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Ten-Year Cost Projections for Medicare B
eneficiaries 65 Years or Older With HIV
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July 7, 2026
Download the PDF here
Download the PDF here
Results The simulated cohort was informed by 111 600 PWH enrolled in Medicare at the start of 2026 (mean [SD] age, 70.9 [5.0] years; 77% male). The analysis found that 121 890 PWH would be enrolled in Medicare and in care by the end of 2026, including 60 390 PWH aged 65 to 69 years, 36 340 aged 70 to 74 years, 17 200 aged 75 to 79 years, and 7970 aged 80 years or older. By the end of 2035, this number would increase to 193 560, with increases in each age category (65-69 years: 70 490; 70-74 years: 62 820; 75-79 years: 38 290; 80 years and older: 21 960).
Annual costs to Medicare for PWH aged 65 years or older and receiving care for HIV would increase from $10.9 billion by the end of 2026 to $27.3 billion by the end of 2035. Cumulative costs over 10 years were projected to be $187.2 billion, with 63% of cumulative costs due to antiretroviral therapy (ART).
If ART costs are reduced by 60%, Medicare would save $70.3 billion over the next decade; projected savings due to the Inflation Reduction Act and generic ART would be $19.4 billion, accounting for the timing of onset and estimated reductions. Based on uncertainties in the number of Medicare beneficiaries and costs of care, sensitivity analyses found that cumulative costs would range from $103.3 billion to $267.5 billion over the next decade.
Clinicians must better understand the care needs of people aging with HIV given the increased risk of comorbidities and benefits of considering multimorbidity and polypharmacy.47-49 Health care systems will need to offer comprehensive, person-centered care to address the rising burden of comorbidities and health care use.48-50
Current estimates suggest that 340B revenue from ART cost reductions may decrease by 45% to 50% through reduced reimbursement due to the IRA55; similar reductions would likely occur with a switch to generic ART. Although there is mixed evidence on the impact of the 340B program in increasing care access,59-63ART cost reductions would lead to substantially lower reimbursement, which could necessitate alternative funding, such as increased federal grants, to ensure that PWH continue to receive the care they need.56
Conclusions
In this economic evaluation using microsimulation modeling, we projected that the number of Medicare beneficiaries aged 65 years or older receiving care for HIV in the US could increase 1.6-fold over the next decade. Medicare could insure nearly 200 000 older individuals by 2035, resulting in $187.2 billion in cumulative costs to Medicare over the decade. Reductions in ART costs, based on recent legislation and near-term generic availability, have the potential to lead to substantial decreases in Medicare spending for older beneficiaries with HIV.
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