The Advance Beneficiary Notice (ABN): what to do when a provider asks you to sign

Why providers give an ABN when they expect Medicare not to pay, your three options on the form, and how it affects appeals and your bill.

An Advance Beneficiary Notice of Noncoverage (ABN) is a form a provider gives you before a service when they think Original Medicare may not pay.

Your three options

1. Option 1: get the service and have the provider bill Medicare. If Medicare denies it, you pay but can appeal.
2. Option 2: get the service, and the provider does not bill Medicare. You pay and cannot appeal.
3. Option 3: decline the service.

Why it matters

Without a valid ABN, a provider generally cannot bill you for a service Medicare denies as not medically necessary. With one, you are responsible.

Medigap and the ABN

If Medicare denies a service, Medigap generally will not pay either. Choosing option 1 preserves your right to appeal; see the five appeal levels.

Questions to ask

Why does the provider think Medicare won't pay? Is there a covered alternative? What is the cost? Licensed agents, such as Maru Insurance in Florida and Washington, can explain how your supplement treats denied claims.

Questions people ask

What is an ABN?

A notice that Medicare may not pay for a service.

Do I have to sign it?

You must choose an option to receive the service.

Can I appeal after signing?

Yes, if you choose option 1.

Will Medigap pay if Medicare denies?

Generally no.

Independent educational site. Not affiliated with or endorsed by the U.S. government, the federal Medicare program, or any insurance company. Figures are 2026 amounts published by CMS unless noted; check Medicare.gov for your situation.