Medicare 2026

Hospices Must Now List What They Won't Cover: The New Election Statement Addendum

If you or someone you love is considering hospice care through Medicare, there's an important change worth knowing about. Starting with hospice elections that begin on or after October 1, 2026, every hospice must give each patient a written document that spells out — in plain language — any conditions, items, services and drugs the hospice has decided it will not cover because, in its clinical judgment, they are unrelated to the terminal illness.

This document isn't new in concept, but it is newly mandatory for everyone. CMS first created it in the FY 2020 hospice rule, but back then a patient or family member had to know to ask for it. In a final rule issued July 30, 2026 (published August 3, 2026 and effective October 1, 2026), CMS made the addendum required at the time of every hospice election. CMS said Medicare spending outside the hospice benefit for people enrolled in hospice grew substantially and consistently from FY 2020 through FY 2024 — a sign that many families didn't realize the addendum existed or why it mattered.

What the addendum has to say

The document must be titled "Patient Notification of Hospice Non-Covered Items, Services, and Drugs." It must list every condition, item, service, and drug the hospice has determined is unrelated to the terminal illness and related conditions — and therefore will not be covered under the hospice benefit. For each item, the hospice must include a written clinical explanation in language the patient or representative can understand.

That last part matters. The point of the addendum is not to generate a stack of jargon. It's to help families understand, in real time, what the hospice is agreeing to take care of and what it is not.

Timing and updates

For hospice elections starting on or after October 1, 2026, the addendum has to be provided in writing at the time of the hospice election — which the regulation defines as within the first 5 days of the effective date of the election.

Plans of care change. If a change affects what the hospice will or won't cover, the hospice must update the addendum and get the update to the patient or representative in writing within 3 days.

Signing — and not signing

A signature on the addendum only acknowledges that you received it. It does not mean you agree with the hospice's decisions about what is or isn't related to the terminal illness. If a patient or representative refuses to sign, the hospice must write the reason directly on the addendum.

And if you disagree with what the hospice has decided? The addendum itself must explain that immediate advocacy is available through the Medicare Beneficiary and Family Centered Care Quality Improvement Organization — the BFCC-QIO — which can review the hospice's determination.

Why this matters for day-to-day care

Once hospice care begins, the hospice benefit is meant to cover everything needed for the terminal illness and related conditions. Patients pay a copayment of up to $5 for each prescription for outpatient drugs for pain and symptom management. Care that is truly unrelated to the terminal illness is still covered by Original Medicare, with the usual deductibles and coinsurance.

The friction tends to show up in the gray zone: a long-standing condition, a medication the person has taken for years, a service a specialist wants to continue. If the hospice decides that item is unrelated to the terminal illness, it will appear on the addendum — and you'll know up front whether to expect it to be billed elsewhere under Original Medicare rather than covered by the hospice.

A good moment to review the rest of your coverage

While we're on the subject of knowing what's covered, a few national Medicare items to keep on your radar for 2027:

• The Part D out-of-pocket cap rises to $2,400 in 2027 (it is $2,100 in 2026).
• The most any Part D plan may charge as a deductible in 2027 is $700.
• The Part D base beneficiary premium for 2027 is $41.33 — a national figure used to calculate the late-enrollment penalty. Actual plan premiums are set plan by plan.
• Annual Enrollment runs October 15 – December 7, 2026, with choices taking effect January 1, 2027.
• The Social Security Administration announced a 3.6 percent cost-of-living adjustment for benefits payable beginning January 2027.

The 2027 Part B standard premium and deductible, and the 2027 IRMAA income brackets, have not yet been announced. CMS typically releases them in the fall, usually November.

A quick word on enrollment flexibility worth remembering year-round: since 2025, people with Medicaid or Extra Help have a monthly Special Enrollment Period to switch to Original Medicare with a stand-alone Part D plan or to change stand-alone Part D plans. Full-benefit dual-eligible individuals may join an integrated D-SNP in any month.

And on the broader question of coverage design — Medicare Advantage versus Original Medicare with a Medigap and Part D plan — both have real trade-offs. Medicare Advantage often bundles extras and uses provider networks and prior authorization; Original Medicare with Medigap offers broad provider choice with predictable cost-sharing but a separate Part D plan and premium. What fits depends on your health, your providers, your budget, and your preferences.

Where to go next

For plain-English explanations of hospice coverage, the addendum, and your appeal rights, visit Medicare.gov or call 1-800-MEDICARE (TTY 1-877-486-2048), available 24 hours a day, 7 days a week.