Cigna and Baylor Scott & White Are Leaving the Texas Marketplace: What Happens to Your Plan on January 1

If you buy your own health insurance in Houston and your card says Cigna or Baylor Scott & White Health Plan, your coverage is ending on December 31, 2026. Not changing. Ending.

Both insurers are leaving the Texas individual Marketplace at the same time. Between them they cover a substantial share of the state’s Marketplace enrollees, and every one of those households needs a different plan before January 1.

Here is the part most people miss: if you do nothing, you will probably still have insurance on January 1. HealthCare.gov will move you somewhere automatically. That is the problem.

The short answer: when your insurer stops offering Marketplace plans entirely, federal rules let the Exchange re-enroll you in a similar plan from a different insurer. “Similar” is determined by the Exchange, and it does not guarantee that your doctors are in network or that your prescriptions are on the formulary. You can override that pick by actively choosing your own plan during Open Enrollment, which runs November 1, 2026 through January 15, 2027. Choose by December 15 if you want coverage to start January 1.

Which Texas plans are ending, and when

Two separate decisions, made for different reasons, landing in the same plan year.

Cigna announced on April 30, 2026 that it would exit the Affordable Care Act individual market entirely — all 11 states where it sells plans, both on and off the exchange, effective for the 2027 plan year. Texas is one of those 11. The company framed it as a decision about scale rather than about Texas specifically; its incoming chief executive described the individual market as “small business for us today, and it’s been shrinking in recent years.” Cigna reported more than 350,000 on-exchange members across those states.

Baylor Scott & White Health Plan notified regulators that it would discontinue Individual Marketplace plans after December 31, 2026, and separately exit Texas Medicaid Managed Care as of August 31, 2026. The plan cited changes in how Texas procures its Medicaid contracts along with what it called “Individual Marketplace complexities.” Roughly 100,000 Texas Marketplace enrollees are affected — about 2.6% of the state’s Marketplace.

One clarification worth making plainly, because it causes real alarm in Houston: Baylor Scott & White Health is not closing. Its hospitals, clinics and physicians continue operating. What is ending is the insurance product its health plan subsidiary sold on the Marketplace. If you are a patient there, you keep your doctors — but you will need a different insurance plan that includes them, and that is exactly the thing to verify rather than assume.

If your coverage comes from somewhere else — an employer, Medicaid, or Medicare — none of this affects you. This is specifically about individual and family plans bought through the Marketplace or directly from these two insurers.

What happens if you do nothing

This is the question people actually have, and the answer is counterintuitive. You will most likely be enrolled in something. You just will not have picked it.

Federal regulation at 45 CFR 155.335(j) sets out a re-enrollment hierarchy the Exchange follows each year. Normally it is unremarkable: you get renewed into the same plan. When your plan is gone, it walks down a list — the same product, then the same metal level with the most similar network, then a different product from the same insurer.

But when your insurer has left the Marketplace altogether, there is no same-insurer option left on the list. The regulation then says:

“No QHPs from the same issuer are available through the Exchange, the Exchange may enroll the enrollee in a QHP issued by a different issuer, to the extent permitted by applicable State law… (i) As directed by the applicable State regulatory authority; or (ii) If the applicable State regulatory authority declines to provide direction, in a similar QHP from a different issuer, as determined by the Exchange.”

Read that last clause again: a similar plan from a different insurer, as determined by the Exchange. Not determined by you, and not determined by whether your doctor takes it.

There is one guardrail in the rule worth knowing: the Exchange may not move someone with metal-level coverage into a catastrophic plan, and catastrophic coverage is not treated as a level above or below the metal tiers for this purpose.

The override is simple and it is entirely in your hands. The regulation applies “unless the enrollee terminates coverage, including termination of coverage in connection with voluntarily selecting a different QHP.” Pick your own plan, and the automatic assignment never happens.

Why “similar” is not the same as suitable

The word doing the work in that regulation is “similar,” and it is doing less work than it sounds like.

A plan can be similar in the ways the Exchange can measure — metal level, premium range, plan type — and still be wrong for your household in the ways that actually cost money. Three things commonly fail to carry over:

• Your doctors. Networks are built insurer by insurer. A new insurer’s silver HMO has no obligation to contract with the same Houston physician groups your old plan did.
• Your prescriptions. Formularies, tiers and prior-authorization rules are plan-specific. A drug that cost you a $10 copay can land on a specialty tier.
• Your hospital. This matters more in Houston than almost anywhere, because the major systems here contract selectively. A plan can be perfectly good and still not include the system where your specialist practices.

We have written separately about how HMO, EPO and PPO networks differ in Houston, and about the newer category of Marketplace plans with no provider network at all. Both are worth reading before you accept any replacement, automatic or chosen.

There is also a subsidy dimension. Your premium tax credit is calculated against the second-lowest-cost silver plan available to you — the benchmark. When insurers leave a rating area, the benchmark can move, which changes your subsidy even if your own plan’s sticker price did not change. The automatic assignment does not optimize for this. It is not designed to.

The dates that actually matter

Open Enrollment for 2027 coverage runs November 1, 2026 through January 15, 2027 on HealthCare.gov. Within that window there is a second date that decides when your coverage starts.

For anyone in a discontinued plan, December 15 is the operative deadline, not January 15. Enrolling on January 10 is technically on time and still leaves you uninsured for the whole of January — which is precisely when a deductible year resets and when people schedule the appointments they put off over the holidays.

Whether a discontinued plan gives you a Special Enrollment Period

It does, and it is listed explicitly. HealthCare.gov names “your individual plan or your Marketplace plan is discontinued (no longer exists)” among the events that qualify you for a Special Enrollment Period, with 60 days to enroll after the loss — or before it, if you know the loss is coming within 60 days.

That is a genuine safety net, and it is also the wrong thing to rely on. Two reasons.

First, you do not need it. Your plan ends December 31, inside Open Enrollment. The ordinary route is open, and it is the route that gets you January 1 coverage.

Second, leaning on the Special Enrollment Period usually means a coverage gap. A plan selected in January starts February 1 at the earliest. The 60-day window is there for people who were not notified properly, who missed the deadline, or whose circumstances changed — not as a planning tool.

Use it if you need it. Do not aim for it.

What this means in Harris County

Three households, three different problems.

1. A family of four on a Baylor Scott & White silver plan

Their pediatrician and their primary care physician are both inside the Baylor Scott & White system. The instinct is to panic about losing the doctors. They are not losing the doctors — the clinics stay open. What they need is a 2027 plan from a different insurer whose network includes those same clinics, which is a question with a factual answer you can check in advance.

If no reasonable plan includes them, that is a real tradeoff to weigh deliberately rather than discover in February.

2. A self-employed couple in their late fifties on a Cigna plan

Highest exposure of any group here. They are too young for Medicare, they buy their own coverage, and their premiums are already the largest in the individual market because premiums rise with age. If their income sits above four times the federal poverty level they get no premium tax credit at all, which we covered in detail in our guide to the 400% subsidy cliff.

For this couple the automatic assignment is the worst outcome available: a plan they did not choose, at a price they did not model, in a year when the market is repricing. They should shop actively the week Open Enrollment opens.

3. Someone who turns 65 in early 2027

A particular trap. If you turn 65 in, say, March 2027, you may be tempted to take whatever the Exchange assigns for January and February and then move to Medicare. Sometimes that is right. But the Medicare transition has its own deadlines and its own penalties for getting the timing wrong, and a Marketplace plan is not a neutral placeholder. Our pages on Medicare eligibility and working past 65 cover the sequencing, and it is worth a conversation rather than a guess.

How to check a replacement plan properly

In order. The premium comes later than most people put it.

1. Find the discontinuation notice. Your insurer must tell you the plan is ending. Keep it — it is your documentation if you need the Special Enrollment Period later.
2. Write down your doctors. Every one you intend to keep, with the practice name, not just the person. Physicians can participate through one group and not another.
3. Write down your prescriptions. Exact drug, dose, and the pharmacy you use.
4. Check each candidate plan’s network against that list. Verify with the insurer or the practice, not only with a directory — directories go stale.
5. Check the formulary for every drug. Note the tier and whether prior authorization or step therapy applies.
6. Look at the total, not the premium. Deductible, out-of-pocket maximum, specialist copays, and what the premium is after your tax credit.
7. Re-check your subsidy at your actual expected 2027 income. If the benchmark plan in your rating area changed, your credit changed.
8. Report income accurately. Underestimating now means repaying the excess at tax time, which we wrote about in reporting income changes to the Marketplace.
9. Enroll by December 15. Then confirm the insurer has you, and pay the first premium — coverage is not active until that first payment clears.

Where the premium increases fit in

Carrier exits and price increases are arriving together, and they are separate stories.

Nationally, the Peterson-KFF Health System Tracker found a median proposed increase of 15% across 276 insurers with publicly available filings — a second consecutive double-digit year, after a median finalized increase near 20% for 2026. KFF’s participation tracker counts nine carriers leaving the Marketplaces for 2027 and six entering new states.

We are deliberately not quoting a single statewide Texas figure here, and the reason is worth stating. Several widely circulated numbers for Texas — a specific insurer count, a specific average increase — do not hold up against a primary source. KFF notes that Texas is one of only three states where filings are publicly available for just a portion of participating insurers. CMS has not published its 2027 Marketplace public use files; the official sets currently run 2014 through 2026 only. Confirmed Texas plan data posts when window shopping opens on HealthCare.gov, in late October.

What the rate environment does change is the stakes of the automatic assignment. In a flat year, being moved into a similar plan is a minor inconvenience. In a repricing year, it can be the difference between a premium you planned for and one you did not. For the rate picture itself, our earlier analysis of 2027 ACA Marketplace rates in Texas goes through the filing and review process in detail.

Frequently asked questions

Talk it through with someone local

The work here is not complicated, but it is specific: take your doctors and your prescriptions, and find out which 2027 Houston plans actually cover them. That is a factual question with a factual answer, and it is much easier to answer in November than to fix in February.

If your plan is one of the two ending, bring the discontinuation notice, a list of your providers, and your prescriptions. We can tell you what the Exchange would likely assign you and what you would pick instead, and the gap between those two is usually the whole point.

Call 832-400-6538 or email sara@wisehealthins.com, or read more about the ACA health insurance plans and health insurance options we work with. We serve clients from North Houston and South Houston.

This article is for general information and is accurate as of October 5, 2026. It is not medical, tax or legal advice. Plan availability, networks, formularies and premiums vary by insurer, plan and rating area, and 2027 Texas plan details are confirmed only when they post on HealthCare.gov. Named insurers are identified for factual accuracy and nothing here implies an endorsement by or of any insurer. Talk to a licensed agent before choosing a plan.