Original Medicare does not cover routine dental treatments such as root canals. However, some Medicare Advantage plans include this coverage.
A person can contact Medicare to find out if their Medicare Advantage plan covers root canals. Different plans may offer different coverage, so it is important to know what the costs involved may be.
Read on to learn more about Medicare Advantage coverage for root canals. This article also looks at the costs involved and where to get help with the costs of root canals.
Glossary of Medicare terms
We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:
- Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Original Medicare, which includes Part A and Part B, does not pay for root canals. These plans do not cover routine dental treatment.
Original Medicare will only cover dental services if:
- it is a severe procedure that requires hospital admission
- it relates to the treatment of another condition, such as:
- tooth extraction for a dental infection before receiving cancer treatment
- oral exams and dental treatment for heart valve replacements or certain transplants
- treatment for a complication of head and neck cancer treatment
As a routine root canal would not likely fall into these categories, Medicare will typically exclude root canals from coverage under parts A and B.
Learn more about Medicare and dental coverage.
Many Medicare Advantage plans offer coverage for routine dental treatment, including root canals.
According to the Kaiser Family Foundation, around 98% of people with Medicare Advantage have dental coverage in 2024.
While many Medicare Advantage plans include dental coverage, some people may need to pay extra to add the coverage to their plan.
Medicare Advantage enrollees may need to check their level of dental coverage with their insurance provider. Plans that only cover preventive dental services, such as X-rays or cleaning, may not pay for root canals. They will usually need a plan that provides comprehensive dental coverage.
Some plans may also have a yearly spending limit for dental services or specific networks of dental providers that an individual must use.
The cost of a root canal depends on the complexity of the dental issue and the tooth that needs treatment.
According to the American Association of Endodontists, molars are more complex to treat and will likely cost more.
However, endodontic treatments that involve removing the inside of a tooth generally cost less than the full removal of a tooth. This is because implants or bridges are then necessary to restore a person’s ability to chew and prevent other teeth from moving in the jaw.
Most often, people who undergo more intensive routine dental treatments such as root canals will have to pay a 50% coinsurance. This means that an individual will still be liable for half of the treatment costs.
Learn about Medicare Advantage costs.
If a person needs a root canal to treat a dental infection but cannot pay for root canals, several options are available, including:
- asking a dentist about dental membership savings plans, low cost care, or free services they offer
- visiting a Federally Qualified Health Center (FQHC), which may provide low cost dental services on a sliding scale regardless of income
- visiting a local dental school clinic, which may limit costs to materials and equipment without charging dentistry fees
- contacting dental health nonprofits, such as Dental Lifeline Network, which provides dental care for individuals with special needs, or America’s Dentists Care Foundation, which connects people with lower cost dental care
- exploring government programs such as Medicaid that can provide income-dependent low cost dental insurance benefits for families
A person can also ask a dental health professional about what cost-saving options are available to them locally.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
Original Medicare does not pay for root canals, but many Medicare Advantage plans cover both preventive dental services and extensive treatments such as root canals.
As not every Medicare Advantage plan covers dental care, individuals may need to discuss specific coverage details with their insurance provider.
Root canal costs vary depending on the severity of infection and which tooth needs treatment. People may be able to access lower cost care through local volunteer and dentist programs, government-backed low income insurance, or dental schools.