Getting married in Texas: health insurance and the tax credit

Priya Nair is 31 and works as a freelance graphic designer from the spare bedroom of a rented duplex in Lakewood, in East Dallas. Her clients are mostly restaurants and small breweries. At open enrollment she picked a Silver plan on HealthCare.gov for 2026, with a tax credit and cost-sharing reductions worked out on her own income.

Andre Collins is 33 and an account manager at a Dallas company that sells commercial flooring. He has a high-deductible health plan through his job that covers only him. They married on Saturday, April 18, 2026, in her sister’s backyard a few streets from the duplex, with about 40 guests and a taco truck.

Does getting married let you enroll in a marketplace plan outside open enrollment? Yes, if at least one of you had qualifying health coverage for 1 or more days in the 60 days before the wedding. You then have 60 days to pick a plan. Any tax credit changes too, because both incomes now count.

Priya and Andre are fictional. The rules in their story come from HealthCare.gov, CMS and the IRS.

The marriage rule, in brief

A wedding is a qualifying life event: it opens a Special Enrollment Period outside open enrollment. Texans enroll through HealthCare.gov. In short:

• Prior coverage. At least one spouse must have had qualifying health coverage for 1 or more days in the 60 days before the wedding. The exceptions are for someone who lived abroad or in a U.S. territory, for American Indians, and for someone who lived where no marketplace plan was available.
• The window. 60 days after the wedding to pick a plan.
• When coverage starts. The first of the month after picking a plan.
• Proof. The marketplace may ask for documents proving the marriage. After picking a plan, there are 30 days to send them.
• Who it’s for. The new household member. The spouse who is already enrolled can add the new spouse to their plan, or the new spouse can go on a separate plan. HealthCare.gov is plain about the limit: “Current enrollees can’t change plans.” The household moves to another plan at the same metal level only if the current plan’s rules won’t take the new member.
• Reporting. Enrollees must report changes in income and household members within 30 days.

The tax credit has limits of its own. In 2026 it’s for household incomes from 100% to 400% of the poverty guideline, for people buying through the marketplace who can’t get other qualifying coverage, such as Medicaid, CHIP or affordable job-based coverage. There is no credit above 400% in 2026: the temporary expansion ended after 2025.

Priya and Andre’s story

Before the wedding

At open enrollment, Priya estimated her 2026 income at $26,000. HealthCare.gov asks self-employed people to “include the income you expect to make from your business after expenses,” so that was her net figure. For one person, it’s about 166% of the poverty guideline.

That put her expected contribution toward the benchmark plan at about $108 a month. It also made her eligible for cost-sharing reductions, which come only with a Silver plan. At her income, that meant a Silver plan with 87% actuarial value instead of the standard 70%: the plan pays a bigger share of covered costs, through lower deductibles and copays.

The Tuesday after the wedding, they spread both sets of plan papers across Priya’s kitchen table.

The clock starts

The wedding started a 60-day window, which ran into mid-June. The prior-coverage rule was easy to meet: Andre had been on his job-based plan for years, and Priya had her marketplace plan. One of them would have been enough.

Andre’s employer plan was a separate question. It has its own rules, and its own deadline, for adding a spouse after a wedding. On Wednesday he emailed HR to ask for both, and for his share for family coverage instead of self-only.

One household, one income

Married, Priya and Andre are one household for the tax credit. Household income is her income plus his, measured against the poverty guideline for two people. To claim the credit, a married couple generally has to file a joint tax return; the IRS makes exceptions only in narrow cases, such as domestic abuse or abandonment.

Andre expects $58,000 from his job in 2026. Added to Priya’s $26,000, that’s $84,000, about 397% of the poverty guideline for two. Her expected contribution toward the benchmark rose from about $108 a month to about $697. And at that income, her Silver plan no longer came with cost-sharing reductions, which stop at 250%.

They were also close to a line. In 2026 there is no tax credit above 400% of the poverty guideline, which for two people is $84,600, and they were $600 under it. A year-end bonus for Andre, or one large client for Priya, could push them over. Above the line there’s no credit for the year, and for tax years after 2025 there’s no cap on repayment: every dollar of advance credit would go back at tax time.

Three ways to cover two people

That evening they wrote three options on the back of a leftover seating chart.

Option 1: Priya joins Andre’s plan at work. This depended on HR’s answer: the plan’s rules and deadline for adding a spouse, and what family coverage would cost Andre each month.

Option 2: Priya keeps her marketplace plan. The offer of Andre’s plan matters here. Someone offered affordable job-based coverage that meets minimum value can’t get the credit, and for a spouse, affordability is judged on the employee’s share for family coverage. In 2026 it counts as affordable if that share is no more than 9.96% of household income: for them, about $697 a month.

HR’s answer put Andre’s share for family coverage above that line, so Priya could still get the credit. It would be figured as before, from the benchmark plan’s premium, but against an expected contribution of about $697 a month instead of about $108, so it would be smaller. If the benchmark premium for her comes to less than about $697 a month, nothing is left for the credit to cover.

Option 3: Andre moves to the marketplace too. The wedding let Priya add Andre to her plan, or he could take a separate one. Either way he’d get no credit. As the employee, he is judged on the self-only cost. His share for self-only coverage was well under about $697 a month, and HR confirmed his plan meets minimum value, so it counts as affordable for him.

Could the wedding be Priya’s chance to move from Silver to Gold, now that her Silver plan would lose its cost-sharing reductions? It couldn’t. The window was for adding Andre. As a current enrollee, Priya couldn’t use it to change her own plan.

The choice

They decided to keep separate coverage. They compared what each option would cost them each month after any credit, and what each plan’s deductible would mean in a bad year. Priya’s own plan came out ahead for the rest of 2026, and it kept her with the doctor she had seen for years. Moving Andre would have meant trading his job-based plan for one with no credit.

Priya will compare Gold and Silver at open enrollment this fall. Texas has Silver plans on HealthCare.gov priced with a 1.40 cost-sharing reduction factor from 2026 plans, under a state rule, so someone who gets no cost-sharing reductions should compare Gold with Silver. In 2026, 1,723,001 of the 4,172,233 Texans who picked a marketplace plan chose Gold, or 41.3%.

The paperwork

On Monday, May 4, 16 days after the wedding, Priya updated her HealthCare.gov application with the marriage, a household of two and their expected income of $84,000. Her advance credit was worked out again on the new numbers, and her plan no longer came with cost-sharing reductions. Had Andre joined her plan, the marketplace could have asked for proof of the marriage, with 30 days after picking the plan to send it.

The first months

After the update, Priya’s monthly share of her premium went up, because her advance credit went down.

The $600 gap became part of their routine. Priya keeps a running total of what she invoices, and if a bonus or a big job comes in, they’ll update their estimate within 30 days rather than wait for tax season.

The year still gets settled at tax time. The credit is based on income for the whole calendar year, including the months before the wedding, when Priya’s advance credit was figured on her income alone. How those months come out on Form 8962 is a question for their tax preparer and the form’s instructions.

The numbers

Step by step, with the poverty guidelines used for 2026 coverage.

Before the wedding: Priya alone

Step 1. Household: 1 person. Income: $26,000, her expected net income from her business.

Step 2. Poverty guideline for 1 person: $15,650. $26,000 divided by $15,650 is 1.66, or about 166%.

Step 3. Applicable percentage. Between 150% and 200%, it rises on a sliding scale from 4.19% to 6.60%. At 166%, about a third of the way up, it is about 4.97%.

Step 4. Expected contribution: $26,000 times 4.97% is about $1,292 a year. Divided by 12, that’s about $108 a month.

Step 5. Cost-sharing reductions: over 150% to 200%, a Silver plan with 87% actuarial value.

After the wedding: a household of two

Step 1. Household: 2 people. Income: $26,000 plus $58,000 is $84,000.

Step 2. Poverty guideline for 2 people: $21,150. $84,000 divided by $21,150 is 3.97, or about 397%.

Step 3. Applicable percentage: from 300% to 400%, it is 9.96%.

Step 4. Expected contribution: $84,000 times 9.96% is about $8,366 a year. Divided by 12, that’s about $697 a month.

Step 5. Cost-sharing reductions: none, because their income is over 250%.

Step 6. The 400% line for two people is $84,600. $84,600 minus $84,000 leaves $600.

Step 7. The affordability line for job-based coverage in 2026 is also 9.96% of household income, so about $697 a month settles both tests. Andre’s share for family coverage was above it, so Priya can get the credit. His share for self-only coverage was well under it, so he can’t.

In each case, the credit covers the rest of the benchmark plan’s premium (the second-lowest-cost Silver plan where they live) after the expected contribution, and it can be used on any metal level. Premiums depend on age, ZIP code, plan and insurer, so this example gives no dollar figure for a premium or for the credit.

What could have gone wrong

Letting the 60 days run out. After mid-June, adding Andre to a marketplace plan would have needed open enrollment or another qualifying life event. His employer plan’s deadline was its own, which they needed from HR rather than a guess.

No prior coverage. If neither of them had qualifying coverage in the 60 days before the wedding, and no exception applied, the wedding wouldn’t have opened a window.

Not reporting the change. Left at $26,000 for one person, Priya’s advance credit would have kept coming as if her expected contribution were about $108 a month instead of about $697. The extra would go back at tax time, every dollar of it, with no repayment cap. If their income comes in lower than the estimate, they may get more back.

Crossing 400%. At $600 under the line, a modest raise, a bonus or a new client could take the credit away for the year, and every dollar of advance credit would be repaid.

Questions to work through

Did either of you have coverage in the 60 days before the wedding? One of you with 1 or more days of qualifying coverage is enough. If neither of you did, check whether an exception applies, such as having lived abroad.

What does your spouse’s job charge for family coverage? Compare the employee’s share with 9.96% of your combined household income. If it’s at or under that, the spouse offered it can’t get the tax credit. The employee is judged on the self-only cost. Ask HR, too, about the plan’s own deadline for adding a spouse.

How close are you to 400%? For two people, the line for 2026 coverage is $84,600. Above it there’s no credit for the year, and no cap on repaying advance credit.

Does your Silver plan still come with cost-sharing reductions? Not above 250% of the poverty guideline. If yours stop, compare Gold with Silver at the next open enrollment, especially in Texas.

Have you reported the marriage? Report it, and your new household income, within 30 days. A licensed broker can check the numbers and your window with you.

The short version

Priya and Andre’s wedding in Dallas opened a 60-day Special Enrollment Period, because at least one of them had coverage before it. Their combined $84,000, about 397% of the poverty guideline for two, raised Priya’s expected contribution from about $108 to about $697 a month and ended her cost-sharing reductions. Andre’s share for family coverage was above that line, so Priya stayed eligible for a smaller credit. His affordable self-only coverage meant none for him. They kept separate plans, reported the change within 30 days, and are watching the $600 between their income and the 400% line.

This is a summary of how the rules work, not legal or tax advice. HealthCare.gov, your plan’s documents and your own tax situation have the final word.