Who sends it: Your doctor, lab, supplier or other provider, in person before a service, if you have Original Medicare.
What this form is
The Advance Beneficiary Notice of Noncoverage, or ABN, is a standard Medicare form, number CMS-R-131. A provider gives it to you when they expect Medicare may not pay for a service or item that Medicare covers in some cases. Common reasons: the test is done more often than Medicare allows, or Medicare may not see it as medically necessary for you.
The ABN is used only with Original Medicare. Medicare Advantage plans and drug plans do not use it. If you are in a plan, ask the plan before the service whether it is covered.
What should be on it
- The provider's name and contact information
- The exact service or item
- The reason Medicare may not pay
- An estimated cost
- Three options with boxes to check, and a place to sign and date
The three options
Only Option 1 keeps your right to a Medicare decision and an appeal. You can ask questions before you choose.
- Option 1: you want the service and want Medicare billed. If Medicare says no, you may have to pay, but the claim shows up on your Medicare Summary Notice and you can appeal.
- Option 2: you want the service but do not want Medicare billed. You pay, no claim goes to Medicare, and you cannot appeal.
- Option 3: you do not want the service. You do not pay, and nothing is sent to Medicare.
What to do
- Ask why they think Medicare will not pay. If it is a limit on how often you can have it, ask when it would be covered again.
- Ask what it will cost in dollars, and whether your Medigap or other insurance may help.
- Check one option, then sign and date the form.
- Ask for a copy and keep it.
- If you chose Option 1, watch for the claim on your next Medicare Summary Notice.
If you were not given one
If a provider should have given you an ABN and did not, you generally do not have to pay for a service Medicare denies for these reasons. If you get a bill like that, call 1-800-MEDICARE (1-800-633-4227) or a SHIP counselor (shiphelp.org) before you pay it.
How to tell a real one from a fake
A real ABN is handed to you at the office, or given to you by the provider before a scheduled service, and names a specific service you were about to get. It does not arrive out of the blue by text or phone call. Be wary of anyone who calls about a Medicare form and asks for your Medicare number to send you free equipment, braces or tests.
Have one in front of you?
Take a clear photo and text it to Uncle at +1 208 214 0093. He tells you in plain words what it says, what it wants from you, and anything that looks wrong. How to take a clear photo.
This page explains what this kind of letter usually means. Your letter is the final word on your dates and amounts. For a decision about taxes, health coverage or a legal matter, call the office that sent it, using the number on its official website, or ask a professional you trust.
Read next
- Medicare Summary Notice
- Explanation of Benefits (EOB)
- Protect your Medicare number
- See all letters explained
Written by the Textuncle team. Last updated October 3, 2026.
Text Uncle