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New Medicare ABN 2026

Many of you have asked about the new ABN (Medicare waiver) for 2026. See below for details and effective date.

The Centers for Medicare & Medicaid Services (CMS) periodically releases updated ABN forms. Medical Providers must ensure they are using the currently approved version of Form CMS-R-131, which is valid through March 31, 2029.

The Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131, is a written notice from a healthcare provider. It warns Original (Traditional) Medicare patients that Medicare may deny payment for a service, making the patient personally responsible for the full bill. When an ABN is used appropriately, and the patient is alerted prior to the service being performed, the EOMB will transfer responsibility of payment to the patient under the payment code PR (patient responsibility).

When is an ABN issued?

An ABN is issued before a patient receives an item or service, usually under the following circumstances:

  • Not Medically Reasonable and Necessary: The provider believes Medicare will determine the service or item does not meet medical necessity guidelines.
  • Statutory Exclusions: The treatment or item is something Medicare never covers (e.g., most routine dental care, cosmetic surgery).
  • Experimental: The treatment is considered experimental or investigational.

Patient Options Under an ABN

When presented with an ABN, the patient must choose one of three options on the form before receiving the care:

  • They want Medicare billed: This allows the provider to submit a claim to Medicare. If Medicare denies it, the patient will be billed and have pay out-of-pocket, but they may preserve the right to appeal the decision.
  • They want the item/service, but do not want Medicare billed: The patient pays for the service out-of-pocket and cannot appeal to Medicare (this is typically used if the patient does not have Original Medicare or wants to bypass Medicare rules).
  • The patient does not want the item/service: They decline the care, and no one is billed.

Who receives an ABN?

This form is for Original or Traditional Medicare (fee-for-service) beneficiaries only. If a patient is enrolled in a private Medicare Advantage Plan, that insurance plan may use a different process, such as a Hospital-Issued Notice of Non-coverage (HINN)

Instructions to complete the form and copies can be found on the CMS website:

https://www.cms.gov/medicare/forms-notices/beneficiary-notices-initiative/ffs-abn