March 18th 2024
By Ari Parker
While Original Medicare doesn't cover root canals, you can find coverage through Medicare Advantage or alternative insurance options.
By Ari Parker
In general, Original Medicare doesn’t cover dental care, including services for a root canal. This can be limiting, but you do have options with Medicare Advantage plans or private insurance plans.
In this guide, we’ll explore what Medicare does cover, how Medicare Advantage plans cover root canals, and what alternative options you have for covering a root canal.
Original Medicare does not cover root canals.
Some Medicare Advantage plans offer additional coverage for dental care, which may include root canal services.
Other alternatives to cover root canals include paying for private dental coverage and finding low-cost or free dental clinics in your area.
A root canal is a dental procedure that treats infections or damage that has reached the inner part of the tooth, known as the pulp. The pulp contains nerves, blood vessels, and connective tissues, which are important for tooth health. When a tooth's pulp becomes infected or inflamed, it can cause severe pain. In severe cases, this infection may result in losing your tooth.
During a root canal, your dentist will numb the area around the affected tooth using local anesthesia so you don’t experience too much pain. Then, they will access the pulp by creating an opening in the crown of the tooth. Then, your dentist will remove the infected tissue, clean the inside of the tooth thoroughly, and shape the root canals to prepare them for filling.
After your dentist finishes the root canal, they will typically place a filling on the crown of the tooth. Your dentist may recommend a dental crown to protect and strengthen the tooth.
Deep decay: When tooth decay reaches the inner pulp of the tooth, it can cause infection and inflammation.
Tooth trauma: If your tooth cracked or fractured due to an injury or other means, it may expose the inner part to bacteria, which could lead to an infection that requires a root canal.
Repeated dental procedures: Teeth that have needed multiple dental procedures, such as fillings or crowns, may develop inflammation or infection in the pulp.
Abscess: Abscesses are pus-filled bumps caused by bacterial infection, and they can form at the tooth's root. If this occurs, you may need a root canal to remove the infection to relieve pain and heal your tooth.
Original Medicare doesn’t cover routine dental services, including procedures for root canals, fillings, and crowns. Original Medicare may cover oral care to fix an underlying health issue prior to surgery, but otherwise it doesn’t provide dental coverage.
Original Medicare’s lack of dental coverage is frustrating for many beneficiaries. A root canal can cost upwards of $1,141 out of pocket, which is pretty expensive.
If dental coverage is a priority for you, you have two options:
You can find a Medicare Advantage plan that provides dental coverage
You can pay for a private dental plan to complement Original Medicare
We’ll discuss both of these options in greater detail below.
Also called Part C, Medicare Advantage plans are a bundled, private alternative to Original Medicare. These plans cover the same equipment and services as Original Medicare in addition to other benefits—like dental coverage. Medicare Advantage plans have varying coverage, but may cover the following routine dental services:
Teeth cleanings
Routine dental exams
X-rays
Fillings and minor dental repairs
Root canals
Simple tooth extractions
Dentures
More extensive benefits beyond routine dental care at a premium price
Keep in mind that not every Medicare Advantage plan is the same. The Medicare Advantage plans available to you will depend on your location, and the benefits you receive for dental care can vary from plan to plan. That means the cost of your root canal will depend on your specific plan. Some Medicare Advantage plans may offer comprehensive dental coverage. Others may provide more limited coverage or require you to pay higher out-of-pocket costs.
To determine the cost of a root canal with your specific Medicare Advantage plan, you should contact your insurance provider or review your summary of benefits.
If you prefer to complement your Original Medicare plan with private insurance, you can opt to buy a dental package from an insurance provider. Monthly premiums, deductibles, and out-of-pocket costs will vary from policy to policy. Be sure to review these details carefully before you choose a private dental plan.
You can get free or low-cost dental coverage in a few ways:
Search for dental schools in your area. Dental schools often provide free or inexpensive dental services from knowledgeable and supervised students.
Find low-cost or free dental clinics in your area. If you’re eligible, you can receive care on a sliding scale.
If you’re thinking about enrolling in a Medicare Advantage plan, dental coverage is one of the things to consider. Talking to a licensed Medicare Advisor can help you compare your options for dental coverage and other care you need to determine which plans are the best fit for your healthcare and budget needs. Get free, personalized advice by calling us at 855-900-2427 now or scheduling a time to chat.
