No, Medicare does not cover root canals. Medicare may cover dental services during a hospital stay, such as if you’re admitted to the hospital after suffering a head injury that includes damage to your jaw or teeth. However, it does not cover services such as routine dental checkups, fillings, tooth extractions, or root canals.
Beneficiaries seeking more comprehensive dental benefits may consider Medicare Advantage Plans. These plans often have extended benefits like vision care, hearing services, and dental coverage, including for routine services like a root canal. Read on to learn more about Medicare dental coverage, the cost of root canals, and other coverage options.
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Dental Care of Importance for Older Americans
While patients of any age may need root canals, older Americans are more likely to experience dental problems. Among adults 65 and over, 20% have untreated tooth decay and 68% have gum disease. In addition, older adults are more likely to be diagnosed with oral and pharyngeal cancers.
Any of these issues may damage or infect the roots of your teeth, leading to significant discomfort. A root canal can help save your teeth rather than having them removed or replaced entirely, making coverage for this routine service critical.
What Is a Root Canal?
A root canal removes the infected and diseased inner part of your tooth before cleaning the cavity and refilling it with a dental sealer to prevent further infection. They are often the treatment for tooth infections that reach to the root of the tooth. Common causes of infected tooth roots include:
- Deep tooth decay due to cavities
- Cracks or chips in teeth that expose the dental pulp
- Faulty dental crowns
- Multiple dental procedures on the same tooth
It’s also possible that injury to a tooth may cause infection even if there are no apparent cracks or holes. For example, if you fall and injure your jaw, this may cause internal injury to the tooth, leading to infection.
Medicare’s Coverage of Dental Care
Original Medicare may cover some of the cost if you are admitted to the hospital for dental procedures due to an underlying medical condition. Medicare may also cover dental services if these services are necessary for the success of other treatments.
For example, Medicare Part A may cover root canals or tooth extractions to resolve mouth infections if this is part of a cancer treatment. Medicare may also cover oral exams and dental treatments before procedures such as heart valve replacement, bone marrow, organ, or kidney transplants to reduce the risk of rejection, as well as treatments for complications you experience while getting head and neck cancer treatment services. However, beyond these limited exceptions, Medicare does not provide root canal coverage.
Consider Medicare Advantage For Root Canal Coverage
Medicare Advantage Plans are Medicare-approved insurance sold by private providers. While these plans must cover all the same services as Original Medicare, they often include additional benefits such as dental, vision, and hearing coverage. As a result, they may provide coverage for dental services such as regular cleanings, X-rays, and root canals. Depending on the plan, root canals may be fully or partially covered.
Medicare Advantage Plans vary in the type and amount of dental coverage offered, so be sure to compare the benefits if you plan to have a root canal. You may also work with a licensed insurance agent or broker to look over your plan options, letting them know that dental coverage is one of your priorities.
Additional Benefits Related to Root Canals
Medicare Advantage Plans that provide extensive dental and oral surgery benefits might include a variety of extra perks specific to oral surgery. These additional advantages differ by plan and may include:
- Part D Drug coverage: Many Medicare Advantage Plans incorporate Part D, which covers a range of prescription drugs for Medicare beneficiaries. This coverage could help with the medications needed for recovery post-oral surgery, such as pain relievers and antibiotics.
- Routine dental care: Often included in Medicare Advantage Plans, dental coverage may extend to post-surgical follow-ups like x-rays and exams. It might also include other necessary post-procedure services, like solutions if there is a complication from the root canal.
- Over-the-counter (OTC) items: Certain plans may cover health-related items that do not need a prescription. After a root canal, this coverage can be useful for items like over-the-counter pain relievers.
- Grocery allowances: Some plans provide allowances for healthy groceries, helping beneficiaries purchase soft foods required after a root canal.
- Non-emergency medical transportation: Benefits for transportation can offer rides to and from medical appointments and pharmacies, which is particularly beneficial for those unable to drive but need to see a doctor about root canal complications.
To explore Medicare Advantage Plans with these additional benefits, speak with a licensed insurance agent or broker.
How Much Root Canals Cost with Medicare
The cost of a root canal varies depending on the severity of the infection, where you are having the procedure done, and what type of coverage you have in place.
- Deductible: The deductible is the amount you need to pay out-of-pocket before Medicare starts paying. The Part A deductible of $1,632 per benefit period applies for any work performed during a hospital stay. For outpatient procedures, the Part B deductible of $240 per year applies. Medicare Advantage Plans may have different deductibles, and some plans also have different deductibles specifically for dental work.
- Coinsurance: Coinsurance is the percentage of the cost of covered services you’re responsible for paying. For example, you may pay 20% while your insurance plan covers the remaining 80% of costs. Cost-sharing requirements in Medicare Advantage vary from plan to plan.
- Out-of-pocket maximum: The out-of-pocket maximum is the most you will pay for covered services per year. Medicare Advantage Plans have an out-of-pocket maximum of $8,850 or less in 2024, depending on the plan. There is no limit in Original Medicare.
Without any insurance coverage, root canals cost an average of $1,000 to $1,800. The cost of a root canal can also be higher if the infection in your tooth has spread to other parts of your mouth, which may require additional services to solve the issue.
Other Options for Root Canal Coverage
Along with Original Medicare and Medicare Advantage, there are other options for root canal coverage, including stand-alone dental insurance, Medicaid, and community health programs. Here’s a look at each in more detail.
- Stand-alone dental insurance: Stand-alone dental plans work the same way as other health insurance: You pay a premium each month along with a deductible before your plan begins to pay. Your plan may have a yearly maximum along with a waiting period before you can make dental claims. The difference is that these plans cover dental services only. These plans often cover root canals, cleanings, check-ups, X-rays, and preventative procedures.
- Medicaid: Medicaid may also cover dental services. While all state Medicaid programs provide dental services for children, states determine which services are offered to adults. Check with your state’s Medicaid program to see if it will cover your root canal.
- Community health programs: Community health programs offer another option for dental coverage. Patients may be able to obtain dental services through federally funded community health centers that offer services at a reduced fee or free of charge.
Putting It All Together
Root canal coverage is not part of Original Medicare unless it is deemed medically necessary during a hospital inpatient stay, which limits access to this coverage. Medicare Advantage Plans may offer more robust dental coverage options, including coverage for root canals and other routine care services like fillings and crowns. Work with a licensed insurance agent or broker if you are interested in finding a plan that offers comprehensive dental benefits.