If you have Original Medicare and your doctor, health care provider, or supplier thinks Medicare probably (or certainly) won't pay for items or services, he or she may give you a written notice called an "Advance Beneficiary Notice of Noncoverage" (ABN). Other types of ABNs include the "Skilled Nursing Facility Advance Beneficiary Notice," "Home Health Advance Beneficiary Notice," and "Hospital Issued Notice of Noncoverage."
The ABN explains what Medicare won't pay for, the reasons why Medicare won't pay, and also gives an estimate of costs. The ABN helps to give you information to make an informed choice about whether or not to get items or services, understanding that you may have to accept responsibility for payment.
You’ll be asked to choose an option box and sign the notice to say that you read and understood it. You must choose one of the following options:
- To get the items or services that Medicare may not pay for and agree to pay if Medicare doesn't. Your provider or supplier will submit a claim to Medicare for the items or services. If Medicare denies payment, you can still file an appeal.
- To get the items or services that Medicare may not pay for and agree to pay out-of-pocket costs at that time. You request that no claim be submitted to Medicare. You won't be able to appeal because no claim will be filed.
- To not get the items or services. No claim is filed, and you aren't responsible to pay. You won't be able to appeal because no claim will be filed.
An ABN isn't an official denial of coverage by Medicare. You have the right to file an appeal if payment is denied when a claim is submitted.
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