Open season starts Monday, Nov. 9. Under current Office of Personnel Management policy, federal employee health plans will exclude gender-affirming hormones and surgery in 2027, including for patients already in treatment. “Beginning in the 2027 Plan Year, Carriers must remove any exceptions process,” the Office of Personnel Management told insurers in a March 31 call letter.
The letter puts that rule under the heading “Sex Rejection Treatments.” Plans must continue covering counseling. “Counseling services for possible or diagnosed gender dysphoria must still be covered,” it says.
“The Federal Benefits Open Season for the 2027 Plan Year will be held from November 9 through December 14, 2026,” according to OPM’s open season highlights.
The rules apply to both the Federal Employees Health Benefits (FEHB) and Postal Service Health Benefits (PSHB) programs. They cover employees, retirees and eligible family members. OPM’s hormone exclusion concerns transition-related treatment, not every use of the same medications.
How FEHB Gender-Affirming Care Coverage Shrank From 2026 to 2027
Seven months after President Donald Trump signed Executive Order 14168, OPM’s Aug. 15, 2025, letter dropped coverage of “chemical and surgical modification of an individual’s sex traits through medical interventions” for 2026. The exclusion “applies regardless of age,” OPM wrote.
For 2026 only, “Carriers must establish an exceptions process” for people already mid-treatment, the letter said, “applied on a case-by-case basis.”
Riley Roe, a nonbinary State Department employee in the lawsuit, never qualified. Roe “has not yet commenced any course of gender-affirming care,” the workers’ lawsuit says.
“As a result, many transgender individuals enrolled in FEHB no longer have access to insurance coverage for gender-affirming care,” Jody L. Herman and Elana Redfield of the Williams Institute at UCLA School of Law wrote in a July report. They estimate that “at least 39,400 transgender individuals are covered by FEHB,” a count that includes employees, retirees and family members on their plans. (HHS separately narrowed Section 504 disability protection for gender dysphoria on Oct. 30.)
Doe v. Kupor Lawsuit Adds a Sixth Federal Worker
“This categorical denial of treatment for those who require continuing gender-affirming care is akin to denying continuing insulin treatment for someone with diabetes,” five federal workers said in the complaint they filed against OPM Director Scott Kupor on Aug. 3. They’re suing in federal court in Washington under Title VII of the Civil Rights Act, which bars sex discrimination at work.
A transgender woman using the pseudonym Vanessa Voe joined them Nov. 2 in an amended complaint. She took a civilian Defense Department job in August, and if she pays for her hormone therapy herself, the filing says, “she will have to ration it, taking less than the prescribed dosage.”
“Our message to the Trump administration is simple: We’ll see you in court,” Kelley Robinson, president of the Human Rights Campaign Foundation, said when HRC announced the suit. “This odious policy is the latest example of the Trump administration’s obsession with targeting transgender people,” she said.
Charlotte Coe, another State Department employee in the suit, has complications from a 2025 operation. The corrective surgery her doctor recommended is “considered gender-affirming care so it will not be covered by her FEHB insurance in Plan Year 2027,” the amended complaint says. “Federal employees have been through the wringer with the Trump administration,” said Cathy Harris, a former Merit Systems Protection Board member and one of the workers’ lawyers, in the same announcement.
OPM didn’t respond to Government Executive’s request for comment on the suit, and U.S. District Judge Amit Mehta, who now has the case, hasn’t ruled on whether it can go forward as a class action. “A Federal Judge will decide whether the matter can proceed on a class basis, and who will be covered by it,” HRC tells federal workers on its case page.
Premiums Rise 10.9% as Democrats Take Both Chambers
Enrollees’ share of Federal Employees Health Benefits premiums will rise 10.9% on average in 2027, OPM says. Individual increases vary by plan and enrollment type. “A 10.9 percent increase in health insurance premiums makes the proposed pay freeze even more unacceptable,” Doreen Greenwald, national president of the National Treasury Employees Union, said in a Sept. 30 statement.
The Associated Press has called both the House and the Senate for Democrats after Tuesday’s midterms, Spectrum News reported. (Gayety’s LGBTQ+ election results track the individual races.)
In March, Rep. Emily Randall, D-Wash., and 43 other Democrats wrote to Kupor: “Gender affirming care is evidence-based and recognized as medically necessary by every major U.S. medical association.” They said OPM rolled out the ban without enough transparency for workers choosing 2026 plans. “This is unfair and unacceptable,” they wrote.
Open season closes Dec. 14, 2026. The new Congress takes office Jan. 3, 2027, but the election does not itself change OPM’s coverage policy.
