Does Medicare Help With or Cover End-of-Life Counseling?

Certified Care Manager, Aging Life Care Professional, and National Master Guardian Emeritus

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Medicare has many benefits, and end-of-life counseling is definitely one of them. Navigating the challenging and heart-wrenching terrain of death and dying can feel lonely and confusing. Counseling from your physician may not seem like such a comforting idea at first, but having someone explain the medical and pain relief side of end-of-life can be a big help.

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Also, Medicare covers routine counseling for depression, anxiety, and family conflict or marital issues. These sessions can be ongoing for as long as you need or for as long as Medicare will authorize payment for sessions. Having someone to talk to and support you during times of stress is invaluable. 

Does Medicare Offer Advance Care Planning or End-of-Life Counseling?

Medicare does pay for advance care planning and end-of-life counseling, but there may be some restrictions and possible co-pays. We will look at both of these services separately to give you an idea of what to expect.

Taking advantage of the benefits you and your loved one are entitled to can help support you during times of stress.

Advance planning

Advance planning is a broad term that can encompass everything from advance directives to end-of-life wishes. Advance planning can also include things such as long-term care options, which require you to think about what kind of care you want, where you want it, and how to finance it. 

Advance directives are legal documents that allow you to state what medical care you do or do not want to receive in the event you become incapacitated. It is also something everyone over the age of 18 should complete.

Advance directives also allow you to designate a guardian to help make those types of medical decisions. Each state has a different advance cirective form, and some states allow the designated person to access medical information or advocate for a loved one immediately.

Medicare does pay for limited advance planning as part of the annual wellness visit. You may be familiar with the yearly wellness visit to your physician that is covered by Medicare. The visit includes a risk assessment questionnaire to evaluate what areas need improvement.  The visit also entails, but is not limited to:

  • A cognitive test to screen for Alzheimer’s and dementia
  • A review of your medications and other health providers
  • Labs that may be covered by Medicare 
  • Vital signs such as blood pressure, weight, and heart rate
  • A review of preventative screenings such as mammogram, colonoscopy or prostate exam

As part of the wellness visit, your provider will ask you about advance directives, if you have them prepared and if any updates are required. Some advance directives also allow you to state your end-of-life wishes or state what medical interventions you want should you become incapacitated. If you do not have advance directives, the physician or assistant will help you fill them out.

Depending on your physician relationship, they may also discuss other advance planning topics like home care, home healthcare, assisted living, and memory care. Your physician might ask you about your home situation and whether you need assistance to remain safe. These questions can enable your physician to connect you with community or health resources.

End-of-life counseling

End-of-life counseling by your physician is now a Medicare-covered benefit. Keep in mind that Medicare also covers hospice care, which is end-of-life medical and comfort care by a team specializing in pain relief and eliminating aggressive treatment.

Also, depending on whether you have original Medicare or a Medicare Advantage plan, you can get covered counseling for any mental health concerns that may coincide with or be the result of end-of-life care.

Medicare is currently covering teletherapy due to COVID concerns so that you do not have to leave your residence to participate. You can find a therapist contracted with Medicare to offer psychotherapy and preferably one who deals in issues related to aging, grief, and end-of-life issues.

ยป MORE: Your loved one is never far. Honor their legacy with this post-loss checklist.

 

What End-Of-Life Care or Counseling Does Medicare Usually Cover?

Under Medicare, end-of-life counseling with your physician allows for and encourages discussing topics important to end-of-life decisions. Some of these discussions can include things like finding out the benefits of hospice care, how to alleviate suffering and pain, different consequences to different treatment options, specific but common patient wishes and how they can affect your care, and any alternatives to invasive or life-extending treatments. 

Regardless of whether it is original or a Medicare Advantage plan, Medicare will cover hospice (end-of-life) care. A physician must certify that the patient has a terminal diagnosis, which will likely end in death in about six months. Hospice provides nursing, social work, aides, and chaplain services. 

Medicare covers general counseling for depression, anxiety, loss, grief, or other mental health concerns. You do not have to be on hospice or at the end-of-life to qualify for therapy or counseling. Under original Medicare with a secondary insurance, it is possible to have all of your therapy costs covered. By contrast on a Medicare Advantage plan, there might be co-pays and restrictions on covered providers.

Tips for Starting End-of-Life Planning If You Have Medicare

End-of-life care planning should ideally start before you need it. Otherwise, you may be too sick to make informed and rational decisions about what you want. As hard as it may be to think about planning for the end of life, it is the one thing that will happen to everyone. Planning can help give you peace of mind when the time comes. Involving your family and clergy might give you some support in making these emotional decisions. 

1. FIll out advance directives

Your advance directives allow you to designate who you want to make healthcare and end-of-life decisions on your behalf if you are unable to. Advance directives also walk you through the process of determining under what conditions you would want life-sustaining efforts to cease. 

Exploring end-of-life questions will help you crystalize and make plans for death. These plans include cremation vs. traditional earth burial, estate settlement, funeral plans, and specifics on what quality of life means to you and how to achieve it.

2. Understand hospice

Understanding hospice care is a critical part of planning. Most people wait until time is running out before they start this valuable support service. Once people start hospice, they often say they wish they had started sooner. However, there are some limitations to the hospice benefit that will be important to know.

First, hospice is not considered to be 24-hour care. A nurse is available on average about three times a week and is on-call if needed. Aides come to assist with bathing and hygiene up to three times a week. Aides will come daily if required, but usually for an hour. Planning for additional care under these circumstances is a good idea. If your loved one requires more than what hospice can provide, you may want to hire private caregivers.

Hospice also prioritizes comfort care and pain relief. Most curative treatment is discontinued. If you decide to pursue hospitalization or other treatment for your hospice condition, hospice will discharge you. It is your right to change your mind about receiving treatment, but know that you will no longer qualify for hospice if you do.

Finally, your hospice team will include a social worker and a chaplain. Chaplains are trained to provide spiritual counsel to hospice patients that are consistent with the patient’s wishes. Chaplains assist loved ones with feelings of guilt, remorse, fear of death, and any other strong emotions that accompany the end of life. This support is called “spiritual counseling” and differs from physician counseling in that the purpose is comfort, acceptance, and compassion throughout the dying process.  

3. Plan for out-of-pocket costs

Whether your loved one is in hospice or not, there might be some out-of-pocket costs. When someone requires help with bathing, dressing, transferring, cooking, or transportation, these duties are fulfilled by privately paid caregivers.

You may want to plan for out-of-pocket costs now to avoid surprises later. Medicare does not pay for in-home care except time-limited medical home health care (if you are not in hospice care). 

4. Research alternative care settings

Not everyone dies at home, although that is what most people prefer. Alternative care settings may be necessary, but are not covered by Medicare. Care settings include assisted living (which has aides, medication management, and nursing as part of their staffing) and, in some cases, nursing home care. Hospice is available in each of these settings. Without a long-term care policy however, these care costs (except for hospice) will be your responsibility.

In some cases, a hospice residence might be an option. The advantage of residential hospice is that it provides more care around the clock. But, the cost of room and board at a residential hospice facility will be your responsibility.

Medicare and End of Life Counseling and Advance Planning

Understanding Medicare coverage can be confusing and complicated, as benefits are always changing. People sometimes expect Medicare to pay for services and housing that aren’t covered. On the other hand, valuable support like hospice, end-of-life counseling, and advance planning are underutilized. Good planning is based on sound knowledge. Plan for what Medicare doesn’t cover and take advantage of what it does. 

If you're looking for more on end-of-life care, read our guides on a nurse's role in end-of-life care and palliative care vs. hospice.


Sources

  1. “Yearly Wellness Visits.” Medicare.gov, www.medicare.gov/coverage/yearly-wellness-visits

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