San Antonio is the seventh-largest city in the United States and the second-largest in Texas, home to more than 1.4 million people in the city proper and nearly 2.6 million across the San Antonio–New Braunfels metro area. Bexar County's health insurance landscape is defined by three large forces: the military, the healthcare sector itself, and a large working-class population that earns too little to afford unsubsidized coverage but, thanks to Texas's refusal to expand Medicaid, too much to qualify for Medicaid. Understanding those forces shapes how you find coverage in San Antonio.
Texas is one of ten states that has not expanded Medicaid under the Affordable Care Act. For San Antonio residents, this creates a coverage gap that hits hardest in the city's working-class and service-industry communities. Under Texas Medicaid rules, most working-age adults without dependent children do not qualify regardless of income. Adults with children qualify only at very low income thresholds — well below the federal poverty level.
The practical consequence: a restaurant worker or retail employee earning $18,000 per year — below 100% FPL — does not qualify for Texas Medicaid (no qualifying children) and also does not qualify for ACA premium tax credits, which start at 100% FPL. They are in the gap. San Antonio has a larger uninsured population than the national average as a direct result.
Community health centers fill part of this gap. CommuniCare Health Centers, a federally qualified health center with multiple locations across Bexar County, provides primary and preventive care on a sliding-fee scale regardless of insurance status. For lower-income San Antonio residents without coverage, FQHC clinics are an important resource for ongoing care.
For San Antonio residents above 100% FPL without employer coverage, the ACA marketplace at HealthCare.gov is the primary path. Bexar County has a competitive marketplace by Texas standards — several carriers participate, giving residents real choices at different price points:
Enhanced premium tax credits have remained generous in 2026. Households earning between 100% and 300% FPL can often find Silver plans with very low net premiums. At 150% FPL (roughly $21,900 for a single adult), benchmark Silver plan premiums are typically $0 to $15 per month after subsidy. At 250% FPL (roughly $36,450), expect modest premiums with strong cost-sharing reductions if you choose Silver tier.
Joint Base San Antonio is the largest military installation in the United States, comprising three major components: Lackland Air Force Base on the city's southwest side (Air Force Basic Military Training, Air Education and Training Command), Fort Sam Houston on the northeast (Army Medical Center of Excellence, military medical training), and Randolph Air Force Base on the northeast metro fringe. Together they generate a military population exceeding 250,000 active duty, reserve, civilian employees, family members, retirees, and veterans in the metro area.
Active duty service members and their enrolled families are covered by TRICARE through San Antonio's military treatment facilities. Brooke Army Medical Center (BAMC) at Fort Sam Houston is a major regional military medical center — a Level I trauma center that also trains military physicians. Wilford Hall Ambulatory Surgical Center at Lackland handles outpatient specialty care. TRICARE Prime enrollees in San Antonio get primary care through these facilities with referrals to civilian network providers for additional specialty needs.
Veterans in San Antonio are served by the South Texas Veterans Health Care System — one of the largest VA systems in the country, anchored by the Audie L. Murphy VA Medical Center near UT Health San Antonio and multiple community-based outpatient clinics across the metro. Veterans enrolled in VA care receive primary care, mental health services, and most specialty services through this system.
Military retirees who are not yet Medicare-eligible use TRICARE Select or TRICARE Prime. Those who are Medicare-eligible (65+) transition to TRICARE For Life, which functions as supplemental coverage alongside Medicare. Understanding which TRICARE option applies to your military status is essential for Bexar County residents navigating coverage.
Healthcare is one of San Antonio's largest employment sectors. UT Health San Antonio (the University of Texas Health Science Center) anchors academic medicine in the city, with affiliated teaching hospitals and specialty clinics. University Health — the county public hospital system formerly known as University Hospital — is the safety-net hospital for Bexar County and a major employer in its own right.
Methodist Healthcare System (seven hospitals in the metro), Baptist Health System (also seven hospitals), and the CHRISTUS Health facilities round out the major health system presence. For most of San Antonio's employed healthcare workers, employer group coverage through these large institutions means the ACA marketplace is less relevant — but support staff, per diem workers, and employees at smaller healthcare businesses often find themselves in the marketplace.
The following income ranges apply to a single adult in 2026. Household income thresholds scale with family size.
San Antonio is a majority-Hispanic city, and navigating health insurance in Spanish is a real need. HealthCare.gov offers full Spanish-language support at CuidadoDeSalud.gov. Many licensed insurance brokers in San Antonio are bilingual. Community First Health Plans offers Spanish-language member services. CommuniCare Health Centers provides care in Spanish at all locations. If you need bilingual assistance finding coverage, ask your broker specifically about Spanish-speaking support — it is widely available in Bexar County.