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Article Title

Increasing Preventive Care With Expanded Medicare Coverage Under the Affordable Care Act

Publication Date

4-30-2015

Keywords

preventive visit, Medicare coverage

Abstract

Background/Aims: Under the Patient Protection and Affordable Care Act (ACA), Medicare coverage was expanded in 2011 to fully cover comprehensive annual preventive care visits. We assessed the impact of this coverage expansion on the utilization of preventive services.

Methods: We used 2007–2013 electronic health record data from primary care patients of Medicare-eligible age (65–75) at a large multispecialty organization in California (N=204,388 patient-years). Using a difference-in-differences approach, we compared trends in preventive visits and recommended preventive care services across insurance coverage groups (Medicare fee-for-service [FFS] and HMO, private FFS and HMO) pre- and post-ACA. This analytic design allows us to assess the effects of the ACA controlling for contemporaneous changes in practice.

Results: Prior to the ACA, each year 1.4% of Medicare FFS enrollees had a Medicare-covered preventive visit. This rose substantially with coverage expansion to 27.5%. With expanded Medicare coverage, their use of privately covered or self-paid preventive visits decreased by two-thirds, from 16.0% pre-ACA to 5.5% post-ACA, which suggests that Medicare is partially substituting for previously privately covered or self-pay preventive care visits. Even with an overall increase in preventive visit use, rates of preventive visits in 2011–2013 among Medicare FFS beneficiaries were still 10–20% lower than other insurance groups (Medicare HMO: 52.7%, private HMO: 43.5%, private FFS: 42.6%). Frequency of nonpreventive office visits has been decreasing, more rapidly among Medicare FFS enrollees, during the same time period. Completion of many recommended preventive services among Medicare FFS enrollees increased, particularly in those requiring extended physician time.

Discussion: Expanded preventive visit coverage under ACA led to a marked increase in preventive visits among Medicare enrollees. Preventive visits have replaced some routine office visits. The use of preventive visits among Medicare FFS enrollees may continue to increase, as the rate of utilization is still lower than seniors with private coverage only.

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