title: Medicare annual preventive care visits: use increased among fee-for-service patients, but many do not participate.
abstract: Under the Affordable Care Act (ACA), Medicare coverage expanded in 2011 to fully cover annual preventive care visits. We assessed the impact of coverage expansion, using 2007-13 data from primary care patients of Medicare-eligible age at the Palo Alto Medical Foundation (204,388 patient-years), which serves people in four counties near San Francisco, California. We compared trends in preventive visits and recommended preventive services among Medicare fee-for-service and Medicare health maintenance organization (HMO) patients as well as non-Medicare patients ages 65-75 who were covered by private fee-for-service and private HMO plans. Among Medicare fee-for-service patients, the annual use of preventive visits rose from 1.4 percent before the implementation of the ACA to 27.5 percent afterward. This increase was significantly larger than was seen for patients in the other insurance groups. Nevertheless, rates of annual preventive care visit use among Medicare fee-for-service patients remained 10-20 percentage points lower than was the case for people with private coverage (43-44 percent) or those in a Medicare HMO (53 percent). ACA policy changes led to increased preventive service use by Medicare fee-for-service beneficiaries, which suggests that Medicare coverage expansion is an effective way to increase seniors' use of preventive services.
authors.affiliation: Sukyung Chung (chungs@pamfri.org) is an assistant scientist at the Palo Alto Medical Foundation Research Institute (PAMFRI), in California.
authors.forename: Sukyung
authors.initials: S
authors.lastname: Chung
authors.affiliation: Lenard I. Lesser is an assistant research physician at PAMFRI.
authors.forename: Lenard I
authors.initials: LI
authors.lastname: Lesser
authors.affiliation: Diane S. Lauderdale is department chair and a professor of epidemiology at the University of Chicago, in Illinois.
authors.forename: Diane S
authors.initials: DS
authors.lastname: Lauderdale
authors.affiliation: Nicole E. Johns is a research associate at PAMFRI.
authors.forename: Nicole E
authors.initials: NE
authors.lastname: Johns
authors.affiliation: Latha P. Palaniappan is a clinical professor at Stanford University, in Palo Alto, California.
authors.forename: Latha P
authors.initials: LP
authors.lastname: Palaniappan
authors.affiliation: Harold S. Luft is senior investigator at and director of PAMFRI.
authors.forename: Harold S
authors.initials: HS
authors.lastname: Luft
mesh_terms: D000368:Aged; D002140:California; D018588:Fee-for-Service Plans / Q000706:statistics & numerical data*; D005260:Female; D018166:Health Care Reform / Q000706:statistics & numerical data; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D058991:Patient Protection and Affordable Care Act / Q000706:statistics & numerical data*; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D014481:United States; D014600:Utilization Review / Q000706:statistics & numerical data
keywords: Access To Care; Elderly; Health Reform; Medicare