Medicare, Advanced Directives, and End of Life Counseling

The Patient's Right to Full Disclosure

End of Life Medicare
Medicare now offers end of life counseling. Dorann Weber/Moment Open/Getty Images

Medicare covers more people over 65 years old than other insurance plans combined. In fact, it covers 55 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?

What Is an Advanced Directive?

If you know what a do not resuscitate order (DNR) is, you know something about advanced directives. Advanced 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 advanced 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 advanced directives is included as part of your "Welcome to Medicare" visit and annual "Wellness" visits.

What Is 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 doctor 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 doctor has no financial incentive to get you to sign an advanced directive or otherwise. The doctor 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 doctor about advanced 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 their condition from every angle before they can make an informed decision.

The Institute of Medicine outlined their 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 doctor about advanced directives every year. 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. 

Sources:

Advanced Directives and Long-Term Care. Medicare.gov. https://www.medicare.gov/manage-your-health/advance-directives/advance-directives-and-long-term-care.html.

10 FAQs: Medicare’s Role in End-of-Life Care. The Henry J. Kaiser Family Foundation. http://kff.org/medicare/fact-sheet/10-faqs-medicares-role-in-end-of-life-care/. Updated September 26, 2016.

FastStats: Older Personal's Health.  Centers for Disease Control and Prevention, National Center for Health Statistics. https://www.cdc.gov/nchs/fastats/older- american-health.htm. Updated May 3, 2017.

Hospice and Respite Care. Medicare.gov. https://www.medicare.gov/coverage/hospice-and-respite-care.html.

Continue Reading