Advance care planning outreach: Medicare coverage, voluntary wording and HIPAA for patient invitations

Advance care planning is a conversation about the care a patient would want if they could no longer make decisions for themselves, and about who should speak for them. Primary care, geriatrics, cardiology, oncology, nephrology and pulmonology practices offer it, and so do hospitals, nursing homes, home health agencies and hospices. Inviting patients to it is different from promoting any other service. The patient has to feel free to say no, the topic touches fear and grief, and the cost depends on when and how the conversation happens. This guide covers how to describe the service, how to word cost, what the privacy rules say about invitations, and what to avoid.

Two related topics have their own guides and are not repeated here. Inviting patients to the Medicare yearly wellness visit, where advance care planning can be an optional part, is in our annual wellness visit outreach guide. Marketing a palliative care program, including how it differs from hospice, is in our palliative care marketing guide.

What advance care planning is, in Medicare’s words

The Medicare.gov page on advance care planning describes it as “discussing and preparing for care you would get in the future if you need help making decisions for yourself.” It explains that a patient may choose to complete an advance directive, which it calls a legal document that records wishes about future medical treatment, and that advance directives include 2 parts: a health care proxy, which the page notes is also called a durable power of attorney, who makes decisions if the patient cannot, and a living will that describes which treatments the patient wants if their life is threatened.

The CMS fact sheet for clinicians, Advance Care Planning (MLN909289, March 2026), calls it “a voluntary, face-to-face discussion” between the clinician and the patient or their family member, caregiver, or surrogate, as appropriate. It says the discussion may cover advance directives “with or without helping a patient complete legal forms.” Use this language on your service page. It is plain, it comes from the payer, and it does not promise anything the visit cannot deliver.

Describe what happens in your visit in the same plain terms:

• Who leads the conversation: a physician, nurse practitioner, physician assistant or clinical nurse specialist, as your practice staffs it.
• Who may come: the patient, and a family member, caregiver or the person they may name as their agent.
• Where it can happen: in the office, at home, in a nursing home or hospital, or by video if telehealth rules in effect at the time allow it.
• What the patient leaves with: a chance to talk through wishes, an explanation of the forms used where they live, and help completing them if they want it.

Voluntary means the patient decides, so say so

The federal sources cited here share one word for this service. Medicare.gov says Part B covers “voluntary advance care planning.” The CMS fact sheet says clinicians must document “the fact that the visit was voluntary.” The rule for the yearly wellness visit, 42 CFR 410.15, lists advance care planning as something furnished “at the discretion of the beneficiary.” Medicare.gov also tells patients: “You have the right to carry out your plans as you choose without discrimination.”

Your outreach should read the same way. An invitation that sounds like a required step, a deadline or a warning works against the rule your clinician has to document. Phrases to leave out of letters, texts, ads and call scripts:

• “Required for all patients over a set age” or “needed before your next visit.”
• “Don’t leave your family to decide” or any line built on guilt or fear.
• “Complete your paperwork today” as a call to action on the first contact.
• Any suggestion that a patient’s care, scheduling or standing with the practice depends on having a directive.

Wording that fits: “If you would like to talk about your wishes for future care and who you would want to speak for you, our clinicians can set aside time for that conversation. It is your choice, and you can change your mind or update your plans at any time.” The last part echoes Medicare.gov, which says “You can update your advance directive at any time.”

Cost wording: when the patient pays nothing, and when they do not

Cost is where invitations go wrong. Medicare.gov states the rule this way: “You pay nothing if your health care provider accepts assignment and this planning is part of your ‘Welcome to Medicare’ or yearly ‘Wellness’ visit. If you get it as part of other medical treatment, the Part B deductible and coinsurance apply.” The CMS fact sheet adds the billing conditions for the waiver when the planning happens with the yearly wellness visit: same day, same provider, billed on the same claim with the preventive services modifier. It also says that if the wellness visit is denied for exceeding the once-per-year limit, the deductible and coinsurance apply to the planning.

So a line such as “free advance care planning for Medicare patients” is wrong as soon as the conversation happens at a separate visit or alongside other treatment. Under 16 CFR 251.1, the FTC guide on the use of the word free, all the terms and conditions of a free offer “should be set forth clearly and conspicuously at the outset of the offer.” Section 5 of the FTC Act, 15 U.S.C. 45, prohibits deceptive acts and practices, and 15 U.S.C. 52 covers false advertisements for services. Safer wording for Medicare patients repeats the two conditions: no cost to you when it is part of your Welcome to Medicare or yearly Wellness visit and we accept assignment; at other visits, your Part B deductible and coinsurance apply.

For patients with other coverage, say that cost depends on their plan and that your staff will check before the visit. Do not copy the Medicare wording onto a page aimed at everyone.

The CMS fact sheet also says there is no limit on the number of times advance care planning can be reported for a patient in a period, and that when it is billed more than once in a year, the record should show a change in the patient’s health status or wishes. That is a billing and documentation point for your clinicians. It is not a reason to send repeated invitations to the same patient, and recall messages should never be timed to billing.

Forms are set state by state, and lawyers still have a role

The CMS fact sheet says advance directives “can differ from state to state” and that clinicians can generally find the forms through the state attorney general. It lists examples: do not resuscitate orders, health care powers of attorney, health care proxies, instruction directives, living wills, medical orders for life-sustaining treatment, and psychiatric advance directives. Witness, notary and agent rules are set state by state as well.

Two practical points follow for your website. First, do not post a single downloadable form as if it works everywhere; link to the source your state uses, or say your staff will provide the current form at the visit. Second, Medicare.gov says patients can talk about an advance directive “with an attorney or your health care provider.” Do not suggest a clinical visit replaces legal advice when a patient has questions about estates, guardianship or property. Your page can say that the visit covers health care wishes and the forms used for them, and that legal questions belong with a lawyer.

Medicare.gov also names places patients can go for help: their provider or attorney, the Eldercare Locator, and their state health department. Citing those as further help is fine. Do not imply your practice is affiliated with any of them.

Who to invite, and what HIPAA says about the invitation

The HIPAA Privacy Rule defines marketing in 45 CFR 164.501 as a communication about a product or service “that encourages recipients of the communication to purchase or use the product or service.” The same definition carves out communications made for treatment of an individual, including care coordination, and communications that describe “a health-related product or service” that is provided by the covered entity making the communication. The carve-outs do not apply where the covered entity receives financial remuneration from a third party in exchange for making the communication.

In practice, a message from your practice to your own patients inviting them to an advance care planning visit with your clinicians fits the description of your own health-related service, as long as no outside party pays you to send it. Under 45 CFR 164.508(a)(3), a communication that is marketing needs the patient’s written authorization, with two narrow exceptions: a face-to-face communication and a promotional gift of nominal value. Where a third party pays, the authorization must state that remuneration is involved.

Situations that cross that line:

• Sending patients a flyer for an estate planning law firm, funeral home, insurance agent or senior living community that pays you or gives you something in return.
• Sharing a list of older patients with any outside business so it can contact them about wills, trusts or end-of-life products.
• Sponsoring an advance care planning seminar with a business that receives the attendee list.

Choosing whom to invite also deserves care. Selecting patients from the record by diagnosis, prognosis or recent hospital stay is a clinical decision for your clinicians, and the message itself should not reveal why someone was chosen. A text that reads “because of your recent diagnosis, we recommend planning now” discloses health information to anyone who sees the phone and turns a voluntary offer into pressure. A neutral line that invites the patient to talk with their clinician about future care wishes does neither.

Your website needs the same care. A page about advance care planning, a booking form for it, or a quiz about end-of-life wishes tells a tracking tool something about the visitor’s health. Keep ad tracking off those pages, and ask for contact details only on the first form.

Hospitals, nursing homes, home health and hospice: rules already apply

If your organization is a hospital, critical access hospital, rural emergency hospital, skilled nursing facility, nursing facility, home health agency, hospice or another provider listed in 42 CFR 489.102, the regulation already sets duties around advance directives. Those providers must give adult patients written information about their rights under state law to make decisions about medical care, including the right to accept or refuse treatment and to formulate advance directives “at the individual’s option.” They must document in the record whether the person has executed one, and must “Not condition the provision of care or otherwise discriminate against an individual based on whether or not the individual has executed an advance directive.”

The same section requires these providers to educate staff and to “Provide for community education regarding issues concerning advance directives,” and says a provider must be able to document its community education efforts. That gives a facility a legitimate reason to run public talks and publish plain guides. Keep those materials educational, keep the no-conditioning rule visible in admission and intake copy, and keep a record of what you ran, when and for whom.

Community talks and seminars

A public talk on advance directives at a library, senior center or place of worship can be useful, and it is not a sales event. Points that keep it that way:

• Describe the talk by its content and speaker credentials, with no promise of a form completed or a legal outcome.
• Collect sign-in details only if attendees choose to give them, and say what you will do with them.
• Do not sign people up for a visit at the event; give them a way to call later if they want to.
• Keep paying partners out of the room unless attendees are told who they are and nothing about attendees is shared with them.
• Hand out forms only from the official source your state uses, with the date you printed them.

Tone, grief and the crisis line

Content about future care can reach people who are scared, grieving or exhausted from caregiving. Write with plain words, no countdowns, no images of hospital beds or sad families staged for effect, and no lines about how long anyone has left. Do not present the practice as a crisis service. Where your pages or messages discuss fear, loss or caregiver strain, add one plain line: if you or someone you care for is in crisis, call or text 988; for a medical emergency, call 911. The SAMHSA 988 page describes 988 as offering 24/7 support, and says to text, call or chat 988.

Illustration: two invitations for the same service

Illustration: a primary care practice sends a text to patients over a set age that reads “Medicare now requires an advance directive. Book your FREE planning visit this week so your family isn’t left guessing. Reply YES.” It names a requirement that does not exist, attaches free without the conditions, uses guilt, and asks for an immediate commitment by text.

Illustration: the same practice rewrites it as “[Practice name]: If you would like to talk about your wishes for future medical care and who you would want to speak for you, our clinicians can make time for that conversation. It is your choice. For Medicare patients, there is no cost when it is part of your Welcome to Medicare or yearly Wellness visit and we accept assignment; at other visits your Part B deductible and coinsurance apply. Call [phone] if you would like to schedule. Reply STOP to opt out.” It is voluntary, the cost wording carries the conditions, and nothing in it reveals a diagnosis.

Checklist before an advance care planning campaign goes live

• The service page uses Medicare’s own description and says the conversation is voluntary.
• No message calls planning required, uses a deadline, or ties care or scheduling to having a directive.
• Medicare cost wording carries both conditions: Welcome to Medicare or yearly Wellness visit, and assignment.
• Other coverage is described as checked before the visit.
• Forms are linked to or supplied from the official source your state uses, and legal questions are pointed to a lawyer.
• Invitations describe only your own service, and no outside business pays for or receives anything from them.
• Messages do not reveal why a patient was selected.
• No ad tracking runs on planning pages or booking forms, and first forms ask for contact details only.
• Facilities listed in 42 CFR 489.102 keep the no-conditioning rule in intake copy and document community education.
• Emotional content carries the 988 and 911 line, separate from any form.

How we help

We build websites, local search, Google Ads and AI front desk tools for independent practices and health businesses. For advance care planning, that means service pages that use Medicare’s own words, search content written around the questions families ask, and inquiry forms that keep health information away from tracking tools. We do not decide coverage, forms or clinical questions; your clinicians and counsel do. Our tools are built with HIPAA in mind. We confirm in writing what a BAA covers before any patient information flows through a tool, and if it is not covered, we do not route patient information through it. We are not a healthcare provider and we do not give legal or medical advice. We do not sell lead lists and we do not pay for referrals. For the wider rules, see our healthcare marketing rules hub.

Sources

• Medicare.gov: Advance care planning
• CMS MLN fact sheet: Advance Care Planning, MLN909289 (March 2026, PDF)
• 42 CFR 410.15: Annual wellness visits
• 42 CFR 489.102: Requirements for providers (advance directives)
• 45 CFR 164.501: Definitions (marketing)
• 45 CFR 164.508: Uses and disclosures for which an authorization is required
• 15 U.S.C. 45: Unfair methods of competition unlawful
• 15 U.S.C. 52: Dissemination of false advertisements
• 16 CFR 251.1: Guide concerning use of the word free
• SAMHSA: 988 Suicide and Crisis Lifeline

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