On August 1st, an important provision of the Affordable Care Act kicks in that many women will welcome with open arms, or, uh, legs — something the government is calling Affordable Access to Preventative Care, but that you can think of as No Copay Day, the magical day when you no longer have to pay for birth control or breast exams or a number of other ladyparts-related health care. This means that in a matter of hours, your privates may be about to get much less expensive (and with the money you save, you may be able to buy yourself an entirely new vagina, an investment vagina. A pair of vacation breasts on a lake in the northwoods, like you've always wanted but thought you could never afford.) So how will No Copay Day affect you? And how do you know if you're eligible?


First, the good news: thanks to the Affordable Care Act, seven categories of medical services American women once had to pay for will no longer require a copay — that means that your insurance policy will cover the entire cost of the services. And some of the things that women in the past may have foregone — domestic violence counseling and cervical cancer screening, for example — will be covered in an effort to remove financial barriers between women and they care they may need (and remind women that President Obama wants to personally be their best friend). In addition to some cervical cancer and domestic violence services, starting August 1st, new insurance plans are required to cover the cost of birth control (including condoms and tube-tying), breastfeeding supplies, enhanced STI screening, gestational diabetes screening, and, just for good measure, an annual well woman doctor visit, just to make sure everything's humming along under the hood.

But before you get too excited, hold your fancy dancing horses, Ann Romney. As with everything, there are caveats — on August 1st, you can't just pirouette impishly into your nearest medical provider's office, hop into the stirrups, brandish your vagina, and demand some free diagnostic cervical scraping. And you can't just grab handfuls of Yaz from giant Trick Or Treat bowls in your nearest pharmacy. To avoid committing an embarrassing medical faux pas, here's the red tape.


The not-so-good news: if you're not already covered by insurance — either through your employer, your spouse's employer, your parent's employer, or your academic institution — you won't suddenly have coverage on Wednesday. The copay free preventative care requirements only apply to plans — both new and/or re-enrolled — that begin on or after August 1st of this year. And if your insurance plan is through a religious institution, the rule may not apply to you for another year, if at all. Further, uninsured ladies who aren't on Medicaid will have to wait until 2014, when the Affordable Care Act requires everyone to either have insurance or pay a penalty, to access the same services at no up-front cost.

So, how do you know when you start not having to pay for certain cervices? And how do you get those "free" services?

The first thing you need to determine is when your plan year starts, as this piece of the Affordable Care Act only applies to new insurance policies that begin on or after August 1st. Luckily, August 1st is when a lot of school and university health care plan years begin, so, by design, many college women insured through their alma maters or employees of those institutions should be set (unless that organization is a religious institution, but more on that later). According to the advocacy organization the National Council of Jewish Women, while there's no hard and fast standard for when most plan years start, many employer plan years start on January 1st. You can determine when your plan year starts by combing through the stock photo-packed glossy brochures that your insurance company IRL spams your mailbox with, or you can do the easier thing and bother your company's HR rep until they tell you what's going on. You can also call your insurance company to get more information.

But wait! There's more fine print. Certain plans that have been "grandfathered in" won't need to adjust to the new ACA requirements. The NCJW explains,

Grandfathered plans are those which existed prior to March 23, 2010 and have not substantially changed their benefits or cost sharing requirements; they are exempt from some of the law's consumer protections and benefits, including coverage of these new preventive services. However, per a broad survey of large employers conducted by Hewitt Associates, by 2014, most grandfathered plans will be considered "new" under the ACA.


Additionally, as we've written about fairly extensively, some religious-run organizations like colleges and hospitals haven't taken too kindly to the idea that women who work, enroll in school, or are married to people who work there will have access to copay-free whore pills and have fought the provision tooth and nail. As a result, the Obama administration has compromised, giving them an extra year to comply with the requirements of the Ladyparts Maintenance Package, and has offered them a way to pass the entire cost of women's health services onto the insurance company, but they're still filing lawsuits left and right. If you have questions about your coverage, it's best to mosey over to the scented lotion cloud that surrounds where the HR people sit and ask, or talk to your insurance company.


Once you've determined that your insurance plan does indeed begin on or after August 1st of this year, and that the employer or institution providing that insurance isn't somehow exempt from having to cover preventative health care with no copay, you can schedule appointments with providers as necessary. But I'd make sure to specify that I was seeing the doctor for services that are supposed to be covered by the ACA with no copay; in my experience, sometimes doctor's offices notice you have good insurance and try to sneak some expensive tests in to pad the bottom line like how kids grocery shopping with their babysitter will throw brand name cereal in the cart when the stuff that comes in a bag is, like, half as expensive (anecdata: as a kid, we had Wisconsin teachers' union insurance, which was excellent, but never have I ever been poked and prodded and tested and scraped so much in my life. I wasn't sickly!)

And another sort of bummer: there's this fine print from the Department of Health and Human Services,

...the rules governing coverage of preventive services which allow plans to use reasonable medical management to help define the nature of the covered service apply to women's preventive services. Plans will retain the flexibility to control costs and promote efficient delivery of care by, for example, continuing to charge cost sharing for branded drugs if a generic version is available and just as effective and safe.


In other words, even if your body can't stand the generic equivalent of the pill you're used to taking, your insurance company can still insist that you're just being a big whiner and should suck it up or pay up.

Ugh, having a vagina is so complicated and fraught. It's like living with a nervous beagle in a studio apartment.


Despite its flaws, red tape, and extensive caveats, entirely covering preventative women's health services is a good move for public health and should be a good move for women's sanity. But just how effective — and helpful — it actually is remains to be seen. We also should be wary of people who opt to abuse the system — after all, now that getting lactation counseling is free for mothers who want it, who's to say that women won't just schedule hundreds of lactation counseling appointments for themselves? And what of all the recreational gestational diabetes screenings that are about to occur?

[HHS]