What Is a Hospice Election Statement (What Am I Signing)?

A hospice election statement is the form you sign to start the Medicare hospice benefit. On it you choose comfort-focused (palliative) care for a terminal illness instead of treatment aimed at curing it, name the hospice you want, name the doctor or other clinician you want overseeing your care, and set the date coverage begins. Medicare.gov says it must be completed before you get any hospice services. It is not a one-way door: you can cancel it later in writing.

What changed on October 1, 2026: for hospice elections that begin on or after that date, the hospice must give you a written addendum listing any conditions, drugs, items, and services it has decided are unrelated to the terminal illness and that it will not cover. You no longer have to ask for it. It is due within the first 5 days of the election's effective date (42 CFR 418.24).

What the election statement must include

Layouts differ between hospices, but federal rules (42 CFR 418.24(b)) require every election statement to contain:

• The hospice you are choosing. One Medicare-certified hospice provides your hospice care.
• Your attending physician, with your acknowledgment that this was your choice. The attending can be a doctor, a nurse practitioner, or a physician assistant: the person you identify as having the biggest role in your medical care. This is how you keep your own doctor involved. See do you pay anything to keep your own doctor while on hospice.
• Your acknowledgment that hospice care is palliative, not curative, for the terminal illness and related conditions.
• Your acknowledgment that you received information about what the hospice covers and what Medicare services you waive. The form must also tell you that services unrelated to the terminal illness are exceptional and unusual.
• Information about your cost-sharing for hospice services.
• The election statement addendum (described below), for elections beginning on or after October 1, 2026.
• Information about the BFCC-QIO, Medicare's quality improvement organization, including your right to immediate advocacy and how to contact it.
• The effective date: the first day of hospice care or a later date, but never earlier than the date you sign.
• Your signature or your representative's.

The addendum: the list of what hospice won't cover

When you elect hospice, the hospice becomes responsible for care related to the terminal illness. Anything it decides is unrelated goes back to regular Medicare or your other coverage, with their usual deductibles and copays. The addendum puts those decisions in writing, so you know in advance which current prescriptions or treatments the hospice will not pay for.

• Its name. The regulation titles it “Patient Notification of Hospice Non-Covered Items, Services, and Drugs.”
• When you get it. In writing, within the first 5 days of the election's effective date, for elections beginning on or after October 1, 2026. Medicare.gov and older guidance still describe it as something you ask for. That was the rule for earlier elections; under the current regulation it comes automatically.
• What it lists. The terminal diagnosis, your other conditions, the specific items, services, and drugs the hospice considers unrelated and won't cover, a written clinical explanation of why, and a reference to any clinical guidelines the hospice relied on. It must also explain its purpose and tell you about your right to immediate advocacy through the BFCC-QIO.
• When it changes. If your plan of care changes in a way that affects those decisions, the hospice must update the addendum within 3 days and give you the update in writing.
• What your signature means. You sign and date it to show you received it, not that you agree with it. If you refuse to sign, the hospice records the reason on the addendum.

Other providers and Medicare contractors can see the addendum, so it also helps your pharmacy and other doctors know who should be billed. Exceptions: if the patient dies, revokes, or is discharged before the hospice provides it, the addendum is not required, and the hospice notes why in the record.

What if you disagree with the addendum?

Start with the hospice: ask the physician to explain why a drug or condition was classified as unrelated. If that does not resolve it, the addendum must tell you how to reach the BFCC-QIO and use your right to immediate advocacy. For other problems with a hospice, see how to file a complaint about a hospice.

What signing does and does not do

Signing the election statement DOES	Signing DOES NOT
Start the Medicare hospice benefit on the effective date	Require a DNR
Name your hospice and your attending physician	Lock you in: you can revoke it in writing
Waive Medicare payment for treatment aimed at curing the terminal illness	Stop Original Medicare from covering health problems that aren't part of the terminal illness
Make the hospice responsible for related drugs, equipment, and care	Pay room and board at home or in a nursing home where you live

Costs, per Medicare.gov: you pay up to $5 per prescription for outpatient drugs for pain and symptom management, and you may pay 5% of the Medicare-approved amount for inpatient respite care. Medicare doesn't cover room and board if you get hospice care at home, and you may have to pay it if you live in a facility such as a nursing home. Short-term inpatient or respite stays that the hospice team arranges are covered. See hospice copays and coinsurance under Medicare and hospice room and board: who pays.

Who can sign

The patient signs if able. If the patient is mentally or physically incapacitated, a representative can sign: under Medicare's definition, someone with authority under state law (by statute or by court appointment) to make medical decisions or to elect or revoke hospice for the patient. That can include a legal guardian. Whether a health care agent named in a power of attorney qualifies depends on your state's law, so ask the hospice social worker to confirm before anything is signed. More in your rights as a hospice patient.

When does coverage start?

On the effective date written on the statement. That can be the day you sign or a later date, but it cannot be backdated before the signature. Separately, the hospice must file a Notice of Election with its Medicare contractor within 5 calendar days of the effective date. That is the hospice's paperwork, not yours: if it files late, Medicare does not pay for the days before the filing, and the hospice cannot bill you for them.

How to undo it, or switch hospices

• Revoking. You or your representative can revoke at any time by filing a signed statement with the hospice that gives the date revocation takes effect, which cannot be earlier than the date you revoke. A verbal revocation is not accepted. You lose hospice coverage for the remaining days of that benefit period, your regular Medicare coverage resumes, and you can elect hospice again later for any period you are still eligible for. See can you leave hospice and resume treatment.
• Switching hospices. You can change your hospice once per benefit period by filing a signed statement with both hospices naming each one and the effective date. This is a transfer, not a revocation. See how to switch hospice providers.

How signing fits into enrollment

1. Referral and evaluation. A doctor refers you, or the family asks a hospice for an evaluation.
2. Certification. For the first benefit period, the hospice doctor and your regular doctor (if you have one) certify a terminal illness, meaning a life expectancy of six months or less if the illness runs its normal course.
3. The election statement. You or your representative sign it.
4. The addendum. Delivered in writing within 5 days of the effective date.
5. Plan of care. The team writes your plan and starts visits, medications, and equipment.

For the full walkthrough, see how to enroll a loved one in hospice and what documents you need to start hospice.

Before you sign: questions to ask

• Which of the patient's current medications and treatments will you cover, and which will appear on the addendum as unrelated?
• Who is listed as the attending physician, and is that the person we chose?
• What will we pay out of pocket, including drug copays and room and board where the patient lives?
• What effective date are we putting on the form?
• Who has legal authority to sign if the patient can't?

Nothing on the form requires you to sign on the first visit. Vague answers about what is “related” versus “unrelated” are a reason to slow down. Because the form names one hospice, it is worth comparing providers first: you can compare hospices near you and review their family-survey scores.

Frequently asked questions

Do I have to ask for the election statement addendum?

Not for elections that begin on or after October 1, 2026. The hospice must give it to you in writing within the first 5 days of the effective date. For earlier elections, the addendum was provided when requested.

Does signing the addendum mean I agree with it?

No. Your signature only acknowledges that you received it. If you disagree, raise it with the hospice physician, and you can contact the BFCC-QIO for immediate advocacy.

Can I undo the election statement after signing?

Yes. File a signed, dated revocation with the hospice; a verbal one doesn't count. You give up the remaining days of that benefit period, regular Medicare resumes, and you can re-elect hospice later if you are eligible.

Does signing require a DNR?

No. Federal rules bar hospices from conditioning care on whether you have an advance directive. Your team will talk with you about resuscitation wishes, but a DNR is not required. See does hospice require a DNR.

Can I keep my own doctor?

Yes. You name your attending physician on the election statement. It can be your regular doctor, a nurse practitioner, or a physician assistant, and you acknowledge on the form that the choice was yours.

Is the election statement the same as the Notice of Election?

No. You sign the election statement. The Notice of Election is a filing the hospice sends to its Medicare contractor within 5 calendar days of the effective date. If the hospice files late, it cannot bill you for the uncovered days.

What if the patient can't sign?

A representative with authority under state law to make the patient's medical decisions signs instead, such as a legal guardian. The hospice social worker can help confirm who that is.