Signing an Advance Beneficiary Notice of Noncoverage (ABN) at the front desk isn't the same as agreeing you owe the money, and it doesn't cost you your right to appeal. The ABN is the written notice your Medicare provider gives you before a service the program usually covers but expects to deny this time. It hands you a choice: get the service and agree to pay if Medicare says no, or turn it down.
In This Guide
- Key Takeaways
- What an Advance Beneficiary Notice Actually Is
- Why You Got an Advance Beneficiary Notice
- The Choice an ABN Asks You to Make
- Does Signing an ABN Mean You Owe the Money?
- ABNs and Medicare Advantage
- Frequently Asked Questions
- Learn More
What an Advance Beneficiary Notice Actually Is
The Advance Beneficiary Notice of Noncoverage, ABN for short, is a standard federal form: Form CMS-R-131. Your provider, practitioner, or supplier gives it to you before furnishing an item or service to an Original Medicare (fee-for-service) patient when Medicare payment is expected to be denied.Centers for Medicare & Medicaid Services. (n.d.). CMS — FFS ABN (Beneficiary Notices Initiative). cms.gov. Retrieved Jul 24, 2026, from https://www.cms.gov/medicare/forms-notices/beneficiary-notices-initiative/ffs-abn That last part is the whole point of the notice, so it's worth sitting with.
The form has one job: to move the potential bill onto you if you choose to go ahead.Centers for Medicare & Medicaid Services. (n.d.). CMS — FFS ABN (Beneficiary Notices Initiative). cms.gov. Retrieved Jul 24, 2026, from https://www.cms.gov/medicare/forms-notices/beneficiary-notices-initiative/ffs-abn In plain terms, it's your provider saying, "Medicare probably won't pay for this, so before we do it, I need you to know you might be the one paying." It isn't a sales tactic and it isn't optional paperwork the office invented. It's the notice federal rules require them to give you first, so the decision is yours to make with your eyes open.
You'll see an ABN from all kinds of providers, not just doctors' offices. Independent labs, home health agencies, and hospices use it too.Centers for Medicare & Medicaid Services. (n.d.). CMS — FFS ABN (Beneficiary Notices Initiative). cms.gov. Retrieved Jul 24, 2026, from https://www.cms.gov/medicare/forms-notices/beneficiary-notices-initiative/ffs-abn So if a form like this turns up at a blood draw or a home-health visit, it's the same notice doing the same job.
Why You Got an Advance Beneficiary Notice
You got an ABN for a service Medicare does normally cover. If Medicare never covered it, there'd be nothing to warn you about; you'd just pay, the way you would for anything Medicare doesn't touch.
The ABN shows up in the in-between case: the service is generally covered, but Medicare is expected to deny it this time.Centers for Medicare & Medicaid Services. (n.d.). CMS — FFS ABN (Beneficiary Notices Initiative). cms.gov. Retrieved Jul 24, 2026, from https://www.cms.gov/medicare/forms-notices/beneficiary-notices-initiative/ffs-abn A common reason is that the service isn't considered reasonable and necessary for your particular situation.Centers for Medicare & Medicaid Services. (n.d.). CMS — FFS ABN (Beneficiary Notices Initiative). cms.gov. Retrieved Jul 24, 2026, from https://www.cms.gov/medicare/forms-notices/beneficiary-notices-initiative/ffs-abn Maybe the test is being done more often than Medicare's rules allow, or the diagnosis on file doesn't match what Medicare expects for that service. Your provider can't promise how Medicare will rule, but they have good reason to think a denial is coming, so they give you the notice before doing the work rather than surprising you with a bill after.
If you want the bigger picture of the kinds of care Medicare leaves out entirely, see our guide on what Medicare doesn't cover. The ABN is a narrower thing: a heads-up about a covered service that may get denied in your specific case.
The Choice an ABN Asks You to Make
Read past the explanation and every ABN comes down to one boxed choice. You pick one option, sign, and that signature just says you read and understood the notice.Centers for Medicare & Medicaid Services. (n.d.). CMS — FFS ABN (Beneficiary Notices Initiative). cms.gov. Retrieved Jul 24, 2026, from https://www.cms.gov/medicare/forms-notices/beneficiary-notices-initiative/ffs-abn The three options differ in one thing that matters later: whether a claim ever reaches Medicare, because that's what decides if you can appeal.
| Option | What you're choosing | If Medicare denies, who pays | Can you appeal? |
|---|---|---|---|
| Option 1 | Get the service and have your provider bill Medicare | You do, but a claim was filed | Yes |
| Option 2 | Get the service, but don't bill Medicare | You do, up front | No |
| Option 3 | Decline the service | No one, because it isn't done | No |
Option 1 is the one most people want, and it's easy to see why. You still get the care, and because a claim goes to Medicare, you keep the ability to appeal if Medicare denies it.Centers for Medicare & Medicaid Services. (n.d.). CMS — FFS ABN (Beneficiary Notices Initiative). cms.gov. Retrieved Jul 24, 2026, from https://www.cms.gov/medicare/forms-notices/beneficiary-notices-initiative/ffs-abn You might end up paying, but you get a real shot at Medicare's decision first.
Option 2 gets you the service too, but you're telling your provider not to bill Medicare at all. You pay, and because no claim was submitted, there's nothing to appeal.Centers for Medicare & Medicaid Services. (n.d.). CMS — FFS ABN (Beneficiary Notices Initiative). cms.gov. Retrieved Jul 24, 2026, from https://www.cms.gov/medicare/forms-notices/beneficiary-notices-initiative/ffs-abn Option 3 is the walk-away: you decline the service, so there's no claim, no bill, and no appeal.Centers for Medicare & Medicaid Services. (n.d.). CMS — FFS ABN (Beneficiary Notices Initiative). cms.gov. Retrieved Jul 24, 2026, from https://www.cms.gov/medicare/forms-notices/beneficiary-notices-initiative/ffs-abn If you're not sure the service is worth the risk of paying out of pocket, that's a fair conversation to have with your provider before you check a box.
Does Signing an ABN Mean You Owe the Money?
This is the fear that makes people freeze at the counter, so let's be clear. Signing an ABN is not an official Medicare denial of coverage.Centers for Medicare & Medicaid Services. (n.d.). CMS — FFS ABN (Beneficiary Notices Initiative). cms.gov. Retrieved Jul 24, 2026, from https://www.cms.gov/medicare/forms-notices/beneficiary-notices-initiative/ffs-abn You're acknowledging that you were warned, not agreeing that you owe.
And you don't give up your appeal rights by signing. If you choose Option 1, a claim goes to Medicare, and if Medicare denies payment, you have the right to file an appeal.Centers for Medicare & Medicaid Services. (n.d.). CMS — FFS ABN (Beneficiary Notices Initiative). cms.gov. Retrieved Jul 24, 2026, from https://www.cms.gov/medicare/forms-notices/beneficiary-notices-initiative/ffs-abn Medicare's own decision is what ultimately settles whether you're responsible, not the form you signed at the front desk. So the practical move, if you want the service and want to preserve every right you have, is usually Option 1: get the care, let the claim go in, and appeal if it's denied. Our guide to appealing a Medicare denial walks through how that process works and the deadlines that come with it.
ABNs and Medicare Advantage
One boundary trips people up, so it's worth stating plainly. The ABN is an Original Medicare form. Medicare's guidance is that it should not be used for items and services provided under Medicare Advantage (Part C) or the Part D prescription drug benefit, which use different notices.Centers for Medicare & Medicaid Services. (n.d.). CMS — FFS ABN (Beneficiary Notices Initiative). cms.gov. Retrieved Jul 24, 2026, from https://www.cms.gov/medicare/forms-notices/beneficiary-notices-initiative/ffs-abn
So if your coverage is a Medicare Advantage plan rather than Original Medicare, the CMS-R-131 form isn't the notice your plan uses, and its rules don't automatically describe how your plan handles a coverage question. Check your plan's own materials or call the plan directly to understand its process. What this article covers is the Original Medicare ABN.
Frequently Asked Questions
What is a Medicare ABN?
It's an Advance Beneficiary Notice of Noncoverage, Form CMS-R-131. Your provider gives it to you before a service Original Medicare usually covers but is expected to deny in your case, so you can decide whether to go ahead knowing you might have to pay.
Does signing an ABN mean I have to pay?
No, not by itself. An ABN isn't an official Medicare denial. It means you were warned that Medicare may not pay. If you choose the option where a claim is still submitted to Medicare and Medicare denies it, you're responsible for the cost, but you can appeal that decision first.
Does an ABN waive my right to appeal?
No. If you pick the option to receive the service and have your provider bill Medicare, a claim goes in, and you keep the right to appeal if Medicare denies payment. You only lose the ability to appeal if you choose an option where no claim is submitted.
What are the three options on an ABN?
Option 1: get the service and have your provider bill Medicare (you can appeal a denial). Option 2: get the service but don't bill Medicare (you pay and can't appeal). Option 3: decline the service (nothing is billed and there's nothing to appeal).
Does Medicare Advantage use an ABN?
No. Medicare's guidance is that the ABN isn't used for items and services under Medicare Advantage (Part C) or Part D. Those plans use their own notices, so check your plan's materials for how it handles a coverage question.
Learn More
Find personalized help understanding a Medicare notice you were asked to sign at brevy.com.
The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.