Now that we're into the 2026 plan year, you're likely noticing changes to your Federal Employees Health Benefits (FEHB) coverage. FEHB 2026 gender-affirming care coverage now includes exclusions for certain medical and surgical services related to gender transition. Here's what you need to know: Counseling for gender dysphoria remains covered, and plans offer an exceptions process for people who are mid-treatment. But the specifics (how exclusions work, what the exceptions process looks like, how prescriptions are handled) depend on your individual plan documents. Grab your 2026 brochure and Summary of Benefits & Coverage. That's where you'll find what actually applies to your situation.
What Does Your Plan Actually Cover?
Start with your plan documents and look at both what's excluded and what remains covered. Counseling services for gender dysphoria continue as a covered benefit. Then look at the details that affect access: preauthorization requirements, referral rules, network restrictions.
Pharmacy coverage needs careful attention. Hormone medications aren't blanket-excluded, but coverage depends on what they're prescribed for. If you're using hormones for gender transition specifically, check your formulary for exclusions, step therapy, quantity limits, or prior authorization requirements. But keep in mind, these same medications prescribed for other medical conditions like endometriosis, cancer treatment, or other health issues remain covered. Mental health benefits run through some plans' separate vendors with their own access rules.
If you're already getting treatment, this matters a lot. Call and ask about your plan's exceptions process and what happens to your care. Plans maintain processes for people mid-treatment, but you need to know how yours works.
Medicare Coordination for Retirees
Retirees, this part's for you. Medicare Parts A and B handle different services in different ways. Inpatient stuff, outpatient visits, anesthesia, complications from procedures. Your area might have local coverage determinations that completely change what Medicare will cover. Worth looking into before you assume anything.
Then there's Part D for prescriptions. You're basically comparing two formularies side by side and trying to figure out which one pays for what. Add Medigap or Medicare Advantage on top of that? Now you're tracking networks, prior authorizations, whether you're covered if you travel, and what your actual out-of-pocket maximum ends up being. It's a lot. Gaps usually show up right here in the coordination piece.
Learn more about your retirement benefits at our No-Cost webinars, featuring Ed Zurndorfer -
Alternative Coverage Paths to Explore
Even though Open Season has passed, it's worth knowing what options exist if your current plan isn't working for you. Plans differ on pharmacy policies, how easy it is to see a therapist, and what their exceptions process looks like. Keep that in mind for next November and December.
Sometimes insurance just won't go far enough. Cash-pay packages exist. Centers of excellence exist. If you're going that route, get everything in writing — itemized costs, payment terms, the whole thing. Don't agree to something based on a verbal estimate.
Patient-assistance programs can help with medication costs. So can manufacturer programs and nonprofit grants. They're out there if you're willing to hunt for them.
When You Get Denied
A denial isn't necessarily final. Plans have appeals processes, and you should absolutely use them. Get your doctor to write a letter of medical necessity. Include clinical documentation. Ask for a peer-to-peer review if they offer it.
Find out about exceptions. Some plans will make exceptions for people already in treatment. Ask about transitional fills if you're on medication and worried about running out while the appeal drags on.
Save everything. Every email, every phone call summary, every piece of paper. Appeals live or die on documentation and whether you met the deadlines. Don't give them a procedural reason to say no.
Budgeting and Logistics
Build yourself a real budget with actual line items. Consultations, procedures, medications, travel if you need it, hotels, and post-op care. All of it. Then verify whether your plan's out-of-network caps apply, and if those pre-service estimates they give you are binding or just guesses.
Authorization delays happen. Appeals take time. That creates weird gaps where you thought you'd be paying in March, but you're actually paying in June. Beef up your emergency fund a little to handle that kind of timing mismatch.
Take Control Of What You Can
Coverage changes every year. That's just reality. But you can still plan. Check what your 2026 plan covers, know what to look for during the next Open Season, sort out Medicare if that applies to you, and understand how appeals work before you're stuck needing one.
Need help figuring out your next steps? The team at Serving Those Who Serve is available at [email protected].
The information has been obtained from sources considered reliable but we do not guarantee that the foregoing material is accurate or complete. Any opinions are those of Serving Those Who Serve writers and not necessarily those of RJFS or Raymond James. Any information is not a complete summary or statement of all available data necessary for making an investment decision and does not constitute a recommendation. Investing involves risk and you may incur a profit or loss regardless of strategy suggested. Every investor’s situation is unique and you should consider your investment goals, risk tolerance, and time horizon before making any investment or financial decision. Prior to making an investment decision, please consult with your financial advisor about your individual situation. While we are familiar with the tax provisions of the issues presented herein, as Financial Advisors of RJFS, we are not qualified to render advice on tax or legal matters. You should discuss tax or legal matters with the appropriate professional. **
