OBJECTIVES: To examine the economic burden and health care utilizations of patients diagnosed with chronic obstructive pulmonary disease (COPD) within the U.S. Medicare population.  METHODS: Patients diagnosed with COPD (International Classification of Disease 9^thRevision Clinical Modification [ICD-9-CM] codes: 491, 492, 496) were identified using the U.S. national Medicare claims dataset from 01JAN2009 to 31DEC2011. The first diagnosis date was defined as the index date. A comparator group was created by identifying patients without a COPD diagnosis but of similar age, region, gender, index year and baseline Charlson Comorbidity Index scores. The index date for the comparator group was randomly chosen to reduce selection bias. One-year pre- and post-index continuous health plan enrollment was required for both groups. A 1:1 propensity score matching was used to compare follow-up health care costs and utilizations between the COPD and comparison cohorts, adjusted for baseline demographic and clinical characteristics.  RESULTS: A total of 422,024 patients were identified for the COPD and comparison cohorts. After applying a 1:1 matching, a total of 123,356 patients were matched from each cohort, with well-balanced baseline characteristics. COPD patients had higher health care utilization, including Medicare carrier (98.1% vs. 70.1%), Durable Medical Equipment (DME, 37.4% vs. 15.8%) and Home Health Agency (HHA, 17.2% vs. 4.6%) claims, outpatient visits (73.9% vs. 41.7%) and inpatient (32.5% vs. 6.8%), skilled nursing facility (SNF, 10.0% vs. 2.2%) and hospice admissions (1.2% vs. 0.6%) and prescription drug claims (53.4% vs. 49.8%), resulting in higher health care costs for Medicare carrier ($3,391 vs. $1,313), DME ($413 vs. $97), HHA ($923 vs. $228), outpatient ($10,110 vs. $3,514), inpatient ($5,983 vs. 1,045), SNF ($1,982 vs. $368), hospice ($304 vs. $143), pharmacy ($1,180 vs. $692) and total costs ($24,288 vs. $7,399) (p<0.0001).  CONCLUSIONS: COPD patients are associated with high economic burden and health care utilization.