The Hospice Election Statement Addendum: The Paper You Now Get With Every Election

When a person signs up for hospice, there are forms to sign at a hard time. One of those forms is new in a key way. It is called the election statement addendum. Since October 1, 2026, hospices must give this paper to every patient who elects hospice, not just to those who ask for it. This guide explains what the addendum is, what it lists, and what to check before you sign. Our Hospice section holds more guides for families at this stage.

What the election statement is

The election statement is the form a patient signs to start hospice under Medicare. Signing it means the patient chooses hospice care for the terminal illness. It also means Medicare pays the hospice for that care, in place of most other Medicare payment for the illness.

Hospice is for a person whose doctor and the hospice doctor agree that life expectancy is 6 months or less if the illness runs its normal course (Ledger B1). The election statement names the hospice that will give the care. It states the date the election starts. The patient, or a person who acts for the patient, signs it.

The addendum is a second paper that now goes with that statement. It adds detail the statement itself does not carry. The two papers work as a pair.

What the addendum lists

The addendum lists the care, drugs, and items the hospice has judged to be outside its cover. For each item, it states why. The most common reason is that the item is not linked to the terminal illness or to a related condition. Hospice pays for care tied to the terminal illness. Care for other health problems stays with your other cover.

The list can name things like:

The addendum should also tell you what you can do if you do not agree with a line on the list. You can ask the hospice to review it. You can also ask about your right to seek care outside hospice and what that choice means for payment.

• Drugs for a health problem that is not linked to the terminal illness.
• Visits or tests the hospice team does not see as part of the plan of care.
• Care from a doctor or clinic outside the hospice plan.
• Items the hospice sees as comfort aids it does not supply.

Why this paper now goes to every patient

Before this rule, a patient got the addendum only if they asked for it at the time of the election. Many families did not know it existed, so they never asked. Some learned what hospice would not pay for only when a bill came.

The rule changed on October 1, 2026. From that date, hospices must give the addendum to every electing patient (Ledger section C rule note). The aim is plain: each family sees, in writing and at the start, what hospice covers and what it does not.

The paper must come in writing within 5 calendar days of the election's effective date. If the plan of care changes later, the hospice must give an updated addendum within 3 calendar days (Ledger section C rule note). The signed addendum goes in the medical record.

The enforcement note for late 2026

CMS has said it will use enforcement discretion from October 1, 2026 through December 31, 2026 (Ledger section C rule note). In that window, the groups that review claims will not deny a claim just because an addendum is missing or has a flaw. They will focus on teaching hospices the new duty.

That window does not pause the duty. The hospice still must give you the paper. If you elect hospice in late 2026 and no addendum comes, ask for it. Your right to the paper does not rest on the enforcement window.

What hospice costs the patient

The addendum is about what hospice does not cover. It helps to know what hospice costs on the covered side too.

There is no deductible for hospice care (Ledger A14). For outpatient drugs for pain and symptom control, the patient pays up to $5 per drug (Ledger A14). For inpatient respite care, the patient pays 5% of the Medicare-approved amount (Ledger A14). Respite care is a short stay that gives the home caregiver a rest.

Costs for care outside hospice follow the rules of the cover that pays for that care. That may be Medicare for an unrelated problem, or another plan. The addendum helps you see which costs those might be before they arise.

Who pays for what

• Medicare pays the hospice for care tied to the terminal illness and related conditions, once the election is in effect.
• The patient pays up to $5 for each outpatient drug for pain and symptom control (Ledger A14), and 5% for inpatient respite care (Ledger A14).
• Medicare or another plan may pay for care for health problems not linked to the terminal illness, under that cover's own rules.
• The patient or family pays for items the addendum lists as not covered, if they choose to get those items on their own.
• Medicaid can help some patients with costs if they qualify under their state rules. Private pay covers what no program covers.

Sample situation

Mary is 82 and elects hospice after her doctor says her heart illness gives her a life expectancy of 6 months or less (Ledger B1). On the second day, the hospice nurse brings the election statement and the addendum. The addendum lists one of her drugs as not covered, since it treats a thyroid problem not linked to her heart illness. Mary sees that her thyroid care stays with her usual doctor and her usual cover, which is what she wants. She signs, keeps her copy in a folder, and shows it to her daughter so they both know which costs stay with which cover. Three weeks later her plan of care changes, and the hospice brings an updated addendum within 3 calendar days, as the rule asks (Ledger section C rule note).

What to check before you sign

• Read each item on the list and the reason next to it. Ask about any line you do not grasp.
• Ask which of your current drugs and visits the list touches, and which stay as they are.
• Ask how to ask for a review if you think an item should be covered.
• Keep your signed copy with your other care papers, and give a copy to your main family contact.
• If no addendum comes within 5 calendar days of your start date, ask the hospice for it in writing.
• If your plan of care changes, watch for an updated addendum within 3 calendar days.
• Read our hospice first-call guide for what to ask when you first speak with a hospice, and our guide on the levels of hospice care for how care changes as needs grow.

Sources

• https://www.cms.gov/medicare/payment/fee-for-service-providers/hospice
• https://www.medicare.gov/coverage/hospice-care
• https://www.medicare.gov/basics/costs