Do all three ACA marketplace insurers in North Dakota cover gender-affirming care?

All three insurers offering individual Affordable Care Act plans in North Dakota in 2026 provide coverage for at least some gender-affirming care.

Blue Cross Blue Shield of North Dakota’s marketplace policy covers gender-affirmation services and requires precertification for surgery.

Sanford Health Plan covers medically necessary treatment for gender dysphoria,
including surgical and nonsurgical services, though some procedures are excluded and prior authorization is required. 

Medica also has coverage criteria for gender-affirming procedures and says hormone treatment does not require prior authorization. Coverage can vary by specific plan. 

North Dakota does not mandate insurance coverage of gender-affirming care. State law also generally prohibits gender-transition procedures or medications for minors, subject to statutory exceptions.

The issue drew renewed attention after a federal court on Aug. 14 struck down a rule that would have prevented certain gender-affirming procedures from qualifying as essential health benefits under the ACA.