Enrolling people with prediabetes ages 60-64 in a proven weight loss program could save Medicare $7 billion or more.

Rising chronic disease prevalence among Medicare beneficiaries, including new enrollees, is a key driver of health care spending. Randomized trials have shown that lifestyle modification interventions such as those in the National Diabetes Prevention Program clinical trial reduce the incidence of chronic disease and that community-based programs applying the same principles can produce net health care savings. We propose expanding a proven, community-based weight loss program nationwide and enrolling overweight and obese prediabetic adults ages 60-64. We estimate that making the program available to a single cohort of eligible people could save Medicare $1.8-$2.3 billion over the following ten years. Estimated savings would be even higher ($3.0-$3.7 billion) if equally overweight people at risk for cardiovascular disease were also enrolled. We estimate that lifetime Medicare savings could range from approximately $7 billion to $15 billion, depending on how broadly program eligibility was defined and actual levels of program participation, for a single "wave" of eligible people. In this context we propose that Medicare expand its new wellness benefit to include reimbursement for this and other qualifying behavior change programs.