Medicare Coverage of Advance Care Planning

Medicare Part B covers voluntary advance care planning—i.e., discussions of beneficiary preferences for end-of-life care. Coverage for this service arose out of recommendations from a wide range of stakeholders and bipartisan members of Congress, and began in 2016. 

What is advance care planning? 

Advance care planning is a service that supports conversations between you and your doctors and non-physician practitioners (NPPs) to decide what type of care may be right for you if you have a life-limiting conditions or incapacitating illness.  

During these conversations, doctors/NPPs may talk through and help you plan for a time when you cannot make your own medical decisions. If you have a life-threatening condition, the practitioner may discuss creating a disease-specific plan, help you explore your understanding of the illness progression, and discuss your own and your family’s hopes, fears, and concerns. They may also talk about care choices during a critical event, and how aggressive you would like treatment to be (e.g., whether to use resuscitation, antibiotics, and feeding tubes). 

Is advance care planning the same as an advance directive? 

Advance care planning is not the same as an advance directive. An advance directive is a legal document that specifies what should happen if a person is no longer able to make his/her own medical decisions. Advance directives take many forms, such as living wills and durable powers of attorney for health care.

If you are looking to prepare an advance directive, you should download your state forms and complete these according to your state’s rules to make the documents legally binding. Your doctor/NPP can assist with the completion of these forms. 

Do I have to have a terminal illness to take advantage of this benefit? 

No. The advance care planning benefit is open to anyone with Medicare. Indeed, often the best time to begin to discuss end-of-life care may be before a person is diagnosed with a life-threatening condition, when there is plenty of time to consider your preferences.  

Having these discussions early also may be useful in guiding future care and treatment decisions by family members and caregivers should you become incapacitated and unable to make your choices known. 

Advance care planning is not meant to be a one-time conversation, but a series of discussions over the course of a person’s life.  

Can I change my mind about end-of-life plans later on? 

Absolutely. Advance care planning is a continuous discussion. Should you complete any forms, such as an advance directive, this can be revoked at any time, so long as you still have the capacity to make that decision or complete new forms. 

What’s the difference between advance care planning and hospice care? 

Advance care planning may include a discussion about hospice care, how it works, and how it fits in to choices about end-of-life care. 

Hospice care is a care choice that a person may make if he/she is diagnosed with a terminal illness with a life expectancy of six months or less. When someone chooses hospice, he/she signs a statement saying that they accept palliative care instead of other Medicare-covered treatments for the illness. Learn more about how hospice works. 

What does advance care planning cost? 

There are two ways you can receive advance care planning; each has different cost implications: 

• If you choose to have this service in conjunction with the Annual Wellness Visit, there is no cost-sharing liability (though the physician can bill Medicare for both the Annual Wellness Visit and advance care discussion separately).
• If you receives advance care planning separate from the Annual Wellness Visit, you will have to pay the 20% cost-sharing (after the Part B deductible) associated with using this service, as you would with other Medicare-covered services.