Medicare Adds End of Life Counseling to Its Covered Services

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 the age of 65 years than any other insurance plan. Add to that the fact that more than 1.9 million Americans in this age group die every year and end of life issues are brought to the forefront.

During the 2008 presidential race, the issue of "death panels" was raised by then vice presidential candidate Sarah Palin. 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.

The end of life debate is now resurrected as Medicare approves coverage for advanced care counseling starting in 2016.

Until now, Medicare only offered coverage for advanced care directives as part of the Welcome to Medicare Exam. This exam is a one-time visit that can be scheduled within your first 12 months of Medicare coverage and addresses a number of medical issues. Beyond that, a doctor would have to incorporate these talks into other visits, knowing he would not be compensated for his time.

The truth is none of these scenarios leave adequate time to discuss the complex issues of death and dying. A 15 or 20-minute visit is not going to do the job. 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 could make an informed decision.

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 untoward 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. 

The Institute of Medicine outlined their recommendations for end-of-life counseling in 2014. The Care Planning Act of 2015 was since 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, have endorsed the legislation.

The controversy over "death panels" arose due to concerns that those who participated in these counseling sessions would be bound to go on hospice. That could not be further from the truth. 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. The doctor has no financial incentive to get you to sign an advanced directive or otherwise.


Centers for Disease Control and Prevention. National Vital Statistics Report - Deaths: Final Data for 2013. Accessed August 17, 2015.

The Henry J. Kaiser Family Foundation. 10 FAQs: Medicare’s Role in End-of-Life Care. Updated July 9, 2015. Accessed August 17, 2015.

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