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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D. Gilson is a writer and author of essays, poetry, and scholarship that explore the relationship between popular culture, literature, sexuality, and memoir. His latest book is Jesus Freak, with Will Stockton, part of Bloomsbury’s 33 1/3 Series. His other books include I Will Say This Exactly One Time and Crush. His first chapbook, Catch & Release, won the 2012 Robin Becker Prize from Seve...

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UPDATED: Jun 1, 2022

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The Highlights

  • 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.


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