Medicare 2026

Medicare's 2027 Rules Make Room for More Advance Care Planning Help From Your Doctor's Team

Advance care planning is the conversation where you talk through what matters to you if you ever become seriously ill — who should speak for you, what treatments you'd want or want to skip, and how to put those wishes in writing. Starting January 1, 2027, Medicare will pay for more of that conversation to happen with the trained staff who work alongside your doctor, not just the doctor alone.

What's actually changing in 2027

On November 9, 2026, CMS published its CY 2027 physician fee schedule final rule (CMS-1848-F) in the Federal Register. It takes effect January 1, 2027. Among many provisions, it finalizes two new billing codes for advance care planning done by clinical staff under a treating physician's or practitioner's direction:

• G0572 covers the first 20 minutes of staff time.
• G0573 covers each additional 20 minutes of staff time.

These sit alongside the existing advance care planning codes (99497 and 99498), which continue to cover the practitioner's own time. The new staff-time codes can be billed with the practitioner codes when each person's time threshold is met. For the new codes specifically, if staff time alone doesn't quite reach the threshold, practitioner time can be counted along with staff time.

CMS also reiterated that the "direct supervision" requirement for these services can be satisfied by audio-visual technology — meaning the supervising clinician doesn't have to be physically in the same room, as long as they're available in real time by audio-video connection.

Why this matters to you as a patient

Advance care planning takes time to do well. It involves thinking out loud, asking questions, learning what a health care proxy is, and sometimes filling out forms. Doctors' schedules are tight, and in many practices a nurse, social worker, or other trained staff member is better positioned to sit with you for a longer conversation.

The new codes give practices a clear way to be paid when their staff do that work. CMS noted that the use of advance care planning services has grown from about 650,000 services in 2016 to about 2.5 million a year in 2025 — a big jump, but still a small share of the roughly 68 million people on Medicare. The agency said it will update its Advance Care Planning MLN fact sheet to help practices understand existing billing rules.

What you'll pay

Under Medicare.gov's general rule:

• No cost to you when advance care planning is done as part of your "Welcome to Medicare" visit or your yearly wellness visit, and your provider accepts assignment.
• Part B deductible and coinsurance apply when it's provided as part of other medical treatment.

Ask the front desk how the visit will be coded if you're not sure. There's no harm in asking.

Your rights in the conversation

CMS has been explicit: clinicians must not, under any circumstances, attempt to influence your advance care planning decisions. You're not being steered. You can:

• Choose to have the conversation, or decline it.
• Name anyone you trust as your health care proxy (the exact form depends on where you live).
• Change your mind later and update your documents.
• Share your wishes with family members and the hospitals you use.

A few 2027 numbers worth knowing

While we're talking about 2027, here are the national figures CMS has confirmed:

• The Part D out-of-pocket cap rises to $2,400 in 2027 (up from $2,100 in 2026). Once your out-of-pocket spending on covered drugs reaches that cap, you pay $0 for covered drugs the rest of the year.
• The most any Part D plan can charge as a deductible in 2027 is $700.
• The Part D base beneficiary premium for 2027 is $41.33 — a national figure used to calculate the late-enrollment penalty; actual plan premiums are set plan by plan.
• Social Security announced a 3.6% cost-of-living adjustment for benefits payable beginning January 2027.

The 2027 Part B standard premium and deductible, and the 2027 IRMAA income brackets, had not been announced at the time of writing. CMS typically releases those figures in the fall. Check Medicare.gov for the latest.

When you can make Medicare changes

Annual Open Enrollment for 2027 coverage runs October 15 – December 7, 2026, with new choices taking effect January 1, 2027.

If you have Medicaid or Extra Help, you have a monthly Special Enrollment Period to move to Original Medicare paired with a stand-alone Part D plan, or to switch stand-alone Part D plans. If you are full-benefit dual-eligible (both Medicare and full Medicaid), you can join an integrated Dual Eligible Special Needs Plan (D-SNP) in any month.

Original Medicare vs. Medicare Advantage: a neutral note

Advance care planning is covered under both paths, but how you access care differs:

• Original Medicare (often with a Medigap policy and a stand-alone Part D plan): broad access to any provider who accepts Medicare; Medigap can help with out-of-pocket costs; you pay separate premiums.
• Medicare Advantage: bundles hospital, medical, and usually drug coverage through a private plan, often with extra benefits, but typically uses provider networks and prior authorization.

Neither is "better." The right fit depends on your doctors, your medications, your budget, and how you prefer to get care.

Where to go next

For official, up-to-date information on advance care planning, preventive visits, Part D, and enrollment windows, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048), available 24/7.