New Regulations Increase Medicare Funding for Advance Care Planning: Time To Update Your Health Care Proxy

Until recently, under previous Medicare regulations, doctors could bill Medicare for advance care planning conversations with their patients only if those discussions occurred during the “Welcome to Medicare” visit.  However, most elders are not concerned with advance care planning at the time they enroll in Medicare.  A recent change by the Centers for Medicare and Medicaid Services (CMS) to their billing codes, which became effective January 1, 2016, allows doctors to bill Medicare for advance care planning discussions at patients’ annual wellness visits, in addition to the “Welcome” visit.


Medicare patients should take advantage of this change in regulations to discuss with their doctors the options available to them as they age and their circumstances change.  Advance care planning, also known as end-of-life planning, focuses on the elder’s available care options as their health declines and also on their specific wishes regarding the use of life-sustaining treatment if they have no chance of meaningful recovery.  Too many elders, almost 40% over age 65, have no advance care plans in writing.  Having a written advance care plan will not only improve the quality of care at end-of-life and help to insure one’s wishes are carried out, but it will also help to provide comfort to loved ones at an emotional time.


The change in regulations will also encourage doctors to initiate the advance care planning discussion with their Medicare patients so that they can bill for their services.  The financial incentive to doctors will hopefully cause them to raise the topic of advance care planning at every annual visit, until their patients have taken action.


Any advance care planning should involve several steps.  First, a discussion with your doctor is an opportunity to learn about the different options available to you.  Second, discussing your options and ultimately, your specific wishes with your loved ones, gives you the opportunity to express how you wish to be treated as you reach the end of your life.  Lastly, and perhaps the most important, memorializing your wishes in a valid health care proxy gives your loved ones the authority to carry out your wishes (especially if you lack the legal capacity to make your own health decisions at the end of your life).


In my practice, I have seen too many times the failure of elders to take that last step and execute a health care proxy.  The alternative to a health care proxy (which appoints someone as your agent with respect to health care decisions and end-of-life care) is a guardianship, which is costly, time-consuming, involves court supervision and takes time to initiate.


In 2016, make two resolutions: (1) talk to your doctor about advance care planning options at your annual wellness visit; and, (2) consult an elder law attorney to memorialize your wishes in a health care proxy.  Do it for yourself and also the comfort of your loved ones.


To read more about the new Medicare regulations go to