Medicare and Advance Care Planning, April, 2016

Q: My mother’s doctor says we should arrange for an appointment for her advance care planning. What does that mean, and will her Medicare cover it?

A: Advance care planning can involve several steps to help plan for an individual’s end-of-life care.

End-of-life care can encompass all health care provided to someone in the days or years before death, whether the cause of death is sudden or a result of a terminal illness that runs a longer course.

Advance care planning can help an individual determine which types of care best fit their personal wishes. It enables the patient to formulate advanced directives: a living will, the designation of a healthcare proxy, Medical Orders for Life-Sustaining Treatment, and the preparation for hospice care, among other things. This planning can also help an individual to share these wishes with their family, friends, and physician.

While meeting with your mother’s physician, she can learn about the health care options that are available to her for end-of-life care. She will then be able to determine which types of care best fit her personal needs and wishes.

Starting January 1, 2016, Medicare offers advance care planning as a separate service provided by physicians and other health care professionals.

Medicare will cover advance care planning provided in medical offices and facility settings, including hospitals.

Beneficiaries are subject to cost sharing for advance care planning, the same as with other physician services.

Advance care planning may be billed on the same day or on a different day of other medical services, but may not be billed on the same date of service as certain critical care services.

If your mother would like to discuss advance care planning during her annual wellness visit, her doctor may provide it during the visit but bill Medicare separately for it. Beneficiaries will not have any cost sharing liability for advance care planning provided in conjunction with their annual wellness visit.

If you or someone you know has questions about advance care planning or anything else related to Medicare, call SHIP at 1-800-452-4800, 1-866-846-0139 TDD or online at You can also find us on Facebook and Twitter.