A Medicare waiver, or Advance Beneficiary Notice, informs patients covered by Medicare of any lack of coverage for medical services or equipment, making them responsible for payment. The waiver does not mean denial of care, but patients have the right to refuse treatment or appeal non-payment decisions.
A Medicare waiver, also known as an ABN, or Advance Beneficiary Notice, is a document received before treatment services or equipment are provided. The waiver consists of informing the patient covered by Medicare of any lack of coverage. In effect, it states that the patient has been advised that the medical services or devices requested may not be covered by the patient’s Medicare plan. In this case, the patient is responsible for paying the costs incurred during the treatment or for the equipment purchased.
Medicare is broken down into parts. Each part, A, B and D, covers different things. For example, Part A generally covers things like hospitalization, skilled nursing facilities, and hospice care. Part B generally covers medically necessary medical services, preventive care, and some medical equipment. Part D provides coverage of optional prescriptions. But just because you have the Medicare plan to cover your expected course of treatment doesn’t mean it will be covered in full.
Sometimes, services or equipment that your health care provider determines are medically necessary may not be covered. Many alternative medical practices and eye care are examples of medically relevant treatments that are not covered by Medicare. At other times, Medicare may cover limited expenses. For example, some services are only covered a certain number of times within a certain time frame. This is where the Medicare waiver comes into play.
A Medicare waiver does not mean that a patient is denied care or equipment. It also does not mean that treatment is not medically necessary. It simply means that the expenses incurred may be higher than the patient’s normal Medicare co-pay, as Medicare typically does not cover 100% of the costs.
The Medicare waiver gives the patient the right to accept the possibility that the expenses incurred may be out-of-pocket. It also gives you the right to refuse treatment or equipment. Although the Medicare exemption does not mean that there is no possibility of getting coverage for services or equipment, because the patient is offered the right to appeal the non-payment decision.
If a patient receives a Medicare, or ABN, exemption, the first step is to contact the doctor who prescribes the service or device to be used. There may be alternatives to consider. The doctor can also play an important role in the appeals process to demonstrate that the course of treatment is medically relevant and can assist the patient in recovering from a specific disorder or disease.
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