What to clarify before signing a hospice election statement

A hospice election is a benefit decision with practical effects on care and payment. Ask for the statement in a format you can understand and discuss unanswered questions before signing.

Who pays

	Medicare	Medicaid	Private pay	Private insurance
How it works	Eligible Part A beneficiaries may elect the hospice benefit through a Medicare-approved hospice. Ordinary residential room and board is generally excluded.	Hospice is an optional state-plan benefit. Verify adult eligibility and coordination with other coverage through the state and hospice.	Ordinary housing charges and additional daily assistance may remain the household’s responsibility.	Ask the policy administrator and hospice to confirm coverage, network participation, cost sharing, and excluded charges.

Treat an information conversation and an election as different steps

Ask whether the meeting is intended to provide information, assess eligibility, or complete an election. Knowing the purpose helps the person prepare questions without assuming that listening to a hospice presentation already means agreeing to services. Ask which documents are informational and which require a decision or signature. Request time to read the statement in a usable format and to involve chosen supporters or an authorized representative as appropriate. If someone uses the word enrollment loosely, ask what action they mean and when the benefit would start. A clear process should identify the proposed hospice, the individual decision being made, and the questions still open before the household treats the arrangement as final.

Confirm who is making the decision and how they are supported

Ask the clinician and hospice to explain eligibility, the proposed start date, and the person's treatment goals. Include the person receiving care as fully as they can participate, with interpretation or other communication assistance when needed. If another person is expected to sign, ask the hospice what authority and documentation are required under the applicable rules. A family relationship alone does not establish authority. This guide does not decide capacity, interpret a power of attorney, or determine who may sign in a particular state. Those issues may require qualified professional advice. Identify uncertainty early so it can be addressed through the proper process before a form is handed over.

Sample situation

Elena Torres sits with her son, Marco, to read a hospice election statement before she signs it. She asks if this meeting is just to give information, or if signing today will start the election. She asks for time to read each part and ask questions with no rush.

Elena checks the basics on the page. She reads the hospice name, the planned start date, and the name of the attending professional. She asks how that person will work with the hospice team. Marco writes down who gave each answer and what still needs a follow-up.

Next, they go through her care one item at a time. They list her treatments, drugs, appointments, transport, supplies, and equipment. For each item, Elena asks what will go on, what the hospice must help arrange, and what needs a separate talk about coverage. She does not guess if an item is related or unrelated.

Elena asks who will give her the required addendum. She asks the hospice to explain, in plain words, what it lists as unrelated. She asks what signing the addendum means. She also asks which home costs, such as room and board, stay apart from the election.

Before she signs, Elena sums up what she has learned in her own words. She names the one question that is still open. She asks the hospice to fix any part she got wrong, just as the guide above suggests.

Ask for a plain-language explanation of the election's scope

Request an explanation of how the hospice election affects payment for care of the terminal illness and related conditions. Ask the hospice and treating clinicians to discuss the person's specific questions rather than relying on a blanket statement that all treatment ends or all expenses become free. Bring a list of planned appointments and current services as a prompt for that discussion. Do not decide yourself whether an individual item is related or unrelated from the title of a diagnosis or service. Ask who makes and explains that determination, what written information is available, and how a disagreement is reviewed. The statement is part of an individual benefit and care-planning process, not simply a routine mailing-list or appointment registration form.

Check the provider name, start date, and attending information

Read the identifying and timing information carefully and ask the hospice to correct errors through its normal process. Confirm the selected hospice, proposed effective date, and attending professional identified on the statement. Ask how that professional will work with the hospice team. If a familiar clinician's role is unclear, request clarification from the appropriate offices instead of assuming that the relationship continues unchanged or ends automatically. Keep a record of who answered the question and what follow-up remains. Clear names, dates, contacts, and professional roles help the household understand who is responsible when the election takes effect.

Discuss present services one by one

Use a service list to organize questions about current treatments, drugs, clinicians, scheduled appointments, transport, supplies, and equipment. Ask the responsible professionals which arrangements continue, which need coordination through hospice, and which require another coverage explanation. Do not cancel, replace, or alter treatment or equipment based on this guide. If an item is considered unrelated to the terminal illness and related conditions, ask about the written addendum and explanation. Request written information about possible patient charges and ordinary room and board. When a question remains unanswered, identify who will resolve it and whether the answer is needed to understand the proposed election and immediate arrangements.

Keep the election addendum with the statement

For Medicare hospice elections starting October 1, 2026, the hospice must provide a written election statement addendum to the person or representative. This separate document explains which conditions, items, services, and drugs the hospice considers unrelated to the terminal illness and related conditions. It includes the hospice's clinical explanation in understandable language. Ask the hospice to explain unfamiliar terms and how the document relates to current services. The addendum does not replace the election statement.

Guidance from the Centers for Medicare & Medicaid Services (CMS) sets the initial delivery period at five calendar days from the election's effective date. When a care-plan change affects the addendum's determinations, an updated addendum is due within three calendar days. Keep the effective date and each received version together. Ask which determination changed rather than assuming that every care-plan adjustment requires a different addendum. These are document-delivery periods, not a calculation of an individual's appeal deadline.

The regulation says signing the addendum acknowledges receiving it; it does not mean agreeing with the hospice's determinations. It also requires the hospice to document a refusal to sign. Ask the hospice to explain the particular form and any unresolved concern. This guide does not recommend signing or refusing a document in an individual case. Questions about a representative's authority or a disputed legal effect need appropriate qualified help.

The addendum identifies access to immediate advocacy through the Beneficiary and Family-Centered Care Quality Improvement Organization, or BFCC-QIO. Use the contact information supplied with the document to ask about that assistance. Do not classify a medication or service yourself or assume that an unrelated-item listing guarantees payment by another insurer. Keep billing questions connected to the responsible payer and the hospice's actual explanation.

CMS's initial payment-enforcement discretion runs from October 1 through December 31, 2026. During that period, contractors will not deny claims solely for a missing or incomplete addendum; the duty to furnish it continues. The regulation also has specific exceptions when a person dies, revokes, or is discharged before delivery or signature within the required period. Ask the hospice to explain any exception it relies on. Do not treat this general guide as a decision about a particular claim, signature, or dispute.

Separate the hospice statement from residence and private-help contracts

A person may be considering hospice while also signing documents for a care home, assisted living facility, nursing home, or separately hired helper. Ask which organization each agreement belongs to and what it covers. Keep ordinary housing charges, extra assistance fees, and possible hospice cost sharing in separate parts of the discussion. A hospice election should not be assumed to pay a residence's room and board merely because hospice staff visit there. If someone presents several forms together, request a clear explanation of the purpose and effect of each. This can help prevent a household from treating one signature as an answer to different service, payment, privacy, or residential questions that deserve their own review.

Ask what happens immediately after the effective date

Before the meeting ends, confirm the first planned contact, how the household receives the care plan, and which telephone number to use for questions. Ask who coordinates any agreed delivery or service handoff and who confirms it is complete. An election date is not itself proof that every practical arrangement has occurred. If a residence is involved, ask how staff receive the relevant information and whom they contact when questions arise. Keep the person receiving care and authorized supporters informed about what remains pending. A simple list of the first steps can reveal a missing appointment or unconfirmed responsibility before the household assumes that another organization has automatically taken over every part of the arrangement.

Learn the routes for concerns and later choices

Ask the hospice how the person can raise a concern, seek a review of a coverage issue, request a provider change, or discuss revoking an election. These are different actions with different procedures and possible benefit or timing consequences. Request the applicable written information and ask who can explain it for the particular situation. Also ask who coordinates care if services change; a former provider should not be assumed to have resumed responsibility automatically. This guide does not recommend a choice or interpret an individual dispute. Identify any need for qualified legal, clinical, or benefits assistance so an uncertain explanation is not treated as settled.

Keep the final documents and explanations together

Ask for the completed statement and relevant notices through the hospice's normal process. Store them where the person and authorized supporters can find them, with the contact information used during the discussion. Keep any written explanation of excluded items, patient charges, or unresolved questions alongside the statement rather than relying only on a relative's memory. Avoid placing signed forms or medical identifiers in a public comment area or an unsecured shared notebook. If a supporter is taking notes, ask them to distinguish the professional explanation from their own interpretation. A clear document record makes it easier to ask a precise follow-up question and to understand which version of an agreement or notice was in effect at a particular time.

Use a final understanding check without rushing the decision

Before signing, the person or authorized representative can summarize what they understand: which hospice is selected, when the election begins, how care for the terminal illness and related conditions is arranged, what household expenses remain separate, and whom to contact with questions. Ask the hospice to correct any misunderstanding. If an important question is still open, identify it explicitly rather than treating silence as agreement. A supporter can help organize questions without deciding for the person or representing an unresolved issue as approved. The purpose of this check is not to turn a complex situation into a test that someone must pass. It is to make the decision, immediate responsibilities, and remaining uncertainties understandable enough for the appropriate individual discussion and informed choice.

A planning example for an unanswered election question

Suppose the person considering hospice asks who will coordinate an already scheduled outside appointment, and the intake conversation has not yet produced a clear answer. Put that question on the unresolved list and identify which hospice professional or treating office will explain it. A relative can take notes, but should not resolve the benefit or clinical question by guessing from an online article. This fictional example does not advise whether to sign or delay an individual election. It illustrates how to preserve a specific question so the responsible professionals can address it within the actual decision process.

Questions to take to the care discussion

• Has the person received an understandable explanation of eligibility, goals, start date, and the particular statement they are being asked to sign?
• If another person signs, has the hospice confirmed the authority required rather than assuming any accompanying relative may make the decision?
• Have current treatments, medications, and outside appointments been discussed individually so the effects of election are clear before arrangements change?
• Who confirms the first visits and delivery arrangements, and what help remains the responsibility of the household or residential setting?
• Does the person know how to raise concerns or change the arrangement, and who will coordinate care if the election is later revoked?
• Who will provide the required addendum, explain its determinations, and send an update if a relevant care-plan change occurs?

Sources

• Hospice care — Medicare.gov
• Hospice Benefits — Medicaid.gov
• Long-term care — Medicare.gov
• Hospice News & Announcements: mandatory election statement addendum — Centers for Medicare & Medicaid Services
• MLN Connects Newsletter for October 1, 2026: hospice addendum implementation — Centers for Medicare & Medicaid Services
• 42 CFR 418.24 — Election of hospice care — Electronic Code of Federal Regulations