Preventive Services Among Medicare Beneficiaries With Supplemental Coverage Versus HMO Enrollees, Medicaid Recipients, and Elders With No Additional Coverage

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Abstract
Studies conducted when Medicare began to cover preventive services, found that beneficiaries with supplemental insurance were much more likely to have such services than those without additional coverage. To examine preventive services among Medicare beneficiaries with supplemental insurance, Medicaid, health maintenance organization (HMO) enrollees, and those without additional insurance. Analysis of the 1996 Medical Expenditure Panel Survey, a nationally representative multistage survey. 2,251 persons aged 65 and older with Medicare coverage. Self-reported preventive services, specifically, blood pressure measurement, cholesterol testing, influenza vaccination, mammography, Papanicolau (Pap) testing, and breast and prostate examinations. Multivariate modeling was used to adjust for age, education, race/ethnicity, and functional status. Elders without additional coverage were approximately 10% points less likely to have influenza vaccination, cholesterol testing, mammography, or Pap smears than those with supplemental coverage (P <0.05). Multivariate adjustment attenuated some of these differences with age and education being the most important predictors of having preventive services. HMO enrollees were more likely to have mammograms than those with supplemental coverage (P <0.05). Several years after Medicare extended coverage to include preventive services, differences in utilization of such services among elders with and without supplemental insurance have narrowed substantially.