What is Medicare and Who Is Covered?
In the early 1960’s only half of older adults in the United States had health insurance. For those uninsured older adults, coverage was expensive. It was determined at that time that neither income nor medical history should be a determinant for coverage and that a system was essential to help manage health risks for aging adults. In 1965 Medicare was created under Social Security. Currently, 52 million or 16% of the total population of the United States are enrolled in Medicare. Introduced as government sponsored health insurance for individuals 65 and older, the program has grown in multiple ways since it was first introduced.
Patient Self-Determination Act of 1991 Since its inception, there have been various pieces of legislation passed to bring Medicare in line with changing times and needs, including an expansion in 1972 to cover people under age 65 with disabilities who receive Social Security disability benefits for two years, and for those with end stage renal disease (who get it sooner than 2 years). Currently, 17% (9 million individuals) qualify by disability/health status.
In 1991 another expansion called the Patient Self-Determination Act of 1991 included a list of Medicare requirements for health care facilities. In part, the Act requires facilities, including hospitals and skilled nursing facilities, to ask a patient upon admission, if he or she has an advance directive. If there is an AD, the Act calls for the patient’s medical record to reflect its existence.
Advance Care Planning
What are some types of coverage currently covered under Medicare? Doctor services, nursing care, medical equipment (like wheelchairs or walkers), medical supplies (like bandages and catheters), drugs for symptom control and pain relief, short-term care in the hospital (including respite and inpatient for pain and symptom management). In January, 2016, Advance Care Planning became a new covered service.
Advance Care Planning supports patients’ efforts to make better and informed decisions about end-of-life care when they are of sound mind. ACP coverage reimburses physicians for counseling patients about healthcare options, most especially before they become physically or mentally incapable of making decisions, because judgment can be compromised at the time of a diagnosis or terminal illness. Advantages of advanced care planning include, but are not limited to:
- Considerations for preferences, decision-making, and planning can be done away from the stress brought on by a time-limit, resulting from a diagnosis or terminal illness.
- Learn about health care options available for end-of-life care.
- Determine which types of care best fit personal preferences.
Advance Care Planning Is Not Covered in a Single Conversation
The process of advance care planning is aimed at getting to right answers and preserving dignity for the patient. Advance Care Planning is now covered as a separate service provided by physicians and other qualifying health professionals. ACP can be provided in medical offices and facility settings, including hospitals. When provided during the annual wellness visit, the health professional bills Medicare separately and the patient incurs no cost for the service.
Medicare covered ACP is intended to open lines of communication with practitioners and loved ones before a crisis. Medical conditions can be complex and are unique to circumstances related to the individual patient. As such, it is expected everything will not be covered in a single conversation. Effective communication about complicated matters such as end-of-life planning translates into a series of conversations over years. The process is aimed at getting to right answers and preserving dignity for the patient. ACP includes early conversations between patients and practitioners:
- During well visits
- Diagnoses of serious illness
- Before illness progresses
- During course of treatment
Although this new coverage indicates progress has been made, patients as consumers, are entitled to counseling and should make it a point to receive this service. If a person feels there is hesitance or push-back from the healthcare provider, the patient will have to be the one to initiate the conversation. No matter how disinclined a physician feels, patients receiving Medicare support are entitled to advance care planning. To learn more about Medicare’s role in end-of-life care visit http://kff.org/medicare/fact-sheet/10-faqs-medicares-role-in-end-of-life-care/
To learn more about communicating with healthcare providers, explore The Art of Goodbye publications at https://edis.ifas.ufl.edu/topic_series_eole