In root canals, the infected tooth pulp is removed, cleaned, and sealed. This prevents future microbial attacks. So, if your tooth is decaying, it’s better to choose a root canal over tooth extraction. Your natural tooth will stay intact, and you won’t have to rely on fake implants. 

However, root canal is not a cheap option. The average cost of a root canal treatment is between $700 to $1500 in the US.  This might raise a question: does Medicare cover root canals? 

Original Medicare (Part A and B) does not cover dental services. It will not pay for routine checkups, fillings, surgeries, or any other tooth-related process. You must have Medicare Advantage for that. 

Is root canal covered by Medicare Advantage?

Medicare Advantage plans (also known as Part C) are offered by private insurance companies approved by Medicare. These plans are an alternative to Original Medicare and often provide additional coverage beyond what Original Medicare offers.

So, you will receive coverage for dental, vision, and wellness programs. However, the coverage specifics – including whether root canals are covered – can vary widely among different Medicare Advantage plans.

Here are a few points to consider regarding root canal coverage under Medicare Advantage:

• Varied Coverage: Some Medicare Advantage plans might include dental coverage that extends to procedures like root canals, but it’s not guaranteed. Plans differ in coverage levels and services included.
• Eligibility Criteria: Generally, you need to provide a written prescription that deems the root canal treatment medically necessary. However, some Medicare Advantage plans may ask for medical history and other details. 
• Limitations: Different plans might have different limitations, such as waiting periods, annual maximums, or specific networks of dentists where the coverage applies.

It’s essential to carefully review the specific details of a Medicare Advantage plan, particularly its dental coverage, before enrollment. This includes checking which procedures are covered, any limitations, and the associated costs.

How much does root canal cost?

The cost of a root canal can vary widely based on several factors, including:

• Location: Costs can differ significantly based on where you live. Urban areas might have higher prices compared to rural locations.
• Dentist’s Expertise and Experience: Fees might vary depending on the dentist’s skill level and experience.
• Tooth Location: The tooth’s position in the mouth can affect the complexity of the procedure and thus, the cost.
• Extent of Damage: The severity of the dental issue requiring the root canal can impact the cost. For instance, a simple root canal for a tooth with minimal damage might cost less than a complex procedure for a severely infected tooth.
• Additional Costs: The total expense might also include costs for X-rays, consultations, medications, and any necessary restoration work like crowns or fillings after the root canal.

On average, the cost of a root canal procedure for a single tooth in the United States can range from $700 to $1,500. This estimate is for the procedure itself and doesn’t include the cost of the crown or any other follow-up treatments.

Suggested Read: Does Medicare cover dental implants?

Root canal costs with Medicare Advantage

With Medicare Advantage, your root canal costs can be as low as $500. The exact amount depends on your plan’s deductible, premium, and co-payment policies. So, make sure to contact the plan provider for details.

Important: Medicare sets a limit on out-of-pocket expenses for Part C plans. If you have already reached this limit for the year, you won’t have to spend a penny more on the approved services. In 2024, this out-of-pocket maximum limit is $8,850. 

Alternative & supplementary coverage options

If you don’t have a Medicare Advantage plan, it’s still possible to get coverage for your root canal treatment. Here are some options to consider:

• Private Dental Insurance

Standalone dental insurance plans are available through private companies. They often offer various levels of coverage for routine check-ups, cleanings, and major procedures like root canals. 

• Medicaid 

Medicaid is a supplemental government-funded insurance for people with disabilities or low incomes. Its coverage policies vary by state, but in most circumstances, a root canal treatment is covered.

• VA Dental Care

VA dental care is provided to eligible veterans through the US Department of Veterans Affairs. If you or your immediate family served in the military, you may get coverage for a root canal.

Summary 

Medicare covers root canal treatment only when you are a Part C enrollee. Original Medicare (Part A and B) will not offer any coverage for dental procedures. 

The extent of coverage depends on your specific plan. But generally, you should expect to pay a minimum of $500 while Medicare will pay the remaining $1000+ amount. You can further lower this cost through Medicaid, VA dental care, or private dental insurance.