Making the decision to begin hospice care can be emotional and overwhelming for both a Medicare beneficiary and their family.
Now, a new Medicare rule is designed to make one important part of that decision clearer.
Beginning October 1, 2026, Medicare-certified hospices must provide every beneficiary entering hospice—or the beneficiary's representative—with a written addendum explaining which conditions, services, medical items, and medications the hospice has determined are not related to the terminal illness and therefore will not be covered under the Medicare hospice benefit.
Previously, that written list generally had to be provided only when the beneficiary or representative requested it. Under the new rule, the hospice must now provide it automatically for hospice elections beginning on or after October 1.
For Florida families navigating Medicare hospice care in Tampa Bay, Riverview, Apollo Beach, Brandon, Bradenton, Sarasota, and throughout the Gulf Coast, this additional transparency can help prevent confusion about what Medicare hospice coverage includes.
What Does Medicare Hospice Cover?
Medicare's hospice benefit is available to qualifying beneficiaries who have Medicare Part A, are certified as terminally ill with a life expectancy of six months or less if the illness follows its normal course, choose comfort-focused hospice care, and receive care from a Medicare-approved hospice organization.
Once hospice is elected, the hospice generally assumes responsibility for services related to the terminal illness and related conditions.
That can include services such as nursing care, certain physician services, hospice aides, medical equipment, supplies, medications for pain and symptom management, counseling, and other medically necessary hospice services.
But that doesn't mean every medical service or prescription a beneficiary receives automatically becomes part of the hospice benefit.
Someone may have another medical condition that the hospice determines is unrelated to the terminal illness.
That distinction is where the new notice becomes especially important.
What Changed on October 1?
CMS calls the new document the Hospice Election Statement Addendum.
For every hospice election beginning on or after October 1, 2026, the hospice must provide the beneficiary or representative with the addendum in writing.
It must identify conditions, items, services, and drugs that the hospice believes are unrelated to the patient's terminal illness and related conditions—and therefore aren't being covered under the hospice benefit.
The hospice must also explain why it considers those services unrelated.
CMS's model notice specifically requires the explanation to be understandable to the beneficiary or representative.
That matters because families shouldn't be left trying to decipher complicated billing terminology while making decisions about end-of-life care.
How Quickly Must the Hospice Provide the Notice?
The deadline is relatively short.
For a new hospice election beginning on or after October 1, the written addendum generally must be provided within the first five calendar days of the hospice election effective date.
If the patient's plan of care later changes in a way that affects which services, medications, or conditions the hospice considers unrelated, the hospice must provide an updated addendum within three calendar days of that change.
That means families should receive this information early rather than discovering a coverage disagreement after a bill arrives.
Why Would Something Be Considered Unrelated to Hospice?
Imagine a Medicare beneficiary enters hospice because of advanced cancer but also has another health condition that the hospice determines isn't related to the terminal diagnosis.
Certain care associated with that unrelated condition might continue to be covered separately under Medicare, depending on the circumstances.
The hospice addendum is intended to identify those distinctions clearly.
CMS describes services unrelated to a beneficiary's terminal illness as relatively uncommon because hospice is expected to provide nearly all care associated with the terminal illness and related conditions.
The important point for families is this:
A service appearing on the addendum doesn't necessarily mean Medicare will never cover it.
It means the hospice has determined that the service isn't covered through the hospice benefit because it believes the service is unrelated to the terminal illness and related conditions.
How another Medicare benefit may apply can depend on the individual circumstances.
Families Have the Right to Question the Decision
The new notice isn't simply informational.
It must also explain that Medicare beneficiaries have a right to seek Immediate Advocacy through their Beneficiary and Family-Centered Care Quality Improvement Organization, commonly called a BFCC-QIO, when they disagree with the hospice's determination.
In other words, families don't simply have to accept an unexplained statement that a drug or service isn't hospice-related.
They can ask questions about the clinical reasoning behind that decision and use Medicare's advocacy process when appropriate.
That is one reason keeping the written addendum is important.
Does Signing the Addendum Mean You Agree With It?
No.
The addendum is intended to document that the beneficiary or representative received the information.
CMS guidance has made clear that signing the addendum acknowledges receipt; it does not necessarily mean the beneficiary agrees with every hospice determination.
If you're helping a parent, spouse, or other family member enter hospice, read the document carefully and ask questions about anything you don't understand.
What About Prescription Drugs?
Prescription coverage can become confusing after someone elects hospice.
The hospice benefit generally covers medications used for pain relief and symptom management related to the terminal illness and related conditions.
CMS notes that hospice beneficiaries can have limited cost sharing for covered outpatient hospice drugs: generally 5% of the hospice's cost for the drug, with the beneficiary's payment capped at $5 per prescription in applicable circumstances.
If the hospice considers another medication unrelated to the terminal condition, the new written addendum should identify that determination.
That's particularly helpful for beneficiaries who take medications for several different chronic conditions.
Five Questions Florida Families Should Ask
When a loved one begins hospice care, consider asking:
1. Which diagnoses does the hospice consider related to the terminal illness?
2. Are any current medications considered unrelated?
3. Are there doctors, treatments, equipment, or services that won't be covered through hospice?
4. If something isn't covered by hospice, could it potentially be covered elsewhere under Medicare?
5. Who should we contact if we disagree with a coverage determination?
These questions can help families understand responsibilities before unexpected issues arise.
Frequently Asked Questions
Is the hospice addendum required for everyone starting Medicare hospice now?
For Medicare hospice elections beginning on or after October 1, 2026, CMS requires the written hospice election statement addendum to be furnished to the beneficiary or representative.
How soon should I receive it?
Generally within the first five calendar days of the effective date of the hospice election.
What does the addendum list?
It identifies conditions, items, services, and drugs the hospice has determined are unrelated to the terminal illness and related conditions and therefore aren't covered under the hospice benefit. It must also provide a clinical explanation.
Can the list change?
Yes. If the hospice changes the patient's plan of care and that affects the determination, an updated addendum generally must be provided within three calendar days.
What if my family disagrees with the hospice?
The notice must explain the beneficiary's right to contact the BFCC-QIO and request Immediate Advocacy regarding the hospice's determination.
Clearer Information Can Make a Difficult Time Easier to Navigate
Hospice decisions are deeply personal.
Insurance paperwork should not make them harder than they already are.
Medicare's new requirement gives beneficiaries and families clearer written information about what the hospice believes is covered, what it believes falls outside the hospice benefit, and what rights beneficiaries have when they disagree.
For Florida seniors and families along the Gulf Coast, understanding Medicare before a healthcare crisis can make navigating these decisions considerably easier.
If you have questions about your Medicare coverage, Medicare Advantage, Medicare Supplement, or how your insurance works alongside other Medicare benefits, My Local Coverage can help you understand your options.
Visit My Local Coverage or call (813) 608-0986 for personalized assistance.
