Thursday, July 14, 2016

New Eligibility Criteria for End of Life Care

Talking about one’s last days is not a pleasant exercise. We all know that we will die one day, but it is human nature to try and avoid discussing it. However, thinking about it, talking about it and planning for the end, unpleasant though it is, can take away some of the pain, both for you and those you leave behind.

Preparing For the End

Millions of California residents are eligible for health care benefits that will affect the nature and quality of care they will receive in their last day. The problem is that many of them do not know about it. Both Medicare and Medi-Cal (the state version of Medicare aimed at those with low incomes) are now offering coverage for discussions between patients, or their family members, and medical professionals on end of life care. This does not mean finding and moving to a nursing home or assisted living facility – those options can be exercised at the patient’s discretion. What Medicare and Medi-Cal are now offering, is planning for what happens if you are unable to communicate your wishes for treatment. For example, if you have a stroke that leaves you unable to communicate, and unconscious, do you want to be placed on a ventilator or would you prefer to pass on naturally? Who will make these decisions for you? The quality of your life, or of your death, could depend on this.

You Can Talk To Your Doctor

Medi-Cal, which covers 13 million Californians covers advance care planning between doctors and patients / family members. Doctors can bill for these discussion twice every year without prior authorization. There is no patient age limitation for this. Medicare, with 5 million members in California, offers covers for these planning discussions for those over 65 years of age and also for younger people with specific disabilities. There is no limit on the number of discussions with the doctor.

The aim of this coverage is to enable people to prepare an “Advance Care Directive” that will dictate the course of their medical treatment if they are unable to communicate these themselves. You can state what treatment is acceptable, under what conditions and when a DNR (Do Not Resuscitate) will come into force.

Many doctors are uncomfortable initiating these discussion, both on a personal level and because they feel that a patient may misunderstand the intent and become upset. If your doctor is hesitant to discuss these issues, it is up to you to carry the conversation forward, understand the options for you and your family and then formally document the decisions that have been made. You have the freedom to change your decisions at a later date if so desired.

Talk To Your Insurance Agent

Along with Medicare and Medi-Cal, some private insurance plans also cover end of life planning discussions. If you are not covered or unsure of your coverage, talk to an insurance professional to know what your status is and if needed, get an insurance plan that provides you this coverage. You owe it to yourself and those you love.

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