Why Medicare can't pay
Washington voters approved the Death with Dignity Act, Initiative 1000, in November 2008, and it took effect March 5, 2009 (chapter 70.245 RCW). It lets certain terminally ill adults request medication they can take themselves to end their lives. But Medicare is a federal program, and 42 U.S.C. 14402 says federal health care funds may not be used to provide or pay for any item or service furnished to cause, or assist in causing, a person's death, or to pay for coverage that includes it. That covers Medicare Part A, Part B and Part D, and Medicare Advantage plans, which are paid with Medicare funds.
The same federal law makes clear that it doesn't restrict care to relieve pain or discomfort, even care that may increase the risk of death, or withholding or withdrawing treatment.
What Medicare still covers at the end of life
- Hospice. If your doctor and the hospice medical director certify that you are terminally ill with a life expectancy of six months or less, Part A covers hospice care focused on comfort, including medications for pain and symptoms, nursing, medical equipment, social work, and grief support for your family. You keep Medicare coverage for health problems unrelated to the terminal illness. Hospice is covered under Original Medicare even if you have a Medicare Advantage plan.
- Advance care planning. Medicare covers voluntary conversations with your doctor about your wishes, such as a POLST form or an advance directive, as part of a visit or your yearly wellness visit.
- Palliative care to manage symptoms is covered under Part A and Part B like other medically necessary care.
How the Washington law works
To qualify, you must be an adult Washington resident who can make and communicate informed decisions and has a terminal disease expected to cause death within six months. You make an oral and a written request to your attending qualified medical provider and repeat the oral request at least seven days after the first one; the provider must offer you a chance to rescind it. Only willing providers take part, and a hospital, hospice or other provider may prohibit participation on its premises if it gives notice of its policy. The Department of Health collects required forms; it paused its annual statistical reports after 2025 budget cuts but says access under the Act remains in place.
Washington law also protects your insurance: under RCW 70.245.170, a request can't affect life, health or accident insurance or annuities.
Get help
Talk with your doctor or hospice team about end-of-life options, and see Death with Dignity and end-of-life care. For questions about how your Medicare plan covers hospice and palliative care, call 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048) or your plan. A licensed insurance agent with Benefits Life can also explain plan coverage at no cost to you: (206) SENIORS (206-736-4677), TTY 711.
Related questions
Does the WA Cares Fund work with Medicare?
Long-term care help Medicare doesn't cover.
Does Apple Health pay Medicare premiums?
Help with Medicare costs.
What is Washington's Medicare phone number?
Official numbers.
Sources
- 42 U.S.C. 14402 — Restriction on use of federal funds under health care programs (Assisted Suicide Funding Restriction Act of 1997)
- Washington State Department of Health — Death with Dignity Act
- Chapter 70.245 RCW — The Washington Death with Dignity Act
- RCW 70.245.090 — Written and oral requests (seven-day waiting period)
- RCW 70.245.170 — Insurance or annuity policies
- RCW 70.245.190 — Participation by health care providers
- Medicare.gov — Hospice care
- Medicare.gov — Advance care planning
Frequently asked questions
Will I lose hospice if I ask about Death with Dignity?
Asking about or using the law doesn't end your Medicare coverage. Medicare's hospice benefit continues to cover comfort care for a terminal illness. Individual hospices and providers in Washington may choose not to take part in the Act itself, so ask about their policy.
Who qualifies under Washington's law?
An adult 18 or older who is a Washington resident, can make and communicate informed health care decisions, and has an incurable, irreversible disease expected to cause death within six months. Age or disability alone doesn't qualify anyone.
Does it affect life insurance or health insurance?
Washington law says making or rescinding a request can't affect the sale, issue or rates of life, health or accident insurance or annuities, and taking the medication under the Act doesn't affect those policies.
Who pays for the medication then?
Because federal funds can't be used, the patient or family generally pays, unless other coverage that isn't federally funded applies. Ask the prescribing provider and pharmacy about the cost in advance.
Medicare in your Washington county
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