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By Frank Flores, founder of FamiliaLista · Updated November 3, 2026

How hospice starts in Texas: the election statement and who signs

Hospice starts with one paper: the election statement. You sign it, or your representative signs it if you can't. It names the hospice and the doctor you chose. You can keep your own doctor, change hospices, or stop hospice at any time. Here is how it works, and what to decide ahead.

Who can choose hospice?

To get hospice under Medicare, you need Part A, and your hospice doctor and your regular doctor, if you have one, certify that you're terminally ill with a life expectancy of 6 months or less. You accept comfort care instead of care to cure your illness, and you sign a statement choosing hospice. Sources: 42 CFR §418.20, eligibility, Medicare.gov, hospice care.

Who signs the election statement

You sign it yourself. If you are physically or mentally unable, your representative signs it. Under Medicare rules, that is a person with authority under state law to make medical decisions or choose hospice for you, and it can include a legal guardian. In Texas, the agent in a medical power of attorney makes health care decisions when you can't. Name that person now and tell them what you want. Read the medical power of attorney in Texas. Sources: 42 CFR §418.24, election of hospice care, 42 CFR §418.3, definitions, Tex. Health & Safety Code ch. 166.

What the election statement says

The hospice you chose.
The attending physician you chose, and that the choice was yours. This can be your regular doctor or nurse practitioner.
That hospice care is for comfort, not cure, and that you understand what Medicare stops covering for your terminal illness.
The start date. It can be the first day of care or later, but not before you sign.
Information on what you may owe, and how to reach the Medicare quality organization (BFCC-QIO) for immediate help if you disagree.
Your signature, or your representative's.

Medicare says the statement must be done before you get any hospice services. Sources: 42 CFR §418.24, election of hospice care, Medicare.gov, hospice care.

Keep your own doctor

You can keep seeing your regular doctor or nurse practitioner if you choose them as the attending professional who helps oversee your hospice care. Ask your doctor now if they will stay with you. To change your attending doctor later, you sign a statement with the hospice naming the new doctor and the date. Sources: Medicare.gov, hospice care, 42 CFR §418.24, election of hospice care.

Papers the hospice files and gives you

Notice of Election. The hospice files it with Medicare within 5 calendar days after your start date. If it files late, Medicare doesn't pay for those days, and the hospice can't bill you for them.
The list of what hospice won't cover. For elections starting on or after October 1, 2026, the hospice must give you a written addendum called "Patient Notification of Hospice Non-Covered Items, Services, and Drugs," within the first 5 days. It lists what the hospice decided is unrelated to your terminal illness, with a plain-language reason. Signing it only shows you got it, not that you agree. If your plan of care changes, the hospice updates it within 3 days.

Keep a copy of the election statement and the addendum with your papers. Source: 42 CFR §418.24, election of hospice care.

What Medicare covers in hospice

Your hospice team sets up a plan of care. It can include doctor and nursing services, aides and homemaker services, drugs and medical equipment for pain and symptoms, medical supplies, therapy, social services, dietary counseling, short-term inpatient care, respite care so your caregiver can rest, and spiritual and grief counseling for you and your family. Hospice care can be at home, in assisted living or in a nursing home. Medicare doesn't cover room and board where you live, like a nursing home, treatment meant to cure the terminal illness, or care from a hospice you didn't choose. Call your hospice team before getting other care for your terminal illness. Medicare still pays for health problems that aren't part of it. Source: Medicare.gov, hospice care.

Changing or stopping hospice

Stop at any time. You or your representative sign a statement with the date it ends, and that date can't be earlier than the day you sign. Your regular Medicare coverage starts again.
Don't sign a stop form early. Medicare says no one should ask you to sign forms about stopping hospice when you start. Sign only on the day you choose to stop.
Go back later. If you qualify, you can choose hospice again.
Change hospices once in each benefit period. You file a statement with both hospices naming them and the date.
How long. Hospice comes in two 90-day periods, then an unlimited number of 60-day periods, as long as the doctor recertifies.

Sources: 42 CFR §418.28, revoking hospice, 42 CFR §418.30, changing hospice, Medicare.gov, hospice care.

Grief support for the family

Every Medicare hospice must have a bereavement program and make it available to the family up to 1 year after the death. It can also reach residents of the nursing home where your loved one lived, when the plan includes them. Source: 42 CFR §418.64, core services.

The out-of-hospital DNR

If you don't want CPR when your heart or breathing stops at home, in a nursing home or in hospice, Texas has an out-of-hospital do-not-resuscitate order. Your attending physician signs it, and you can revoke it at any time. Read the HIPAA release and out-of-hospital DNR in Texas. Sources: Texas DSHS, OOH-DNR questions and answers, Tex. Health & Safety Code ch. 166.

Decide these ahead

[ ] Who signs for you if you can't.
[ ] Whether your own doctor will stay on as your attending.
[ ] Which hospice you would choose. Ask if it's Medicare-approved, how your doctor will work with theirs, and how they handle emergencies after hours.
[ ] Where you keep the election statement and the addendum.

Source: Medicare.gov, hospice care.

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Frequently asked questions

Who signs the hospice election statement?

The patient. If the patient is physically or mentally incapacitated, a representative with authority under state law signs it, which can include a legal guardian.

Can I keep my own doctor in hospice?

Yes. You can choose your regular doctor or nurse practitioner as your attending professional on the election statement.

What is the hospice non-covered items addendum?

For elections on or after October 1, 2026, the hospice must give you a written list of items, services and drugs it won't cover because they are unrelated to your terminal illness, within the first 5 days.

Can I stop hospice?

Yes, at any time. You sign a statement with the end date, your regular Medicare coverage starts again, and you can choose hospice again later if you qualify.

Sources

General information, not legal or financial advice. Rules change; check the official sources above or talk to a licensed professional about your situation.