage as a result, with out-of-pocket premiums rising an average of 115 percent for 2026 and the state’s nonelderly uninsured rate climbing from 16.8 percent to as high as 20 percent.18Bush School – Texas A&M University. Expiring Federal Health Subsidies That’s the environment catastrophic plans are showing up in — as a low-premium option for Texans who’ve been priced out of subsidized coverage and can absorb a high-deductible risk.
Not the Same Thing: Texas Farm Bureau Health Plans
You may see the Texas Farm Bureau Health Plans “Major Medical” product marketed as “catastrophic protection.” It isn’t an ACA catastrophic plan. It’s authorized under Texas Insurance Code § 1682 as a nonprofit agricultural organization health benefit and is explicitly not insurance under state law.19Texas Farm Bureau Health Plans. Major Medical It doesn’t meet ACA minimum requirements, uses medical underwriting, and can impose waiting periods for pre-existing conditions.20Texas Farm Bureau Health Plans. Individual and Family Plans Enrollment requires Farm Bureau membership, and coverage runs through the UnitedHealthcare ChoicePlus network.21Texas Farm Bureau. TFB Health Plan FAQ Premiums can be lower for healthy applicants, but applicants can be denied, and the ACA’s guaranteed issue, pre-existing condition protection, and essential health benefit rules do not apply.