A Skilled Nursing Facility Advance Beneficiary Notice (SNF ABN, form CMS-10055) is a notice a nursing home gives people with Original Medicare before care it thinks Medicare may not pay for. CMS says the facility must give it to shift the cost to you if Medicare denies payment. The form has three options, and only Option 1 has the facility bill Medicare for an official decision you can appeal.
When does a nursing home give a SNF ABN?
CMS says skilled nursing facilities must give the notice to Original Medicare patients before providing:
- An item or service Medicare usually pays for but may not pay for this time because it may not be medically reasonable and necessary.
- Custodial care.
Common example: you've been getting rehab, and the facility thinks you no longer need daily skilled care, but you want to keep getting therapy.
CMS also says the facility isn't required to give written notice before care that Medicare never covers, though it may give one as a courtesy.
How is this different from the Notice of Medicare Non-Coverage?
You may get both, and they do different jobs:
- Notice of Medicare Non-Coverage (NOMNC): says when your covered services will end and how to ask for a fast appeal by noon the day before. See Medicare Advantage plan ended nursing home rehab coverage, which covers the fast appeal steps.
- SNF ABN: asks what you want to do about continuing care that Medicare may not pay for, and makes you responsible for the cost if Medicare says no.
This page is about the SNF ABN. For whether Medicare covers your stay at all, see skilled nursing facility bills and Medicare.
What are the three options?
CMS describes them this way:
Option 1: Get the care and bill Medicare. You keep getting the care. The facility must send a claim to Medicare, and Medicare's decision comes on your Medicare Summary Notice. If Medicare doesn't pay, you're responsible, but you can appeal. CMS says the facility isn't allowed to collect money for Part A services until Medicare makes its decision.
Option 2: Get the care, but don't bill Medicare. You keep getting the care and pay for it yourself. Medicare isn't billed for a decision, so you can't appeal.
Option 3: Don't get the care. You stop the care listed. You aren't responsible for paying for it, and you can't appeal to see if Medicare would pay. The form notes Medicare Part B may still cover some care, but not room and board, which you'd pay for.
Which option should I pick?
That depends on your situation, and it's your choice. A few things to weigh:
- Option 1 keeps your appeal rights and gets an official Medicare decision. CMS also notes that people who need a Medicare denial to file with secondary insurance should choose Option 1.
- Option 2 means paying without a Medicare decision.
- Option 3 means the care stops.
CMS says the facility must not pick or pre-select an option for you. If you're physically unable to mark your choice, staff may mark it at your request and note that they did.
Questions to ask before you choose:
- "Why do you think Medicare won't pay?"
- "What's the daily cost listed on the notice?"
- "What does the doctor or therapist say about the care I still need?"
What if I'm deciding for a parent?
Ask the facility to explain the notice to you and your parent together. Read the cost estimate, the reason, and the options. If your parent can't decide, the person legally allowed to make decisions for them should sign.
What to say to the facility:
"Before we sign, can you walk us through this SNF ABN? What's the reason you expect Medicare won't pay, what's the daily cost, and what notes support that? We'd like a copy."