If you follow the news at all, you've probably heard that the Trump administration made sweeping changes to U.S. foreign aid starting on the first day of the second term. What you may not have heard is how those changes connect — directly and indirectly — to the health programs that serve older Americans, including Medicare beneficiaries living with HIV, those who rely on CDC-coordinated domestic health infrastructure, and anyone who cares about where U.S. health policy is heading. This article breaks it down plainly, because the connection between a foreign aid program and your Medicare plan is more real than it might first appear.
PEPFAR — the U.S. President's Emergency Plan for AIDS Relief — was first authorized by Congress in 2003 and has since become the largest commitment by any single nation to fight a single disease in history. It operates in more than 50 countries, and the United States has been the top donor to global HIV efforts both through PEPFAR directly and through contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria. The program is credited with saving 26 million lives and enabling 7.8 million babies to be born HIV-free. Beyond those headline numbers, independent research has found that PEPFAR funding is associated with reductions in all-cause mortality, increases in childhood immunization rates, GDP growth in recipient countries, and higher school retention among children. These are not small footnotes — they represent decades of bipartisan investment that has made the United States a global health leader.
Starting January 20, 2025, the administration issued a series of executive actions that fundamentally altered how foreign assistance works. First came an executive order calling for a 90-day review of all foreign aid. That was followed by a stop-work order that froze payments and services for programs already underway — including PEPFAR-funded clinics, supply chains, and healthcare worker salaries in dozens of countries. USAID, the agency that historically administered much of PEPFAR's implementation, was effectively dissolved: most staff were let go, most contracts were cancelled, and most foreign assistance awards were terminated. A humanitarian waiver was issued to allow some life-saving services to continue, but program implementers on the ground found it narrow and difficult to obtain in practice. As of mid-2026, responsibility for remaining global health programs has been transferred to the State Department, and legal challenges to these actions have produced limited relief.
So why does this matter to a Medicare beneficiary in, say, Ohio or Florida? The answer runs through several channels. First, PEPFAR is not purely an overseas program. Its authorizing statute places it under the oversight of a U.S. Global AIDS Coordinator at the State Department, but its implementation has historically run through USAID and — critically for domestic purposes — the Centers for Disease Control and Prevention (CDC). The CDC plays a central role in U.S. domestic HIV surveillance, prevention programs, and the data infrastructure that informs Medicare and Medicaid coverage decisions for HIV-related care. When the agencies coordinating PEPFAR face budget cuts, reorganization, or staff reductions, those effects do not stay neatly overseas. They ripple into the domestic public health apparatus that Medicare beneficiaries depend on.
Second, consider the Medicare population living with HIV. Thanks to decades of medical advances — many of them accelerated by PEPFAR-era research and drug development partnerships — people with HIV are living longer than ever. The CDC estimates that more than half of Americans living with HIV are now age 50 or older, and a growing share are Medicare-eligible. These beneficiaries rely heavily on Medicare Part D prescription drug plans and Medicare Advantage plans with drug coverage (MA-PD plans) to afford antiretroviral therapy (ART). A standard HIV regimen can cost $3,000 to $5,000 per month at list price before insurance. Under Medicare Part D in 2025, the out-of-pocket cap was set at $2,000 annually — a significant improvement from prior years — but formulary placement of specific HIV drugs still varies dramatically from plan to plan. If you or a loved one is managing HIV on Medicare, the specific tier at which your antiretroviral is placed on a plan's formulary can mean the difference between a $10 copay and a $200 coinsurance charge per fill.
Data Snapshot: According to CMS.gov data, in 2025 there were approximately 4,000 Medicare Advantage plans available nationwide across all plan types, with an average monthly premium of around $17 for MA-PD plans. The average basic Part D premium in 2025 was approximately $46.50 per month, according to CMS projections. Star ratings data from CMS shows that roughly 40% of Medicare Advantage enrollees were in plans rated 4 stars or higher in 2025 — a figure that matters because high-star plans often offer richer drug formularies and more supplemental benefits, including care coordination services that can be especially valuable for beneficiaries managing chronic conditions like HIV.
Third, the proposed cuts and reorganization at the Department of Health and Human Services (HHS) — which oversees both CMS (the agency that runs Medicare) and the CDC — are likely to affect global health programs that have domestic counterparts. HHS restructuring announced in 2025 included significant reductions in CDC staffing and program budgets. The CDC's Division of HIV Prevention, which coordinates with state health departments to fund HIV testing, linkage to care, and treatment support, draws on some of the same institutional infrastructure and expertise that supports PEPFAR implementation. Cuts to one tend to weaken the other. For Medicare beneficiaries, this matters because CDC-funded programs often serve as the on-ramp that connects newly diagnosed individuals — including older adults who may not realize they are at risk — to Medicare-covered HIV care.
PEPFAR has been reauthorized by Congress four times, most recently in March 2024 for one year. That authorization expired on March 25, 2025. However, it is important to understand that PEPFAR is a permanent part of U.S. law — it does not simply disappear when a reauthorization lapses. Eight specific time-bound provisions expired with the March 2025 authorization, but the core program continues as long as Congress appropriates funding for it. The fight over PEPFAR's future is therefore as much a budget fight as a policy fight. If Congress fails to appropriate funds — or if the executive branch declines to spend appropriated funds, which has been a point of legal contention — the program's operations can be curtailed even without a formal repeal.
For Medicare beneficiaries who want to take practical action, the most important step right now is to review your current drug coverage before the Annual Enrollment Period opens on October 15. The AEP runs from October 15 through December 7 each year, and any changes you make take effect January 1. If you are living with HIV, you should pull up your current plan's formulary — available at Medicare.gov's Plan Finder tool — and check exactly which tier your antiretroviral medications fall on, whether prior authorization is required, and whether your preferred pharmacy is in-network. If your plan has changed its formulary for the upcoming year (plans are required to notify you of significant changes by September 30), that is your signal to shop alternatives during AEP.
If you are not currently enrolled in a Medicare Advantage plan and are considering one, be aware that MA plans vary enormously in how they cover HIV-related care. Some plans include robust care coordination programs, zero-dollar telehealth visits with infectious disease specialists, and preferred cost-sharing for HIV medications. Others place branded antiretrovirals on high-cost tiers with 25% to 33% coinsurance. The Medicare Plan Finder at Medicare.gov allows you to enter your specific medications and compare estimated annual drug costs across plans in your zip code — this is the single most useful tool available to you during AEP, and it takes about 15 minutes to use.
If you are in Original Medicare (Parts A and B) with a standalone Part D plan and a Medigap supplement, your drug coverage situation is different but equally worth reviewing. Medigap plans do not cover prescription drugs — that is handled entirely by your Part D plan. The good news is that the $2,000 annual out-of-pocket cap on Part D, which took effect in 2025 under the Inflation Reduction Act, provides meaningful protection for high-cost drug users. The Medicare Extra Help program (also called the Low Income Subsidy) can further reduce Part D costs for beneficiaries with limited income and assets — in 2025, the full Extra Help benefit was available to individuals with incomes up to about 135% of the federal poverty level, roughly $20,000 for a single person.
Beyond your own coverage, there is a broader civic dimension to this story that seniors are well-positioned to act on. PEPFAR has historically enjoyed strong bipartisan support precisely because its results are measurable and its cost-effectiveness is well-documented. The program's disruption is not a partisan talking point — it is a public health reality with consequences that extend from sub-Saharan Africa to the domestic agencies that protect Medicare beneficiaries. If you want to weigh in, your congressional representatives' offices are the right place to start. Both the Senate Foreign Relations Committee and the House Foreign Affairs Committee have jurisdiction over PEPFAR reauthorization, and constituent calls and letters do influence appropriations decisions.
Finally, if you are a Medicare beneficiary who wants to stay current on how federal health policy changes affect your coverage, bookmark Medicare.gov and CMS.gov for official plan and cost information. The State Health Insurance Assistance Program (SHIP) in your state offers free, unbiased counseling from trained volunteers who can help you compare plans during AEP — find your local SHIP counselor at shiphelp.org. These are not salespeople; they are volunteers whose only job is to help you understand your options. In a policy environment that is changing rapidly, having a knowledgeable human being walk through your specific situation with you is worth more than any algorithm.