Advance Care Planning For Medicare Beneficiaries Increased Substantially, But Prevalence Remained Low: Study examines Medicare outpatient advance care planning claims and prevalence.
Abstract
In 2016 fee-for-service Medicare began reimbursing physicians for advance care planning conversations with enrollees during outpatient visits and waived the copayment for advance care planning when it was part of the Medicare annual wellness visit. Advance care planning is intended to help providers treat patients in ways consistent with their wishes and may also reduce unnecessary health care use and spending. Examining fee-for-service Medicare claims, we found a substantial increase in outpatient advance care planning claims between 2016 and 2019, although prevalence remained below 7.5 percent for all patient subgroups analyzed. Roughly half of beneficiaries with advance care planning claims received the service at an annual wellness visit; the remainder received it at a different outpatient visit. Among those with claims, Black, Hispanic, and Medicaid dual-eligible patients and patients with comorbidities were less likely to have a claim at an annual wellness visit, largely because they have fewer such visits overall. Medicare's annual wellness visits offer the potential to expand enrollees' access to advance care planning at no expense to them, in advance of serious illness, and to populations less likely to undertake advance care planning generally.
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In 2017, less than 3% of fee-for-service Medicare beneficiaries had at least one claim for advance care planning.
“In 2017, less than 3% of fee‐for‐service Medicare beneficiaries had at least one claim for advance care planning. 940”
From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [940]
Medicare beneficiaries with newly diagnosed Alzheimer's were 1.3 times as likely to have one or more claims for advance care planning compared with individuals without newly diagnosed conditions.
“However, compared with individuals without newly diagnosed conditions, Medicare beneficiaries with newly diagnosed Alzheimer's were 1.3 times as likely to have one or more claims for advance care planning.”
From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [940]
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Wec, A., Wu, M., Scerpella, D. L., Zhang, Z., Peereboom, D., Colburn, J. L., Nothelle, S. K., Green, A. R., Wolff, J. L., & Powell, D. S. (2026) · Alzheimer s & Dementia · doi:10.1002/alz.71576
Xie, Z., Liang, J., Patel, B., Hong, Y., & Jacobs, M. (2026) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/10499091261462061
Bitar, H., Leitner, A. T., Dale, W., Mecusker, E. D., Jun, C. S., Ramirez, C. T., Liou, E., Razavi, M., FERRELL, B. R., Ekaputri, S., et al. (2026) · JCO Oncology Practice · doi:10.1200/op-26-00234
Dementia and End-of-Life Shared Decision-Making Among Older US Adults
Xie, Z., Hong, Y., Armstrong, M. J., Wang, X., & Jacobs, M. (2026) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2026.106490
- Authors
- Palmer, M. K., Jacobson, M., & Enguidanos, S.
- Affiliations
- University of Nevada, Las Vegas (US)
- University of Southern California (US)
- Venue
- Health Affairs
- Publisher
- Health Affairs Publishing, LLC
- Published
- 2021-04-01
- Volume
- 40
- Issue
- 4
- Pages
- 613-621
- ISSN
- 0278-2715 (ISSN-L)
- 1544-5208
- OpenAlex
- W3151638068
- Cited by
- 61
- References
- 41
- Citations by year
- 2026: 8 · 2025: 10 · 2024: 13 · 2023: 17 · 2022: 9 · 2021: 4
- FWCI
- 9.29
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Health Affairs (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Keywords
- advance care planning, Medicare, fee-for-service Medicare, annual wellness visit, physician reimbursement, Medicaid dual eligibility, racial and ethnic disparities, comorbidities, outpatient visits, health care utilization
- MeSH terms
- Aged, Medicare, Humans, Medicaid, United States, Prevalence, Fee-for-Service Plans, Advance Care Planning
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