I think a few of the ladies here had great insurance coverage. I'll let them chime in on their experience.
Under Minnesota Law, it is illegal for an insurance company to discriminate by refusing coverage for gender-affirming care, including surgery. They might not cover services out of network or out of state, but it might be worthwhile to investigate. Even if the monthly premiums are pretty high, it could be worth it to adjust your budget to afford that insurance.
Medicare does cover surgery with the letters of recommendation that most surgeons require. With Medicare's deductible, co-pays, co-insurance, and other not-covered costs, I can't afford to have them pay for an x-ray, let alone major surgery. I took out a personal loan from my bank (USAA) to pay for my facial surgery. $11,000 total and I am still paying on that.
I am hopeful that Harris will get elected and change the VA's policy of discrimination against transgender veterans. It is a shame that the Department of Veterans Affairs appears to be the only U.S. government agency that does this.