A Notice of Medicare Non-Coverage is the written warning a skilled nursing facility, home health agency, rehabilitation facility or hospice must give you at least two calendar days before your Medicare-covered services end. It is a standardized federal form, CMS-10123, and it is one page. Families call it the NOMNC, and the moment it appears, a very short clock starts.
Almost nobody reads it in time. It is handed over during a busy afternoon, someone signs it to acknowledge receipt, and the significance registers two days later when the business office quotes a private-pay rate. Signing it is not agreeing with it — the signature acknowledges only that you received it.
This page walks through the exact documents and moments where the notice appears, in the order a family meets them, and what to do at each one. Everything is stated as of 2026; CMS revises its forms and instructions periodically, so confirm current requirements with Medicare, the facility, or your State Health Insurance Assistance Program. Pine Lake Legacy provides education and a free policy review only and does not give benefits, legal or medical advice.
In This Article
- Moment One: The Form Is Handed to You, CMS-10123
- Moment Two: You Call the QIO, and the DENC Arrives
- Moment Three: The Business Office Quotes the Private-Pay Rate
- Moment Four: Somebody Says the Word Improvement
- Notices This One Gets Confused With
- Whether a Life Insurance Policy Is an Answer Here, and Honestly Usually Not Today
- Frequently Asked Questions
Moment One: The Form Is Handed to You, CMS-10123
The provider must deliver the NOMNC to the beneficiary or the beneficiary’s authorized representative no later than two calendar days before covered services end. If the stay is shorter than two days, it must be delivered at the time of admission. If the representative is not physically present, the provider may deliver by telephone with a follow-up mailing, documenting the contact.
Read four things on the form immediately. The effective date coverage ends. The service being terminated, since a NOMNC can end one service while others continue. The telephone number of the Beneficiary and Family Centered Care Quality Improvement Organization for your state, printed on the form. And the deadline: to obtain an expedited appeal, you must contact the QIO no later than noon of the calendar day before coverage ends.
That noon deadline is the entire ballgame, and it is why the form cannot wait until evening. Put the QIO number in your phone the moment the page is in your hand.
One thing the NOMNC is not: it is not a discharge notice and it does not require anyone to leave. It says Medicare stops paying. Whether the resident stays and pays privately, transitions to another payer, or goes home is a separate decision. See what a discharge notice is, which is a different document with different rights.
Moment Two: You Call the QIO, and the DENC Arrives
Calling the QIO is free and it does two useful things at once. It starts an independent review of whether the services should continue, and it triggers the provider’s obligation to give you a second form: the Detailed Explanation of Non-Coverage, CMS-10124.
The DENC is the document that actually says why. It must identify the specific facts and the Medicare coverage rules, policies or provisions on which the termination decision rests. The NOMNC tells you coverage is ending; the DENC tells you the reasoning. If you are going to argue, argue with the DENC in hand.
The QIO reviews the medical record and typically issues a decision quickly — generally within about 72 hours of your request, and often by close of business the day after it receives the records. While the expedited appeal is pending, you are generally not financially liable for the disputed services through the date of the QIO’s decision, provided you requested the review by the deadline. That protection is the practical reason to file even a weak appeal: it buys days of coverage at no cost and no risk beyond the paperwork.
If the QIO agrees with the provider, there is a further level of expedited reconsideration available. Ask the QIO how to request it at the time you receive the decision, because that deadline is short too.
Moment Three: The Business Office Quotes the Private-Pay Rate
This is where the notice turns into a number. Once Medicare coverage ends, the bill converts to private pay, Medicaid if eligible, long-term care insurance if a policy exists and its elimination period is satisfied, or a Veterans benefit.
The figures, as of 2026, from national cost-of-care surveys: a semi-private nursing facility room commonly runs in the range of $9,000 to $11,000 a month and a private room higher, with wide regional variation. Memory care and assisted living run lower, home care lower still depending on hours. Ask the business office for the daily rate, what is included, what is billed separately, and the date the private-pay rate begins. Get it in writing before anyone signs an admission or continuing-stay agreement — see what to look for in the admission agreement.
Ask three more questions in the same meeting. Whether the facility accepts Medicaid and whether the current room is a Medicaid-certified bed, because a transfer may otherwise be required later. Whether a Medicaid application can be started now, since eligibility processing takes time and retroactive coverage rules may help. And what happens to the bill if the QIO appeal succeeds after private-pay billing has begun.
Our page on the private-pay runway covers how to calculate how many months a household can actually cover.
| Notice | Form | When It Is Given | How to Appeal |
|---|---|---|---|
| Notice of Medicare Non-Coverage | CMS-10123 | At least 2 days before covered services end | Call the state QIO by noon the day before coverage ends |
| Detailed Explanation of Non-Coverage | CMS-10124 | After you request a QIO review | Not itself appealable; it explains the reasoning |
| Important Message from Medicare | CMS-R-193 | At hospital admission and before discharge | Call the QIO before the planned discharge |
| Advance Beneficiary Notice | CMS-R-131 | Before an outpatient service expected to be uncovered | Choose an option box, then appeal any denial |
| Medicare Outpatient Observation Notice | CMS-10611 | After more than 24 hours under observation | Ask the hospital to review the admission status |
Moment Four: Somebody Says the Word Improvement
A common reason given for ending skilled coverage is that the patient has plateaued and is no longer improving. That reasoning has been formally addressed. Under the settlement in the Jimmo v. Sebelius class action, approved in 2013, CMS confirmed that Medicare coverage of skilled nursing and therapy services does not turn on whether the patient shows potential for improvement, and that skilled care needed to maintain a patient’s condition or to slow deterioration can qualify. CMS maintains a dedicated settlement page and issued clarifying guidance to contractors.
That does not mean coverage is unlimited or that maintenance care always qualifies. It means no improvement is not by itself a lawful basis for termination, and it is a point worth raising, in those words, with the QIO and with the facility’s medical director.
Two other reasons families should question rather than accept. If the argument is that the qualifying hospital stay was insufficient, check whether time was spent under observation status, which does not count toward the inpatient requirement. And if this is a rehabilitation stay that ended sooner than anyone expected, see what to do when rehab ends early.
Notices This One Gets Confused With
Medicare uses several notices and they are not interchangeable. Using the wrong appeal route because you have the wrong form is a common and costly error.
The Important Message from Medicare is the hospital inpatient notice, given at admission and again before discharge, and it is what you use to appeal a hospital discharge. The NOMNC covers skilled nursing, home health, rehabilitation and hospice instead.
The Advance Beneficiary Notice of Noncoverage is given before an outpatient Part B service the provider expects Medicare will not cover, offering you the choice of receiving it and accepting liability. It is prospective and optional; the NOMNC is neither.
The Medicare Outpatient Observation Notice tells you that you are an outpatient under observation rather than admitted, which affects whether a later skilled nursing stay is covered at all.
A Medicaid denial notice comes from the state, not from Medicare, and it triggers a fair hearing right with a state deadline.
An involuntary discharge notice from a nursing facility is a state-regulated document with its own appeal rights and, in most states, a required notice period. See how the expedited appeal works and, for help navigating any of this, contact your Long-Term Care Ombudsman, whose services are free.
Whether a Life Insurance Policy Is an Answer Here, and Honestly Usually Not Today
Families sometimes ask whether an in-force life insurance policy can solve the problem the NOMNC just created. It is worth being precise, because the honest answer has two halves.
For the next 48 hours, no. A secondary-market policy review runs on medical records and carrier documents, and the full process from first review to funded payment commonly takes roughly 60 to 120 days. Nothing about it helps with a bill starting Thursday. Anyone who suggests otherwise is selling. The tools for the next 48 hours are the QIO appeal, the DENC, the facility’s financial counselor, a Medicaid application, and the ombudsman.
For the next six to twelve months, sometimes yes. The NOMNC is frequently the moment a family realizes the funding runway is much shorter than they assumed. If there is a permanent policy with a meaningful death benefit on an insured whose health has declined, its market value may substantially exceed its cash surrender value, and starting a review now means the money is available before the runway ends rather than after.
And the cases where the answer is a flat no: term insurance with no cash value and no conversion right, a small final expense policy already earmarked for a funeral, a policy sitting inside a burial exclusion that is protecting Medicaid eligibility, a healthy insured, or a surviving spouse who will need the death benefit. In each of those, keeping the policy is right and being told so quickly saves months.
Pine Lake Legacy does not purchase policies and is not licensed in every state. A free review will give you a realistic number or a plain no. Send the policy cover page, or call (732) 978-9575 — after you have called the QIO.
Frequently Asked Questions
Does signing the NOMNC mean I agree that coverage should end?
No. Your signature acknowledges only that you received the notice, and refusing to sign does not stop the termination or extend coverage. The provider will simply document that delivery was attempted. What preserves your rights is calling the Quality Improvement Organization printed on the form before the deadline.
What is the deadline to appeal?
To get an expedited review you must contact the Quality Improvement Organization named on the notice no later than noon of the calendar day before coverage is scheduled to end. That is why the form should never sit unread until evening. The QIO number is printed on the notice itself.
Will I be billed while the appeal is pending?
Generally you are not financially liable for the disputed services through the date of the QIO’s decision, provided you requested the expedited review by the deadline. That protection is a practical reason to file even an uncertain appeal, since it buys covered days at no cost beyond the paperwork involved.
Can coverage end just because my parent stopped improving?
Lack of improvement is not by itself a lawful basis. Under the Jimmo v. Sebelius settlement approved in 2013, CMS confirmed that coverage of skilled services does not depend on potential for improvement and that care to maintain a condition or slow decline can qualify. Raise that point directly with the QIO.
What happens to the bill after Medicare stops?
It converts to private pay, Medicaid if eligible, long-term care insurance if a policy exists and its elimination period is met, or a Veterans benefit. Ask the business office for the daily rate in writing, whether the bed is Medicaid-certified, and whether a Medicaid application can be started immediately.
Can I sell a life insurance policy fast enough to cover this?
Not within the two-day window. A secondary-market review runs on medical and carrier records and commonly takes roughly sixty to one hundred twenty days from start to funding. It can be a real answer for the months after, but the tools for this week are the appeal, the ombudsman and a Medicaid application.
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Related Reading
- What Is An Expedited Medicare Appeal
- What Is Medicare Observation Status
- Facility Issued A Discharge Notice
- Rehab Benefit Ending Earlier Than Expected
- Nursing Home Private Pay Runway
- What Is A Long Term Care Ombudsman
- Nursing Home Admission Agreement
Pine Lake Legacy does not purchase life insurance policies and does not provide legal, tax, or investment advice. Information provided is for educational purposes only. Eligibility for any option, including life settlements, is not guaranteed and depends on individual circumstances, policy terms, underwriting, and market conditions. Consult independent legal, tax, or financial professionals before making decisions regarding a life insurance policy.