Medicare, Advance Directives, and End of Life Counseling

Medicare covers more people over 65 years old than other insurance plans combined. In fact, it covers more than 59 million Americans—those who are healthy, those with chronic medical conditions, and those at the end of life. 

The unfortunate truth is that 1.9 million Medicare-aged people pass away each year. It would be irresponsible for Medicare to not address end of life issues. What exactly does Medicare cover and how can you benefit from those services?

Patient holding hands with family member
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What Is an Advance Directive?

If you know what a do not resuscitate order (DNR) is, you know something about advance directives. Advance directives are documents that specify how you want to be cared for in the case that you are no longer able to make medical decisions.

Living wills and/or a durable power of attorney are the most common advance directives. These documents outline your wishes and/or assign a health proxy to act on your behalf if you become permanently unconscious or terminally ill. You may choose to pursue or withhold life-prolonging medical care such as:

In these documents, you may also specify your wishes for palliative care and organ donation.

It is not always comfortable to face your own mortality, but to face the end of life with dignity, it is important to take the time to think about these issues. Without a living will or durable power of attorney, family members may be uncertain about your wishes and could subject you to care you may or may not want.

Discussion of advance directives is included as part of your "Welcome to Medicare" visit and annual "Wellness" visits.

End of Life Counseling

The controversy over "death panels" first took root during the 2008 presidential race when then vice presidential candidate Sarah Palin coined the term. She had criticized Obamacare's plan for end of life counseling, stating it was a means for bureaucrats to coerce elderly and disabled patients into hospice care. Nothing could be further from the truth.

Many people pursue aggressive treatments at the end of life because they do not know about their other options. This could lead to unnecessary hospitalizations or treatments that have unfavorable side effects. While many people would choose to pursue these treatments regardless, others may prefer to defer them in favor of more conservative measures. They need to know that they have the choice.

End of life counseling is an opportunity to learn about your options, not to commit to a decision. The healthcare provider must be forthcoming and give you all the information you need to know about your health and available treatment options to help you plan, whether those treatments are aggressive or palliative. He must offer you reasonable expectations. The healthcare provider has no financial incentive to get you to sign an advance directive or otherwise. The healthcare provider simply needs time to outline the full scope of options.

Medicare Coverage for End of Life Counseling

Before 2016, Medicare did not cover end of life counseling. You could talk to your healthcare provider about advance care directives as part of the Welcome to Medicare Exam or the Annual Wellness Visit, but these visits are intended to cover an array of other services and medical issues. It leaves little time to address the issue in a meaningful way.

Simply put, a 15- or 20-minute visit is not going to be adequate to discuss the complex issues of death and dying. Oftentimes, multiple visits are required to educate and discuss the different options available to someone who is making end of life plans. The patient, his family, and his loved ones deserve time to learn more about the condition from every angle before making an informed decision.

The Institute of Medicine outlined its recommendations for end of life counseling in 2014. The Care Planning Act of 2015 was then introduced by Democratic Senator Mark Warner of Virginia and Republican Senator Johnny Isakson of Georgia. More than 40 organizations, including AARP, the American Medical Association, the National Council on Aging and the National Hospice and Palliative Care Organization, endorsed the legislation.

Thanks to these efforts, Medicare enacted end of life counseling as a covered benefit in 2016. Now you have all the time you need to talk about what matters most.

A Word From Verywell

Medicare allows you time to talk with your healthcare provider about advance directives every year, but that may not be enough time to get to the heart of the matter. If you have a terminal illness, you have chronic medical conditions, or you are simply advancing in years, you may need more time to discuss your future plans. End of life counseling, a benefit now covered by Medicare, may provide you that option.

3 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. The Kaiser Family Foundation. Total Number of Medicare Beneficiaries. 2018.

  2. Advance directives & long-term care.

  3. 10 FAQs: Medicare’s Role in End-of-Life Care. The Henry J. Kaiser Family Foundation.

Additional Reading

By Tanya Feke, MD
Tanya Feke, MD, is a board-certified family physician, patient advocate and best-selling author of "Medicare Essentials: A Physician Insider Explains the Fine Print."