Is Root Canal Covered by Insurance in the USA? (Answered 2023)

A root canal is a dental procedure that is used to treat an infected tooth. The procedure involves removing the infected pulp from the tooth and then sealing the tooth. Root canals can be expensive, but most dental insurance plans cover them.

Root canal do not covered by general health insurance but most dental insurance plans cover root canals. However, the amount of coverage varies depending on the plan. Some plans may cover the entire cost of the procedure, while others may only cover a percentage of the cost.

Most dental insurance plans in the United States help cover some of the costs associated with preventative, basic, and major dental procedures. The level of coverage depends on the specific plan. Dental insurance can be obtained through employer-sponsored plans, privately purchased plans, or government sponsored insurance programs like Medicaid. Most plans require the patient to pay a percentage of the total cost in the form of copayments or coinsurance.

Coverage for Root Canals in Dental Specific Insurances:

The good news is that root canal therapy is considered an essential dental procedure and is covered to some extent by most dental insurance plans. However, the amount of coverage can vary greatly.

Here are some general guidelines on root canal coverage:

• Basic dental plans usually cover about 50% of the total cost for a root canal after any deductible is met.
• Major or comprehensive dental plans often cover 60-80% of the total cost of a root canal.
• Dental HMO plans may cap the amount covered for certain procedures like root canals, which could leave the patient paying more out-of-pocket.
• Medicaid dental benefits often fully cover root canals for children but may cap benefits for adults.
• Some dental plans may have waiting periods for coverage on major work like root canals, especially on newly purchased private plans.

To get the full picture on coverage, patients will need to check the details of their specific insurance plan and confirm directly with their dental insurance provider. Be aware that insurance will not cover the entire cost of a root canal, so patients should expect to pay a portion themselves.

How much does a root canal cost without insurance?

The cost of a root canal varies depending on the location of the dental office and the experience of the dentist. However, you can expect to pay between $600 and $1,200 for a root canal.

Action Plan for you if you already have Dental Insurance:

Dental insurance coverage for root canal treatment can vary significantly depending on several factors:

1. Type of Dental Insurance: Dental insurance plans in the USA can be broadly categorized into Dental Health Maintenance Organizations (DHMOs) and Dental Preferred Provider Organizations (DPPOs). Coverage for root canal treatment may differ between these plan types.
2. Plan Specifics: Even within the same category of insurance, different plans may offer varying degrees of coverage for root canal treatment. The specific benefits of your plan will be outlined in your insurance policy documentation.
3. Treatment Necessity: Insurance providers often evaluate the necessity of the procedure. Root canal treatment is more likely to be covered if it is deemed medically necessary to save a tooth. In cases of elective or cosmetic procedures, coverage may be limited.
4. Waiting Periods: Some dental insurance plans have waiting periods before they cover major procedures like root canals. During this waiting period, you may need to pay for the treatment out-of-pocket.
5. Annual Maximums: Most dental insurance plans have an annual maximum coverage limit. If the cost of your root canal exceeds this limit, you will be responsible for the remaining expenses.
6. In-Network vs. Out-of-Network Providers: Your insurance plan may have a network of preferred dental providers. Visiting an in-network dentist can often result in higher coverage levels than going out of network.
7. Pre-Authorization: Some dental plans require pre-authorization for certain procedures, including root canals. Be sure to check with your insurance provider and dentist to determine if pre-authorization is needed.
8. Co-Pays and Deductibles: Depending on your plan, you may be responsible for co-pays and deductibles, which can affect the overall cost of the procedure.

3 Things you Should do to Claim Coverage

To determine whether your dental insurance covers root canal treatment and to understand your coverage better:

1. Review Your Policy:

Carefully read your dental insurance policy documents, paying attention to the section that outlines coverage for major dental procedures.

2. Contact Your Insurance Provider:

Reach out to your insurance provider’s customer service or visit their website to inquire about coverage specifics for root canal therapy.

3. Consult Your Dentist:

Your dentist can provide guidance on insurance coverage and may be able to help you navigate the claims process.

Need Help? Contact us or get your best quote.

Major Benefits of a root canal?

A root canal has a number of benefits, including:

• It can relieve the pain and infection associated with a tooth abscess.
• It can help to save the tooth from being extracted.
• It can prevent the infection from spreading to other teeth.
• It can improve the appearance of the tooth.

Possible Risks involved in a root canal?

A root canal is a very safe procedure, but there are a few risks involved. These risks include:

• Infection: The tooth may become infected after the root canal.
• Pain: The tooth may be sore for a few days after the root canal.
• Damage to the tooth: The root canal may damage the tooth, and it may need to be crowned or extracted.

Conclusion:

While usually not fully covered, root canal therapy tends to be partially covered by most dental insurance plans in the United States. However, the exact amount covered can vary greatly. To find out the specifics of your coverage, carefully review your dental insurance plan details and ask your dental office to confirm what percentage you can expect to be covered for a root canal procedure. Understanding your insurance benefits can help you budget appropriately for this common dental treatment.