Use of Advance Care Planning Codes Among Transgender Medicare Beneficiaries

We examined the use of advance care planning (ACP) among Medicare beneficiaries who were identified as transgender. This study is a cross-sectional analysis of Medicare claims from 2016 to 2018, comparing ACP visits between transgender and other beneficiaries. Beneficiaries identified as transgender were slightly more likely than those who were dual eligible for Medicaid and Medicare, and the remaining fee-for-service Medicare population, to have received a claim for ACP. However, racial and ethnic differences exist and transgender beneficiaries were more likely to receive an ACP claim from hospice/palliative care clinicians compared with primary care clinicians relative to other beneficiaries. Differences in ACP provision may exacerbate disparities in access to ACP benefits faced by transgender patients.