Gender Affirming Care and Health Insurance
A Guide for Transgender and Gender Expansive Federal Employees and Dependents
While this page uses “you” and “yours,” these terms also apply to covered dependents on an insurance plan.
Disclaimer
This webpage provides general information and resources. It is not legal advice. For specific legal concerns, please consult with a qualified attorney or your agency’s legal counsel.
Gender affirming care (GAC) is a wide range of social, medical, surgical, mental health services and more that helps someone align themselves with their gender identity. You do not need to undergo a social, medical, or legal transition or undergo any other specific steps to be the gender you are. You can approach the topics below in a timeline that suits you and your priorities the best.
1. Explore Your Gender!
Join our beloved GET Community to connect with other gender expansive and transgender people and allies in the federal workplace. You do not need to be currently in the federal workplace to join, nor do you have to be a federal employee.
The Additional Resources section at the bottom has a list of subreddit communities that can help nurture gender euphoria and community. Reading books that are aimed at helping you through your gender journey can also be helpful and affirming.
Some of our members highly recommend “Trans Bodies, Trans Selves” and “You and Your Gender Identity: A Guide to Discovery” by Dara Hoffman-Fox. These books guide you through your gender identity exploration and share advice to consider when starting your social and/or medical transition if you choose to socially, legally, or medically transition.
Also consider reading books with first-hand accounts from trans and gender expansive folks: PFLAG book list, Genwell booklist, and Sunnyvale Public Library booklist.
2. Mental Health
Find a therapist, especially one who specializes in gender confirmation for the LGBTQIA+ community. This should be done early in the process, especially as most medical procedures for gender affirming care require letters from a therapist who has been seeing you for a while. It is important to find a therapist who is affirming and respects whatever you are going through and does not pathologize your gender identity or exploring your gender identity.
You can shop around and have introduction appointments with a few until you find a good match. Make sure to ask up front if letters for insurance coverage are something they can provide, how many sessions they require prior to writing a letter, and if they have additional fees for letter writing.
Finding a mental health care provider:
- PFS’s Mental Health Resources
- Some health insurances have preferred providers for gender affirming care and keep a list that they may refer you to. Call your insurance company for more information if you cannot locate it on your plan’s website.
- PsychologyToday.com also has a great filter tool. Under “Find a Therapist”, enter your location. Then under “All Filters” select “Transgender” under “Specialties”, along with any other filters you want (such as insurance coverage, types of therapy, those familiar with a specific race or ethnicity, etc.) If none are available in your area with your filters in place, cite this as evidence to try to get your health insurance to cover someone out of network as in network. Reach out to your insurance company directly to go this route.
- Trans Health Project List of Trans Health Care Providers. They also have a list of Gender Centers that can help connect you to mental health resources.
- Section 5 on Gender Affirming Care Providers, and Section 7 for Additional Resources, both below.
3. Obtain Health Insurance
Each year, a team from PFS compiles the PFS FEHB spreadsheet with FEHB plan information for gender affirming care and fertility benefits for the upcoming calendar year.
We also strongly recommend reviewing the Additional Resources section, below, such as TLDEF’s health insurance tutorial which offers a very comprehensive guide for understanding insurance medical policies.
For 2026, federal employees and their dependents (19+ years old) cannot obtain gender affirming care treatment unless it’s considered continuity of coverage from previous years. Some plans are stating you need to remain on the same plan to be considered continuity, but this is not the case with other plans. Most plans do not specify what this means and are awaiting more information. Individuals under the age of 19 cannot currently obtain gender affirming care under FEHB plans. More information is forthcoming about how to appeal for coverage. In the meantime, you can reach out to legal resources provided at the bottom of the page. If you’d like more information about lawsuits regarding this matter, reach out to PFS.
You do NOT have to enroll in an FEHB plan as a federal employee. You can instead obtain coverage through the ACA marketplace, a spouse, military benefits, etc. Note if you decide to get healthcare through the ACA, you likely will not qualify for government contributions, premiums will be paid with after-tax dollars, and other considerations (view Federal Employees Affordable Care Act Notification).
General insurance tips:
- Make sure to check for preauthorization requirements, verify benefits, and check the price of your prescriptions, copays, and any other anticipated medical care you may need.
- Some plans offer travel benefits for gender affirming procedures, typically surgeries. If you think that a planned procedure such as a gender-affirming surgery might require you to travel, be sure to ask about this benefit.
- When in doubt, call insurance representatives about specifics in coverage and plan offerings. Some may have dollar maximums or region limits (i.e., no reimbursement for international travel).
- For nationwide insurance companies, each region handles their own claims/preauthorization. There historically have been differences between and even within regional coverage. Documentation that something was previously covered in your region should not be taken as concrete evidence that it will be covered in your specific case.
- Performing a word search for “gender”, “dysphoria”, or “fertility” within the plan brochure may also help you find the information you are looking for.
- Some plan brochures state they cover facial gender affirming surgery (FGAS) but do not specify which kinds of surgeries are covered.
4. Consider purchasing Short Term Disability privately
Check out different private short term disability plans, as it is currently not available through the federal workplace. Most short term disability policies require you have a plan for a certain time frame (>1-2 years) before requesting disability for a planned surgery.
These short term disability plans will pay you a percentage of your salary, but the details vary on when it kicks in, how long they will pay, and the percentage. Some gender affirming surgeries require a long recovery (6-12 weeks is common). Your accrued leave may not be enough to cover your absence and FMLA is typically unpaid (you can use it for extra protection while you take paid leave, it does NOT provide additional paid leave).
5. Find Gender Affirming Care Providers
Find a health care provider to provide the gender affirming care you need! The Trans Health Project put together this list of Finding Trans Health Care Providers. Asking your community is a fantastic way to find out quickly which office is LGBTQIA+ friendly and which to stay away from.
Make sure to understand who does and doesn’t take your insurance, and if they specialize in gender affirming care. If they do not specialize in gender affirming care, are you and the provider comfortable proceeding regardless?
A benefit of having a health care provider who is familiar with gender affirming care means they might know how to get insurance companies to cover gender affirming care without using the term “gender dysphoria” (or related). A common way is diagnosing someone with an endocrine disorder instead of gender dysphoria to get access to needed hormones, as both are medically accurate diagnoses. Another way is helping people who were assigned female at birth (AFAB) access to top surgery (double mastectomy) via a reduction in breast cancer risk instead of a gender dysphoria diagnosis. The communities in the Resources Section, below, can also provide advice in this regard.
If you live in a larger city, there is likely a local LGBTQIA+ nonprofit or medical facility that can help refer you to finding gender affirming medical care in your area: DC’s Whitman-Walker; Los Angeles LGBT Center, Chicago’s Center on Halstead, Denver’s The Center on Colfax, etc. They typically also provide support groups, legal assistance, resource navigation, etc.
Also review the list of resources below.
6. Appeal for Coverage
If your Gender Affirming Care was not immediately covered by your insurance company, you can appeal for coverage, or choose to pay out of pocket.
For FEHB plans, you can find information on appealing for coverage in your insurance plan’s brochure Section 3 and Section 8. Each appeal process has a time frame in which you need to file for an appeal for coverage, so make sure to read each section thoroughly. In both, you appeal to the insurance company first, then if you disagree with the insurance company’s decision, you can appeal directly to OPM.
Brochure Section 3 – contains information on appealing for coverage of pre-service claims, where your Prior Authorization was denied. If you disagree with the outcome and decide to appeal further, you would then follow the Disputed Claims appeal process to OPM in Section 8.
Brochure Section 8 – contains information on appealing coverage of a post-service claim. Also details the Disputed Claims appeal process to OPM if you disagree with the outcome of the initial appeal.
For non-FEHB plans, refer to your health insurance plan’s brochure-equivalent or call the insurance company’s customer support desk for more information.
At the bottom of Additional Resources, below, there are many legal resources you can reach out to for legal help, some of which is pro bono.
7. Additional Resources
Discords
There are many local and nationwide Discords, such as No More Dysphoria, which can be incredibly helpful for finding local doctors, surgery prep/recovery advice, clothing swaps, meme sharing, etc.
Facebook Groups and Reddit
There are countless Facebook groups and subreddits, especially ones for multiple intersectional identities. For example, there’s a Facebook group for the intersection of Ehlers Danlos Syndrome, Gender Diversity, and Neurodivergence.
A subreddit where people discuss the logistics of surgeries and procedures, share experiences and photos of their surgery result, share news that impacts trans healthcare. There is a wiki in the sidebar that catalogs and organizes the posts on the sub (and other subreddits and non-reddit websites). Includes info on HRT, hair removal, surgeries, surgeons, reviews, photos, etc. Contains links to other active trans subreddits and resources, so this is a good place to get started.
A subreddit with questions and answers from the community that trans and cis people may have about anything related to being trans or gender non-conforming. Contains links to other trans subreddits, so this is a good place to get started
A subreddit that is for people who are nonbinary.
A subreddit that is for people who were assigned male at birth (AMAB). Discuss a “mtf” (“male to female”) experience.
A subreddit that is for people who were assigned female at birth (AFAB). Discuss a “ftm” (“female to male”) trans experience.
A subreddit where trans people send before and after photos throughout their transition. This can be helpful for getting excited about your transition and managing expectations.
A meme sharing subreddit. Good source for humor or commiseration.
WPATH SOC 8 Gender-affirming surgical procedures list
The non-definitive list of gender affirming procedures as defined by WPATH. Will be used by your medical care providers to justify the medical necessity of a procedure to an insurance company. Some insurance companies exclusively use it to determine coverage benefits.
Impact Litigator, fights for civil rights and liberties for all Americans. LGBTQIA+ Rights is the direct link to their gender affirming healthcare section which also includes a confidential form for assistance.
Was formed in 2024 by the National Center for Transgender Equality (NCTE) and Transgender Legal Defense and Education Fund (TLDEF), two long-time champions for the trans community, merged together as one organization. They run important projects such as the Trans Health Project (above), Name Change Project, Trans Legal Services Directory, etc. A4TE is maintaining a comprehensive and downloadable Trans Legal Survival Guide, most recently updated in July 2025, which includes sections on health care (including appeals) and seeking legal assistance. They have been known to host educational sessions available online through their organizing department.
LGBTQIA2S+ advocacy group that focuses on representation in media.
Human Rights Campaign strives to end discrimination against LGBTQ+ people and realize a world that achieves fundamental fairness and equality for all.
A major LGBTQ+ legal organization focused litigation, policy and education which is taken on recent cases to defend the rights of transgender and gender non-binary persons on recent sport bans, bathroom bans, military service bans, and on access to lifesaving gender affirming health care. Besides litigation, Lambda Legal will hosts informational sessions on the legal landscape.
National Black Trans Advocacy Coalition
The only social justice organization led by black trans people to collectively address the inequities faced in the black transgender human experience.
National Queer Asian Pacific Islander Alliance
Empowers LGBTQ+ Asians and Pacific Islanders through community capacity building, policy advocacy, and resource development.
Another 50+ year old organization that focuses on litigation and policy matters, the National Women’s Law Center fights for gender justice and works to drive solutions to gender inequity issues that include LGBTQ people in their scope. Their areas of practice include matters of sex discrimination and harassment in education, the workplace and in healthcare.
PFLAG is the nation’s largest organization dedicated to supporting, educating, and advocating for LGBTQ+ people and those who love them. They have local chapters and support networks across the US for those who are family members of a person transitioning and LGBTQIA+. They also give wonderful free information sessions on various LGBTQIA+ topics and advocacy.
Transgender Law Center (TLC) is the largest national trans-led organization advocating for a world in which all people are free to define themselves and their futures. Grounded in legal expertise and committed to racial justice, TLC employs a variety of community-driven strategies to keep transgender and gender nonconforming people alive, thriving, and fighting for liberation.
Transgender Legal Defense and Education Fund (TLDEF) Trans Health Project
The Trans Health Project takes a comprehensive, systematic approach to expanding access to transgender-related health care by educating affected individuals about their legal rights; cultivating a robust movement to achieve health care equity; expanding enforcement of existing legal protections; and driving clinical policy changes among insurance carriers.
The primary activities include developing a network of attorneys capable of challenging exclusions and medical necessity denials; launching a national health care helpline for transgender individuals and advocates to receive timely assistance; and educating individuals, transgender organizations, medical and mental health providers and billing offices.
THP engages in alternative dispute resolution and policy advocacy to establish positive precedent in priority areas including Medicaid, employee-sponsored health plans, and ending the ongoing categorical exclusions for common surgeries such as facial surgery and chest surgery for transgender minors.
Understanding Medical Policies | Gender Centers | Insurance Tutorial
An organization that advocates for the urgent and unique needs of TGI Latin@ immigrants, and also provides direct services to TGI individuals in the Los Angeles area