Does Medicare Cover Root Canals?
No, Medicare does not cover root canals. Generally, Original Medicare (Part A and Part B) does not cover most dental services, such as cleanings and checkups, fillings, root canals, etc. However, if you choose to purchase a Medicare Advantage (Part C) plan instead of Original Medicare, these plans often cover most dental care.
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Understanding Root Canals
When a tooth is damaged or has a bad cavity, bacteria can enter the pulp — the tooth’s center. If left untreated, the infection can spread and cause complications such as pain, swelling, infection, and abscesses. A root canal is a dental procedure to repair the damaged or infected tooth and is done instead of pulling or removing the tooth.
Preventative care, such as brushing, flossing, and regular cleanings, can help reduce the likelihood of needing a root canal. While Original Medicare does not cover root canals or other dental services, there are options for gaining coverage when you need it the most.
Limitations on How Medicare Covers Root Canals
The only time that Medicare will cover a root canal is if it is needed as a part of a more extensive procedure that is covered, and your physician says the procedure is medically necessary. Medicare does not provide coverage for routine root canals or any other non-medically necessary dental services. You will need additional insurance if you want dental services to be covered.
Does Medigap Cover Root Canals?
No, Medigap will not cover root canals. A Medigap policy — also known as a Medicare Supplement — is an optional policy that you can purchase to help cover gaps in your Original Medicare coverage. For a service to be covered on a Medigap policy, it must first be covered by Medicare. Since Medicare does not cover dental services, a Medigap policy will not cover a root canal either.
How Medicare Advantage Covers Root Canals
A Medicare Advantage plan is insurance coverage that replaces Original Medicare Part A and Part B and also usually includes additional coverage such as dental, vision, and prescriptions. Private insurance companies sell Medicare Advantage plans, meaning specific benefits and costs vary by insurer, though all plans must cover the same benefits as Original Medicare at minimum.
Most Medicare Advantage plans will include dental coverage and will cover a root canal as a routine dental procedure. However, some plans will require the provider performing the procedure to be part of a selected network. It is also important to note that a copay and deductible may be due when the procedure is performed. You should review each policy carefully, as these expenses differ from plan to plan.
How to Enroll in Medicare Advantage Dental Coverage
To enroll in a Medicare Advantage plan with dental benefits, follow these steps:
- Find your options. Contact a trusted insurance agent or broker to begin your search, or visit Medicare.gov to search on your own to find which plans are available in your area.
- Review and compare the benefits. In addition to offering dental benefits in general, compare each plan’s coverages. For example, some plans may offer more comprehensive preventative coverage for services such as cleanings, while others may offer fewer coverages but at an ultimately lower cost. Determine what balance of benefits and cost works for you.
- Check the dental network. Medicare Advantage plans utilize health networks, so it is important to ensure your preferred providers and dentists are within your plan’s network for coverage.
- Make your decision and enroll. Once you have determined which plan best suits your needs, complete the enrollment process. You may do this with an agent, broker, through the Medicare website, or directly with the insurance company.
How Much Do Root Canals Cost With Medicare?
Paying for a root canal out of pocket can cost $1,000 or more. Since Medicare will not cover root canals, you would be looking at paying the total amount without any assistance. There are other alternatives to help cover the cost of a root canal if your procedure is not covered by Medicare, such as private insurance, Medicaid, nonprofit organizations, and more. Additionally, some dentists will offer payment plans if you’re paying out of pocket.
The Costs With Medicare Advantage
If you have a Medicare Advantage plan, the cost of a root canal will vary depending on your specific policy. It is essential to choose an in-network provider to ensure the lowest out-of-pocket costs. You should review your plan carefully to understand the copays and deductibles on dental care.
Alternative Coverage For Root Canals
If you choose Original Medicare, you will have no coverage within that plan for dental care. As an alternative, the following options may be explored:
- Private insurance: Private insurance plans may be used for dental services. These may be provided through your employer or purchased as a standalone policy from a private company.
- Veterans Affairs (VA) benefits: If you are eligible for VA benefits, it may offer coverage for root canals. However, VA benefits are usually limited, and may only pay up to 50% of the cost of the procedure.
- Medicaid: Medicaid is a national health insurance program specifically for those with low incomes or disabilities. Each state’s coverage may differ, but Medicaid usually covers root canals with little to no out-of-pocket expense.
- Nonprofit organizations: If you have no dental benefits, you may look at a nonprofit organization that will help pay some or all of the cost of the root canal. You can find a list of these nonprofits at www.nonprofitpoint.com.
- Self-insurance: Self-insurance is when you pay out of pocket for the root canal procedure. Often, a dental office may offer reduced cash prices or payment plans if you are self-insured.
- Dental schools: Dental schools are parts of institutions where students train to become dentists. The students will perform procedures, like root canals, under the supervision of a professional as part of their training. You can get a root canal performed at a dental school for a much lower cost than a dental office.
All in All
While you can minimize the need for a root canal by maintaining healthy oral habits and preventative services, there is no guarantee that it can be totally prevented. There will be no coverage if you only have Original Medicare and need a root canal. However, there are many options including Medicare Advantage plans and dental schools to ensure you receive the treatment you need.