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Choosing hospice care is already one of the hardest decisions a family makes, and it usually happens fast. Until now, hospices only had to hand over a written list of what they wouldn't cover if you specifically asked for one, and most families in crisis don't know to ask.
A new Medicare rule changes that. Starting October 1, 2026, every hospice has to give every Medicare patient a written disclosure of what's excluded, automatically, not just on request. Here's what the rule actually requires and the questions worth asking before you sign anything.
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What the New Rule Actually Requires
The Centers for Medicare & Medicaid Services finalized its fiscal year 2027 hospice rule this month. The part that matters most for families: every hospice must now give an election statement addendum, a written list of the conditions, services, items, and drugs the hospice considers unrelated to the terminal illness and therefore won't cover, to every Medicare patient who elects hospice care. Before this rule, hospices only had to provide it if a patient or family specifically requested it.
The rule takes effect October 1, 2026. CMS also updated hospice payment rates by 2.3% for fiscal year 2027, and starting no earlier than fiscal year 2028, Medicare's Care Compare website will flag hospices that don't submit at least 90% of required quality data.
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If you're comparing hospice providers before a decision is urgent, Hospice Fraud Is Making Headlines. Here's How to Vet a Provider Before You Need One walks through the questions to ask ahead of time.
Why the Old Rule Left Families Guessing
Hospice covers the terminal diagnosis and related symptoms, not automatically every medical need a patient has. A condition unrelated to the terminal illness, a fall injury or a separate infection, for example, can fall outside hospice coverage, and families often found that out only after a bill arrived. Asking for the disclosure used to be the exception. Now it's the rule.
This doesn't mean hospice coverage got smaller. It means the paperwork that was always supposed to explain the boundary now has to reach you automatically, in writing, before you're deep into a decision made under pressure.
Get the Timing Right
The addendum has to reach you within five days of your hospice election if you ask for it verbally, or within three days if you request it in writing, once the hospice has your request. Under the new rule, you shouldn't have to ask at all, since every Medicare patient gets it automatically starting October 1, 2026. Confirm you received it before you sign the election statement, not after.
If a hospice can't produce the addendum or seems unfamiliar with the new requirement, that's worth a direct question. The rule is federal, and it isn't optional.
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Confirm you have it in hand for Choosing a hospice right now before signing the election statement.
Get a plain answer on what's marked unrelated to the terminal diagnosis.
Know how to challenge an unrelated-care determination before you need to use it.
A new diagnosis or symptom may change what's related or unrelated to the terminal illness.
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Common questions
What is a hospice election statement addendum?
It's a written list of the conditions, services, items, and drugs a hospice considers unrelated to the patient's terminal illness and therefore won't cover. Starting October 1, 2026, every hospice must give it automatically to every Medicare patient who elects hospice care, not just those who ask.
Does this mean hospice covers less than it used to?
No. The coverage rules didn't change. What changed is that hospices must now automatically disclose, in writing, what falls outside hospice coverage instead of only providing that information when a family specifically requests it.
What if I disagree with what my hospice marked as unrelated to my condition?
Ask the hospice about its appeal process before you need to use it. You can challenge a determination that a condition or service is unrelated to your terminal diagnosis.
When does the new hospice disclosure rule take effect?
October 1, 2026. It's part of CMS's fiscal year 2027 hospice final rule, which also updated hospice payment rates by 2.3% for the year.
