What is a Fair Price for a Root Canal and is it Worth it?

Medicare Benefits Solutions
Feb 7, 2022

When the pulp of a tooth becomes infected due to bacteria entering through a deep cavity, a loose filling, or a crack, you might need root canal therapy. Dentists use endodontic therapy – root canal – to remove the infection; protect the tooth, bones, and tissues from further infection; and avoid having to extract the tooth. 

Tooth extraction solves the issue of infection but can cause other problems in the mouth like the shifting of surrounding teeth and an improper bite which may require additional oral surgery to correct. Root canal therapy generally takes three to four visits to the dentist and costs can vary depending on how complicated the procedure is and what type of crown or filling you get to cover the tooth.

Dental Insurance Coverage for Endodontics

If you have your health insurance coverage through Original Medicare Parts A and B, routine root canals and other dental care services aren’t included in your benefits. As a rule, Original Medicare doesn’t cover services like exams, teeth cleaning, extractions, and root canal therapy; nor does it cover dental appliances like dentures, retainers, or orthodontics. 

However, if you require dental care services due to an illness, injury, or medical complication that also requires an inpatient hospital stay, your Original Medicare benefits can help cover medically necessary dental care. To be eligible for this benefit, your health care providers and the hospital or medical facility must accept Medicare assignment. 

If you get your dental care while you are an inpatient, Medicare Part A (hospital insurance) covers 100 percent of the approved cost. You are responsible for your Part A deductible for the current benefit period. You may also pay coinsurance costs if your hospital stay exceeds 60 days. 

If you have a dental procedure as an outpatient, Medicare Part B (medical insurance) covers 80 percent of the cost if the procedure is certified as being medically necessary and is done by a dentist or other medical professional that accepts Medicare assignment. You are responsible for the remaining 20 percent of the cost, plus your Part B annual deductible. 

Root Canal and Crown Cost with Insurance

Medicare Advantage (Part C) plans are sold by private insurance providers who work with Medicare. Part C plans are required to provide at least all the benefits that are included in Original Medicare Parts A and B, but they can also provide extra benefits like routine dental care.

Because Medicare Advantage plans with routine dental care benefits are becoming more and more popular these days, many Part C plans available across the country include this type of coverage. 

Part C plans that include routine dental care generally cover the following services:

  • Oral examinations
  • Teeth cleaning
  • Dental x-rays
  • Diagnostic exams
  • Teeth filling and other types of restorative services
  • Endodontic therapy (Root canal therapy)
  • Periodontic treatment for gum disease and other types of oral inflammation
  • Tooth extraction
  • Crowns, bridges, tooth implants, and dentures

Your dental care services might be limited to a certain number per six-month or one-year coverage, but this depends on your individual Part C policy. Also depending on the plan you have, you may be required to use dentists and other health care providers, medical suppliers, and health care facilities that your plan includes in its network of providers. 

If you aren’t certain about what provider network restrictions your plan includes, you can find this information in your printed policy, at your provider’s official website, or by calling your provider.

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