Transgender and gender-expansive adults face many difficult questions as they map out their transition and determine what types of transition-related care to seek, if any. At no time is this more clear than when it comes to medical decisions about physical transition. Once tough decisions have been made, another challenge becomes apparent: paying for the medical services being sought. This session will explore the intricate and evolving landscape of insurance coverage for gender-related medical services. With the Affordable Care Act on the chopping block, growing awareness of the needs of transgender and gender-expansive patients, and multiple treatment options, providers must be knowledgeable about what their clients and patients can expect to encounter as they seek to cover the costs of their transition-related care.