Medicare to cover advance care planning

Beginning Jan. 1, Medicare Part B will cover advance care planning for all beneficiaries. Learn more about this service in a new fact sheet from the 
NCOA Center for Benefits Access

Medicare Coverage of Advance Care Planning

Beginning in 2016, Medicare Part B will cover advance care planning—i.e., discussions of beneficiary preferences for end-of-life care. This coverage arises out of recommendations from a wide range of stakeholders and bipartisan members of Congress, and was outlined in a final rule published by the Centers for Medicare & Medicaid Services (CMS) in
November 2015.
What is advance care planning?

Advance care planning is a service that supports conversations between patients and their doctors and non-physician practitioners (NPPs) to decide what type of care may be right for them in the event of life-limiting conditions or incapacitating illness. During these conversations, doctors/NPPs may talk through and help the person plan for a time when he/she cannot make his/her own medical decisions. If the beneficiary has a lifethreatening
condition, the practitioner may discuss creating a disease-specific plan, help
the beneficiary explore his/ her understanding of the illness progression, and discuss his/her own and their family’s hopes, fears, and concerns. They may also talk about care choices during a critical event, and how aggressive they would like their treatment to be (e.g., resuscitation status, antibiotics, and feeding tubes).

Does a person have to have a terminal illness to take advantage of this benefit?

No. The advance care planning benefit is open to anyone with Medicare. Indeed, often the best time to begin to discuss end-of-life care may be before a person is diagnosed with a life-threatening condition, when there is plenty of time to consider one’s preferences. Having these discussions early also may be useful in guiding future care and treatment decisions by family members and caregivers should the person become incapacitated and
unable to make his/her choices known. 
Advance care planning is not meant to be a one-time conversation, but a series of discussions over the course of a person’s life.

What do my clients need to know about Medicare costs for this service?
The advance care planning benefit is not one of the free preventive services under Part B. Your clients will have to pay the 20% cost-sharing (after the Part B deductible) associated with using this service, as they would with other Medicare-covered services. However, if a client chooses to have this service in conjunction with his/her Annual Wellness Visit, he/she will not have any cost-sharing liability (though the physician can bill Medicare for
both the AWV and advance care discussion separately).

Beginning January 1, 2016, two billing codes will be available for health providers to use for payment by Medicare when providing advance care planning services. Previously, physicians could only seek reimbursement from Medicare for this service under very limited circumstances.