An Advance Beneficiary Notice of Noncoverage (ABN) is a written warning that Original Medicare may not pay for an item or service. A doctor, provider, or supplier may give you one before you receive care. The notice should identify the item, explain why payment may be denied, and estimate the cost.

A required ABN warns of an expected denial of a service Medicare normally covers under some circumstances, such as a test performed too often. A voluntary notice may describe a service Medicare never covers, such as a routine physical. The rules for these notices and the choices they offer differ. The choices below apply to the usual required ABN. Medicare explains ABNs.

What Choices Does the ABN Give You?

The notice generally lets you choose to:

  • Receive the item and require the provider to submit a Medicare claim. If Medicare denies it, you may owe the cost but can appeal.
  • Receive the item without having a claim submitted. You may owe the cost and generally cannot appeal because Medicare did not make a decision.
  • Decline the item or service and avoid that charge.

Read the notice, select an option, and keep a copy. You must receive it before the service, with a specific reason Medicare may not pay and a reasonable cost estimate. You must also have a real chance to decide. Signing does not make a notice valid if it is blank, incomplete, late, or a general warning without the required details.

Is an ABN a Medicare Denial?

No. An ABN is a warning from the provider, not an official Medicare payment decision. Medicare makes a decision after a claim is submitted.

An ABN is mainly used with Original Medicare. Medicare Advantage plans use different coverage-decision and notice processes.

Questions to Ask Before Signing

Ask why the provider expects Medicare will not pay, whether a covered alternative exists, what the total estimated cost is, and whether you want a claim submitted to preserve appeal rights. For non-emergency care, you can take time to clarify the notice.

If you want Medicare to decide, select the option that requires a claim. If care is ending or you are leaving a hospital, check the separate discharge or end-of-care notice and its appeal deadline; an ABN is not the notice for every situation.

Medicare policy sources last checked: October 8, 2026.