Medicare Advance Care Planning: Cost & How It Works (2026)

Medicare advance care planning, the talk with your care team about the care you'd want if you ever couldn't speak for yourself, is free at your yearly Wellness visit. Putting that conversation off is completely understandable, and the reassuring part is that having it costs most people nothing. There is one wrinkle families do get billed by, so this guide explains what it covers, what it costs in 2026, and the one thing to ask your provider so the conversation stays free.

What the conversation actually looks like

If the phrase sounds clinical, the reality is more human than that. Advance care planning is simply a face-to-face conversation about the kind of care you would want in the future if you ever couldn't make decisions for yourself. Nothing more is required of you than talking, and you can move at whatever pace feels right.

Two details widen who that conversation can involve, and both matter to real families. It does not have to be a physician: throughout its billing guidance Medicare treats a nurse practitioner, physician assistant, or clinical nurse specialist as able to hold and bill the conversation, provided their scope of practice and Medicare benefit category cover it and they are authorized to bill Medicare independently. And it does not have to include the patient. Medicare defines the service as a discussion between the practitioner and the patient or their family member, caregiver, or surrogate, as appropriate, so a family can have the conversation on behalf of someone who can no longer take part in it.1

That conversation may also include completing an advance directive, a document that records your wishes so the people around you know what you'd choose. The two most common forms do different jobs. A living will spells out the treatments you would or wouldn't want, such as whether you'd want a ventilator or a feeding tube. A health care proxy, sometimes called a durable power of attorney for health care, names a person you trust to make decisions for you when you can't. Many people complete both: one says what you want, the other says who speaks for you. You don't have to complete either to have the conversation.1

This is your plan, in your words. It exists so that if a hard moment ever comes, your family and your care team already know what matters to you, instead of having to guess.

What Medicare advance care planning costs

For most people the cost here is the simplest part, and it is usually nothing. But the "free" promise has a condition, and the condition is exactly where families get an unexpected bill.

Medicare Part B covers advance care planning, and medicare.gov says you pay $0 for it when it's done as part of your one-time Welcome to Medicare preventive visit or your yearly Wellness visit, as long as your provider accepts assignment. CMS's own billing guidance is narrower: it waives the cost only at the yearly Wellness visit and never mentions the Welcome to Medicare visit, so if you plan to have the conversation at that first visit, ask the office before the appointment whether you'll owe anything. Both of those wellness visits are themselves $0 preventive services, with the Part B deductible waived.1,3

Here is the part that catches families off guard. That $0 price holds only when the conversation happens during the wellness visit and your provider bills it as part of that visit. If advance care planning is split into a separate follow-up appointment, or you raise it at a sick visit for something else, it's billed on its own, and the standard Part B cost-sharing applies: you pay the deductible if you haven't met it yet ($283 in 2026), then 20% of the Medicare-approved amount.1,2

So the single most useful thing you can do is ask for the timing on purpose. Tell your provider you'd like to include advance care planning during your Annual Wellness Visit, so it's billed into that visit and stays free. Under CMS's billing rules, the deductible and coinsurance are waived only when the planning happens on the same day as your Annual Wellness Visit, with the same provider, billed on the same claim and coded as a preventive service. If that Wellness visit is denied because it goes over the once-a-year limit, the usual cost-sharing applies to the planning too. Knowing that ahead of time lets you choose the moment instead of being surprised by a charge later.1

Here is the same rule at a glance.1,2

Your advance directive stays yours to change

One worry that comes up often: people assume that once they complete an advance directive, they're locked into it. It doesn't work that way. Nothing about it is permanent against your will: you can update your advance directive at any time.1

Because it only helps if the right people can find it, the most useful thing you can do is share copies with the people who'd need them: your family, the person you've named as your proxy, and your providers. If you ever can't speak for yourself or tell anyone you have one, federal rules let your provider give advance directive information to your family or surrogate in line with your state's law.1

A practical note: advance directives can differ from state to state, so it's worth checking your own state's requirements, especially if you move. The forms can generally be found through your state attorney general. For help, Medicare points people to their provider or an attorney, the Eldercare Locator, and their state health department.1

How to start Medicare advance care planning

You don't need to prepare anything to begin. The simplest path is to raise it at an appointment you already have coming up: at your next Annual Wellness Visit, tell your doctor you'd like to include advance care planning. Because it's covered at no cost during that visit, that one sentence is often all it takes.1

If you want to put your wishes in writing, you can complete an advance directive on your own, before or after the visit, using the state-specific forms above. You may also hear about medical orders for life-sustaining treatment or a do-not-resuscitate order. CMS counts both among the forms an advance directive can take, alongside living wills and health care proxies, and your provider can tell you whether one fits your situation.1 If you have a question about your Medicare coverage first, you can call 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048) and talk with a real person any time, day or night, except some federal holidays, or read Medicare's own overview at medicare.gov.4

When to revisit it

Advance care planning isn't a one-time errand you check off. The wishes you'd record at 65 in good health may look different after a serious diagnosis, a hospitalization, or the loss of a spouse.

It's a kindness to yourself to revisit the conversation after any major health change, and to make sure the people who'd act on your behalf still have current copies. Because the yearly Wellness visit can include advance care planning at no cost, that annual appointment is a natural, low-pressure time to ask whether anything in your plan should change.1

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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.