Q. I hear that Medicare will now pay for me to discuss my end-of-life wishes with my doctor. Is this true?
A. Yes, beginning January 1 of 2016, Medicare will begin reimbursing physicians for time spent in counseling patients regarding their end-of-life wishes. This development, just announced October 31, 2015, by the Center for Medicare and Medicaid Services (“CMS”), was 6 years in the making and has been supported by the American Medical Association and many other groups and individuals.
Originally a part of the Affordable Care Act, this provision was removed in 2010, just before passage, to avoid the political controversy which arose when some individuals, notably former Vice Presidential Candidate Sarah Palin, accused the Obama administration of supporting “death panels”. Since then, the mood of the country has changed and the desire to encourage end-of-life counseling has gained broad support.
Until this announcement, Medicare only paid physicians for end-of-life counseling if the counseling occurred during the one time “Welcome to Medicare” examination that occurred within a beneficiary’s first 12 months of Medicare enrollment. The problem with that arrangement was that many beneficiaries were neither interested nor prepared to discuss this matter with their physician during that very first Medicare visit.
Beginning January 1, 2016, patients may now schedule a visit with their physician for the sole purpose of advance care planning, and the physician may now bill Medicare for that counseling. Alternatively, the patient may choose to discuss advance planning as part of his visit to address other healthcare issues. In either event, the physician may now bill Medicare for separate reimbursement, using one of two new billing codes added to the Medicare Physician Fee Schedule, effective in 2016.
One tip: if the discussion takes place during the Annual Wellness Visit, you will typically have no co-pays and the doctor will still get fully reimbursed. However, if the discussion takes place during any other visit, you may then have the usual co-pays just as for other Medicare services.
Another tip: if you have a Medicare Advantage Plan, be sure to first check with your plan to see whether it covers this counseling and, if it does not, ask if the plan can still bill Medicare for your advance planning visit.
Once you have these discussions with your physician, be sure to take the next steps and create or update your Advance Health Care Directive and discuss your wishes with your family and designated health care agent. Just as you may prepare a will or trust to plan for your assets, so, too, must you plan for your end-of-life healthcare. In doing so, you will be doing a service, not only for yourself, but also for your loved ones who may one day take comfort in knowing that your own wishes were honored.