Does Medicare cover balloon sinuplasty?
Medicare covers balloon sinuplasty as long as it is medically necessary. Your balloon sinuplasty Medicare coverage and out-of-pocket costs will depend on whether you have Original Medicare or Medicare Advantage. Out-of-pocket costs for balloon sinuplasty not covered by Original Medicare, such as deductibles and coinsurance, may be covered by a Medicare Supplement plan.
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Shawn Laib
Insurance and Finance Writer
Since graduating from the University of WA with a B.A. in English Literature, Shawn has been professionally writing in the spheres of entertainment, retirement planning, HR, insurance, business, marketing, and politics. His work has been published on SUPERJUMP, FanFare, Den of Geek, and Amplihigher. He is passionate about using his writing skills and insurance knowledge to educate the general...
Insurance and Finance Writer
UPDATED: Jul 6, 2023
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UPDATED: Jul 6, 2023
It’s all about you. We want to help you make the right coverage choices.
Advertiser Disclosure: We strive to help you make confident insurance decisions. Comparison shopping should be easy. We are not affiliated with any one insurance provider and cannot guarantee quotes from any single provider.
Our insurance industry partnerships don’t influence our content. Our opinions are our own. To compare quotes from many different insurance companies please enter your ZIP code on this page to use the free quote tool. The more quotes you compare, the more chances to save.
On This Page
- Balloon sinuplasty is covered by both Original Medicare and Medicare Advantage
- The procedure must be medically necessary to be covered
- You may have to pay a deductible and coinsurance amount depending on your plan
Does Medicare cover balloon sinuplasty? Medicare will cover balloon sinuplasty as long as it is deemed medically necessary. Original Medicare will cover this procedure under Medicare Part B, but it will be subject to the deductible and may have a coinsurance amount. Balloon sinuplasty Medicare Advantage coverage will vary. The procedure will still be covered, but your health insurance plan will determine deductibles and coinsurance.
A Medicare Supplement plan can help cover the out-of-pocket costs of balloon sinuplasty with Medicare. Enter your ZIP code to compare rates today.
What is the coverage for balloon sinuplasty with Medicare?
Medicare covers sinus procedures including balloon sinuplasty in a hospital or office setting. Your According to Medicare, your Part B coverage will pay for this treatment as long as it is medically necessary. Your doctor will help you to determine whether this procedure is necessary for your condition.
If you have Medicare Advantage, you should contact your plan provider to find out what coverage is provided for balloon sinuplasty.
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How much is the out-of-pocket cost of balloon sinuplasty with Medicare?
Your out-of-pocket cost for a balloon sinuplasty procedure will depend on how much of your deductible has been paid to date and the amount billed for the procedure by your provider. In most cases, you will also have to pay a 20 percent health care coinsurance amount.
The cost of a balloon sinuplasty procedure with Medicare Advantage will depend on the benefits in your plan. Since Advantage plans differ by provider, the amount of your deductible and coinsurance will also vary. Check with your plan provider to find out what you can expect to pay.
You can combine a Medicare Supplement plan with Original Medicare to reduce or eliminate out-of-pocket costs associated with procedures like balloon sinuplasty. These plans cover deductibles, coinsurance, and other fees not covered under Medicare.
Does Medicare cover balloon sinuplasty? The Bottom Line
Medicare does cover balloon sinuplasty, but you may have some out-of-pocket costs. Medicare Advantage or Medicare Supplement can reduce what you have to pay for medical procedures, and some Medicare Advantage plans have no additional monthly cost.
To compare your options for Medicare coverage to cover balloon sinuplasty, enter your ZIP code below.
Case Studies: Balloon Sinuplasty and Medicare Coverage
Case Study 1: John’s Balloon Sinuplasty Experience
John, a Medicare beneficiary with Original Medicare, recently underwent a balloon sinuplasty procedure to alleviate his chronic sinusitis. He consulted with his doctor, who determined that the procedure was medically necessary. Under Original Medicare, John’s balloon sinuplasty was covered under Medicare Part B.
However, he was responsible for paying the deductible and a portion of the coinsurance.
Case Study 2: Mary’s Balloon Sinuplasty With Medicare Advantage
Mary, another Medicare beneficiary, had Medicare Advantage instead of Original Medicare. She wanted to explore balloon sinuplasty as a treatment option for her chronic sinusitis. Mary contacted her Medicare Advantage plan provider to understand the coverage for this procedure.
Although the balloon sinuplasty was covered by her plan, the specific deductibles and coinsurance amounts varied.
Case Study 3: Sarah’s Medicare Supplement Plan and Balloon Sinuplasty
Sarah, a Medicare beneficiary with Original Medicare, underwent a balloon sinuplasty procedure to address her chronic sinusitis. She had a Medicare Supplement plan in place to help cover her out-of-pocket costs.
Thanks to her Medicare Supplement plan, Sarah’s deductibles and coinsurance associated with the balloon sinuplasty procedure were covered, reducing her financial responsibility.
Frequently Asked Questions
Does Medicare cover balloon sinuplasty?
Yes, Medicare does cover balloon sinuplasty under certain circumstances. Medicare is a federal health insurance program in the United States that provides coverage for eligible individuals who are 65 years or older, as well as certain individuals with disabilities or specific medical conditions.
What other treatments are available for chronic sinusitis?
Other treatments for chronic sinusitis may include antibiotics, nasal sprays, decongestants, saline irrigation, and surgery.
What are the risks and complications of balloon sinuplasty?
The risks and complications of balloon sinuplasty may include bleeding, infection, sinus pain, and nasal bleeding or discharge.
Does Medicare cover all costs of balloon sinuplasty?
Medicare coverage for balloon sinuplasty typically includes the procedure itself and related services such as anesthesia and facility fees, but beneficiaries may still be responsible for co-payments, deductibles, or other out-of-pocket expenses.
Can I get a second opinion before deciding on balloon sinuplasty?
Yes, you have the right to seek a second opinion from another qualified provider before deciding on any medical treatment, including balloon sinuplasty.
What should I expect after balloon sinuplasty?
After balloon sinuplasty, you may experience some mild discomfort, nasal congestion, or drainage, but most patients can resume normal activities within a few days.
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Shawn Laib
Insurance and Finance Writer
Since graduating from the University of WA with a B.A. in English Literature, Shawn has been professionally writing in the spheres of entertainment, retirement planning, HR, insurance, business, marketing, and politics. His work has been published on SUPERJUMP, FanFare, Den of Geek, and Amplihigher. He is passionate about using his writing skills and insurance knowledge to educate the general...
Insurance and Finance Writer
Editorial Guidelines: We are a free online resource for anyone interested in learning more about insurance. Our goal is to be an objective, third-party resource for everything insurance related. We update our site regularly, and all content is reviewed by insurance experts.