Medicare Hospice Election Statement Addendum: New 2026 Rule Explained

CMS finalized a rule requiring hospices to provide a hospice election statement addendum to every Medicare beneficiary at the time the person elects hospice. The regulations take effect October 1, 2026. Previously, the hospice generally had to provide this addendum only when the beneficiary or representative requested it.

The addendum is meant to make coverage boundaries clearer before care begins. It must identify the conditions, items, services, or drugs the hospice determines are not related to the terminal illness and related conditions—and therefore will not be covered under that hospice benefit—and explain the hospice’s reasoning.

To receive the Medicare hospice benefit, an eligible person signs a hospice election statement choosing comfort-focused hospice care instead of Medicare-covered treatment intended to cure the terminal illness and related conditions. The election statement identifies the hospice, the effective date, and other important information about the choice.

The addendum adds patient-specific detail about what the hospice considers unrelated to that terminal illness. Read both documents. A general description of hospice coverage cannot tell you how the hospice has classified a particular medication, specialist visit, test, hospital service, or other care in your situation.

Medicare describes hospice as a comprehensive benefit. Care for the terminal illness and related conditions generally must be provided by or arranged through the hospice team. That can include symptom control, pain relief, nursing, equipment, supplies, drugs, and other services included in the plan of care.

Original Medicare can still pay for covered care for a health problem that is not part of the terminal illness or related conditions, subject to the usual coverage rules, deductibles, and coinsurance. The addendum helps the beneficiary, family, hospice, and non-hospice clinicians understand which payment path the hospice expects to apply.

When an addendum says the hospice will not cover an item because it considers the item unrelated, that does not by itself guarantee payment by Original Medicare, Part D, a Medicare Advantage plan, or other insurance. The item still has to meet the coverage rules that apply outside the hospice benefit.

Before receiving non-hospice care, ask who is expected to bill Medicare, whether the provider accepts Medicare, whether authorization or other plan rules apply, and what you may owe. For emergency or urgent needs, seek appropriate care and communicate with the hospice team as soon as practical.

Ask the hospice to review the addendum line by line: Which diagnoses are considered terminal or related? Which current prescriptions, equipment, therapies, specialists, hospital services, or tests does the hospice expect to cover? Which does it classify as unrelated, and why? Who should the family call before arranging care outside the hospice?

Also ask how the hospice will update the addendum if the plan of care or coverage determination changes. Keep a copy with the election statement, current medication list, plan of care, hospice contact information, and any written cost information.

The addendum is a coverage disclosure, not medical advice. Do not stop a prescription, cancel care, or change treatment solely because an item appears on the list. Ask the hospice clinician and the prescribing or treating clinician how the classification affects the care plan and what alternatives are available.

If the language is unclear or you disagree with the explanation, ask the hospice for a plain-language review and written clarification. You can also contact 1-800-MEDICARE or your State Health Insurance Assistance Program for free, independent Medicare counseling about coverage questions.

Medicare.gov says a person pays nothing for hospice care from a Medicare-approved hospice provider. A copayment of up to $5 can apply to each outpatient prescription for pain and symptom management, and a person may pay 5% of the Medicare-approved amount for inpatient respite care. Room and board is generally not covered when hospice is received at home or in a nursing home or hospice inpatient facility.

Different costs can apply to covered care for unrelated health problems. Ask whether the expected charge belongs under the hospice benefit or another part of Medicare, and do not assume that “unrelated” means free or that “hospice-covered” means every possible service is included.

For hospice elections on or after October 1, 2026, expect the addendum at the time of election. If you are already receiving hospice care or considering hospice before that date, Medicare.gov says you can request a list of the items, services, and drugs the hospice has determined are unrelated, including the reason for each determination.

Choosing hospice is a personal care decision, not a plan-shopping shortcut. Compare Medicare-approved hospices through Medicare Care Compare, talk with the care team about goals and services, and ask how after-hours support, medications, equipment, inpatient care, respite care, and non-hospice treatment are handled before you elect the benefit.

CMS: “Fiscal Year 2027 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements Final Rule,” issued July 30, 2026. Federal Register: “Medicare Program; FY 2027 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements,” published August 3, 2026. Medicare.gov: “Hospice Care Coverage.” These official sources explain the mandatory addendum, its October 1 effective date, hospice eligibility and coverage, care for unrelated conditions, and beneficiary cost-sharing basics.