Medicare Hospice Coverage: New Notice Families Must Receive in 2027
A new Medicare hospice notice could help keep families from being blindsided by medications, services, equipment, or supplies the hospice says it will not cover.
Updated July 31, 2026 • The rule takes effect October 1, 2026.
The short answer
For hospice elections beginning on or after October 1, 2026, every Medicare beneficiary—or the beneficiary’s representative—must receive a written hospice election statement addendum. It explains which conditions, items, services, and drugs the hospice has determined are unrelated to the terminal illness and therefore will not be covered through the hospice benefit.
Signing confirms receipt. It does not mean you agree. And something the hospice excludes may still qualify for coverage through Original Medicare, Medicare Part D, or an existing Medicare Advantage plan.
Hospice decisions often happen during one of the hardest days a family will ever face. There may be doctors to call, medications to organize, equipment arriving at the home, and paperwork that needs an immediate signature. Understanding Medicare hospice coverage before signing can help prevent confusion and unexpected costs later.
That is precisely why this finalized Medicare change matters. Families should not have to know the name of an obscure form—or know that they must request it—to learn what the hospice will and will not cover.
Does Medicare cover hospice care?
Yes. Medicare Part A covers hospice care for an eligible person who is terminally ill, accepts comfort-focused care instead of treatment intended to cure the terminal illness, and elects the Medicare hospice benefit through a Medicare-approved hospice. The hospice benefit generally covers the care, medications, medical equipment, and supplies needed for the terminal illness and related conditions.
Normal Medicare coverage rules may still apply to care for health problems that are unrelated to the terminal illness. The new notice discussed below helps families understand where the hospice believes that line has been drawn.
What is the new Medicare hospice addendum?
The document is formally titled “Patient Notification of Hospice Non-Covered Items, Services, and Drugs.” It accompanies the hospice election statement.
When a person elects Medicare hospice, the hospice generally becomes responsible for care related to the terminal illness and related conditions. CMS has long maintained that the hospice benefit is comprehensive and that services furnished outside hospice for a terminally ill beneficiary should be unusual and exceptional.
Sometimes, however, the hospice determines that a particular condition, medication, supply, or service is unrelated to the terminal illness. The addendum creates a written record of those determinations and the hospice’s reasons for making them.
Who must receive the notice, and when?
| Requirement | What it means for families |
|---|---|
| Who receives it | Every Medicare beneficiary electing hospice on or after October 1, 2026, or the beneficiary’s authorized representative. |
| Initial deadline | The hospice must provide it in writing within the first five days of the effective date of the hospice election. |
| Updates | If a plan-of-care change affects the hospice’s related-or-unrelated determinations, the hospice must update the addendum within three days and give the update to the beneficiary or representative. |
| Who may access it | The document must be kept available for the beneficiary or representative, non-hospice healthcare providers, and Medicare contractors. |
If a patient dies, revokes hospice, or is discharged before the applicable deadline, the hospice may not have to furnish or obtain a signature on the document. The hospice must document why it was not completed, provided, or signed.
What must the addendum explain?
The addendum must include:
- The hospice’s name and the patient’s identifying information
- The terminal illness and related conditions identified by the hospice
- Conditions the hospice considers unrelated to the terminal illness
- The associated items, services, and drugs the hospice will not cover
- A clinical explanation written in language the patient or representative can understand
- References to relevant clinical practices, policies, or coverage guidelines
- Information about the right to immediate advocacy through the Medicare Beneficiary and Family Centered Care Quality Improvement Organization, or BFCC-QIO
- The date the hospice furnished the addendum
The clinical explanation matters. A family should receive more than a vague statement such as “not hospice related.” The explanation should tell them why the hospice believes the particular condition, drug, supply, or service is unrelated and not needed for pain or symptom management.
What medications, services, or supplies might appear?
There is no universal list. These decisions must be individualized based on the patient’s diagnoses, condition, goals, preferences, and plan of care.
Depending on the patient’s circumstances, an addendum could address:
- Prescription medications
- Diabetes medications and testing supplies
- Heart, blood-pressure, or anticoagulant medications
- Wound care and wound-care supplies
- Oxygen and respiratory equipment
- Wheelchairs, hospital beds, or other durable medical equipment
- Physician or specialist visits
- Laboratory tests, hospital care, or emergency services
Signing confirms receipt—not agreement
The beneficiary or representative will be asked to sign and date the addendum. But the rule requires the document to explain that the signature is only an acknowledgment that the addendum was received.
If you disagree, you can sign to confirm receipt and still question the hospice’s determination. Ask for a copy of the signed document before the hospice representative leaves.
What should you do if you disagree?
1. Ask the hospice to explain its decision
Ask why the condition or item is considered unrelated and what clinical information supports that decision. If the explanation is difficult to understand, ask the hospice to explain it differently and in writing.
2. Ask whether the attending physician was consulted
A patient’s full medical picture matters. Ask whether the hospice considered all diagnoses, current symptoms, medications, and the attending physician’s opinion.
3. Ask about immediate advocacy
The addendum must include information about contacting the BFCC-QIO for immediate advocacy if the patient or representative disagrees with the hospice’s determination. The BFCC-QIO can help address the concern with the hospice. You can also call 1-800-MEDICARE (1-800-633-4227) for help locating the organization serving your state.
4. Understand when a formal Medicare appeal applies
Immediate advocacy over the hospice’s relatedness determination is not exactly the same as appealing a denied Medicare claim. If Original Medicare, Medicare Advantage, or a Part D plan later refuses to cover or pay for an item, service, or drug, follow the appeal instructions on the Medicare Summary Notice or the plan’s written denial.
Keep the addendum, clinical explanation, plan of care, medication list, bills, receipts, and denial notices. These records may help support the appeal.
Not covered by hospice does not always mean not covered by Medicare
This is the distinction families cannot afford to miss.
If the hospice determines that a condition, service, item, or drug is truly unrelated to the terminal illness and related conditions, it may remain eligible for coverage under a separate Medicare benefit.
- Original Medicare may cover medically necessary services for unrelated health conditions, subject to its normal coverage rules, deductibles, and coinsurance.
- Medicare Part D may cover prescription drugs that are unrelated to the terminal illness, subject to the plan’s formulary, pharmacy network, prior authorization, and cost-sharing rules.
- Medicare Advantage members may be able to receive coverage for unrelated medical services or additional benefits through their existing plan, depending on the plan and how the service is obtained.
A simple example
Imagine that Maria elects hospice because of advanced cancer. She also takes a prescription for a separate condition.
If the hospice determines that the prescription is unrelated to her terminal illness and will not cover it through the hospice benefit, the medication should be listed on Maria’s addendum with an understandable clinical explanation.
That does not automatically make Maria responsible for the full price. Her Part D plan may still cover the medication under its normal rules.
But Maria’s family should verify the determination with the hospice and confirm coverage with the drug plan before filling the prescription. If the drug is rejected, they should request a written coverage decision and follow the Part D appeal instructions if appropriate.
Questions families should ask before signing
- What terminal illness and related conditions are listed?
- Which of the patient’s other conditions does the hospice consider unrelated?
- Which medications will the hospice provide and pay for?
- Which medications, services, equipment, or supplies will it not cover?
- Why is each excluded item considered unrelated?
- Could the item be necessary for comfort, pain control, or symptom management?
- Was the attending physician consulted?
- Could Original Medicare, Part D, or the patient’s Medicare Advantage plan cover the excluded item?
- What deductibles, copayments, or coinsurance might apply?
- Who should we call before using the emergency room or hospital?
- Who should we call if a prescription is rejected at the pharmacy?
- How will we receive an updated addendum if the plan of care changes?
- Where is the BFCC-QIO contact information if we disagree?
- May we have a copy of every document we signed?
Why CMS made this change
CMS said families should not have to make an additional request to receive information that affects their care, Medicare rights, and possible out-of-pocket costs. The agency was also concerned that beneficiaries and outside healthcare providers sometimes had difficulty obtaining the addendum.
The new requirement creates a written record that can help families understand the hospice’s decisions, coordinate with outside providers, and identify which part of Medicare may be responsible for payment.
What about the 2.3% hospice payment increase?
The same final rule increases Medicare hospice payment rates by 2.3% for fiscal year 2027. CMS estimates that the updated rates will increase Medicare payments to hospices compared with fiscal year 2026.
That provides useful context, but it does not change the central takeaway for families: beginning October 1, 2026, the hospice must give every new hospice patient or representative the addendum automatically.
The bottom line
Do not treat the hospice addendum as just another signature page.
Read what the hospice says it will not cover. Ask why. Find out whether another part of Medicare may cover it. Keep every version, because the hospice must update the document within three days when a plan-of-care change affects its determinations.
And remember: your signature confirms receipt. It does not mean you agree.
Keep reading
Robin Dall
Florida Medicare Broker & Educator
Robin Dall is a Florida licensed Life, Health & Annuity Agent and founder of RobinsWisdom. This article was researched, written, and reviewed by Robin and reflects Medicare rules and guidance available at the time of publication.
Medicare rules can change, and coverage depends on the individual situation. This article is educational and is not medical or legal advice. Contact the hospice, Medicare, the applicable health or drug plan, or the BFCC-QIO for help with a specific coverage decision.
Official sources
Still not sure how this applies to your situation? Start with the hospice’s explanation, and if something doesn’t add up, check it with Medicare before you make a decision.
Need Help Making Sense of It?
If you’ve checked the details and still feel like you need a decoder ring, that’s where I can help. I’ll help you sort through the Medicare side and figure out what questions to ask next.
Request a Medicare Review
