Obamacare to Send Seniors to Estate Planners before Visiting Their Doctor

End-of-life Medicare consultations ignites new urgency to get wills, trusts, estate plans and medical power of attorney in place.

Physicians can now bill Medicare for hours they spend talking to patients about their healthcare preferences when they reach the end of life or are incapacitated along the way.

Starting today, any senior can initiate a conversation about advance end-of-life health planning as part of the annual Medicare “wellness visit.”

Guidance from Washington and the medical lobby suggests that the goal of this chat is to get seniors to write a living will and assign healthcare power of attorney.

Although it isn’t a mandatory part of the check-up, the fact that doctors are now being paid extra to do so makes them a lot more eager to bring up the topic and guide the conversation toward a signature on the dotted line.

Naturally, this impinges on traditional estate planning territory, but a formal will still trumps whatever happens in the doctor’s office. That’s likely to drive a lot of will-less seniors to finally get legal counsel before their next check-up.

Most needed a will anyway

The good news is that most of these people needed to get some estate planning documents on record anyway.

New numbers from legal information site FindLaw reveal that a full 55% of the adult American population don’t even have a will, much less a power of medical attorney statement, healthcare directive or trust.

The proportion of those who do have a will climbs as people get older and wealthier, but it still hasn’t really budged in the last decade.

As it is, a full 37% of the ultra-high-net-worth people that PNC Advisors surveyed a few years ago -- $10 million to invest and more -- have no estate planning documents in place and 58% have never even talked about it with close family.

Since the whole point of trust documents and other “living will” directives is to document people’s desires before physical infirmity robs them of the ability to speak for themselves, the time to get the process rolling is before someone is sick and sitting in a doctor’s office.

A medical directive, for example, can override any informal “advance medical planning” discussion as long as it’s drafted and signed while someone is still in good physical and mental health.

“Better than nothing” is still not great

Most of the ultra-wealthy people PNC surveyed said they’re simply putting off their estate planning (56%) or actively trying to avoid coming to grips with their own mortality (12%).

Relatively few of these mega-millionaires will ever find themselves in the Medicare clinic anyway, but if their attitudes are anything like those of the clients that run-of-the-mill estate planners typically work with, the annual check-up may be the only chance people have to confront the issue.

For these people, the sentiments expressed by end-of-life planning advocates ring true even if it’s a doctor and not an estate planner on the other side of the desk.

“An individual’s personal wishes, beliefs and values are among the most important factors when making care decisions brought about by a serious or life-limiting illness,” Donald Schumacher of the National Hospice and Palliative Care Organization recently told CNN.

“Such wishes and preferences can be known only if they are discussed openly,” he added.

In these circumstances, a Medicare-mandated healthcare directive may theoretically be better than nothing -- or more to the point, it’s a good first start.

Although even a scribbled healthcare directive can serve in the absence of any other formal statement, a formal living will drafted before or after the Medicare visit will probably take precedence if there are discrepancies or changes.

There’s no evidence that Medicare is leaning on doctors to suggest “do not resuscitate” orders or other money-saving but life-shortening instructions be added to healthcare directives.

But people who are worried about signing anything while they’re sick or in a confused state of mind need to get their wishes on paper as soon as they can.

While they’re at it, these people need to set down their wishes for how they want their property distributed after death.

A stunning 58% of the ultra-high-net-worth types PNC surveyed have never talked to their close family -- much less their lawyers -- about the transfer of their worldly goods.

That’s a real opportunity for estate planners looking to capture a bit of business in the new year.

Scott Martin, contributing editor, The Trust Advisor Blog. Steve Maimes contributed to the editing and research.


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