When Shane Stinson came out as a transgender man in 2013, he thought the hard part was over.

After he was accidentally outed, Stinson said, he found those around him were welcoming and open. He decided to go through with his transition, but did not know what steps to take or how to talk to his doctor. Like many people in the transgender community, Stinson turned to online forums and friends for information.

Through those conversations, Stinson said, he was told his transition could be a financial burden and he got a job to save up money for lab testing and testosterone. The 2015 U.S. Transgender Survey, conducted by the National Center for Transgender Equality, showed that 25 percent of respondents experience insurance problems related to being transgender, such as being denied coverage for gender transition.

Stinson later joined his parents� health insurance plan, which gave him the coverage he needed to start his transition. As a University of Missouri employee on MU�s health insurance plan, he now pays $15 to $20 monthly for testosterone, needles and syringes and takes .625 mililiters of testosterone once every two weeks.

A new Affordable Care Act mandate is expanding coverage for transgender individuals. It requires any organization receiving funding from the Department of Health and Human Services to cover gender dysphoria � the medical term for identifying with a gender other than birth gender � in its health plan, said Margrace Buckler, the city�s human resources director.

The city council will vote on the city�s health plan with UnitedHealthcare for 2017, which includes gender dysphoria, during its Monday meeting. The Columbia/Boone County Department of Public Health and Human Services received $452,000 from the Missouri Department of Health and Senior Services through a contract with the federal department, said city/county health department spokesman Eric Stann.

The city's employee and dependent health insurance premiums will increase 13.8 percent in 2017, Buckler said. However, the increase is not tied to the gender dysphoria coverage, she said�� the city could not calculate any expected cost from the coverage because it has not been part of city heath plans.

Because the county also receives money from the department, its new health plan through Anthem Blue Cross Blue Shield also will include gender dysphoria, said Angela Wehmeyer, the county�s wellness and benefits coordinator.

Ben Cornelius, spokesman for Boone Hospital Center, said BJC HealthCare provides benefits for gender dysphoria psychotherapy and hormone replacement therapy. The University of Missouri System covers gender dysphoria under its employee health plan, said UM spokesman John Fougere.

The mandate protects individuals from being denied health care or coverage based on their sex or gender identity, according to the Department of Health and Human Services website. The mandate also says individuals cannot be limited or denied sex-specific health care, such as a transgender man who wishes to receive mammograms or pap smears.

The city�s health plan would cover psychotherapy, hormone replacement therapy, laboratory testing, puberty suppressing medication and surgeries.

Surgeries come with documentation requirements. Those requirements are common but could limit a person�s ability to receive surgeries, Stinson said.

Amanda Swenson, assistant clinical professor in the MU Department of Family and Community Medicine, said Columbia is fortunate to have accessible primary care for transgender individuals, with doctors who are aware of transgender issues. Surgeries often are not available here, she said, and her patients travel to Arizona, Colorado, the Pacific Northwest, San Francisco and Seattle for genital surgeries. She also has had patients who traveled to Thailand for genital surgeries because the travel and surgery costs have been less expensive there than in the United States.