For individual and family health insurance, San Antonio residents buy 2027 coverage on the federal Marketplace at HealthCare.gov, which serves all of Bexar County. Texas did not expand Medicaid, so premium tax credits start at 100% of the poverty level. Open Enrollment runs Nov 1, 2026 – Jan 15, 2027; enroll by Dec 15 for coverage on Jan 1.
Updated for the 2027 plan year (October 2026). Reviewed by Adam Segall, Licensed Insurance Agent (FL Lic #P101968).
- How health insurance in San Antonio works
- 2027 enrollment dates
- University Health and CareLink
- San Antonio networks to check
- What you pay: subsidies by income
- Military City USA: TRICARE and leaving service
- Mixed-status and Spanish-speaking families
- Free in-person help in Bexar County
- Low income, kids and the coverage gap
- Frequently asked questions
How health insurance in San Antonio works for 2027
If you don’t get coverage through an employer, Medicare or Medicaid, you buy your own plan. For health insurance, San Antonio households in that spot use the ACA Marketplace. Texas does not run a state exchange, so Bexar County residents shop on HealthCare.gov directly or enroll through a licensed agent or assistant connected to it. The price of a given plan is the same either way.
Every Marketplace plan covers essential benefits, including doctor visits, hospital stays, prescriptions, maternity care and mental health. No insurer can turn you down or charge you more for a pre-existing condition. Marketplace plans are also the only individual plans that can carry an income-based premium tax credit.
For the statewide rules, read our Texas health insurance guide. If cost is your main worry, our affordable health insurance in Texas hub compares every route to lower premiums across the state.
2027 enrollment dates for San Antonio shoppers
| When you enroll | When coverage starts |
|---|---|
| Nov 1 – Dec 15, 2026 | January 1, 2027 |
| Dec 16, 2026 – Jan 15, 2027 | February 1, 2027 |
| After Jan 15, 2027 | Only with a qualifying life event |
Treat December 15, 2026 as the real deadline if you want coverage on New Year’s Day. Losing job coverage, moving to San Antonio, getting married or having a baby can open a Special Enrollment Period outside these dates, usually for 60 days. Our Open Enrollment 2027 guide has the full calendar.
Is your carrier leaving? Cigna is ending its ACA Marketplace plans after December 31, 2026, and Texas is one of the 11 states affected. If you received a discontinuation letter, pick a new 2027 plan by December 15 so there is no gap.
University Health and CareLink: real help, but not insurance
San Antonio has a public hospital system that many residents lean on. University Health is the official name in use for the Bexar County Hospital District, a public body governed by a board appointed by the Bexar County Commissioners Court, according to University Health. Its flagship, University Hospital, is the teaching hospital that works with UT Health San Antonio.
University Health runs CareLink, a financial assistance program for Bexar County families without insurance. To join, your income must be at or below 250% of federal poverty guidelines, you must live in Bexar County, and you cannot have or qualify for health insurance. The program’s own CareLink page states plainly that CareLink is not health insurance, and its FAQ notes it only works at University Health within Bexar County.
That distinction matters. If your household earns at least 100% of the poverty level, you may qualify for a subsidized Marketplace plan instead, which covers care at other hospitals and if you travel. Check your Marketplace options before assuming CareLink is your only path.
Health insurance San Antonio networks to check
When you compare health insurance, San Antonio networks matter as much as premiums. Many Marketplace plans here are HMOs or EPOs tied to specific hospital systems, so two plans at a similar price can include very different doctors. Before you choose, search each plan’s 2027 provider directory for your doctors, specialists and preferred hospital.
The systems San Antonio families most often ask about include University Health (the county’s public system), UT Health San Antonio (the city’s academic health science center and its physician practices), and the large private hospital systems across the metro. We don’t rank carriers or hospitals. Networks change every year, and 2027 Bexar County plan data is not final yet, so carriers and networks vary by county. Compare every option for your ZIP code on HealthCare.gov or with Honesty.
Our guide on how to choose a health plan explains HMO, EPO and PPO differences and how to read a drug list.
Honesty.AI checks every 2027 plan in Bexar County against your doctors, prescriptions and subsidy.
What you pay: subsidies by income in Bexar County
What you pay for health insurance, San Antonio or anywhere in Texas, depends on your age, household size, ZIP code and 2027 income. The premium tax credit caps what you pay for the benchmark Silver plan at a set share of income, and you can apply the credit to any metal tier. These are the 2027 shares from the IRS (see IRS.gov).
| Household income (% of poverty level) | Share of income for benchmark Silver (2027) |
|---|---|
| 100% – 133% | 2.15% |
| 133% – 150% | 3.23% – 4.30% |
| 150% – 200% | 4.30% – 6.78% |
| 200% – 250% | 6.78% – 8.66% |
| 250% – 300% | 8.66% – 10.22% |
| 300% – 400% | 10.22% |
| Over 400% | No credit for 2027 |
For one person, 100% of the poverty level is $15,960 and 400% is $63,840. For a family of four, the range runs from $33,000 to $132,000. The enhanced credits expired at the end of 2025, so the 400% cliff is back, and KFF reports insurers proposed a median increase of about 15% nationally for 2027. Shop again rather than auto-renewing. Details are in our 2027 subsidies guide.
Tip: If your income is under 250% of the poverty level, compare Silver plans first. Only Silver carries cost-sharing reductions, which lower deductibles and copays. The 2027 out-of-pocket maximum on any plan is $12,000 for one person.
Military City USA: TRICARE and leaving service
Joint Base San Antonio brings thousands of service members, retirees and families to the area, and Brooke Army Medical Center at JBSA-Fort Sam Houston is the Defense Department’s only Level I trauma center. If your family has TRICARE, HealthCare.gov’s veterans page confirms it counts as qualifying coverage, so you don’t need a Marketplace plan.
The question comes up at separation. Eligible service members may get 180 days of transitional TRICARE through the Transitional Assistance Management Program. When that coverage ends, losing it generally opens a Special Enrollment Period, so plan your Marketplace move before the end date. Contractors and civilian employees at JBSA usually have their own employer options.
Mixed-status and Spanish-speaking families
Many San Antonio households include relatives with different immigration statuses, and 2027 brings a change. Starting January 1, 2027, Marketplace premium savings are limited to green card holders, Cuban or Haitian entrants and Compact of Free Association migrants, according to HealthCare.gov. Other lawfully present immigrants can still buy a plan, but without the credit. See our 2027 immigrant subsidy rules.
Only the people asking for coverage need to give immigration information, and U.S.-citizen children can still get savings, Medicaid or CHIP on their own. You can apply in Spanish at CuidadoDeSalud.gov.
Free in-person enrollment help in Bexar County
Bexar County has two federally funded Navigator groups offering in-person help for 2026–2027, according to the CMS Navigator awardee summary: the Bexar County Community Health Collaborative and CentroMed (El Centro del Barrio). Navigators are free and trained to stay neutral. Book with them or find other assisters at localhelp.healthcare.gov.
The San Antonio Metropolitan Health District (Metro Health) is the joint city-county public health agency for San Antonio and unincorporated Bexar County. It runs immunization clinics and prevention programs, but it doesn’t sell or replace insurance.
Low income, kids and the coverage gap
Because Texas did not expand Medicaid, most adults without children cannot get Medicaid at any income. Adults below 100% of the poverty level with no other eligibility fall into the coverage gap: too little income for a Marketplace credit, no Medicaid. Report your expected 2027 income carefully; if it reaches 100% of the poverty level, you qualify for a credit.
Children are in a better spot. Texas Medicaid and CHIP cover many kids whose parents don’t qualify, and you can apply any time at YourTexasBenefits.com. CentroMed and other community health centers offer sliding-fee primary care; confirm sites at HRSA’s Find a Health Center.
How Honesty helps San Antonio residents
Honesty.AI is a licensed, unbiased, agnostic AI insurance agent that is on your side. It compares every plan sold in your San Antonio ZIP code, applies your subsidy, and checks your doctors and prescriptions against each network. It also lays out ACA, alternative and ancillary plans side by side so the trade-offs are clear.
There’s no office to visit for your health insurance. San Antonio shoppers reach Honesty 24/7 by chat, voice or text, and Honesty® Insurance Services, LLC is licensed in Texas (TX #3156333). Learn how Honesty.AI works.
Find your 2027 San Antonio plan the honest way
Compare every Marketplace plan in Bexar County, apply your subsidy and enroll in minutes. Honesty Is Your Best Policy®.
Frequently asked questions
Where do I buy health insurance in San Antonio?
Individual and family plans in San Antonio are sold on the federal Marketplace at HealthCare.gov, or through a licensed agent or assistant connected to it. Texas has no state exchange, and the same plan costs the same however you enroll.
Is University Health CareLink the same as health insurance?
No. University Health states that CareLink is not health insurance. It is a financial assistance program for uninsured Bexar County residents with income at or below 250% of federal poverty guidelines, and it only works at University Health.
When is the deadline for 2027 coverage in San Antonio?
Open Enrollment runs November 1, 2026 through January 15, 2027. Enroll by December 15, 2026 for coverage starting January 1, 2027. Enrollments from December 16 through January 15 start February 1.
Where can I get free in-person enrollment help in Bexar County?
CMS lists two Navigator groups with in-person help in Bexar County for 2026 to 2027: the Bexar County Community Health Collaborative and CentroMed. Search your ZIP code at localhelp.healthcare.gov to book an appointment.
Do military families at JBSA need a Marketplace plan?
Not while they have TRICARE, which HealthCare.gov treats as qualifying coverage. When TRICARE or transitional TRICARE ends after separation, losing that coverage generally opens a Special Enrollment Period for a Marketplace plan.
Keep learning: compare nearby guides for Austin, Houston and El Paso, see every city in our affordable health insurance in Texas hub, read about affordable health insurance nationally, or learn how the health insurance Marketplace works.
