• Nam Hyo Kim, Marwa Rawy, and Kevin Look.
• University of Wisconsin-Madison, School of Pharmacy, 777 Highland Avenue, Madison, WI 53705, United States of America. Electronic address: namhyo.kim@wisc.edu.
• Prev Med. 2022 Jan 1; 154: 106901.

AbstractThe Health Insurance Marketplace has offered access to private health insurance coverage for over 10 million Americans, including previously uninsured women. Per Affordable Care Act requirements, Marketplace plans must cover preventive services without patient cost-sharing in the same way as in employer-sponsored insurance (ESI). However, no study has evaluated whether the utilization of preventive services is similar between Marketplace enrollees and ESI enrollees. Using the Medical Expenditure Panel Survey data for 2014-2016, we identified working-age women with Marketplace plans (n = 792, N = 2,567,292) and ESI (n = 13,100, N = 52,557,779). We compared the two groups' receipt rates of five evidence-based preventive services: blood pressure screening, influenza vaccine, Pap test, mammogram, and colorectal cancer screening. Unadjusted results showed marketplace enrolled women had significantly lower odds of influenza vaccination, Pap test, and mammogram. However, after controlling for other factors, Marketplace insurance was not associated with lower receipt rates of preventive services, except for influenza vaccination (Adjusted OR = 0.64; 95% CI = 0.50-0.82). Regardless of an individual's private insurance type, higher educational attainment and having a usual source of medical care showed the strongest association with the receipt of all investigated preventive services. With the increased role of the Marketplace as a safety net in the COVID-19 pandemic, more research and outreach efforts should be made to facilitate access to preventive services for its enrollees.Copyright © 2021 Elsevier Inc. All rights reserved.

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