Does Medicare Cover End-of-Life Conversations With My Doctor?

Yes, Medicare began covering advance care planning as a separate service on Jan. 1, 2016. This means that your doctor or other healthcare provider can now be reimbursed for talking with you about your wishes regarding the end of life. During these discussions, your doctor can provide you with information about end-of-life options, such as hospice and palliative care. He or she can also help you determine what options are best suited to your individual needs and wants and help you share your end-of-life wishes with your family and friends. 

For some patients, this conversation can be accomplished in one visit. But most people will need several visits to clarify their goals and develop a cohesive end-of-life care plan. Medicare does not limit the number of visits you may have, but there may be cost-sharing involved.

Before meeting with your doctor, it’s important to think about what you want to accomplish in advance. For example, do you want to discuss specific end-of-life options, such as hospice, palliative care, medical aid in dying or voluntarily stopping eating and drinking? Do you want to clarify your diagnosis and/or prognosis and talk about goals of care? Remember, you don’t have to have a terminal illness to talk about these things. In fact, the ideal time to have the conversation is before you are seriously ill. 

After you’ve thought about your goals, formulate some questions, and be as specific as you can. Here are some suggestions that may be helpful. Feel free to tailor them to your situation and your needs.

• What can I expect from this illness? What is my life expectancy with treatment or with comfort care?
• What kind of symptoms can I expect, and how soon?
• Can I continue to work? For how long?
• Will I need someone to care for me? When?
• Will I be able to stay in my own home? What equipment might I need?
• Can you refer me to hospice? If not now, when? 
• Can I get a palliative care consultation?
• Will you write a POLST for me? An out-of-hospital DNR?
• Are you comfortable working with me if I choose any of these options? (Explore these individually.)
  • Medical aid in dying
  • Voluntarily stopping eating and drinking
  • Palliative sedation 
• If not, will you refer me to someone who will? 

Be prepared for the possibility that your doctor may be uncomfortable discussing some of these issues with you or may resort to medical jargon that is difficult for you to understand. Be polite but persistent. If the doctor seems to be evading your questions, tell them these issues are important to you and you need to discuss them openly so you can plan your life. If they use words you don’t understand, ask them to explain them in a way that’s clear. Remember, this can be one of many discussions. There’s no need to rush. 

It may also be helpful to bring someone with you, such as a partner, spouse, trusted friend or healthcare surrogate, to these appointments to serve as a second set of ears. Discussions about end of life can be stressful, and it is not uncommon for people under stress to have trouble recalling details of what occurred. The other person can also take notes and ask questions about issues that may be unclear.