A POLST form is a signed medical order that tells emergency responders and hospital staff what treatment you do and do not want, and unlike a living will it is an order they must follow immediately, without needing to interpret anything. The letters stand for Physician Orders for Life-Sustaining Treatment, and the national program that maintains standards for it now uses the broader name Portable Medical Orders, a change adopted in 2019 to reflect that clinicians other than physicians may sign in many states.
Some numbers make the form easier to place. One page, usually printed on brightly colored paper so it is visible on a refrigerator. One signature from a clinician, plus the patient’s or their decision maker’s. All 50 states and the District of Columbia have a POLST or POLST-style program at some stage of development, though only some have mature, fully endorsed statewide programs. And one rough eligibility test that clinicians use: would you be surprised if this person died within the next year. If the answer is no, a POLST is appropriate. If yes, it is not.
That last number is the one that matters most, and it is why this form is not for everybody.
In This Article
One Year: The Threshold That Decides Who Should Have One
The surprise question is the informal standard the National POLST program and most state programs use. A POLST is designed for people with serious advancing illness or significant frailty, where decisions about resuscitation, hospitalization and intensive treatment are foreseeable in the near term.
A healthy 68-year-old should not have one. Not because it would be harmful in theory, but because a POLST is an order that travels, and orders written years before they are needed become stale. A healthy person needs an advance directive and a named health care agent, which are documents about the future. A seriously ill person needs a POLST, which is an order about now.
This is the most common mistake families make. Someone reads about POLST, decides everyone in the family should have one, and completes forms for people whose medical situation will change substantially before the form is ever consulted. Then a form written in a stable year drives treatment in a crisis year.
The corollary is that a POLST needs review. Most programs recommend revisiting it at any change in health status, at any transfer between care settings, and at least annually. It can be voided or replaced by the patient or their decision maker at any time.
One Page, Several Sections, and What Each One Actually Orders
Forms differ by state, but the structure is consistent. Section A addresses cardiopulmonary resuscitation: attempt resuscitation, or do not attempt resuscitation. This section applies only when the person has no pulse and is not breathing.
Section B addresses medical interventions when the person still has a pulse. The choices generally run along a spectrum: comfort-focused treatment, selective treatment, or full treatment, with instructions about hospital transfer and intensive care. This is the section most people have never thought about, and it is arguably more consequential than the resuscitation box, because far more decisions fall here.
Many forms add a section on artificially administered nutrition. Some add antibiotics. Read every section, because a person can want full treatment in one and comfort measures in another, and that combination is entirely legitimate.
The form must be signed by a clinician to be an order. In some states a physician only; in others a nurse practitioner or physician assistant as well. An unsigned POLST is a wish list, not an order, and emergency responders may not be able to honor it. Confirm your state’s signature rules with the state health department or the state POLST program.
| Document | Who needs it | Legal nature | Signed by |
|---|---|---|---|
| POLST or portable medical orders | People with serious illness or frailty | A medical order, followed immediately | A clinician, plus patient or decision maker |
| Advance directive or living will | Every adult | A legal document about future wishes | The individual, usually witnessed or notarized |
| Health care proxy | Every adult | Appoints a decision maker | The individual |
| Out-of-hospital DNR | People declining CPR | An order limited to resuscitation | A clinician |
| Plan of care | Anyone receiving facility or agency care | A clinical document, not an order set | The care team |
Different Names in Different States
You may not be handed a form that says POLST. Depending on the state, the same instrument may be called MOLST, for Medical Orders for Life-Sustaining Treatment, used in New York, Maryland and Massachusetts among others; POST, for Physician Orders for Scope of Treatment, used in West Virginia, Indiana and Tennessee; MOST, for Medical Orders for Scope of Treatment, used in Colorado and North Carolina; COLST in Vermont; or a regional name such as TPOPP in the Kansas and Missouri area.
Portability across state lines is the weak point. A POLST is honored reliably within its own state. Whether another state’s emergency responders will honor an out-of-state form varies and, in some states, depends on statutory reciprocity that may not exist. If a person splits the year between two states, or is moving, complete a new form in the destination state. Ask the receiving physician’s office to do it as part of the first visit.
Some states maintain an electronic registry so first responders can retrieve the form. Others rely entirely on the paper copy being physically present. Ask which your state uses, because in a paper-only state, a form in a drawer is a form that does not exist.
The Documents It Is Confused With
An advance directive or living will. A legal document any adult can sign, expressing future wishes about treatment in hypothetical situations. It requires interpretation by a clinician or an agent. It is for everyone. A POLST is a current medical order requiring no interpretation, and it is for people who are already seriously ill.
A health care proxy or durable power of attorney for health care. This names a person to decide for you. It does not say what the decision should be. Every adult should have one, and it complements rather than replaces a POLST. See what a health care proxy does and how a durable power of attorney works.
A DNR order. A do-not-resuscitate order addresses one thing: CPR. A POLST covers CPR plus the broader treatment questions that arise while the person still has a pulse. A standalone out-of-hospital DNR is narrower.
A plan of care. The clinical roadmap a facility or agency writes describing day-to-day care. The POLST should be reflected in it, but they are separate documents.
The rule of thumb: everyone needs an advance directive and a health care agent. Only seriously ill people need a POLST. Both belong in the same folder, and the health care agent needs to know where that folder is.
Where the Money Questions Are, and Are Not
A POLST has no effect on life insurance. It does not void a policy, does not affect a claim, does not change premiums, and is not a factor in whether a death benefit is paid. Choosing comfort-focused care is not a form of self-harm and does not implicate the suicide clause in any policy. If anyone suggests otherwise, they are wrong, and it is worth saying so directly because the fear is real and occasionally exploited.
What is true is adjacent. The households completing POLST forms are usually households where a serious illness is already generating costs, and where a life insurance policy is one of the few remaining liquid assets. Three legitimate paths exist for a policy in that situation.
An accelerated death benefit rider, if the policy has one, lets the owner draw part of the death benefit early upon a qualifying terminal or chronic illness certification, often at no additional charge because many states required carriers to add it by endorsement. Check the policy first; this is the cheapest option and the most overlooked. A viatical settlement is the sale of a policy on someone with a terminal or seriously advanced illness, and it typically pays a substantially higher percentage of face value than a standard settlement because the life expectancy is short. Read how viatical settlements work. A standard life settlement applies to older insureds who are not terminally ill.
Note the tax point, and confirm it with your CPA: under Internal Revenue Code Section 101(g), amounts received for a policy on a terminally ill insured, as defined there, are generally treated like a death benefit and excluded from income, including proceeds from a sale to a licensed viatical settlement provider. That is a meaningful difference from a standard life settlement, and it is one of the few places where the tax rules favor the seller.
Two protective notes. No legitimate buyer needs your POLST. What underwriters use is an attending physician statement and medical records released under a signed HIPAA authorization, and you control what is released. See what an attending physician statement is. And if the person has entered hospice, ask about the hospice benefit before selling anything, because it changes what is already being paid for. If you want a real number for what a policy would bring, a free policy review provides one. Pine Lake Legacy does not purchase policies and does not give tax or legal advice; send the policy cover page or call (732) 978-9575.
Frequently Asked Questions
Who should have a POLST form?
People with serious advancing illness or significant frailty, where decisions about resuscitation and hospitalization are foreseeable within roughly the next year. Clinicians use the surprise question as the informal test. A healthy person does not need one; they need an advance directive and a named health care agent instead, which are documents about the future rather than orders about now.
Is a POLST the same as a living will?
No. A living will is a legal document any adult can sign about hypothetical future situations, and it requires interpretation. A POLST is a current medical order signed by a clinician that emergency responders and hospital staff act on directly. They complement each other, and a seriously ill person should generally have both.
Does my state call it something else?
Very possibly. The same instrument is called MOLST in New York, Maryland and Massachusetts, POST in West Virginia, Indiana and Tennessee, MOST in Colorado and North Carolina, COLST in Vermont, and TPOPP in the Kansas and Missouri region. Ask your state health department or state POLST program which form is current where you live.
Will another state honor my POLST?
Not reliably. Recognition of out-of-state forms varies and in some states depends on a reciprocity statute that may not exist. If a person splits the year between two states or is relocating, complete a new form in the destination state, ideally at the first visit with the receiving physician’s office.
Does a POLST affect my life insurance?
No. It does not void a policy, affect a claim, change premiums, or implicate any policy clause. Choosing comfort-focused treatment is a medical decision with no insurance consequence. If anyone tells you otherwise, they are wrong, and if they are trying to sell you something on that basis, report it to your state insurance department.
If someone is terminally ill, what are the policy options?
Check first for an accelerated death benefit rider, which many policies carry at no charge and which pays part of the death benefit early upon a qualifying certification. A viatical settlement is the sale of a policy on a terminally or seriously ill insured and usually pays a much higher percentage of face than a standard settlement. Confirm tax treatment with your CPA.
Find out what your policy is worth — free, confidential, no obligation.
A 15-minute educational review covers your eligibility, every alternative, and a realistic view of what each path would net you.
Related Reading
- What Is A Health Care Proxy
- What Is A Durable Power Of Attorney
- What Is A Viatical Settlement
- What Is A Life Settlement
- What Is An Attending Physician Statement
- What Is A Hospice Benefit Period
- What Is A Change Of Ownership Form
- How Much Is My Policy Worth
Pine Lake Legacy does not purchase life insurance policies and does not provide legal, tax, or investment advice. Information provided is for educational purposes only. Eligibility for any option, including life settlements, is not guaranteed and depends on individual circumstances, policy terms, underwriting, and market conditions. Consult independent legal, tax, or financial professionals before making decisions regarding a life insurance policy.