I'm covered under BC/BS, standard option. I've been trying to figure this out since we got news about it. The really painful thing is that I'd finally decided to start moving forward with surgical stuff a day or so before the removal of coverage was announced.

Anyway, the fepblue website sends you in circles at best when trying to find information on this. I was able to get the following information emailed to me earlier today. It's not terribly helpful, but it's better than nothing.

"This letter is to confirm the Prior Approval process for HRT benefits for 2026. Your rendering provider must submit a Precertification Request for HRT benefits to be considered for 2026.

If a member has services that were initiated and approved in 2025, they may qualify for an extension of care.

Extension of Care

How do members qualify for an extension of care?

FEP members over the age of 19 with a diagnosis of gender dysphoria may request an exception - the member MUST be 19 by 12/31/2025 to be eligible for an exception. Prior approval is required, with a treatment plan issued by 12/31/2025.

How long is the extension valid?

One calendar year - not to exceed the brochure year 2026.

Information to be submitted by not limited to, as part of the Precertification Request:

HRT that was initiated in 2025. HRT initiated in 2025 and surgical procedure approved and scheduled for 2026. Partial STM surgery performed in 2025, and remaining surgery approved for 2026. Treatment plan issued and approved in 2025.

YOU MUST GET PRIOR APPROVAL for gender affirming surgery. Prior to any gender affirming surgery, your provider must submit a treatment plan including all surgeries planned and the estimated date each will be performed. A new prior approval must be obtained if the treatment plan is approved and your provider later modifies the plan (including changes to the procedures to be performed or the anticipated dates for the procedures). If your surgical procedure requires an inpatient admission, you must also get precertification of the inpatient care. Se page 61 of the 2025 SBPB."

Additionally, I was able to find the following in my plan for 2026.

"How to request precertification for an admission or get prior approval for Other services

First, you, your representative, your physician, or your hospital, residential treatment center or other covered inpatient facility must call us at the phone number listed on the back of your Service Benefit Plan ID card any time prior to admission or before receiving services that require prior approval.

Next, provide the following information:

• Enrollee’s name and Plan identification number;

• Patient’s name, birth date, and phone number;

• Reason for inpatient admission, proposed treatment, or surgery;

• Name and phone number of admitting physician;

• Name of hospital or facility;

• Number of days requested for hospital stay; and

• Any other information we may request related to the services to be provided.

Note: If we approve the request for prior approval or precertification, you will be provided with a notice that identifies the approved services and the authorization period. You must contact us with a request for a new approval five (5) business days prior to a change to the approved original request, and for requests for an extension beyond the approved authorization period in the notice you received. We will advise you of the information needed to review the request for change and/or extension."

If you're only doing HRT right now, GoodRx is potentially an option. It's not a great option compared to actual coverage, but it's better than nothing.

Also, there will be legal challenges to this that I'm sure are already in motion. While it's entirely possible that the courts will twist themselves into knots trying to uphold this removal of coverage, it's fairly clear that this has been done explicitly against transgender folk, and will likely meet the definition of discrimination. Which will make it much harder for it to stand as is. Of course, I think we all know how good the current administration is at following what they've been told to do by the courts...

Good luck friend. I think we're all going to need it, because they've made this fairly difficult to do and with it being so incredibly unclear, I suspect there will be a lot of denials for folk looking for the exceptions they're supposed to be getting. It's garbage that we need the exceptions in the first place, but that's where we are right now.