Death with Dignity Act and Medicare

Oregon voters approved the nation's first Death with Dignity Act in November 1994, and it took effect in October 1997. It allows terminally ill adults to request, and take themselves, medication prescribed by a physician to end their life. The law is narrow and closely regulated. This page explains, factually, how it works and how it interacts with Medicare. It is information, not medical, legal or ethical advice.

What the Act does

The Act (ORS 127.800 to 127.897) lets an adult with a terminal illness that will, in reasonable medical judgment, lead to death within six months request a prescription for medication to end their life. The patient must take the medication themselves; the physician may not administer it, though the physician may be present if the patient wishes.

Who qualifies

According to the Oregon Health Authority, a patient must be:

• 18 or older;
• capable of making and communicating their own health care decisions; and
• diagnosed with a terminal illness that will lead to death within six months.

The attending physician decides whether these criteria are met, and a consulting physician must confirm the diagnosis, prognosis and capacity. If either physician thinks the patient's judgment may be impaired, the patient must be referred for a psychological examination. Both physicians must be M.D.s or D.O.s.

What Medicare does and doesn't cover

Medicare is a federal program. The Assisted Suicide Funding Restriction Act of 1997 (Public Law 105-12; 42 U.S.C. 14402) bars federal funds from paying for any item or service whose purpose is to cause, or assist in causing, a death. The restriction names Medicare (Title XVIII of the Social Security Act) and Medicaid, among other programs. So Medicare does not pay for the Death with Dignity prescription, whether you have Original Medicare, a Medicare Advantage plan or a Part D plan. The Oregon Health Plan (Medicaid) is also subject to the federal bar.

What Medicare continues to cover:

• Care for your underlying illness, hospital stays, doctor visits, tests and medical equipment, with the usual cost sharing.
• The Medicare hospice benefit, including drugs for pain and symptom control, nursing, social work, spiritual care and grief support for your family.
• Voluntary advance care planning with your provider under Part B.

The Oregon law does not say who pays for the medication. As with other services, individual insurers decide whether to cover it. Ask your other insurer, if you have one, before you start.

Hospice and the Act

Hospice and the Death with Dignity Act are separate. Hospice is comfort care for people with a life expectancy of six months or less, covered by Medicare Part A. The Act is a separate legal option. Before prescribing, the attending physician must tell the patient about feasible alternatives, including comfort care, hospice care and pain control. Many people who use the Act are enrolled in hospice; hospice agencies set their own policies on how involved their staff are.

For more, see can I use Death with Dignity while on hospice in Oregon? and does Medicare cover hospice in Oregon?

Residency

The original Act was limited to Oregon residents. The Oregon Health Authority stopped enforcing the residency requirement in March 2022 after a lawsuit settlement, and the 2023 Legislature removed it from the law (HB 2279). OHA's FAQ now says patients do not need to be Oregon residents. Medicare still won't pay for the medication, wherever you live.

The process and waiting periods

1. First oral request. The patient asks the attending physician.
2. Confirmation. The attending and a consulting physician confirm the diagnosis, prognosis and capacity; a psychological examination is required if either suspects impaired judgment.
3. Information about alternatives. The attending physician explains alternatives, including comfort care, hospice and pain control, and asks (but cannot require) the patient to tell next of kin.
4. Written request. The patient signs a written request in front of two witnesses, at least one of whom is not related to the patient.
5. Second oral request. At least 15 days after the first.
6. Prescription. At least 48 hours after the written request. The patient can withdraw the request at any time.

Since January 1, 2020 (Senate Bill 579, 2019), a patient whose life expectancy is shorter than a waiting period is exempt from it: someone with less than 15 days to live skips the 15-day wait, and someone with less than 48 hours skips the 48-hour wait. The physician must document the imminence of death in the medical record.

Participation is voluntary

No physician, pharmacist or health care system is required to take part, and some health systems do not. If your physician or hospital doesn't participate, you can ask for a referral to another physician. The Oregon Health Authority publishes the law, forms and annual reports, but it does not refer patients to providers.

Insurance and death certificates

Oregon law says that actions taken under the Act are not suicide for any legal purpose, and that participation should not affect a life, health or accident insurance or annuity policy on that basis. The state's Center for Health Statistics recommends listing the underlying terminal disease as the cause of death and the manner of death as natural.

What Oregon's annual report shows

The Oregon Health Authority publishes data every year. Its 2025 Data Summary (the 28th annual report, released April 2, 2026) reports:

OHA expects the 2025 death count to rise as more death certificates arrive. It also reports that 92% of the people who died in 2025 were enrolled in hospice.

Where to get information

• Your physician or hospice team: the first place to ask about your options.
• Oregon Health Authority: the law, FAQs and annual reports (linked below).
• 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048): what Medicare covers for hospice and other end-of-life care.

If cost is a concern, a licensed insurance agent can review how your current plan handles hospice and prescriptions; you can request a call from a licensed insurance agent.