Do Marketplace plans cover gender-affirming care? What changes have there been to coverage requirements?

Not necessarily. Coverage varies by state and by plan. Some, but not all, states prohibit health insurance plans from excluding coverage for gender-affirming care. Even in states where coverage is required, it is possible that not all gender affirming services will be covered. For example, a plan might cover hormone therapy but not laser hair removal. In states where coverage for gender-affirming care is not required, some plans may exclude this coverage altogether.

Beginning in plan year 2026, gender-affirming care services covered by ACA-compliant plans (including those sold off the Marketplaces) will no longer be considered an “essential health benefit.” As a result, enrollees may face higher out-of-pocket costs for these services. Patient out-of-pocket costs for gender-affirming care will not be required to count towards deductibles or out-of-pocket maximums and are not protected from lifetime coverage limits.

Consumers seeking coverage in a plan with an exclusion may have legal recourse under the ACA’s major nondiscrimination protections (Section 1557). Section 1557 prohibits sex (and other) discrimination in health care. While the Trump administration has suggested that it will interpret these protections to cover biological sex assigned at birth only, courts can and have found that these protections extend to sexual orientation and gender identity, and that excluding coverage for gender affirming care in ACA-compliant plans is unlawful in certain circumstances.