If you’re receiving care through a skilled nursing facility, home health agency, or outpatient rehabilitation center, there may come a day when your provider hands you a form titled “Notice of Medicare Non-Coverage,” or NOMNC. Don’t panic, but don’t ignore it either. Here’s what it means and what you can do.
What Is an Notice of Medicare Non-Coverage?
A Notice of Medicare Non-Coverage is an official notice that your Medicare-covered care is ending. Your provider, whether that’s a nursing facility, home health agency, hospice, or comprehensive outpatient rehabilitation facility, is required by law to give you this notice at least two days before your Medicare-covered services end.
The notice is meant to protect you. It tells you when coverage will end, why, and, most importantly, that you have the right to appeal.
Why You Might Receive an NOMNC
Providers issue an NOMNC when they believe your condition no longer meets Medicare’s coverage criteria. Medicare generally covers skilled care, meaning care that requires the expertise of a nurse or therapist. Once your provider determines you no longer need that level of care, they’re required to notify you that coverage is ending.
This doesn’t necessarily mean your care was inappropriate or that Medicare will agree with the provider. It simply means the provider has made a judgment call that Medicare coverage no longer applies.
What You Should Do
- Read the notice carefully: The NOMNC will include the date your coverage ends and a brief reason. The notice will also include information about the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO), which is the independent organization that handles Medicare appeals for these situations.
- Decide whether to immediately appeal: You have the right to request a free, expedited review by the BFCC-QIO. If you appeal before your coverage ends, you generally won’t be billed for the disputed services while the review is pending. That protection alone makes filing an appeal worth considering.
- Appeal quickly: You must contact the BFCC-QIO listed on your notice by noon of the day before your coverage ends. You can typically reach them by phone; the number will be printed on your NOMNC. Call it as soon as possible.
- Get a written statement from your provider: After the BFCC-QIO notifies your provider that you appealed, your provider must give you a “detailed explanation of non-coverage” (DENC). This gives you their specific clinical reasoning, which can help you and the reviewer understand the case.
- Talk to your doctor: Your physician may be able to provide documentation supporting continued care. The BFCC-QIO reviewer will consider medical evidence, so your doctor’s input can matter.
What Happens After You Appeal?
Generally, the BFCC-QIO will give you a decision by the close of business the day after it gets the information it needs to make a decision. If the reviewer agrees coverage should continue, Medicare keeps paying. If they side with the provider, your coverage ends, but you can still request a second-level appeal by a Qualified Independent Contractor.
Receiving an NOMNC can feel alarming, especially while you’re recovering from an illness or surgery. But the notice is also your opportunity to push back if you believe the decision is wrong. Act quickly, use the appeal process, and don’t hesitate to involve your doctor and family in the decision.
What Do You Do After Medicare Runs Out?
Many people assume Medicare will cover a stay in a skilled nursing facility or care at home indefinitely, when in reality, coverage is time-limited limited and tied strictly to medical needs. If you receive a Notice of Medicare Non-Coverage and an appeal does not pan out, Medicaid may be an option to help with the cost of care.
Medicaid is a joint federal and state program which can assist those with long-term care expenses, including the cost of long-term or custodial care in a nursing home or a home care aide at your residence. While Medicare provides limited coverage, Medicaid is much more extensive. However, because of its restrictions, qualifying for Medicaid can be extremely difficult. But paying for care long-term without it could be all but impossible. New York Medicaid has complex rules for financial eligibility, including a Resource Allowance (for New York in 2026, $33,038 for an individual applicant and $44,796 for a married couple both applying). Even if your assets are above that, you may still be eligible with proper asset protection planning, such as an irrevocable trust. An elder law attorney can help you put together a plan to qualify for Medicaid.
Contact the experienced elder law attorneys at Kurre Schneps to see how Medicare benefits and Medicaid benefits can help cover the cost of care.
