What Is an Advance Beneficiary Notice (ABN) and What Does Signing One Mean

An Advance Beneficiary Notice of Noncoverage is a written notice that Medicare providers must give you before furnishing items or services they expect Medicare to deny. Signing an ABN means you acknowledge that Medicare may not cover the service and that you agree to pay if it does not.

When providers must give you an ABN

Medicare providers must issue an ABN when they reasonably expect Medicare to deny a claim because the service is not medically necessary, is not covered under your Medicare benefit, or is experimental. The ABN must be provided far enough in advance of the service that you can make an informed decision about whether to proceed.

An ABN is not required for services that Medicare never covers, such as most dental or vision care. It is required specifically for services that are sometimes covered but that the provider believes will be denied in your particular case.

What the ABN form contains

A valid ABN must describe the specific item or service that may not be covered. It must explain why the provider thinks Medicare may not pay. It must include a cost estimate. It must give you the choice to receive the service and agree to pay, or to decline the service.

If an ABN does not contain all required elements or is not given to you before the service with adequate time to consider your decision, it may not be a valid ABN and you may not be responsible for the charges even if Medicare denies the claim.

Your options when given an ABN

You can choose to receive the service, in which case Medicare will process the claim first and deny it if payment is refused, after which you are responsible for the cost. You can request a denial notice from Medicare so you can appeal the denial. Or you can decline the service.

If you want Medicare to make an official determination so you can appeal, check the box on the ABN requesting that the provider submit the claim to Medicare and issue a denial notice. You cannot appeal a denial that was never submitted.

ABNs and Medicare Advantage

Medicare Advantage plans have different notice requirements than Original Medicare. If you have a Medicare Advantage plan, the ABN process described here applies to your plan's equivalent notice process, but the specific forms and procedures may differ. Ask your plan for details.

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Bill Advantage is a document literacy tool. Nothing in this article constitutes legal or medical advice.