Texas Medicaid Income Limits & Subsidy Calculator

Texas Subsidy Income Limits – ACA Marketplace & Medicaid

What Are Income Limits for ACA Subsidies in Texas?

The federal government offers premium tax credits (subsidies) on HealthCare.gov to help lower-income individuals and families afford health insurance. In Texas, income limits for ACA subsidies are based on the Federal Poverty Level (FPL).

2026 ACA Subsidy Eligibility:

• Minimum Income: 100% of the Federal Poverty Level (~$15,960/year for a single person)
• Maximum Income: 400% of the Federal Poverty Level (~$63,840/year for a single person)
• Coverage Gap: If your income is below 100% FPL and you don’t qualify for Medicaid, you may fall into Texas’s coverage gap with no affordable options

The Texas Coverage Gap Explained

Texas has not expanded Medicaid under the Affordable Care Act. This creates a significant gap for working adults without children or disabilities:

• Below 100% FPL: You don’t qualify for Medicaid (unless pregnant or in another special category) AND you don’t qualify for ACA subsidies. Estimated 570,000+ Texans are affected.
• 100% FPL or higher: You qualify for ACA marketplace subsidies on HealthCare.gov

Alternative Resources if You’re in the Coverage Gap:

• Federally Qualified Health Centers (FQHCs)
• County indigent care programs
• Hospital charity care programs

How Subsidy Amount is Calculated

Your subsidy is based on:

• Your household income
• Your household size
• Your age
• The lowest-cost Silver plan in your area

The subsidy ensures your premium doesn’t exceed a percentage of your household income. In 2026, this “affordability percentage” is approximately 2.0% for those near 100% FPL, scaling up to 8.5% for those near 400% FPL.

Income Changes & Annual Updates

Report income or household changes within 10 days to avoid overpayments you may owe back. Re-evaluate your coverage annually during Open Enrollment (November 1 – January 15) to ensure your subsidy still matches your income.

Income Limit for Pregnant Women in Texas

What Is the Medicaid Income Limit for Pregnant Women in Texas?

Pregnant women in Texas qualify for Medicaid at a much higher income level than other adults:

2026 Pregnant Women Medicaid Limit:

• Income Threshold: 203% of the Federal Poverty Level
• Annual Income Limit: Approximately $30,572/year for a single pregnant woman
• Monthly Income Limit: Approximately $2,547/month

Note: These figures are effective March 1, 2026 and based on the 2026 Federal Poverty Level published by HHS.

Why This Matters

This is significantly higher than the general adult Medicaid limit in Texas (which only applies to parents at 18% FPL). Pregnant women have access to comprehensive Medicaid coverage for:

• Prenatal care and doctor visits
• Delivery and postpartum care
• Hospital stays
• Prescription medications
• Mental health and substance abuse treatment
• No premiums, deductibles, or copays

How to Apply for Medicaid as a Pregnant Woman

Application Methods (fastest to slower):

1. YourTexasBenefits.com – Online application (fastest)
2. Phone:
   • 2-1-1 (statewide)
   • 1-877-541-7905
3. In-Person: Visit a local HHSC office (find locations on hhs.texas.gov)
4. Mail: HHSC, P.O. Box 149030, Austin, TX 78714-9030
5. HealthCare.gov: Start an application and be transferred to Texas Medicaid if eligible

Expedited Processing for Pregnant Women

Pregnant women and children may receive expedited decisions on their Medicaid applications—sometimes within days rather than weeks. Contact HHSC to request expedited processing.

Coverage Duration & Postpartum Extension

Medicaid coverage for pregnancy extends through:

• The entire pregnancy and delivery
• 60 days postpartum (2 months after delivery)

Plan ahead for coverage after the postpartum period ends. You may be eligible for ACA subsidies on HealthCare.gov if your income is above 100% FPL.

No Asset Limits for Pregnant Women

Unlike some other Medicaid categories, pregnancy-related Medicaid has no asset test. Your savings, car, or home will not affect your eligibility—only your income matters.

Common Mistakes to Avoid

• Waiting too long to apply: Apply as soon as you find out you’re pregnant to start coverage immediately
• Not reporting changes: Inform HHSC within 10 days if your income or household size changes
• Confusing Medicaid with marketplace plans: If you qualify for Medicaid as a pregnant woman, apply for Medicaid first—it’s free and has better coverage than subsidized marketplace plans
• Forgetting the 60-day postpartum deadline: Plan ahead for coverage after pregnancy ends

Questions? We Can Help

Our licensed insurance agents specialize in Texas health coverage options for pregnant women. We can help you:

• Determine if you qualify for Medicaid pregnancy coverage
• Compare Medicaid vs. ACA marketplace options
• Navigate the application process
• Plan for postpartum coverage

Call us at (972) 666-0578 or use our free income calculator on this page to estimate your eligibility.