Advance Care Planning and Medicare: What's Covered and How to Use It

Most families are unaware that Medicare pays for advance care planning conversations with a doctor. This benefit has existed since 2016, yet uptake remains low — largely because neither patients nor many physicians actively discuss it. If your parent is on Medicare, this is a covered service worth using, and understanding how it works can help you get more out of your next doctor's appointment.

What CMS Advance Care Planning Covers

CMS (Centers for Medicare and Medicaid Services) established billing codes that allow physicians and other qualified providers to bill for advance care planning discussions. These are separate from standard office visit codes and can be billed alongside a regular appointment.

What the conversation can cover:

• Explaining advance directives — what they are, why they matter, and how to complete one
• Discussing healthcare preferences for future scenarios involving serious illness
• Talking through treatment options, including life-sustaining treatments and comfort care
• Completing or reviewing an existing advance directive during the visit
• Answering questions about healthcare proxies and medical power of attorney

What it does not cover:

• Legal preparation of documents (that is an attorney's role)
• Referral to estate planning services
• Financial planning

The Medicare Coverage Details

Medicare Part B covers advance care planning as a preventive service. When billed as a standalone service or alongside the Annual Wellness Visit (AWV), there is no cost-sharing for the patient — meaning your parent pays nothing for this conversation if conducted during the annual wellness visit.

Key billing codes used:

• 99497: First 30 minutes of face-to-face advance care planning
• 99498: Each additional 30 minutes

When billed outside of the Annual Wellness Visit in a regular office visit setting, the usual Part B cost-sharing applies (typically 20% of the Medicare-approved amount after the deductible is met).

Why So Few Families Use This Benefit

Despite being a covered benefit for nearly a decade, advance care planning conversations happen in a small minority of Medicare appointments. The reasons:

Physicians may not initiate it. Many doctors are trained in diagnosis and treatment, not in structured conversations about death and dying. Without a specific prompt, the topic may never come up.

Patients do not know to ask. If your parent has never heard of this benefit, they have no reason to request it. They may not know that asking their doctor "Can we talk about my advance directive?" is actually a covered service.

The Annual Wellness Visit is underused. Many Medicare beneficiaries do not schedule their annual wellness visit at all, missing out on a range of preventive services including this one.

How to Use This Benefit

Step 1: Schedule or Confirm the Annual Wellness Visit

The Annual Wellness Visit is a Medicare-covered visit (no copay) that includes a preventive health assessment and is a natural time for advance care planning. It is separate from a standard sick visit. Many patients have never had one. Call the primary care doctor's office and specifically ask for the "Medicare Annual Wellness Visit."

Step 2: Tell the Doctor You Want to Discuss Advance Care Planning

Do not assume the physician will bring it up. Before or at the start of the appointment, say: "I'd like to talk about advance care planning and my advance directive today." This signals to the provider that you want this coded appropriately and that time should be allocated for the conversation.

Step 3: Come Prepared With Specific Questions

The 30-minute billing increment goes quickly. Prepare beforehand:

• Does my parent have an advance directive on file with this practice?
• Is it up to date with current wishes?
• What would happen if my parent arrived at the ER without any documentation?
• What does a POLST form add beyond a living will, and should my parent have one?
• Who else should have a copy of these documents?

Step 4: Leave With Documents and a Plan

At the end of the visit, confirm:

• Whether an advance directive was reviewed or created
• Where a copy will be filed in the medical record
• Who else (specialists, hospital system) should receive a copy

The Gap Between the Visit and the Documentation

Medicare can pay for the conversation, but it cannot make the family follow through on the paperwork. A common failure pattern: the doctor discusses advance care planning at the annual visit, the patient says they will think about it, and three months later nothing has been documented or filed.

The advance care planning visit is most useful when paired with a concrete next step — completing the actual documents and getting them into the right hands.

Documents to have in place after this visit:

• Signed advance directive (living will and healthcare proxy)
• Copy given to primary care doctor for the medical record
• Copy given to any specialists managing serious conditions
• Copy accessible to family members who may need to act quickly
• POLST form if the parent has a serious or life-limiting condition (requires physician signature)

For Families Managing Care Across Providers

If your parent sees multiple specialists — a cardiologist, an oncologist, a neurologist — each provider may have different information about your parent's wishes. A conversation at the primary care level does not guarantee that the wishes are communicated across the entire care team.

The most reliable solution is a physical document that travels with the patient. The End-of-Life Planner at eldersafetyhub.com/end-of-life-planner/ includes a document locator and medical information worksheet that helps families keep a complete, organized record that can be brought to any appointment. Knowing exactly where the advance directive is — and having multiple copies distributed to the right providers — means the conversation your parent had with their doctor actually carries weight at every point of care.

Advance care planning is a medical benefit, not a bureaucratic formality. Using it while your parent is well — before a crisis forces improvised decisions — is one of the highest-value conversations a family can have.