Starting Today, Hospices Must Give Every New Medicare Enrollee a Written List of What Is Not Covered

Effective October 1, 2026, every Medicare-certified hospice must provide a written Election Statement Addendum to every beneficiary who enrolls in hospice care. The change comes from the fiscal year 2027 Hospice Final Rule, published in the Federal Register on August 3, 2026.

Before today, hospices were required to offer this addendum only if the patient or a representative asked for it. Under the new rule, the addendum is required for each new election regardless of whether anyone requests it. Hospices must deliver it within five days of the hospice election start date. If a plan-of-care update later changes what the hospice will and will not cover, a revised addendum must follow within three days.

The addendum tells the patient or representative, in writing, which conditions, items, services, and drugs the hospice will not cover under the Medicare hospice benefit. Medicare hospice covers care related to the terminal illness and its related conditions. Other healthcare needs remain eligible for coverage under Medicare Part A or Part B outside the hospice benefit. The addendum is designed to prevent surprise billing by making those limits explicit before a patient receives care the hospice will not pay for.

CMS developed a model addendum template that hospices may use to meet the requirement. The shift from an on-request rule to an automatic requirement reflects longstanding federal concern that hospice patients and families often do not learn what the benefit excludes until they have already received care and a bill has arrived.