Medicare Beneficiary Notice
Rights and Responsibilities as a Medicare Beneficiary
As a Medicare beneficiary, you have certain guaranteed rights. These protect you when you receive care, guarantee access to the care services you need and protect you against unethical practices.
Your rights include (but are not limited to) the following:
- The right to information about what services are covered and how much you will have to pay.
- The right to information about all treatment options available to you.
- The right to appeal decisions to deny or limit payment for medical care.
The Centers for Medicare and Medicaid Services (CMS) requires healthcare providers to inform patients of their rights and responsibilities when their physician orders tests and procedures that may not be covered by Medicare.
Doctors recommend tests and procedures based on a wide range of factors including, your personal medical history, medications you are taking and generally accepted medical practices.
While your doctor may find a test or procedure useful in order to provide you with the best care, it is possible that Medicare may not consider the service to be medically necessary.
Medicare covers only those services which are considered necessary for your treatment based on your diagnosis. If there is a chance that Medicare will deny coverage for a service ordered by your doctor, you will be given an Advance Beneficiary Notice (ABN) form to sign.
The purpose of an Advance Beneficiary Notice is to provide notice that Medicare may not pay for the services you will receive.
The Advance Beneficiary Notice tells you which tests and procedures are not considered reasonable and necessary and informs you that you will be financially responsible for the services if Medicare declines payment.
When an Advance Beneficiary Notice is required, it will be explained to you and you will be asked to sign it before you receive the service.
You have two options when an Advance Beneficiary Notice form is presented to you:
- You may agree to be responsible for payment of services that Medicare does not consider reasonable and necessary and receive the services, OR
- You may refuse to be responsible for payment of services that Medicare will not cover and, therefore, not receive the tests or services
