There's some back and forth, but a lot of ACA ("Obamacare") policies do cover trans care now. I signed up for one in CT with Blue Cross that does explicitly cover trans care up to and including surgery, at least if there's an appropriate diagnosis on file and all the hoops have been handled. (I was able to find this out before I signed up, too; the exclusions and everything were available online.) As I understand it, it *is* possible to opt for the ACA even when one's employer offers coverage; at least, I did that, as well. My policy is $700/month for two people, which isn't bad, and it's also not the cheapest they offered.