Medicare and Medicaid HIV spending continues to rise: 11 things to know

The Kaiser Family Foundation has released two fact sheets outlining the role of Medicare and Medicaid for people with HIV, including spending.

Here are 11 things to know about Medicare and Medicaid spending on HIV, as stated in the fact sheets.

1. Medicare spending on HIV totaled $10 billion in fiscal year 2016, representing 51 percent of federal spending on HIV care. However, it represented only 2 percent of total Medicare spending.

2. HIV spending under Medicare has increased over time, as the number of beneficiaries has grown and with the addition of the Part D prescription drug benefit. 

3. Due to Part D, Medicare spending on HIV became the single largest source of federal financing for HIV care in FY 2006, surpassing federal Medicaid spending on the disease for the first time, according to the fact sheets. This was partly due to the shifting of drug costs from Medicaid to Medicare for those who were beneficiaries of both Medicare and Medicaid.

4. Average Medicare per capita spending for HIV-positive beneficiaries was $45,489 in FY 2014. More than half of this total ($26,761, or 59 percent) was Part D drug spending.

5. In contrast, average spending for Medicare beneficiaries overall in FY 2014 was $11,651, of which $1,821 (16 percent) was Part D drug spending.

6. Average annual Medicare spending in FY 2014 was substantially higher for HIV positive beneficiaries who were low-income subsidy recipients compared with HIV positive non-low-income subsidy recipients ($50,262 compared to $34,555).

7. Federal Medicaid spending on HIV is estimated to total $5.9 billion in FY 2016, accounting for 30 percent of all federal spending on HIV care.

8. Combined with the states' share of Medicaid spending (an estimated $3.5 billion in FY 2016), Medicaid is the second largest source of public financing for HIV care in the U.S, after Medicare.

9. Like Medicare spending on HIV, Medicaid spending on the virus has increased over time, reflecting growing numbers of beneficiaries with HIV and the rising cost of care. 

10. Still, in FY 2016 spending on HIV represented less than 2 percent of total Medicaid spending.

11. Annual per capita spending on HIV positive Medicaid beneficiaries was $26,807 in FY 2011, almost five times that of Medicaid beneficiaries overall ($5,790).


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