A slow start: Use of preventive services among seniors following the Affordable Care Act's enhancement of Medicare benefits in the U.S.

•We studied early effects of Medicare coverage enhancements introduced in 2011.•Use of preventive care was examined (2008-2010 vs. 2012) in four groups of seniors.•The groups differed based on the “total health insurance” of group members.•Annual use was unchanged, even among seniors holding only traditional Medicare.•Other barriers besides cost-sharing need to be addressed for reforms to succeed.

ObjectiveBeginning January 1st, 2011 in the United States the Affordable Care Act enhanced Medicare coverage for preventive services by eliminating patient cost-sharing under Part B and by introducing an “Annual Wellness Visit,” also free-of-charge. We evaluated the early effects of these reforms on utilization of preventive services.MethodWe analyzed nationally representative data on 15,044 Medicare seniors from the 2008-2010, and 2012 Medical Expenditure Panel Survey, and examined self-reported cholesterol test, blood pressure check, flu vaccination, endoscopy, fecal occult blood test, prostate specific antigen test, breast examination, and mammography.ResultsEnhanced Medicare benefits had no effects on preventive service utilization among Medicare seniors in 2012, including those with traditional Medicare and no other supplemental insurance, who stood to benefit the most from Part B enhancements.ConclusionThe muted overall response can be partly attributed to the fact that most seniors already held insurance that fully covered preventive services. While insurance enhancements can sometimes raise utilization, in the case of preventive services there are other fundamental barriers that require attention. Educating and incentivizing physicians about the need to refer/recommend screenings, and enhancing knowledge among seniors about the importance of preventive care are two steps that would likely go a long way towards increasing utilization.