August 2026 Monthly AFCNA Webinar-ABN_Spanish_508_v2029

ABN_Spanish_508_v2029 - 1

Pdf Summary

This document is the Spanish version of the Medicare <strong>Advance Beneficiary Notice of Noncoverage (ABN)</strong> form.

It informs a Medicare beneficiary that Medicare may not pay for a listed item, test, service, or care. If Medicare does not cover it, the beneficiary may be responsible for payment. The form includes spaces for patient and notifier information, a description of the service, the reason Medicare may not pay, and the estimated cost.

The beneficiary is instructed to read the notice, ask questions, and choose one of three options:
1. <strong>Receive the service and have it billed to Medicare</strong> for an official payment decision. If Medicare denies payment, the beneficiary may appeal and may owe the bill.
2. <strong>Receive the service but do not bill Medicare.</strong> The beneficiary agrees to pay and cannot appeal Medicare’s payment decision.
3. <strong>Do not receive the service.</strong> The beneficiary owes nothing and cannot appeal.

The notice clarifies that it is <strong>not an official Medicare decision</strong>, provides Medicare contact information, and explains that the beneficiary’s signature confirms receipt and understanding. It also mentions accessibility rights, including large print, braille, and audio formats, and the right to file a discrimination complaint.

The final section is a <strong>Paperwork Reduction Act disclosure</strong>, stating the form is required under Medicare rules, has an OMB control number, and is estimated to take less than 7 minutes to complete. The form ends with signature and date lines.

Keywords

Medicare

Advance Beneficiary Notice

ABN

noncoverage

Spanish form

beneficiary responsibility

payment decision

appeal rights

estimated cost

Paperwork Reduction Act