OBJECTIVES: The Affordable Care Act may produce significant changes in preventive and recommended care by improving access and eliminating cost barriers. The aim of this study was to (1) estimate realized access to recommended tests among adult diabetes populations and (2) examine the equity of access to the recommended care.   METHODS: Data from the Medical Expenditure Panel Survey from years 2012 and 2014 was used to determine annual realized access to recommended care among people with diabetes. Recommended care was defined per recommendations of American Diabetes Association and included— bi-annual HbA1c testing and annual foot, eye, cholesterol test and flu vaccination (5 recommended tests/services). Population characteristics of diabetes populations during years 2012 and 2014 were compared using descriptive statistics. Hierarchical logistic regression was used to determine the equity of access. The outcome variable was defined as receipt of four or five of the preventive tests/services. The predictors were categorized into three broad categories including Predisposing, Enabling and Need. Access to care was considered equitable when need factors were the main determinants of healthcare use. RESULTS:  In 2014, realized access was highest (86% [CI 84.07%-87.94%]) to annual cholesterol test followed by the foot exam (70.5% [68.22-72.87]). Similar trends were observed in 2012. Access to the bi-annual A1c test was lowest compared to all other measures in 2014 (58.1% [55.28% - 60.89%]) as well as 2012 (55.8% [52.94-58.74]). Realized access to four out of five tests/services in 2014 remained very low as well (23.3% [20.87-25.69%]). Results obtained from hierarchical logistic models for both the years, 2014 as well as 2012, confirmed that access was driven still by predisposing and enabling factors rather than need. CONCLUSIONS: Despite policy changes that supported increased potential access, realized access to recommended care among adult diabetes populations remained low.