Advance Beneficiary Notice
An Advance Beneficiary Notice (ABN) is a form that notifies you if Medicare is unlikely to cover a specific service, equipment or test. How you fill out an ABN will determine whether you want the procedure or equipment, and your billing preference. Learning what to expect from an ABN, and when you’re likely to receive one, can best prepare you to make informed medical decisions.
- Written by Lindsey Crossmier
Lindsey Crossmier is an accomplished writer with experience working for The Florida Review and Bookstar PR. As a financial writer, she covers Medicare, life insurance and dental insurance topics for RetireGuide. Research-based data drives her work.Read More
- Edited ByLamia Chowdhury
Lamia Chowdhury is a financial content editor for RetireGuide and has over three years of marketing experience in the finance industry. She has written copy for both digital and print pieces ranging from blogs, radio scripts and search ads to billboards, brochures, mailers and more.Read More
- Published: August 17, 2022
- Updated: September 20, 2022
- 6 min read time
- This page features 5 Cited Research Articles
- Edited By
What Is an Advance Beneficiary Notice (ABN)?
An ABN, also known as Form CMS-R-131, is a document informing you that Medicare is unlikely to offer coverage for a specific service, medication or equipment. Note that an ABN isn’t a denial — you can still receive coverage despite receiving an ABN.
On the ABN form, you can decide whether you want the service, medication or equipment and choose your billing preference — or you can decide to decline altogether.
The purpose of an ABN form is to transfer potential financial responsibility to the Medicare beneficiary if needed. The U.S. Centers for Medicare & Medicaid has a sample ABN form available to help you gain familiarity. Even though an ABN form is only one page, you should still read each line carefully. Once signed, you can become legally responsible if Medicare denies payment.
You can receive an ABN from one of your physicians, providers, home health agencies, hospice providers or lab specialists. ABNs are only valid if they are given to you in advance. This way, you have time to make a premediated health care decision. An ABN will never be required in an emergency.
There are different types of ABNs depending on your circumstance. While they all have slight differences in functionality, they all generally serve the same purpose — to notify you about potential Medicare coverage issues.
- Home Health Agency Advance Beneficiary Notice (HHAABN)
- Home Health Change of Care Notice (HHCCN)
- Notice of Medicare Non-Coverage (NOMNC)
- Detailed Explanation of Non-Coverage (DENC)
- Skilled Nursing Facility Advance Beneficiary Notice (SNFABN)
- Hospital Issued Notice of Non-Coverage (HINN)
Information to Include on an ABN
An ABN has multiple sections with information relevant to your service or treatment.
Your full name will be printed on the form. Whoever gives you the ABN must also provide their full name, address and phone number on the form.
The ABN will have the name of the service or item that might not be covered, the reason why Medicare may not pay, along with the estimated cost.
There are three options in a checklist to consider. What you choose determines if you are getting the treatment or item, as well as your billing decision. You can only choose one option.
- Option 1
- You want the treatment or service, and the notifier will submit a claim to Medicare. With this option, your payment decision can be appealed.
- Option 2
- You want the treatment or service and plan to pay for it out of pocket. A claim will not be sent to Medicare. Therefore, there aren’t appeal rights with this option.
- Option 3
- You do not want the treatment or service. You aren’t responsible for any payment, and you won’t be able to appeal to see if Medicare would pay.
What Kinds of Medicare Are Subject to Advance Beneficiary Notices?
It’s also important to note what conditions will likely warrant an ABN. If your Medicare item or service isn’t deemed reasonable or necessary, you could receive an ABN.
- If the treatment or service is experimental
- If you’ve exceeded the number of services allowed in a specific period for that diagnosis
- If you’re requesting custodial care
- If your outpatient therapy services exceed the therapy threshold amount
Remember, you can only be given an ABN if you have time to consider your options. You cannot be given an ABN if you’re facing an immediate medical emergency. For example, if you’re requesting a service that isn’t immediately necessary — you could be given an ABN. If you’re being rushed into the emergency room with a broken leg — you will not be given an ABN.
To further clarify, you can only be given an ABN if you have Original Medicare and have a considerable amount of time to consider your medical decision.
What To Do if You Receive an Advance Beneficiary Notice
If you receive an ABN, you should talk over this decision with the provider who gave you the ABN form or another qualified individual. When making an important medical decision, it would be in your best interest to have a professional weigh in their recommendation. You’ll then choose one of the three options listed above.
Once you’ve selected an option, you’ll need to sign and date the form. You, and whoever gave you the form, should each keep a copy of the ABN. The form provider will then submit your ABN.
How to Appeal an ABN
If Medicare denies coverage or you disagree with their payment decision, then you can file an appeal. If you file an appeal, they could reconsider their decision.
Before you file an appeal, you should gather all relevant information. This will help your chances of being reconsidered.
- Your Medicare number
- List of specific items or services to be reconsidered, as well as the dates of service
- Explanation of why you think the items or services should be covered
- Any other relevant information that may help your case
If you can’t think of a credible reason why your item or service should be covered, then you shouldn’t try to file an appeal. If you can, there are two simple steps to filing your appeal.
- Review your Medicare Summary Notice (MSN). Your appeal must be filed by the date listed in your MSN. If you missed the deadline, you could still appeal, but you should note why you missed the deadline.
- Fill out a Redetermination Request Form. You’ll need to mail this completed form to the company that handles Medicare claims. Their address will be listed in the “Appeals Information” section on your MSN.
After you file your appeal, the response time is typically 60 days. If Medicare decides to cover the item or service previously declined, then the coverage will be listed on your next MSN.
5 Cited Research Articles
- U.S. Centers for Medicare & Medicaid Services. (2022., June). Medicare Advance Written Notices of Non-Coverage. Retrieved from https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/abn_booklet_icn006266.pdf
- U.S. Centers for Medicare & Medicaid Services. (2021, November). Advance Beneficiary Notice of Non-Coverage Tutorial. Retrieved from https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/ABN-Tutorial/formCMSR131tutorial111915f.html
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Form Instructions Advance Beneficiary Notice of Non-Coverage (ABN). Retrieved from https://www.cms.gov/Medicare/Medicare-General-Information/BNI/Downloads/ABN-Form-Instructions.pdf
- U.S. Centers for Medicare & Medicaid Services. (n.d.). How Do I File an Appeal? Retrieved from https://www.medicare.gov/claims-appeals/how-do-i-file-an-appeal
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Your Protections. Retrieved from https://www.medicare.gov/basics/your-medicare-rights/your-protections
Calling this number connects you to one of our trusted partners.
If you're interested in help navigating your options, a representative will provide you with a free, no-obligation consultation.
Our partners are committed to excellent customer service. They can match you with a qualified professional for your unique objectives.
We/Our Partners do not offer every plan available in your area. Any information provided is limited to those plans offered in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.888-694-0290