Advance Care Planning Basics

What is “advance care planning” and does Medicare cover it?

Advance care planning involves multiple steps designed to help individuals a) learn about the health care options that are available for end-of-life care; b) determine which types of care best fit their personal wishes; and c) share their wishes with family, friends, and their physicians.  

Starting January 1, 2016, Medicare will cover advance care planning as a separate service provided by physicians and other health professionals. As with most other physician services, beneficiaries are subject to cost sharing for advance care planning provided by their physician or health professional. If Medicare beneficiaries desire advance care planning during their annual wellness visit, physicians and other health professionals may provide it during the visit and bill Medicare separately for it. However, beneficiaries will not have any cost sharing liability for advance care planning provided in conjunction with their annual wellness visits.

What are “advance directives?”  Are health care facilities, such as hospitals or skilled nursing facilities, required to keep records of Medicare patients’ advance directives?

Advance directives are written instructions that are intended to reflect a patient’s wishes for health care to guide medical decision-making in the event that a patient is unable to speak for her/himself. Advance directives typically result from advance care planning and often take the form of a living will, which defines the medical treatment that patients prefer if they are incapacitated, or designation of a certain person as a medical power of attorney.  Advance directives fall under state regulation, and the required forms for formal advance directives vary from state to state.

The Patient Self-Determination Act, which took effect in 1991, included a list of Medicare re-quirements for health care facilities regarding advance directives.  Under this law, facilities such as hospitals and skilled nursing facilities must ask each patient upon admission if he or she has an advance directive and record its existence in the patient’s file.  Facilities cannot require any pa-tient to create an advance directive before providing treatment or care, and likewise, Medicare patients are not required to have an advance directive before they receive care. Recent surveys show that among long-term care patients, those receiving care in a facility (such as a nursing home or hospice facility) are more likely to have advance directives in place.

Does Medicare cover hospice care? 

Yes. For terminally-ill Medicare beneficiaries who do not want to pursue curative treatment, Medicare offers a comprehensive hospice benefit covering an array of services, including nursing care, counseling, palliative medications, and up to five days of respite care to assist family caregivers. Hospice care is most often provided in patients’ homes. Medicare patients who elect the hospice benefit have little to no cost-sharing liabilities for most hospice services.  In order to qualify for hospice coverage under Medicare, a physician must confirm that the patient is expected to die within six months if the illness runs a normal course. If the Medicare patient lives longer than six months, hospice coverage may continue if the physician and the hospice team re-certify the eligibility criteria.

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