When you obtain an ABN, you must state how you intend to proceed — or not proceed — with the services and sign a notice. If the ABN is not signed, your provider will be unable to bill you for items or services not covered by Medicare and will generally be unable to provide the care outlined.

Here's everything you need to know about Medicare ABNs.

What does it mean if you get a Medicare ABN?

A Medicare ABN indicates that there is a good chance Medicare will not cover the item or service you are attempting to have covered. It's a heads-up that you might owe more money than you think, and you must sign the form if you want to continue with services.

When you receive an ABN, you will be asked to choose one of several options and sign, indicating that you understand the terms. Among these alternatives are:

Pay first, then file a claim. If you still want the service or item, you may have to pay for it yourself, and the provider may submit a claim to Medicare. If Medicare still does not cover it, you can file an appeal, though you may end up owing the entire balance.

Pay first and do not file a claim. If you still want the service or item, you may have to pay for it yourself, and you have the option of not having your provider submit a claim. In this process, there is no way to file an appeal.

Refuse the product or service. You can also choose not to receive the service or item that Medicare may not cover, and you will not be charged. There are no claims submitted to Medicare.

Does a Medicare ABN mean Medicare won't pay?

No. An ABN is simply a notice from a health care provider or supplier that they believe Medicare will not cover something you are looking for. It is not an official Medicare notice. If you file a claim and Medicare denies it, you can file an appeal.

However, if you proceed with an item or service after signing an ABN, you may be held liable for all charges.

Will I get an ABN if I have Medicare Advantage?

No. Only members with Original Medicare can be issued an ABN by providers and suppliers. Those with Medicare Advantage plans may receive a different type of notice from providers if a service isn't covered, or they may receive no notice if their plan paperwork clearly states that the service isn't covered.

What kinds of ABNs are out there?

There are several types of ABNs, each with its own set of abbreviations. Depending on the circumstances, this is what you might see.

Home Health Agency Advance Beneficiary Notice: You may receive an ABN from a home health agency if the items and services you'd receive aren't considered medically necessary, the only care you require is non-skilled care, or you aren't homebound, among other things.

Home Health Change of Care Notice, or HHCCN: You may receive an ABN or an HHCCN from a home health agency if the agency reduces or discontinues services due to a business decision or because your doctor changed your home health prescription.

NOMNC, or Notice of Medicare Non-Coverage: You should receive a NOMNC from your home health agency at least two days before your covered services end. This notice tells you when your covered services will end and how to file an appeal if you want them to continue.

Detailed Explanation of Non-Coverage, or DENC: If you believe your services are being terminated prematurely, you can appeal your NOMNC and request a review of your case from the Beneficiary and Family Centered Care Quality Improvement Organization, or BFCC-QIO. Your home health agency will then provide a DENC explaining why they believe Medicare will no longer cover your services.

Hospital-Issued Notice of Non-coverage, or HINN: You may get a HINN from a hospital if it believes Medicare may not pay for any part of your Part A inpatient hospital care. This notice will explain why the hospital believes Medicare will not cover your services and how much you will have to pay out of pocket.