Advance Care Planning & Medicare
Medicare will cover advance care planning typically during your annual Medicare wellness visit. Advance care planning is your opportunity to ask your doctor about your options for carrying out your health care wishes in the event that you are unable to make those decisions.
Does Medicare Pay for Advance Care Planning
- As an optional part of your annual Medicare wellness visit to your doctor
- As a separate medically necessary service
There is no limit on the number of times you can seek advance care planning under these two conditions. Your doctor or other qualified medical professional must document any changes to your health status as well as to your wishes for end-of-life care.
What Is Included in Advance Care Planning?
Advance care planning happens during a face-to-face meeting with your doctor or other qualified health care professional. These sessions allow you to make end-of-life health care decisions while you are coherent and capable.
During this meeting, the two of you discuss how you want your health care handled if you are ever unable to make decisions about your health care.
If you are already incapacitated, Medicare will cover this face-to-face discussion between your doctor and your surrogates. Surrogates are family members or others who have been entrusted to make health care decisions for you.
- Life-sustaining treatments and how they work
- Types of treatments you would want
- Types of treatments you would not want
- Your personal values, which you expect to be honored in an end-of-life situation
Advance care planning consists only of informing you of your options and answering your questions. But you may also discuss legal options called advance directives.
What Are Advance Directives?
You can obtain an advance directive through your healthcare provider as part of your Medicare wellness visit or other medical necessity. You can also seek an advance directive through other routes that may not be covered by Medicare.
Advance directives are documents that let you name someone to speak for you regarding your health care wishes if you are incapacitated. Alternatively, an advance directive may define your wishes based on your personal preferences and values.
- In a coma
- Critically injured
- Suffering from late-stage dementia
- Near the end of life
- Terminally ill
These directives serve as a guideline for your medical team in determining the treatment and type of care you wish to have. In addition, they can ease the unnecessary stress and grief your family or other caregivers may be dealing with at the time.
- Instruction directive
- An instruction directive refers to health care interventions you might anticipate for a particular condition — such as CPR or intubation. It lays out which interventions you would accept and which you would reject if you had to be treated for a life-threatening condition. Living wills and do-not-resuscitate orders are examples of instruction directives.
- Living will
- A living will is a legal document that spells out the exact type of care you want or don’t want to keep you alive in the event you are unable to speak for yourself. It may include pain management and organ, tissue or full body donations.
- Do-not-resuscitate and do-not-intubate orders
- These can be included in a living will but do not necessarily have to be an advance directive. You merely need to tell your doctor your wishes, and the orders will go into your medical record. But they should be included in an advance directive if you have a preference for either and may be incapacitated before you are able to make your wishes known.
- Health care power of attorney
- This directive lets you name someone — usually a spouse, other family member, a member of your faith community or a friend — to make health care decisions for you if you are not able to make them for yourself. A health care power of attorney may also be called a health care proxy or a health care surrogate.
Advance directives remain in effect until you regain the ability to speak for yourself.
5 Cited Research Articles
- U.S. Centers for Medicare & Medicaid Services. (2020, October). Advance Care Planning. Retrieved from https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/advancecareplanning.pdf
- Mayo Clinic. (2020, August 22). Living Wills and Advance Directives for Medical Decisions. Retrieved from https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/living-wills/art-20046303
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Advance Care Planning. Retrieved from https://www.medicare.gov/coverage/advance-care-planning
- Academy of American Family Physicians. (n.d.). Advance Care Planning. Retrieved from https://www.aafp.org/family-physician/practice-and-career/getting-paid/coding/advance-care-planning.html
- National Hospice and Palliative Care Organization. (n.d.). Advance Care Planning. Retrieved from https://www.nhpco.org/patients-and-caregivers/advance-care-planning/