Health insurance

Health insurance often doesn't cover gender-validating surgeries or therapies for transgender people, including nonbinary people who want a physical transition. It can be difficult to find an insurer that does, or to persuade one to do so. This is because insurance companies often think transgender health care is merely cosmetic and optional. They don't understand that, for many transgender people, it is life-saving and not optional. This transgender rights issue needs to be addressed by activism, so that it will someday be standard for insurance to cover transgender health care.

Many insurance plans exclude coverage for "services, drugs, or supplies related to sex transformation". When prescribing HRT, some healthcare providers will get around this exclusion by entering the diagnosis as a hormone imbalance.

Even when gender transition care is covered, it may be covered only for binary trans people. For example, some insurance plans will only cover top surgery if the patient reports their gender identity as male.

USA
Some U.S.A. states have banned insurance companies from excluding transition-related care. Additionally, Medicare covers necessary transition-related care since May 2014 when the exclusion was removed.

Even when transition-related services are meant to be included in insurance coverage, nonbinary individuals can have a harder time than binary trans people getting those services covered. "The 2015 U.S. Transgender Survey found that 31 percent of nonbinary respondents had experienced an issue with their insurance coverage for hormone therapy in the previous year, compared to 24 percent of the general transgender population."

The Affordable Care Act and other USA laws prohibit sex-based discrimination, and in 2012, the Department of Health and Human Services clarified in a letter that this provision also covers "discrimination based on gender identity or failure to conform to stereotypical notions of masculinity or femininity".

Starting January 1, 2019, the Blue Shield of California insurance company allows members to mark their gender identity as female, male, or nonbinary (in addition to marking their sex assigned at birth).

Medicare
In April 2018, new cards were issued to all Medicare beneficiaries, and the new cards no longer have a gender indicator. However, Medicare's internal records will list the gender from beneficiary's Social Security data.

For decades, Medicare did not cover transition surgery due to a policy that categorized such treatment as "experimental." That exclusion was eliminated in 2014, and now Medicare covers certain transition services that are deemed "medically necessary". However, depending on where you live, your Medicare local contractor may have specific guidelines for coverage of transition-related care, and the beneficiary may have to file an appeal for services to be covered.

Tricare
As of June 2020, Tricare (insurance for USA's military service members) "covers hormone therapy and psychological counseling for gender dysphoria", but generally does not cover gender-affirming surgery unless a special waiver is obtained. It is unknown if being nonbinary affects these coverages, as the Tricare website only mentions "born one gender, but feels they are the opposite".