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Background: While economic incentives through health insurance are being considered to promote healthy behaviors, little is known about health or financial impacts of incentivizing diet, a leading risk factor for CVD. We estimated health and economic impacts of programs to incentivize healthful foods through Medicare and Medicaid over a 5, 10, and 20 y horizon.Methods: A validated microsimulation model, CVD PREDICT, was used to estimate reductions in CVD events, gains in quality-adjusted life-years (QALYs), costs, and cost-effectiveness of two policy scenarios within Medicare and Medicaid: (1) 20% subsidy on fruits and vegetables (F&V), and (2) 20% subsidy on broader healthful foods including F&V, whole grains, nuts/seeds, seafood and plant-based oils. Model inputs included national demographic and dietary data from NHANES 2009-2014, policy effects from pricing meta-analyses, diet-disease effects from meta-analyses, and policy costs including program and healthcare costs, inflated to constant 2017 US dollars and discounted at 3% annually. Productivity gains were conservatively excluded.Results: Both incentive programs were cost-effective from a healthcare (government affordability) perspective (Table). Over 20 y, a 20% F&V subsidy could prevent 1.24M CVD events; while a broader 20% healthful food subsidy could prevent 1.91M CVD events. Incremental cost-effectiveness ratios for the F&V program ranged from $19,773/QALY for dual eligible to $26,862/QALY for Medicaid beneficiaries; and for the broader healthful food program, from $9,020/QALY for dual eligible to $13,484/QALY for Medicare beneficiaries. Findings were robust to a range of sensitivity analyses; within Medicare, the incentive program was more cost-effective among individuals with lower income. These incentive programs were also cost-effective at 5 and 10 y (not shown).Conclusions: Economic incentives for healthier foods through either Medicare or Medicaid could generate substantial health gains and healthcare cost savings.