Pros and Cons of End-of-Life Counseling in Medicare

Congress addresses topics from life to death, and many in between. One action advocated by House Democrats touched off a fierce debate.

It provides Medicare coverage for "end-of-life" counseling session once every five years. Republicans reacted with suspicion and anger, contending the provision is subject to abuse and would pave the way for government-funded assisted suicide.

End-of-Life Counseling Limits

Since the summer of 2009, there have been debates about the pros and cons providing Medicare coverage for counseling about death. Topics in the counseling must include an explanation of the end-of-life services available such as palliative care (sometimes known as "comfort measures") and hospice.

However, this coverage would only apply to a limited, restricted type of counseling. Its proponents urge it would be strictly voluntary.

  1. No one is required to participate in such counseling
  2. The provision prohibits any encouragement or promotion of suicide or assisted suicide
  3. Only one counseling session would be paid for every five years. More frequent sessions would be covered when the patient is suffering from a life-threatening illness

The Current Debate

The recent upset in the Massachusetts election has many wondering whether health care reform will be passed anytime soon. That turn of events has drawn attention away from the end-of-life counseling controversy.

One research study from the Kaiser Family Foundation highlighted the cost of aging: People over 65 and over spent an average of $8,776 in 2006. In contrast, people between ages 25-44 spent an average of $2,305 on health care in 2006. The economic reality is that the provision could save more than spent by eliminating unwanted end-of-life health care, since a person's express wishes are known in advance.

The debate led Senate aides to withdraw the end-of-life provision.

Making Your Wishes Known

"I need a will made." Many people have made that statement and never get around to having it prepared. It's important that the will meets the legal requirements of your state so it's valid upon your death. Your will is especially important, as you name your executor, who will manage your estate.

An attorney can also assist in preparing other documents, such as a living will or durable power of attorney for health care where you can specify your wishes as to the type of measures you want to be taken if you are dying.

Each state has very specific requirements for signatures, notarizations and language, which must be followed or the document is meaningless. provides all types of legally binding estate planning documents. You can also consult with an attorney at the site if you need help.

Having the right power of attorney and advanced directive forms is important. A power of attorney allows you to name someone to act for you when you're unable to do so. This "attorney in fact" can handle financial matters or make health care decisions for you. State laws vary on the types of power of attorney, and you may need a separate health care power of attorney. An "advanced directive" includes living wills - these documents state your specific wishes for medical care if you can't speak for yourself.

It's never easy to think about having to make these documents - it's never too early; but it can always be too late. You don't need to have a lot of property or assets to make sure family and friends know your wishes.

Questions for Your Attorney

  • Is this something I should get even if it isn't a law?
  • I prepared a will many years ago, but then got divorced. Does my will need to be updated?
  • I don't have any close relatives. Who should be my executor?
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