Ten-Year Cost Projections for Medicare Beneficiaries 65 Years or Older With HIV.

Importance: As the population of older people with HIV (PWH) in the US is growing, costs to Medicare are expected to rise substantially. Objectives: To project the number of Medicare beneficiaries aged 65 years or older receiving care for HIV in the US from 2026 to 2035 and the budget impact on Medicare. Design, Setting, and Participants: This economic evaluation used the Cardiovascular, HIV, Aging, Hearing Loss, Mental Health, and Dementia (CHARMED) simulation model to project the number of Medicare beneficiaries aged 65 years or older receiving care for HIV and associated costs from 2026 to 2035. The model was populated with age- and sex-stratified clinical data and costs derived from 2023 traditional Medicare claims and accounted for enrollment in Medicare Advantage, as well as health care inflation. Data analysis was conducted from September 2023 to May 2026. Main Outcomes and Measures: Number of Medicare beneficiaries aged 65 years or older receiving care for HIV and undiscounted costs to Medicare from 2026 to 2035. 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. Conclusions and Relevance: In this economic evaluation using microsimulation modeling, the number of Medicare beneficiaries aged 65 years or older receiving care for HIV was projected to increase substantially over the next decade, resulting in $187.2 billion in 10-year cumulative costs to Medicare. Reducing ART costs by 60% could lead to 38% lower overall Medicare spending for older Medicare beneficiaries with HIV.