OBJECTIVES: To estimate the return on investment of a digital lifestyle management program for the Medicare population. METHODS: ‘Prevent’ (recognized by the CDC Diabetes Prevention Recognition Program) is a digital lifestyle management program with online behavior change curriculum, health coaching, connected technology and peer group discussion. The analysis sample included 1,121 Medicare-eligible Prevent users who were overweight or obese. Weight at weeks 26 and 0 were used to calculate weight loss due to the program. A microsimulation model simulated the onset of obesity and diabetes comorbidities in the following 10 years, assuming participants regained 1/3 of lost weight within 5 years. The simulation produced separate direct cost estimation for 5 settings – inpatient stays, outpatient visits, prescription drugs, emergency department visits, and other, corresponding to different parts of the Medicare program. Return on investment (ROI) was calculated as the cost saving between 2 scenarios (1) weight loss after ‘Prevent’ and (2) natural progression in the absence of ‘Prevent’. The analysis focused on 2 populations – those with prediabetes and those with cardiovascular risk factors who met USPSTF’s recommendation for intensive behavior counseling. All costs are in 2015 US dollars. RESULTS: Participants lost an average of 6.8% baseline body weight over 26 weeks. The investment in lifestyle management broke even within 2 years. For those who completed the program, 10-year ROI was $12,600 and $8,900 for the prediabetes and CVD risk populations, respectively. Cost reduction in prescription drugs, outpatient visits, and inpatient stays accounted for 55%, 30%, and 10% of total savings, respectively. CONCLUSIONS: Digital lifestyle management like ‘Prevent’ can produce sizable return on investments for Medicare recipients over 10 years, with more than half of the savings coming from prescription drug benefits.