Costs associated with increasing numbers of Medicare beneficiaries with HIV aged 65 years and older from 2026 to 2035.

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 with HIV aged 65y+ on ART in the US from 2026-2035 and the budget impact on Medicare. Design Setting and Participants: We developed the novel CHARMED simulation model and projected the number of Medicare beneficiaries with HIV aged 65y+ on ART and associated costs from 2026 to 2035; we populated the model with age and sex-stratified clinical data and costs derived from 2023 Traditional Medicare (TM) claims and accounted for enrollment in Medicare Advantage, as well as healthcare inflation. Main Outcomes and Measures: Numbers of Medicare beneficiaries with HIV aged 65y+ on ART and undiscounted costs to Medicare from 2026-2035. Results: We projected that 111,600 PWH would be enrolled in Medicare and in care at the beginning of 2026 (65-69y: 57,370; 70-74y: 32,940; 75-79y: 14,670; 80y+: 6,610). By the end of 2035, this number would nearly double, to 193,560 (65-69y: 70,490; 70-74y: 62,820; 75-79y: 38,290; 80y+: 21,960). Annual costs to Medicare for PWH 65y+ on ART would increase 2.5-fold, from $11.4 billion at the end of 2026 to $28.6 billion at the end of 2035. Cumulative 10-year costs are projected to be $195.6 billion with 66.5% of cumulative costs due to ART. If ART costs are reduced by 60% as per the Inflation Reduction Act or generic ART, Medicare would save $78.0 billion over the next decade. Conclusions and Relevance: The number of Medicare beneficiaries with HIV 65y+ on ART will more than double over the next decade, resulting in $195.6 billion in 10-year total costs to Medicare. Reducing ART costs through the IRA or generic oral ART could lead to 40% lower overall Medicare spending for older Medicare beneficiaries with HIV. KEY POINTS: Question: As the population of people with HIV in the US grows older, what are the expected costs to Medicare and the impact of antiretroviral therapy (ART) costs?Findings: Using microsimulation modeling, we find that the number of Medicare beneficiaries with HIV 65y+ on ART will more than double over the next decade. At current costs of ART and health care-associated inflation, total 10-year costs to Medicare are anticipated to be $196.5 billion; reducing ART costs through the Inflation Reduction Act or generic ART could lower Medicare spending by 40%.Meaning: Efforts to reduce ART costs, while maintaining access to high-quality ART, are critical to reduce total Medicare costs as more people with HIV are anticipated to enroll in Medicare in the next 10 years.