OBJECTIVES: High quality diabetes-related care is associated with fewer complications and better health outcomes.  Based on cross-sectional studies, uninsured people are less likely to have high quality diabetes care, but longitudinal studies might better assess insurance effects.  We assessed association between insurance and quality of diabetes care using a difference-in-differences design. METHODS: A sample was drawn from Medical Expenditure Panel Survey (MEPS) 2007 to 2013 data based on inclusion criteria of having diabetes and completing the MEPS Diabetes Care Survey during both years while in a MEPS two-year panel.  Individuals with any missing insurance data were excluded.  Individuals continuously uninsured during year-one but who gained insurance coverage during year-two were the insured group.  Individuals uninsured for both years constituted an uninsured comparison group.  Six diabetes care quality indicators (DCQI), ≥ 2 HbA1C tests per year, annual dilated eye examinations, annual foot examinations, annual influenza vaccine, annual cholesterol tests, and annual blood pressure tests were examined.  Multivariate linear regression models assessed difference-in-differences effects of gaining insurance coverage on receipt of each DCQI, adjusting for age, gender, race, marital status, education, income, and health status. RESULTS: A sample of 548 individuals met selection criteria.  Mean (±Std. Dev.) age was 50.7 ± 10.2 years.  The sample was 55.8% females and predominately white (70.6%).  Overall, the prevalence of meeting each DCQI ranged from 40.7% (influenza vaccine) to 87.5% (blood pressure tests).  Among insured individuals, there was an upward trend in prevalence of meeting each DCQI, though not statistically significant for HbA1C (p=0.086), eye exams (p=0.227), influenza vaccine (p=0.449), or blood pressure tests (p=0.345).  The insured group had significantly more positive change in prevalence of foot examinations, mean (±Std. Error) 20.3 ± 8.6% (p=0.018) and cholesterol tests 18.4 ± 7.2% (p=0.011) than the uninsured group. CONCLUSIONS: Gaining insurance coverage was associated with better diabetes care quality.