Texas health plan · 2025

Managed Care for Families and Individuals · 26250TX0070005

Guardian offers this marketplace plan (Plan ID 26250TX0070005). Use the modules below to compare premiums, coverage structure, provider access, and formulary context against alternative options in the same market.

Metal level: Low Plan type: HMO CSR: Standard Low Off Exchange Plan Issuer: Guardian
Telehealth Data pending HSA eligible Check with issuer Dental Adult/Child Vision Not listed
Pay / Manage Plan

2025 cost summary

Key premiums & cost sharing

Rates mirror the latest CMS import (Tue, 10 Mar 2026 06:40 GMT). Personalize costs with your ZIP, age, and subsidies in the plan finder.

Monthly premium

$8 – $9

Before subsidies

Estimate after subsidies

Deductible

N/A

N/A

See deductible details

Max out-of-pocket

N/A

N/A

Review MOOP rules

Office visits

Primary care See benefits
Specialist See benefits

Drug tiers

Generic See drug coverage
Preferred brand See drug coverage

View formulary tiers

$8 / mo before subsidies

≈ $91 per year before tax credits.

Start with this unsubsidized premium, then apply marketplace tax credits to see your final monthly payment.

  • Ideal for shoppers comparing Bronze vs. Silver budgets.
  • Update your Marketplace application to apply premium tax credits.

$24 / mo before subsidies

≈ $294 per year before tax credits.

Pre-subsidy rate for a couple with one dependent. Switch to Silver CSR plans if you qualify to reduce these numbers.

  • Compares well against PPO vs HMO networks when planning for childcare and telehealth needs.
  • CSR savings require a Silver variant. Use the plan finder to load Silver options if you need lower deductibles.

$34 / mo before subsidies

≈ $406 per year before tax credits.

Pairs with cost-sharing reductions (CSR) when you select a Silver tier and qualify based on income.

  • Use this estimate before adding childcare, dental, or vision extras.
  • CSR Silver variants can lower deductibles dramatically for eligible incomes.
  • CSR savings require a Silver variant. Use the plan finder to load Silver options if you need lower deductibles.

$15 / mo before subsidies

≈ $182 per year before tax credits.

Shows the combined pre-subsidy rate for two adults. Add dependents or subsidies in your application to refine it.

  • Great for households deciding between PPO and HMO networks.
  • Telehealth and HSA perks (when offered) apply to both members.
Issuer profile See benefits
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Enrollment guidance

Stay on top of 2025 ACA deadlines

Open Enrollment window

Marketplace enrollment for 2025 coverage typically runs Nov 1 – Jan 15 (dates may vary slightly in Texas). Submit changes before the deadline to avoid a coverage gap.

  • Enroll by Dec 15 for Jan 1 starts.
  • Finalize plan switches before the window closes.

Special Enrollment Periods

You can change plans mid-year if you experience a qualifying life event (move, childbirth, marriage, loss of other coverage).

  • Report the event within 60 days.
  • Keep documentation handy for Healthcare.gov or your state exchange.

CSR & subsidy reminders

Premium tax credits and cost-sharing reductions (CSR) update annually when you re-submit your marketplace application.

  • Enter accurate income to maximize Advanced Premium Tax Credits.
  • Standard Low Off Exchange Plan plans like this one keep deductibles and copays lower if you qualify.

Thinking about switching?

Before you leave your current plan, compare networks, drug coverage, and total cost using the cards on this page.

  • Match provider networks so ongoing care isn’t disrupted.
  • Confirm prescriptions stay on-formulary or budget for tier changes.

Premium snapshot

Plan identifiers & filings

Track the official identifiers, documents, and filing dates tied to this plan. Open the marketing or formulary links whenever you need the latest PDF from the issuer.

Plan ID 26250TX0070005
Coverage year 2025
State Texas
Issuer Guardian
Variant ID 26250TX0070005-00
Available variants

Standard Off Exchange Plan · 26250TX0070005-00

Standard On Exchange Plan · 26250TX0070005-01
Last plan update Fri, 10 Jan 2025 00:00 GMT
Last HealthPorta import Tue, 10 Mar 2026 06:40 GMT

Network stats

Provider access snapshot

Review the network branding plus the number of in-network clinicians we track from issuer filings. Counts update with each CMS import (Tue, 10 Mar 2026 06:40 GMT).

All providers in Texas N/A
PCPs in Texas N/A
Telehealth support Data pending
Nationwide providers N/A
N/A doctors statewide N/A PCPs N/A OB/GYN

Provider network(s)

['TXN001']

Providers Texas All US states
All N/A N/A
PCP N/A N/A
Allergy N/A N/A
OB/GYN N/A N/A
Dentists N/A N/A

Drug coverage overview

0 drugs tracked

Inspect tier distribution plus authorization, step therapy, and quantity-limit counts sourced from HealthPorta’s formulary import.

Prior authorization Drugs
Required 0
Not Required 0
Step therapy Drugs
Required 0
Not Required 0
Quantity limits Drugs
Has Limit 0
No Limit 0

Customer highlights

What stands out for members

  • Issuer: Guardian · Plan ID 26250TX0070005 · 2025 filing.
  • Variant 26250TX0070005-00 (Standard Off Exchange Plan) currently displayed.
  • Use the cards on this page to explore network stats, drug coverage, and cost-sharing details.
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Benefits

Covered services & limitations

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic Dental Care - Child

$28.00
Tier 1 in-network $28.00
Out-of-network 100.00%

Patient charge listed is a sample copayment of basic service D2140 (Amalgam - one surface, primary or permanent). A complete list of copayments can be obtained from the plans benefit copayment schedule. Actual patient charges will vary based on the procedure but member responsibility for Pediatric Essential Benefits will not exceed the Maximum Out Of Pocket of $425 per child. Plan documents are the final arbiter of coverage.

Exclusions: nan

Major Dental Care - Child

$326.00
Tier 1 in-network $326.00
Out-of-network 100.00%

Patient charge listed is a sample copayment of major service D2510 (Inlay - metallic - one surface). A complete list of copayments can be obtained from the plans benefit copayment schedule. Actual patient charges will vary based on the procedure but member responsibility for Pediatric Essential Benefits will not exceed the Maximum Out Of Pocket of $425 per child. Plan documents are the final arbiter of coverage.

Exclusions: nan

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

Coverage details pending

nan

Exclusions: nan

Basic Dental Care - Adult

$28.00
Tier 1 in-network $28.00
Out-of-network 100.00%

Patient charge listed is a sample copayment of basic service D2140 (Amalgam - one surface, primary or permanent). A complete list of copayments can be obtained from the plans benefit copayment schedule. Actual patient charges will vary based on the procedure. Plan documents are the final arbiter of coverage.

Exclusions: nan

Dental Check-Up for Children

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

Patient charge listed is a sample copayment of preventive service D0120 (Periodic oral evaluation - established patient). A complete list of copayments can be obtained from the plans benefit copayment schedule. Actual patient charges will vary based on the procedure but member responsibility for Pediatric Essential Benefits will not exceed the Maximum Out Of Pocket of $425 per child. Plan documents are the final arbiter of coverage.

Exclusions: nan

Major Dental Care - Adult

$326.00
Tier 1 in-network $326.00
Out-of-network 100.00%

Patient charge listed is a sample copayment of major service D2510 (Inlay - metallic - one surface). A complete list of copayments can be obtained from the plans benefit copayment schedule. Actual patient charges will vary based on the procedure. Plan documents are the final arbiter of coverage.

Exclusions: nan

Orthodontia - Adult

$2,800.00
Tier 1 in-network $2,800.00
Out-of-network 100.00%

Patient charge listed is a sample copayment of orthodontic service D8090 (Comprehensive orthodontic treatment of the adult dentition). A complete list of copayments can be obtained from the plans benefit copayment schedule. Actual patient charges will vary based on the procedure. Plan documents are the final arbiter of coverage.

Exclusions: nan

Orthodontia - Child

$425.00
Tier 1 in-network $425.00
Out-of-network 100.00%

Patient charge listed is a sample copayment of orthodontic service for D8080 (Comprehensive orthodontic treatment of the adolescent dentition) and is for when orthodontic treatment is deemed medically necessary as defined by your state's Pediatric Essential Benefits benchmark definition. The Pediatric Essential Benefits orthodontic coverage does not include cosmetic treatment. Plan documents are the final arbiter of coverage.

Exclusions: nan

Routine Dental Services (Adult)

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

Patient charge listed is a sample copayment of preventive service D0120 (Periodic oral evaluation - established patient). A complete list of copayments can be obtained from the plans benefit copayment schedule. Actual patient charges will vary based on the procedure. Plan documents are the final arbiter of coverage.

Exclusions: nan

Variant attributes

Managed Care for Families and Individuals · Variant 26250TX0070005-00

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2025

CSR Variation Type

Standard Low Off Exchange Plan

HIOS Product ID

26250TX007

Metal Level

Low

Plan ID (Standard Component ID with Variant)

26250TX0070005-00

Plan Marketing Name

Managed Care for Families and Individuals

Plan Variant Marketing Name

Managed Care for Families and Individuals

Issuer & service area

Issuer-provided metadata for this variant.

Issuer ID

26250

Issuer Marketplace Marketing Name

Guardian

Market Coverage

Individual

Multiple In Network Tiers

No

National Network

No

Network ID

TXN001

Out of Country Coverage

No

Out of Service Area Coverage

No

Service Area ID

TXS001

State Code

TX

Cost sharing & actuarial values

Issuer-provided metadata for this variant.

Begin Primary Care Deductible Coinsurance After Number Of Copays

0

Inpatient Copayment Maximum Days

0

Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family Per Group

per group not applicable

Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family Per Person

per person not applicable

Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out

Not Applicable

Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Group

$850 per group

Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Person

$425 per person

Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Individual

$425

Maximum Out of Pocket for Medical EHB Benefits, Out of Network, Family Per Group

per group not applicable

Maximum Out of Pocket for Medical EHB Benefits, Out of Network, Family Per Person

per person not applicable

Maximum Out of Pocket for Medical EHB Benefits, Out of Network, Individual

Not Applicable

Enrollment & documents

Issuer-provided metadata for this variant.

URL for Enrollment Payment

Open link

Additional attributes

Issuer-provided metadata for this variant.

Begin Primary Care Cost-Sharing After Number Of Visits

0

Child-Only Offering

Allows Adult and Child-Only

Composite Rating Offered

No

Dental Only Plan

Yes

EHB Apportionment for Pediatric Dental

1.0

First Tier Utilization

100%

Import Date

2025-01-10 00:01:52

Guaranteed Rate

Guaranteed Rate

New/Existing Plan

New

Medical EHB Deductible, Combined In/Out of Network, Family Per Group

per group not applicable

Medical EHB Deductible, Combined In/Out of Network, Family Per Person

per person not applicable

Medical EHB Deductible, Combined In/Out of Network, Individual

Not Applicable

Medical EHB Deductible, In Network (Tier 1), Family Per Group

per group not applicable

Medical EHB Deductible, In Network (Tier 1), Family Per Person

per person not applicable

Medical EHB Deductible, In Network (Tier 1), Individual

Not Applicable

Medical EHB Deductible, Out of Network, Family Per Group

per group not applicable

Medical EHB Deductible, Out of Network, Family Per Person

per person not applicable

Medical EHB Deductible, Out of Network, Individual

Not Applicable

Plan Effective Date

2025-01-01

Plan Expiration Date

2025-12-31

Plan Type

HMO

QHP/Non QHP

Both

Source Name

HIOS

Plan ID

26250TX0070005

Copay & coinsurance

Pharmacy cost sharing by tier

Drug tier Pharmacy type Copay amount Copay option Coinsurance rate Coinsurance option Mail order

Questions & answers

Frequently asked questions

How do I choose the right ACA plan in Texas?

Managed Care for Families and Individuals (26250TX0070005) is a Low HMO from Guardian in Texas for the 2025 coverage year.

Compare it against other options with the HealthPorta plan finder to confirm premiums, deductibles, and network access fit your household.

Does Managed Care for Families and Individuals support telehealth or virtual urgent care?

The issuer has not published telehealth details yet. Review the Summary of Benefits and Coverage to confirm if virtual visits are included.

Is Managed Care for Families and Individuals HSA-eligible and does it include dental or vision coverage?

HSA eligibility is not published; check the Summary of Benefits or ask the issuer.

Dental add-ons: Adult, Child.

Vision coverage is not listed for this plan.

Does Managed Care for Families and Individuals support mail-order prescriptions?

Mail order coverage is not listed for this plan, so confirm with the issuer before relying on home delivery.

Is there out-of-country coverage for Managed Care for Families and Individuals?

No, out-of-country services are not covered for this plan.

Does Managed Care for Families and Individuals cover care outside the service area?

No, the issuer indicates out-of-service-area care is not covered except for emergencies.

Disclaimer: Based on the Tue, 10 Mar 2026 06:40 GMT HealthPorta import from CMS issuer filings. Data is best-effort and should be validated with the issuer directly. Sources: CMS.gov and the HealthPorta Healthcare MRF API.
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