OBJECTIVES: In the US, more than half of patients with idiopathic pulmonary fibrosis (IPF) are covered by Medicare; yet published data on the economic burden that IPF imposes to this largest US payer are limited. The objective of this study was to compare healthcare resource utilization (HRU) and costs between Medicare beneficiaries with IPF and matched non-IPF controls. METHODS: Administrative claims from a 5% random sample of Medicare beneficiaries (aged 65+) from years 2000 to 2011 were analyzed. Incident IPF patients were identified based on ICD9-CM diagnosis codes, with at least one year enrollment before (pre-index) and after (post-index) the first diagnosis (index date). Up to 5 beneficiaries without IPF were matched to each IPF patient, based on age, gender, race, and region. Annual HRU and medical costs (excluding outpatient drug costs) during the pre-index and post-index periods were compared between IPF patients and the matched controls and univariate descriptive analyses were performed to compare the differences.  RESULTS: A total of 7,855 IPF patients were matched to 38,856 controls. During pre-index period, IPF patients had 2-3 folds higher risk of COPD, asthma and lung infections, 80% higher risk of hospitalization (28.8% vs. 15.8%), and higher total medical costs ($10,124 vs. $5,888) than matched controls (all p<0.05). During post-index period, IPF patients had a higher risk of hospitalization (48.7% vs. 20.8%) and all other types of HRU with the total medical costs $11,955 higher than controls ($20,887 vs. $8,932) (all p<0.05). Inpatient care accounted for 50% of total medical costs of IPF patients in both pre-index and post-index periods. CONCLUSIONS: In the US, IPF patients aged 65 or older had a greater burden of comorbidity and incurred more HRU and medical costs than matched controls. Multidisciplinary team based approach and effective therapies are needed given the high unmet needs.