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

A hospice election statement is the document you sign to officially begin the Medicare hospice benefit. By signing, you (or the patient's legal representative) confirm that you understand hospice is comfort-focused care for a terminal illness and that you are choosing it in place of treatment aimed at curing that illness. It is paperwork, not a one-way door — you can change your mind later.

Think of it as turning a key: it switches on a Medicare benefit and tells everyone involved that the goal of care for the terminal diagnosis has shifted from cure to comfort. Federal rules require that this form be clear and that the hospice explain it to you before you sign.

What the election statement actually says

While the exact layout varies by hospice, a Medicare-compliant election statement must include certain elements so you know what you are agreeing to:

• The hospice you are choosing. You name one Medicare-certified hospice to provide your care. You can change this designated hospice once per benefit period without penalty.
• Acknowledgment of the comfort-care focus. You confirm you understand that hospice care is palliative (symptom-relieving) rather than curative for your terminal condition.
• What you are waiving. You give up Medicare payment for treatments aimed at curing the terminal illness. Care for unrelated conditions and all palliative care continue to be covered.
• The effective date. The day your hospice coverage begins — which can be the day you sign or a later date you choose, but not earlier.
• Your right to information. Newer Medicare rules also give you the right to an election statement addendum that lists conditions, drugs, or services the hospice has determined are unrelated to your terminal illness (and therefore not covered by the hospice). You can request this addendum.

The misconception: “Signing means giving up”

Many families hesitate because they believe the election statement is a permanent surrender. It is not. Choosing hospice does not mean choosing to die sooner, and it does not lock you in. You can revoke the benefit and resume curative treatment at any time, for any reason, simply by signing a revocation statement. You can also re-elect hospice again later if you become eligible.

Signing also does not require a Do Not Resuscitate (DNR) order. Hospice and DNR decisions are separate; you can be on hospice without one, though your team will talk with you about your wishes. (See DNR orders explained for hospice families.)

What signing does and does not cover

Once you elect hospice, Medicare pays the hospice for the services, medications related to the terminal diagnosis, and medical equipment your plan of care requires. Hospice drug copays are limited — up to $5 per prescription for symptom and pain medications. Routine Home Care does not pay for facility room and board; only General Inpatient and inpatient respite levels cover “the bed.” For dual-eligible patients, Medicaid may cover a nursing-home room in participating states.

Signing the election statement DOES	Signing DOES NOT
Start the Medicare hospice benefit	Require a DNR
Name your chosen hospice	Permanently bar curative treatment
Confirm a comfort-care focus	Cover care for the terminal illness aimed at cure
Begin coverage on your chosen date	Pay for room and board under Routine Home Care

The addendum: what “related” vs “unrelated” means for you

The part of the paperwork families most often overlook is the election statement addendum, and it can have real cost consequences. When you elect hospice, the hospice becomes responsible for everything related to your terminal illness — the medications, equipment, and care that treat it or its symptoms. Anything the hospice decides is unrelated to the terminal diagnosis stays with regular Medicare (or your other coverage), which means different copays and a different billing path. The addendum is the written list of what the hospice considers unrelated. Requesting it matters because it tells you, in advance, which of your loved one's existing prescriptions and treatments the hospice will not pay for. If you disagree with how something was classified, that is a conversation to have with the hospice physician before problems show up at the pharmacy counter. You have the right to ask for this list and to have it explained.

How signing fits into the enrollment timeline

The election statement is one step in a short sequence, not the whole process:

• Referral and evaluation — a doctor refers, or the family requests a free hospice evaluation; eligibility is a physician's judgment of a six-month-or-less prognosis if the illness runs its normal course.
• Certification — two physicians (typically the hospice medical director and the patient's doctor) certify the terminal prognosis for the first benefit period.
• The election statement — you or the legal representative sign to start the benefit and name the hospice.
• The plan of care and intake — the team builds the individualized plan and delivers medications and equipment.

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

Who can sign

The patient signs if they are able to make their own decisions. If they cannot, the person with legal authority — typically a healthcare power of attorney or other appointed representative — signs on their behalf. If you are unsure who has authority, the hospice social worker can help clarify before anything is signed. Learn more in your rights as a hospice patient.

Take your time and don't sign under pressure

There is no rule that the election statement must be signed during the first visit, and a reputable hospice will never rush you. If anything is unclear, you are entitled to a plain-language explanation, a copy of the document, and time to read it. Watch for pressure tactics: being urged to sign quickly without explanation, vague answers about which conditions are “related” versus “unrelated,” or reluctance to provide the addendum are reasons to slow down and ask more questions. Because you are choosing one specific hospice on this form, it's worth confirming you're comfortable with that provider first — review their family-survey scores and quality measures, and ask about after-hours coverage. Signing starts the benefit, but it is reversible, and you can switch agencies once per benefit period; still, getting the choice right up front spares everyone a transition during an already hard time.

Frequently asked questions

Can I undo the election statement after signing?

Yes. You can revoke the hospice benefit at any time, for any reason, by signing a revocation statement, and return to standard Medicare. You can also re-elect hospice later if you remain or become eligible. Signing is reversible.

Does signing require a DNR?

No. Hospice enrollment and DNR orders are entirely separate decisions. You can be on hospice without a DNR. Your team will discuss your resuscitation wishes, but they cannot require a DNR as a condition of care.

What is the election statement addendum and should I request it?

It is a written list of conditions, drugs, and services the hospice has determined are unrelated to the terminal illness and therefore not covered by the hospice. Requesting it is wise, because it tells you in advance what the hospice won't pay for, helping you avoid surprise pharmacy or billing issues.

When does my coverage start?

On the effective date you choose, which can be the day you sign or a later date — but it cannot be backdated to before you signed. Confirm the date with the admitting nurse so there's no gap.

What if the patient can't sign?

The person with legal authority, usually a healthcare power of attorney, signs on the patient's behalf. The hospice social worker can help confirm who holds that authority before anything is signed.

Your practical next step

Before you sign, read each section and ask the admitting nurse to explain anything that is unclear — you have the right to a plain-language explanation and a copy of what you signed. Ask specifically which conditions and medications the hospice considers related versus unrelated to the terminal diagnosis, and request the election statement addendum if you want that in writing. If you have not yet chosen a hospice, you can compare hospices near you and review their family-survey scores first. There is no obligation to sign on the spot; take the time you need to feel informed.