Georgia Medicare End-of-Life Care Coverage (2026)

If someone you love has been told their illness is terminal, Medicare already covers most of the care that can keep them comfortable at home, and a Georgia family pays close to nothing for it. Yet most families do not learn this until the final weeks, after months of support have already slipped by. This guide explains how Medicare pays for end-of-life care in Georgia, how Georgia's own advance directive and POLST laws let you record your wishes, and how the two fit together when a serious illness reaches its final stage.

Three things are in play at once, and they are governed by different rules. Medicare, a federal program, pays for the medical care: hospice, advance care planning, and palliative care. Georgia law decides what your written wishes can say and who speaks for you when you no longer can. And your family carries the decisions. Understanding each piece before a crisis, rather than during one, is the single most useful thing a Georgia family can do.

How Medicare covers end-of-life care in Georgia

Medicare's support for end-of-life care rests on three provisions that work together. Knowing what each one pays for tells you what to ask a Georgia doctor or hospital for, and when.

The hospice benefit (Part A)

The Medicare hospice benefit is a Part A benefit that pays for comfort-focused care for people who are terminally ill. To elect it, the beneficiary must be certified by a physician as terminally ill with a life expectancy of 6 months or less if the illness runs its normal course, and must choose hospice (comfort) care instead of curative treatment for that terminal illness. Other Medicare benefits stay in place for unrelated problems: a hospice patient with terminal cancer who breaks a hip in a fall can still have the fracture treated.1

Coverage is organized in benefit periods: two 90-day periods, then an unlimited number of 60-day periods, each requiring recertification that the illness is still terminal. Hospice covers nursing, physician and social-work services, counseling (including spiritual and bereavement support), short-term inpatient and respite care, a home health aide, durable medical equipment, medications for the terminal illness, and therapy. A beneficiary can revoke hospice at any time and return to standard Medicare, and re-elect later if they still qualify.1

Medicare pays the hospice a daily rate at one of four levels of care defined in federal regulation: Routine Home Care (the most common), Continuous Home Care during a symptom crisis, Inpatient Respite Care to give a family caregiver a short break, and General Inpatient Care for acute symptoms that cannot be managed elsewhere. For FY2026, the base Routine Home Care rate is $230.83 per day for days 1 through 60 and $181.94 per day after that, before the local wage-index adjustment. Separately, a hospice's total Medicare payments for a cap year are limited by an aggregate cap: $35,361.44 for the FY2026 cap year, multiplied by the number of Medicare beneficiaries the hospice cared for that year. Anything paid above that aggregate is an overpayment the hospice must refund. This is a limit on the hospice's books, not on any one patient's care, and it does not cut off an individual patient's benefit.4,5,6

For the family, the cost is close to nothing. Medicare hospice charges no more than a $5 copayment for each outpatient prescription drug for pain and symptom management, and 5% of the Medicare-approved amount for inpatient respite care. A Medigap policy or Medicaid (for dual-eligible beneficiaries) typically covers even those small amounts.1

Advance care planning (ACP)

Part B of Medicare covers advance care planning, a voluntary conversation with a doctor or other qualified provider about the care you would want in the future if you became unable to make decisions for yourself. It may include completing an advance directive, and it is billed under two dedicated codes (CPT 99497 for the first 30 minutes and CPT 99498 for each additional 30 minutes). Choosing to have, or not have, this conversation does not affect any other Medicare benefit.2

The cost depends on when it happens. You pay nothing for advance care planning when it is provided as part of your one-time preventive visit as a new enrollee or your yearly Annual Wellness Visit, as long as the provider accepts assignment. If it is done separately, as part of other treatment, the standard Part B deductible ($283 in 2026) and 20% coinsurance apply, and a Medigap policy usually covers the coinsurance. The simplest way to get it at no cost is to ask your primary care doctor to include it at your next yearly Wellness visit.2,3

Palliative care

Palliative care is specialized care that relieves the pain, symptoms, and stress of a serious illness, and it can be provided alongside curative treatment at any stage, not only at the end of life. Medicare covers palliative care consultations and family meetings as ordinary physician services under Part B, with the standard Part B deductible ($283 in 2026) and 20% coinsurance, again usually covered by Medigap. Most large Georgia health systems, including Emory, Wellstar, Piedmont, Northside, and Grady, run palliative care services; ask your doctor for a referral.3

The Patient Self-Determination Act

A 1990 federal law, the Patient Self-Determination Act, is the reason a Georgia hospital or nursing home asks at admission whether you have an advance directive. It requires every Medicare-participating provider to tell patients about their advance directive rights under state law, to document whether they have one, and to never condition care on whether they do. The law is procedural: it makes providers ask and inform, but the substance of what an advance directive can say is left to each state.

Georgia's advance directive law: O.C.G.A. §31-32

Georgia's Advance Directive for Health Care Act, codified at O.C.G.A. §31-32, is the state law that gives your wishes legal force. A 2007 revision folded Georgia's older living-will and health-care-power-of-attorney laws into a single statutory form with four parts you can complete independently:

• Part 1, Health Care Agent. You name an agent (and optional backups) to make medical decisions once a physician determines you cannot. The agent must follow your stated wishes or, if unknown, act in your best interest.
• Part 2, Treatment Preferences. You state what you want in a terminal condition or a permanently unconscious state: whether you want CPR, a breathing machine, tube feeding, or IV fluids, or whether your agent should decide.
• Part 3, Guardianship. You can nominate someone a court should consider as guardian if one is ever needed.
• Part 4, Anatomical Gifts. You record organ- and tissue-donation wishes.

Signing it. You must be 18 or older and of sound mind, and two competent adult witnesses must sign. Witnesses cannot be a health care provider directly involved in your care, facility staff, someone financially responsible for your care, or a beneficiary of your estate (limited exceptions apply for relatives). Georgia does not require a notary. You can revoke the directive at any time, orally or in writing, by destroying it, or by signing a new one.

Two Georgia-specific points matter. Under O.C.G.A. §31-32, an advance directive is inoperative during pregnancy. And if you never complete one, Georgia's surrogate law (O.C.G.A. §31-9-2) sets who decides for you, in order: your spouse, then adult children, then parents, then adult siblings. That default may not match what you would have chosen, which is the strongest reason to name an agent yourself while you can.

Georgia POLST: turning wishes into medical orders

An advance directive says what you want. A POLST (Physician Orders for Life-Sustaining Treatment) is a physician-signed medical order that turns those wishes into instructions emergency responders and clinicians can act on immediately. It is meant for people who are already seriously ill or frail, not for healthy adults, for whom an advance directive is the right document.

The Georgia POLST form is a single bright-pink page that travels with the patient. It records three choices: whether to attempt CPR; how much medical intervention to provide (comfort measures only, selective treatment, or full treatment) for someone who still has a pulse and is breathing; and whether to use artificial nutrition by tube. Both the physician (or APRN) and the patient or their representative sign it. Georgia EMS recognizes POLST and must honor it in the field, which is its whole point: an EMS crew arriving at a home can see the form and follow it. Keep it where it can be found fast, such as on the refrigerator or by the bed, and give copies to any facility where the patient lives. You complete a Georgia POLST with a physician; the Georgia POLST Coalition (678-553-3500) maintains the form.

Curative, palliative, and hospice care: what's the difference

Families most often get stuck on three words that sound similar but mean different things.

• Curative care aims to cure or control the disease itself: chemotherapy, surgery, dialysis. Medicare covers all medically necessary curative care.
• Palliative care treats the symptoms and stress of a serious illness and can run alongside curative treatment at any stage. It does not mean giving up.
• Hospice care is for someone who is terminally ill (a prognosis of 6 months or less) and has chosen to stop curative treatment for that illness in favor of comfort. It is intensive, active care, not the absence of care.

Two myths cause real harm. The first is that hospice means "giving up"; in practice it delivers more hands-on comfort care, not less. The second is that hospice is only for cancer or only for the last few days. Advanced heart failure, COPD, dementia, end-stage renal disease, ALS, and liver disease can all qualify, and because eligibility is a 6-month prognosis, many people receive weeks or months of support, not days. Waiting until the final week is the most common and most costly mistake.1

Two Georgia families and Medicare end-of-life care

These composite examples show how the pieces fit together, both when a family has planned ahead and when a crisis arrives with no plan in place.

Margaret, 78, Atlanta: planning ahead with hospice

Margaret, a retired Atlanta pharmacist, had metastatic pancreatic cancer. After a course of chemotherapy and a procedure to relieve a blocked bile duct, her scans showed the cancer was spreading and the treatment was no longer working. During a hospital stay at Emory University Hospital, her oncologist asked the palliative care team to meet with Margaret and her family.

The conversation, which Medicare paid for, was unhurried. The palliative care doctor asked what Margaret understood, what she hoped for, and what she feared. She was honest that further chemotherapy was unlikely to give Margaret meaningful time and might cost her comfort, and that hospice could deliver intensive care at home. Margaret was clear: "I want to go home. I want to be comfortable. No more chemo."

Over the next hour the team helped Margaret complete a Georgia advance directive, naming her husband as agent and her eldest daughter as backup, with her wishes recorded: no CPR, no breathing machine, no artificial feeding, comfort measures yes. The doctor then signed a Georgia POLST reflecting those choices. Margaret went home the next day with hospice care beginning that afternoon: a nurse, a hospital bed, medications for symptoms, a home health aide, and a 24-hour phone line the family used twice for symptom flares that the on-call nurse handled without a hospital trip. Medicare paid the hospice its daily Routine Home Care rate ($230.83 a day for the first 60 days in 2026) directly, so Margaret's family owed close to nothing. She died at home five weeks later with her family present, and the hospice provided the family bereavement support for the following year.4,1

Charles, 84, Augusta: a crisis with no advance directive

Charles, a retired electrician, had never completed an advance directive. One morning he had a large stroke on the left side of his brain and could no longer speak or move his right side. His wife called 911 and he was taken to Augusta University Health, where he was found to be beyond the window for the clot-dissolving drug and was admitted to the neuro ICU.

Because Charles could not communicate and had no directive, Georgia's surrogate law (O.C.G.A. §31-9-2) put his wife in the role of decision-maker. The stroke and palliative care teams held a family meeting: the prognosis for meaningful recovery was poor, and the choice was between aggressive interventions (a feeding tube, a tracheostomy, indefinite ICU care) and comfort-focused care. His wife recalled Charles saying he never wanted to live "hooked up to machines," and his daughters agreed. She chose comfort care, and, as Georgia practice requires for this kind of decision without a directive, two physicians documented it. Charles was moved to the palliative care unit and died a few days later with his family at his side.

Charles's family carried a heavy weight his wife described afterward as "guessing what Dad would have wanted." Margaret's family did not, because Margaret had told them. That difference, made while a person can still speak, is the practical reason to complete an advance directive before a crisis rather than during one.

Medicare Advantage, dual eligibility, and appeals

Medicare Advantage. Medicare Advantage plans (Part C) must cover advance care planning and palliative care, and hospice is a carve-out: even for someone enrolled in an Advantage plan, Original Medicare (not the plan) pays the hospice benefit. Some Advantage plans add supplemental benefits, such as caregiver support or meal delivery, for chronically ill enrollees.1

Dual eligibility. For Georgia residents who have both Medicare and Medicaid, Medicaid fills gaps Medicare does not cover. When a hospice patient lives in a nursing facility, Medicare hospice covers the hospice services but not the room and board; Georgia Medicaid, run by the Georgia Department of Community Health (1-866-211-0950), covers room and board for full-benefit dual-eligibles. Medicaid also covers Medicare's Part B cost-sharing for dual-eligibles, and Georgia's home and community-based waivers, the Community Care Services Program (CCSP) and SOURCE, can add caregiver support alongside end-of-life care.7

Appeals. If a hospice will not certify or recertify a patient, or a palliative care claim is denied, you can appeal. Start with the provider's or plan's own process, then use Medicare's standard appeal levels; for free help, call 1-800-MEDICARE or Georgia's SHIP counselors. Quality complaints, such as premature discharge or poor symptom management, go to Medicare's Beneficiary and Family Centered Care quality-review contractor.

Learn More

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The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.