Is a Root Canal Covered by Medicare?

Medicare serves as a federal health insurance program primarily for individuals aged 65 or older, some younger people with disabilities, and those with End-Stage Renal Disease. A root canal is a common dental procedure designed to treat infection or damage at the center of a tooth, involving the removal of infected pulp, cleaning, and sealing the tooth. This information aims to clarify the extent to which root canal procedures are covered by Medicare and explore alternative options for dental care.

Medicare Parts A and B and Dental Coverage

Original Medicare, which consists of Part A (Hospital Insurance) and Part B (Medical Insurance), generally does not cover routine dental care. This exclusion extends to most common dental procedures, including cleanings, fillings, tooth extractions, and root canals. Therefore, if an individual has only Original Medicare, they typically bear 100% of the cost for these services.

There are limited circumstances where Original Medicare might provide some dental coverage, primarily when dental services are an integral part of a covered medical service. For example, Part A may cover certain dental services if a patient is admitted to a hospital for a severe dental procedure due to an underlying medical condition or the procedure’s severity. Part B might cover dental services performed by a physician if they are medically necessary for another covered procedure, such as an oral exam before a kidney transplant or a tooth extraction to prepare for radiation treatment.

Medicare Advantage Plans and Dental Benefits

Medicare Advantage plans, also known as Part C, are offered by private insurance companies approved by Medicare, providing an alternative way to receive Medicare benefits. These plans must cover everything Original Medicare Parts A and B cover, and many include additional benefits not covered by Original Medicare, such as dental, vision, and hearing services. Many Medicare Advantage plans offer dental coverage that can include root canal treatment. Approximately 98% of people with Medicare Advantage plans had dental coverage in 2024.

Individuals seeking coverage for root canals should specifically research Medicare Advantage plans that offer comprehensive dental benefits, as not all plans will. Even when dental benefits are included, they often come with limitations such as annual benefit caps, deductibles, coinsurance, or specific provider networks. For instance, some plans may cap yearly dental coverage around $1,000, while others might have higher limits, averaging around $1,300 in 2021. It is important to carefully review a plan’s Summary of Benefits and Evidence of Coverage documents to understand the specific dental services covered, associated costs, and any limitations.

Alternative Options for Dental Care

For individuals without dental coverage through a Medicare Advantage plan or those needing additional options, several alternatives exist to manage dental care costs. Private stand-alone dental insurance plans are available from various insurers, designed to cover a range of dental services, including preventive care, basic services like fillings, and major services such as root canals. These plans typically involve monthly premiums and may have deductibles, coinsurance, annual maximums, and waiting periods before certain procedures are covered.

Another avenue for reduced-cost dental care is through dental schools, where students provide services under the close supervision of experienced, licensed dentists. These academic institutions often offer treatments at significantly lower costs, sometimes 50% or more off typical private practice fees, and may include root canals. Community dental clinics and local health departments also provide affordable care, often operating on a sliding fee scale based on income, making services accessible to low-income individuals. Additionally, discount dental plans offer members reduced prices on dental services from participating providers, without the complexities of traditional insurance, typically for an annual fee.