End of Life Care and Self-Funded Plans

On January 1, 2016, Medicare began providing coverage for advance care planning.   This service includes “early conversations between patients and their practitioners, both before an illness progresses and during the course of treatment, to decide on the type of care that is right for them.” (1)

On January 1, 2016, Blue Cross Blue Shield of Massachusetts also began offering coverage for services that address end-of-life issues.  The insurer “will pay for more counseling sessions between providers and patients to discuss end-of-life care and expand access to hospice services.” (2)

Hospitals are also providing resources and information to patients.  Some are educating patients and families about palliative care options and others are encouraging patients to create written health directives that can be accessed by electronic medical records and by family members facing difficult decisions.

Why are they doing this?

End-of-life care is expensive.  In 2011, Medicare spending for seniors who died during the year averaged $33,500 per beneficiary, four times more than survivors. (3)  About 75% of the people who died in 2010 were 65 and older, making them likely to be covered by Medicare.  But that leaves the other 25%, approximately 625,000 people, under 65 and more likely to be in the workforce.  (4)  One large-scale study of cancer patients found that costs were about 33% less for patients who had end-of-life discussions than for those who didn’t.

There is a disconnect between the treatment people want and the treatment they receive.  Research shows that about 90% of people would like end-of-life services in their homes.  (6)  However, only 30% of people are cared for in this way.  Perhaps earlier intervention and guidance from physicians will educate people on how to find the resources to remain at home receiving palliative care vs. expensive medical interventions and in-patient courses of treatment.

What should your organization do about it?

If your organization employs someone at the end-of-life, the cost of his/her care will likely be high enough to affect your stop loss insurance.  The cost of end-of-life care is compounded by preceding care for a chronic illness or catastrophic event.   What should your organization do to protect your self-funded plan?

  • Be sure that any of your Medicare eligible employees are enrolled so that Medicare coverage will apply.
  • When your health policy renews, consider a plan with a carrier that offers end-of-life coverage.
  • Provide your employees with educational tools from non-profits such as the Conversation Project to help families discuss end-of-life wishes. Many people want less medical intervention, and yet that is not the common trajectory once someone is admitted to a hospital.

If you have additional questions about end of life care for your self-funded plan, please contact us.


(1) Centers for Medicare & Medicaid Services

(2) Boston Globe

(3) Henry J Kaiser Family Foundation

(4) Center for Disease Control

(5) Archives of Internal Medicine (2009)

(6) Henry J Kaiser Family Foundation