Does Medicare Cover Advance Care Planning?

What advance care planning is and that Medicare covers it

Advance care planning (ACP) is a voluntary, face-to-face conversation with your doctor or another qualified provider about the kind of medical care you would want in the future if you became unable to speak for yourself. It also includes help preparing the legal documents that record those wishes.

Medicare Part B covers this planning service. It is entirely your choice — ACP is voluntary, and your agreement to have the discussion is documented in your medical record.

Two documents often come up during ACP. An advance directive is a legal document that records your wishes about future medical treatment in case you cannot make decisions about your own care; you can update it at any time. A health care proxy — sometimes called a 'durable power of attorney' for health care — names someone you trust to make health decisions for you if you are unable to.

What advance care planning costs in 2026

Your cost depends entirely on when and how the planning is done.

• $0 with a wellness visit: You pay nothing for ACP when your provider accepts assignment and the planning is furnished as part of your 'Welcome to Medicare' preventive visit or your yearly 'Wellness' visit. The Part B deductible and coinsurance do not apply.
• Standard costs otherwise: If ACP is furnished as part of other (non-preventive) medical treatment — for example, a regular problem-focused office visit — the standard Part B deductible and 20% coinsurance apply.
• 2026 Part B deductible: $283 per year. After you meet it, you pay 20% coinsurance of the Medicare-approved amount for ACP billed outside a wellness visit.
• The $0 cost-sharing waiver is limited to once per year (when ACP is billed with the Annual Wellness Visit).

The codes on your bill: 99497, 99498, and modifier 33

If you see unfamiliar codes on your Medicare statement after an ACP discussion, here is what they mean.

ACP is billed with two time-based CPT codes. Code 99497 is the base code, covering the explanation and discussion of advance directives for the first 16 to 30 minutes. Code 99498 is an add-on code for each additional 30 minutes. To bill 99497, the provider must spend at least 16 minutes of face-to-face discussion; for shorter conversations, Medicare suggests billing a different service such as an office visit.

The reason your wellness-visit ACP costs nothing is a billing detail: to waive the deductible and coinsurance, the ACP code must be billed with modifier 33 (Preventive Services) on the same date by the same provider as the Annual Wellness Visit. If your provider forgets that modifier — or the ACP was tied to a separate medical problem — you may be charged the deductible and coinsurance instead. If you were charged and expected it to be free, ask the office whether the ACP was billed as part of your wellness visit with modifier 33.

Who can provide it, where, and how often

• Who can provide it: Physicians and qualified non-physician practitioners — such as nurse practitioners, physician assistants, and clinical nurse specialists — whose scope of practice and Medicare benefit category include the service and who can independently bill Medicare. The billing provider must meaningfully participate in the discussion.
• Who can be in the room: The discussion is face-to-face with you and/or your family member(s) and/or a surrogate decision-maker.
• Where: There are no place-of-service limits. ACP can be furnished in a variety of settings — the doctor's office, a hospital, or a facility — depending on your needs and condition.
• How often: There is no specific limit on the number of times ACP can be reported, but documentation must reflect a change in your health status and/or your wishes when it is reported more than once. The $0 cost-sharing waiver, however, is limited to once per year when billed with the Annual Wellness Visit.
• Same-day services: ACP can be billed on the same day as another evaluation and management (E/M) visit or the Annual Wellness Visit. It cannot be reported on the same date by the same provider as certain critical care services.

Advance care planning under Medicare Advantage

If you are enrolled in a Medicare Advantage (Part C) plan instead of Original Medicare, your plan must cover everything Original Medicare Part B covers, including advance care planning.

That said, plan-specific rules can differ — your provider network, referral requirements, and exact cost-sharing may not match Original Medicare. To confirm how your plan handles ACP and what (if anything) you would pay, check your plan's Evidence of Coverage or call the member number on your card.