Does Medicare Cover a Root Canal? 

Thousands of people undergo root canals every year in the United States. This dental procedure removes the pulp from a tooth that’s been infected by bacteria. Having a root canal rather than an extraction, allows you to preserve the structure of the tooth and avoid needing a dental bridge to fill in the gap left by the missing tooth.  

Your dentist may prescribe a root canal if you have any of the following symptoms: 

• Persistent tooth pain usually stemming from deep in the tooth that can spread through your jaw, face, and surrounding teeth
• The tooth is sensitive to hot and cold with pain lasting longer than a few seconds
• Swollen gums and, or jaw
• Tooth discoloration can occur when the pulp is infected because of a lack of blood circulation
• A chipped, cracked, or loose tooth
• Tooth pain when pressure is applied to it

Root canals are common dental procedures. In fact, endodontists and dentists perform over 15 million every year in the United States. A typical root canal requires one or two visits and lasts around 30 to 60 minutes in total. For a single-rooted tooth, the procedure costs between $400 and $1000, and for a multi-rooted tooth about $500 to $1400. 

If you need a root canal, you might be concerned about covering the costs, so here’s a look at whether your Medicare insurance plan can help you. 

Does Medicare cover root canals? 

Medicare beneficiaries who are enrolled in Original Medicare Part A (hospital insurance) and, or Part B (medical insurance)don’t have coverage for routine dental care services like regular check-ups, fillings, teeth cleaning, x-rays, extractions, or root canal procedures.  

Original Medicare only pays for dental services in the following situations: 

• If they are a necessary part of a covered procedure like jaw reconstruction after an accident or injury. 
• Extractions that are necessary for radiation treatments for a neoplastic disease that involves the jaw. 
• Oral examinations only before a kidney transplant or heart valve replacement, and only under certain circumstances. 

Medicare Part A covers the above examinations or treatments if a dentist on a hospital staff performs them, and Medicare Part B covers them if they are done by a physician.  

If you’re enrolled in a Medicare Advantage (MA)plan, you may have access to routine dental care services like root canal procedures.  Medicare Advantage plans are sold by private, Medicare-affiliated insurance companies, and they must cover the same benefits that Original Medicare Parts A and B offer. However, MA plans also have the option to include extra benefits like routine dental care, vision care, and hearing care. Many MA plans available today include the following dental care services for enrollees:

• Periodic oral examinations
• Teeth cleaning (prophylaxis)
• Dental X-rays
• Diagnostic services
• Fillings and other restorative care
• Root canal treatments
• Treatments for gum disease (periodontics)
• Tooth extractions
• Some plans may also cover dentures and bridges

Depending on the type of Medicare Advantage coverage you have, you may be required to use dentists and other health care providers that are approved by your plan. In some cases, if you go outside your plan’s network of providers for care, you don’t get coverage. If you aren’t sure about your plan’s restrictions and allowances, you should ask a plan representative for details before making appointments for your root canal.