I read somewhere and can’t remember where that Gender Reassignment was now being covered. I wanted to check on that and get all the info I can about that. If it is not covered then is there anything that can be done to change that?


There are a number of insurers who offer transgender health coverage, as opposed to having blanket exclusions, either through fully-insured plans or as third party administrator of self-insured plans.

The ACA helps transgender Americans due to its many patient protections such as:

Mandating that insurers must accept preexisting conditions like "gender identity disorder", which was often considered a preexisting condition before the law, or expanding coverage options to low and middle income Americans.

ObamaCare does a lot to help equality of all genders and income levels, but there is no specific anti-discrimination law that protects transgender Americans. Check out the list of insurers below and make sure to understand the insurers rules for transgender health coverage. You will then need to pair up the insurer with a plan offered in your region.

You can find a list of these insurers and their guidelines for gender reassignment or transgender health coverage here.

UPDATE May 13, 2016: HHS finalizes rule to improve health equity under the Affordable Care Act. This ruling makes a lot of headway for transgender health under the ACA. See the HHS press release here.

See our take on the anti-discrimination ruling here, to be clear, it stops short of requiring health plans to pay for gender transition, but makes a lot of headway (explained in the article).

Rate and Comment on the Answer

Your email address will not be published. Required fields are marked *

1 2 3 4 5

This site uses Akismet to reduce spam. Learn how your comment data is processed.

beneficii on

Answer Rating:

This isn’t a good answer. Just because an insurance company is on the list as having plans that cover gender reassignment doesn’t mean the plans YOU have access to will cover it. If you look at their guidelines, they are qualified with statements that YOUR plan may not cover it.

Contrary to what GOPers would like you to believe, there is no federal law or regulation requiring coverage of gender reassignment by insurance plans sold on the exchanges (i.e. the Obamacare plans). Some states may require it, but they are all blue states, and those requirements come from STATE regulation, not federal regulation. Outside of those states requiring insurance plans to cover gender reassignment, I doubt strongly that there is any plan on the exchanges that will cover gender reassignment SURGERY or any related trans surgery (though they may cover hormones). Also, it can be hard to tell until you buy the plan, because the information you get on the exchange about exclusions may not be all-inclusive. You would have to wait to get the Evidence of Coverage to be sure.

ObamaCareFacts.com on

Thank you for adding this information. You are right, just because an insurer WILL cover something doesn’t mean your specific plan will. Still, the elimination of preexisting conditions and the other benefits, rights, and protections of the ACA absolutely do help. As for what plans cover what and if those plans are sold on exchanges, that is going to change from insurer to insurer and region to region. But even a plan outside of the exchange that provides transgender health coverage still has to adhere to new cost sharing limits set forth by the ACA. The point being the ACA does help, but that claim shouldn’t be confused with the idea that all plans provide all benefits or that plans sold on the exchange have to cover more than just essential benefits defined by the ACA.

Amy on

They won’t even cover the hormone therapy. I just talked to them. They don’t cover gender reassignments surgery either because they said it is “cosmetic” and therefore unnecessary. I’ve been researching the laws and supposedly referring to the surgery as “cosmetic” is discriminatory and unconstitutional, yet they get away with it.

polybiustestunit on

Being born with a genital deformity, is a pretty severe “cosmetic” problem.

That’s something that can negatively impact someone’s entire life.


If we can prove that transgender people are who they say they are on a biological level, which we can:

“Transgender: Evidence on the biological nature of gender identity”

Then there is no justification for denying them surgery, so they’re able to live a more normal, happier life.


The question worth asking is: Do these plans cover cleft lip surgery?

That could also be seen as a severe “cosmetic” impairment.

angela walker on

thre is a loop hole for transgender ppl i was told by medicare that its all in how the dr word it . you literally need to get a prescription written and a referal made stating that its a medical necessity and helpful in treating your gid and gender disphoria. ive since moved from the state where was tod this when i switched secondary insurance companies due to my hrt meds not being covered and the copays were outragious… its worth looking into again…

is there anyone in the four corner area that know of any drs that accept medicare for ffs srs or any other gender affirming surgeries ???

Jolien hager on

I got mine brest aug cover med nessary it heloed my gd.

angela on

what process did hard time with medicare nd drs u go thru bcaause im having such a

Angel Etheridge on

Heyy Ima transgender who has no surgery and its causes me to feel sucicidal becuse I don’t pass and I feel really horrible and no one will hire me because my name is t changed can u help me with how your insurance paid for breast aug u

Nancy on

Move to CA. They will pay for it, and you will be welcome there too.

Matthew on

Answer Rating:

The link provided is dead. In addition, even if the link was working, it didn’t lead to a list of available to me plans, only to insurers that MAY have inclusive plans. That’s not helpful. I need a way to tell if the plans available to me have inclusive options.

ObamaCareFacts.com on

We updated the link. We don’t have a list of plans that do offer transgender-related health care, we were simply able to find this list from 2014 of insurers without blanket exclusions. A smart bet would be to call one of these insurers and ask them directly. You would then want to ask if any qualifying plans are sold in the Health Insurance Marketplace in your region. Typically an insurer can help you enroll in a Marketplace plan they sell as well.

Hopefully further research on our part and more comments from our readers will help us to update this page with better answers.

Renee on

Answer Rating:

> “We don’t have a list of plans that do offer transgender-related health care, we were simply able to find this list from 2014 of insurers without blanket exclusions. ”

That’s the whole point of this page and this question. So your answer is, again, useless. It gives no guidance, and the marketplace does not answer the question either, so you can get insurance and roll the dice and see if it covers….or not. Which is actually harmful as most transgendered people have a hard time gaining full employment due to discrimination, and the marketplace will likely be the way the seek coverage with what limited funds they have. Limited funds. As in not able to go back and cancel policies and enroll in another one and cancel it and enroll in another one over and over playing the lottery hoping for a policy with coverage.

Especially when it’s your marketplace and a simple “Covers XYZ” list provided by the insurers participating in it would entirely solve the problem. If you and your fellow bureaucrats could bother to require the answer and list it so people could actually make informed choices.

ObamaCareFacts.com on

We are an independent facts site and in no way related to HealthCare.Gov, HHS, insurers, or the government. We created this page (knowing we didn’t have a solid answer) with the hopes that people would band together and help us compile smart information. Hopefully some day soon we will have community sourced answers on this page that will truly help the next person to come along asking this question.

For now if you are reading this and have any piece of the puzzle please add it in the comments sections below.

Also, our advice is not enroll in a plan and roll the dice… our advice is find a major insurer like BCBS that we know covers transgender health in at least some instances and see what sort of coverage options they have in your region. Then next see if any of those plans are sold on your state’s marketplace.

beneficii on

Answer Rating:

“We don’t have a list of plans that do offer transgender-related health care, we were simply able to find this list from 2014 of insurers without blanket exclusions.’

But they still do have plans with blanket exclusions. They’ve only gotten rid of them in a limited number of plans (while bragging about how progressive they are even though the vast majority of their customers still have no access). Why do you feel the need to whitewash this fact?

Jerry Rogers on

I need insurances for my transgender surgery coming up in November. But I can’t find any insurance that will cover me since I am 62 years of age.

ObamaCareFacts.com on

This certainly isn’t an easy one. We haven’t come across any failsafe methods for finding coverage yet, but calling the insurers in your network and discussing with them is probably a good bet. Hopefully more people will come along and share their story.

Niya on

I was looking to undergo SRS soon. My Dr has left to Practice in another State. Which left my state without a Dr that performs SRS. I’ve went through my Therapist sessions and have both letters and Hrt letter. Already had my Consultation with my Dr for the surgery but she didn’t process my Insurance since she knew she was leaving. The Problem now that she’s gone is My insurance don’t cover out of “Network” (In another state). WOW! Now I’m “Stuck”! What now?

beneficii on

Answer Rating:

And congrats, thanks to the misleading wording on your website, Breitbart has taken advantage to mislead the public that transgender health care activism is unnecessary:

“The Times claims that for many of the estimated 14,500 transgender residents in Los Angeles, that they are so “Desperate for hormonal treatments, transgender patients were turning to friends and illicit dealers for unregulated cocktails of drugs.”

But this statement seems to lack credibility. The Obamacare Facts website lists a “number of insurers who offer transgender health coverage, as opposed to having blanket exclusions, either through fully-insured plans or as third party administrator of self-insured plans.”

Blue Shield of California is highlighted as an insurance company that now has specific guidelines for gender reassignment or transgender health surgery coverage.”


Again, for the vast majority of Americans all health plans available to them HAVE blanket exclusions, even if they are sold by one of the listed health insurance companies. I don’t know why you feel the need to give a cookie to the insurance company by whitewashing this fact.

You need to make this fact CLEAR or your writing falls well short of any journalistic standards and I will work to make that fact CLEAR.

beneficii on

I see Blue Cross Blue Shield of Tennessee (BCBST) is listed as being “inclusive.” I have right here all the policies that will be sold by BCBST on the Tennessee Marketplace Exchange for 2016:


There are a lot of plans, but a sampling of the plans, looking at all the different levels and at high and low deductable plans, shows the exact same blanket exclusion of “Surgeries and related services to change gender (transgender Surgery)” under “Reconstructive Surgery” -> “Exclusions” in every available plan. (Look under “Policy.”)

Kristen on

Answer Rating:

I still can’t get healthcare coverage because I’m transgender. Yes they’ll sign me up to their plan, but they deny EVERYTHING on the basis that I’m trans and they have exclusionary policies. What good is an expensive health I durance policy if it’s useless?

Can I file for an ACA exemption? We’re stuck between a rock and a hard place.

ObamaCareFacts.com on

That is really sad. There is no good exemption based on this fact, but check out the exemptions list: https://obamacarefacts.com/obamacare-exemptions-list/

It probably doesn’t help much in this instance, but keep in mind if something is covered “in-network” it’s subject to the out-of-pocket maximum rule and must be covered after the maximum. Some plans have “out-of-network maximums” which may have some cost sharing amount after that maximum is hit. So you can leverage that in some instances.

Angela Hague on

what state are you in?

Eloisa on

Answer Rating:

How credible is this website?

ObamaCareFacts.com on

This website as in ObamaCareFacts.com? It’s as credible is the small team running it. It’s not professional medical advice. Rather it’s an independent and unofficial information source that is part us doing research since 2012, and part an avenue for other people around the country to come and discuss a given topic related to the ACA.

For this page specifically (on transgender health) we are about as in the dark as any of you. We did some research and shared what we found, but are real hope is that someone out there with the real answers will share them here. This would hopefully lead to this page becoming more accurate, useful, and creditable. Until then it simply serves as a place to come together, connect, and share information with other people facing the same challenges. We would urge any reader to do this. We have no hidden intentions, ties to insurers, or affiliation with government.

Tran's dad on

bull&*(&#t, it varies by state and only a very small handful of states have laws regarding discrimination against those undergoing gender reassignment, and in the individual marketplace, even in those states, coverage for gender reassignment is specifically excluded.

ObamaCareFacts.com on

100% not an easy road to go down. I can only imagine. What this page is about is compiling helpful information. So, knowing that it’s a group of like-minded people looking for answers, let’s be collaborative and helpful.

Charles on

“The ACA helps transgender Americans due to it’s many patient protections”
The ACA helps transgender Americans due to it is many patient protections?

ObamaCareFacts.com on

Derp, grammar error. Its (possessive) not It’s (it is). Meaning that all the new benefits rights and protections help everyone, and many can be seen as improvement in general for transgender health. That said, as can be noted from the comments and content of this page, there is work still to be done.

Linda on

Poor answer, since Section 1557 of the Affordable Care Act *does* forbid sex discrimination by all insurers offering a policy in any exchange as well as the federal government and all state government health plans receiving federal funding. The EEOC, federal courts, Departments of Justice, Education, and Health and Human Services all regard discrimination against transgender people as illegal sex discrimination. 11 states and D.C. explicitly ban trans discrimination in health insurance. While the proposed federal regulation doing likewise is still not final, the Department of Health and Human Services, the federal agency responsible for enforcing Section 1557 of the ACA, has regarded trans discrimination as illegal since at least 2012. By this federal law, Medicare, Medicaid, the Federal Employee Health Benefits Plan, Indian Health Service, National Health Service Corps, and all Obamacare insurers (including their health policies offered outside the exchanges, once the new regulation goes into effect!) must not exclude all transition-related care. The military and VA are bound by conflicting statutes not to offer surgery but do offer all other forms of transition care.

ObamaCareFacts.com on

Thank for the input.

Kate on

Hi there.

First, thank you for creating this site. I do wonder why GID was called a pre-existing condition twice in the same sentence – not for grammar reasons, but because it’s saying insurance has to accept pre-existing conditions that were considered pre-existing conditions before the ACA. I think what was intended was the idea that GID is no longer considered a valid reason to bar coverage under the new law even though one must prove that it’s been a long term pre-existing condition just to get the appropriate “approval” letters from the psych community. Is this an accurate interp?

Anyway, I’m in a related situation which leads to another question: I’m an American citizen and have been living abroad since 2011, and have permanent residence in the country where I live, which means (less a few major details) that I’m paying taxes here, and am exempt from paying tax in the US. I’m also transgender, and have known it since I was about two or three. I still have to jump through all of the psych hoops and yadda-yadda-etc-etc, but plan to come home to the US for my surgery(ies). I have family there, and, frankly, the end results are far superior in the US at this juncture.

Okay, now for the question. As a citizen, am I eligible for coverage in such a situation? Does it matter which state I reside in – meaning, do I need to be insured in the same state as that of my surgeon’s location? In other words, how do I know what region’s plans/insurance providers to look at in the first place, given my current lack of a permanent address in the US?

Oops. That was several questions. They all matter, and you get the gist. Any info?


ObamaCareFacts.com on

Yes, this is an accurate interpretation (and probably stated more clearly), thank you back!

I would say, as general advice, you do have to have a residence in the state you want coverage and that it does matter what state and insurer. Off the top of my head I have a rough time feeling like Mississippi is going to be as progressive as California or New York on this. This is hardly medical advice, but there is an article from the NyTimes on the matter: http://www.nytimes.com/2014/12/11/nyregion/in-new-york-insurance-must-cover-sex-changes-cuomo-says.html?_r=0

Instead of trying to advise where I don’t have expertise I will leave this open and suggest contacting and coordinating with some of the major insurers like BCBS.

Juria Robinson on

I am ftm and I a couple of years ago moved back to my home state South Carolina and have many problems with my health care when it comes to being myself, mainly my hormones,I am covered by medicade ,please help me


I just read the above statement as it relates to transgender reassignment coverage; my thoughts are and question is, If the transgender is covered by insurance and considered cosmetic, then other cosmetic surgeries, ie lipo, tummy tuck etc. should now be covered by Health Insurance as well,,, Please Advise

ObamaCareFacts.com on

Hmm, i’m not sure. The best bet in all instances is to contact your insurer and ask them directly. They are typically knowledgable, helpful, and honest. I don’t know enough about this rule yet to comment myself.

Angela Hague on

those are optional…gender reassigment is NOT.

TJ on

Choosing to mutilate your genitalia because you want to dress up like a boy instead of a girl, or vice versa, is most definitely a choice. If insurance companies are going to start paying for this shit then they damn sure better start paying for boobs jobs, rhinoplasties and butt lifts. Smfh. What a sad effin world we live in.

Angela Hague on

How can I get a list of providers that accept Obama care and work with TG issues?

ObamaCareFacts.com on

Good information is few and far between. I posted the best list I could find above. Here it is: http://www.cheatsheet.com/personal-finance/these-insurers-offer-transgender-health-care-coverage.html/?a=viewall

Lilith on

While this makes headway, I still feel shafted for being born dysphoric with my biological gender. It is a complete nightmare now to continue being trapped in this male body when I feel and have always felt like I should have been born a female. I really need to know if Section 1557 can actually be invoked in legal proceedings to nullify my insurance policy’s blanket exclusions for Gender Reassignment. The way the policy is written, the exclusion very specifically states that anything to do with gender reassignment, not only surgery, but shrink visits, doctor visits, and anything else carrying the ICD-10 code applicable to the condition, is not covered. I am paraphrasing this, but the actual language smells highly discriminatory, clearly written by a lawyer or someone with a nitpicking legal-esque background. This is of concern to me, as I fully intend to go through transition one way or another, for my own sake, and I have every intention of making insurance pay for it, leaving me with a cost more reasonable than $30,000. So, i need to know if I have a legal leg to stand on if I take the insurance company to court over this.

Hormones are a greyish area. Technically, there is a gender code for Rx, which is concerning because if I’m legally male and purchase estradiol, medroxyprogesterone, or spironolactone (the latter without a corresponding medical claim for a cardiological disorder), that gender code could mean something and reject the claim immediately at the pharmacy.It is even worse if any one of those drugs require prior authorisation, which will require the doctor to truthfully divulge the clinical necessity for the drug in question, which will out me as a gender reassignment patient, which, again, is not-covered.

So far, 17 states require gender reassignment to be covered if deemed medically necessary. Florida, my state, is not one of them and I have yet to see any plan that covers this extremely important treatment for a terrible condition to have to live through. I can’t decide which will be more expensive: paying a coinsurance for surgery, drug copays, and doctor copays for the time required by WPATH or picking up and moving and getting re-established in a more accommodating state.

Olivia Halphen "Elliot" on

I currently am losing my Medicaid this month and I need a new health care coverage that won’t cost me an arm and a leg. I start hormones in November when I go see a hormone specialist and I can’t find an inusurance that will cover something along my injection or blood works or medicine or anything. I can’t afford a lot.

Coty Hines on

My Dr. Is leaving for New York beginning of January. Already had my Consultation on Sept. 6, 16. Already turned in my 2Therapist letters, Hrt letter, Identification and Insurance Info. I’m now getting Electrolysis on my genital area. I live in Baltimore. Now the only Dr. Performing this Surgery is leaving. Been told my insurance doesn’t cover out-of town surgery(Priority Partners). Called my insurer and was told she doesn’t see if it doesn’t cover it. This is where I don’t know what to do next? Help Me Please.

Joanne on

Fenway Health released a policy brief on how the ACA affects transgender patients. A few takeaways drawn directly from the text:

“The Section 1557 rule explicitly prohibits discrimination on the basis of gender identity in health care facilities and programs receiving federal funding, including hospitals that receive Medicaid or Medicare funding, federal health centers, and marketplace plans

The rule also specifically protects gender nonconforming and non-binary people from
discrimination in health care.

Examples of discriminatory practices based on gender identity that are now illegal under
Section 1557

 Denying health care or health coverage to individuals on the basis of gender identity
or sex stereotypes

 Categorically excluding coverage for allhealth care related to gender transition

 Denying or limiting coverage for specific health services related to gender transition
if this would result in discrimination against a transgender person

 Treating individuals in a way that is inconsistent with their gender identity,
including in access to facilities

 Denying or limiting treatment for sexspecific health services based on the fact
that a person seeking such services identifies as belonging to another gender (e.g. refusing mammograms to transgender men on the basis that they are only for women)”

If you believe you have been discriminated against based on your gender identity or sexual orientation in a clinical or insurance context, you may file a complaint with the HHS Office of Civil Rights (http://www.hhs.gov/civil-rights/filing-a complaint/complaint-process/index.html) The complaint should be filed within 180 days of when you knew that the act or omission complained of occurred. OCR may extend the 180-day period if you can show “good cause.” Complaints can be filed through mail, fax, e-mail, or the OCR Complaint Portal. (https://ocrportal.hhs.gov/ocr/smartscreen/main.jsf) You may also call OCR’s toll free number at (800) 368-1019 or (800) 537-7697 (TDD) to speak with someone who can answer your questions and guide you through the process. Language assistance services for OCR matters are available and provided free of charge. OCR services are accessible to persons with disabilities.”


Martin M on

It is 100%foolish to cover sex change operations, A man can NOT be a woman{ not matter how deceived he is to imagine so} because a man was NOT born with a uterus or fallopian tubes or breast or a vagina and a woman does have those things!! you all need to follow REAL science {HUMAN ANATOMY} that Doctors have known for years } and not your silly imagination to believe the lie of “transgenderism”. thank you

Billie on

I want insurance coverage, but I need to know that it will help pay. For me to have a sex change. And for my female hormones

John Hammond on

I`m looking for health care insurance that covers Hormone Replacement Treatment. My work insurance is though “Blue Cross an Blue Shields”. “Blue Cross and Blue Shields” does not cover Hormone Replacement Treatment though my work insurance. Where can I find health care insurance that does?

ObamaCareFacts.com on

This isn’t an easy question. If you go on healthcare.gov you can find what is generally the list of insurers in your region. I would from there call each specifically and inquire.

Jose Savinon on

The term “gender identity disorder” is derogatory and should be replaced.

ObamaCareFacts.com on

I’ll take that into consideration. The goal here is to inform people and the language is insurer lingo. Given this, the term is probably best staying. If I replace it with something more “PC” it runs the risk of not being as useful for those researching transgender health coverage.

But 100% agree, upon contemplation it is a bit of a backhanded term…. Seems like a complex subject that merits some sort of philosophical essay. Without getting into that, do you have a suggestion for a replacement term?

Alouette de Mer on

Why do we need a replacement term at all? A term is a term, a way to categorize someone as being freakish or out of the ordinary, so much so that it merits their being labeled with a disorder and their being labeled with their very own “term” in order to describe them. The fact that I’m a woman in a man’s body is referred to as a “disorder” and people search for a “term” to apply to me. The mere fact that I exist is a “disorder.” Term? You want a new term as to how to refer to us? How about this term? How about calling us a “human being?” How’s that for a new term by which to refer to us? We are not a disorder, we are not a term, we are not a disgnosis. And as far as gender transition insurance coverage, it should relate to all aspects of transition…from hormones to surgery and electrolysis and everything else. And also, people are finally waking up as to how they’re being screwed by Obamacare. This is their first real lesson in communism, and it’s at least promising to see some people pulling at the bit as it’s placed into their mouths.

Alouette on

Why do we need a replacement term at all? A term is a term, a way to categorize someone as being freakish or out of the ordinary, so much so that it merits their being labeled with a disorder and their being labeled with their very own “term” in order to describe them. The fact that I’m a woman in a man’s body is referred to as a “disorder” and people search for a “term” to apply to me. The mere fact that I exist is a “disorder.” Term? You want a new term as to how to refer to us? How about this term? How about calling us a “human being?” How’s that for a new term by which to refer to us? We are not a disorder, we are not a term, we are not a disgnosis. And as far as gender transition insurance coverage, it should relate to all aspects of transition…from hormones to surgery and electrolysis and everything else. And also, people are finally waking up as to how they’re being screwed by Obamacare. This is their first real lesson in communism, and how under communism people are promised the moon, till they wake up and realise that with communism nothing is free…and it’s at least promising to see some people pulling at the bit as it’s placed into their mouths. Next comes the whip.

TJ on

It should be treated as a mental health disorder, which is what it is. And that would be cheaper for insurance companies to cover than dick removal surgeries and putting fake boobs on men that should never be done in the first place!

ObamaCareFacts.com on

I was going to remove this comment… but I feel like it is worth us all remembering the sort of attitudes floating around society that hinder the ability of Americans with any sort of non-binary sex, gender, or sexuality to get equal treatment in healthcare or any other area of life.

To be clear, our research shows that this commenters rant is grounded in prejudice, not science.


In words, sex, gender, and sexuality is more like a probability wave. One person may be dealing with mental health issues, another may be “one gender trapped in another genders body” due to epigenetics, another may just feel like getting a boob job. Not really our place to judge, it is more about the individual and their doctor… that is why we need to expand healthcare to account for all needs for all types of Americans.

MB on

I am a 36 year old woman who is in my 3rd year of remission for gynecological cancer. I have medically induced menopause and my ovaries and uterus were fried from radiation. I suffer with many radiation induced complications from surgery. I no longer make any hormones and my health insurance won’t pay for the bioidentical hormone replacement therapy and surgeries/procedures that I need to improve the quality of my life and prevent diseases from lack of hormones. You expect health insurance to cover transgender surgery and hormone replacement for transgenders? Lets get our priorities straight here, how about being thankful and grateful for your health and realize transgender surgery and hormones to become a different sex are not medically indicated or medically necessary. I’m all for transgenders and transitioning and doing what makes you happier, but insurance companies should NOT be covering it. WTF is wrong with this country?

Colleen Fisher on

There better not be benefits available for transgender procedures when I for one am suffering greatly with osteoarthritis in my left foot and left knee in agony from morning to night with “pain management “ because no one wants to accept my “Obamacare”.