The 2026 Transgender Health Insurance Guides to the Marketplace Are Here!

Health insurance is confusing for everyone, but especially for transgender folks. It’s hard to know if an insurance carrier is going to cover the care that you need, especially gender-affirming care. It can be frustrating to have to navigate questions about coverage options, jump through hoops to get a claim approved, and navigate the appeals process if a claim is denied. 

That’s why Out2Enroll is committed to helping transgender individuals understand their coverage options. Each year for the last decade, we’ve reviewed plans from every insurer on the Health Insurance Marketplace and categorized them based on their coverage for gender-affirming care.

The four categories you will find in our guides are:

Clear Coverage

These are policies that affirmatively state that they cover at least some gender-affirming care procedures when medically necessary.

Some Exclusions

These policies may cover some gender-affirming care, but they also have specific exclusions for procedures or services that you may want. For example, some plans state that they only cover hair removal when part of a gender-affirming surgical procedure. If you are looking for coverage for facial hair removal, this plan may not be a good option for you. However, if you are looking for coverage only for hormone therapy, this plan could be fine.

Silent

This category is either for insurers whose plans do not mention gender-affirming care at all or insurers whose plans are not available for review. In these cases, it is best to call the insurer directly and ask for their medical policy for gender-affirming care.

Broad Exclusions

These policies explicitly state that they do not cover any gender-affirming care procedures. We do not recommend enrolling in one of these plans.

Before diving into the guide for your state, please keep in mind that these guides are provided solely for informational purposes and should only be used as a starting point for making a decision about which plan is right for you. We consider a sample of plans and only review them in detail for coverage of gender-affirming care services and procedures. But you likely have other health needs to consider, as well as financial ones. (Check out our Consumer Education Series for more information about how to choose a health plan.) 

In order to review a plan yourself, you can first look at the plan’s Summary of Benefits and Coverage, which will tell you your monthly premium and how much you can expect to pay for certain procedures or office visits. Then, it should have a link to the policy contract for you to review, which may be called the Certificate of Coverage, Evidence of Coverage, or Benefits Booklet. This document will provide more detailed information on every procedure and service that is covered or excluded from the plan. You should also look at your Plan Formulary, which explains what medications are covered and with what degree of out-of-pocket costs. (Check out our post on how to read a policy contract.) Only after reviewing all this information and making sure the plan fits your health needs and your budget should you go ahead and enroll in coverage.

One more thing: You don’t have to do this on your own! If you have trouble finding these documents or understanding what they say, know that help is available. We recommend you contact an LGBTQ-affirming enrollment assister who can help you – for free – over the phone or in person. You can find an assister near you by using our Assister Locator Tool. 

Now that you are ready to dive in, find the guide for your state here:

Find Your Guide