OBJECTIVES: To evaluate advanced liver disease outcomes of Medicare beneficiaries diagnosed with chronic hepatitis C virus (HCV). METHODS: This study was based on 2005-2010 CMS Fee-for-Service Medicare longitudinal claims data which includes 100% of the adjudicated medical claims for all inpatient and outpatient institutional providers and a 5% sample of adjudicated patient claims from the physician office setting.  ICD-9 codes were used to identify patients with chronic HCV and advanced liver disease outcomes. Disease prevalence and trends over time were examined. RESULTS:  In 2010, the prevalence rates of advanced liver disease such as non-decompensated liver disease (26.5% versus 0.4%), decompensated cirrhosis (20.8% versus 1.6%), hepatocellular carcinoma (4.3% versus 0.1%), liver transplant (3.6% versus 0.06%), were higher (all statistically significant, p<0.0001) in the chronic HCV population than the non-HCV population. Prevalence rates of complications remained stable across the six year period, with the exception of decompensated cirrhosis, the prevalence of which increased from 15.0% to 20.8% for chronic HCV patients and 0.6% to 1.6% in non-HCV patients. CONCLUSIONS: Evaluation of Medicare beneficiaries indicates that chronic HCV patients have a greater prevalence of advanced liver disease compared with non-HCV patients. The 6-year prevalence trend of decompensated cirrhosis has increased for both chronic HCV patients and non-HCV patients.