Posted by Endodontists in America said that more than 15 million root canals are performed in the United States every year. So you can see that there are a lot of people who undergo this dental procedure. But then, what exactly is their fate if they are not under dental insurance coverage as well as if they are not certain if their insurance covers endodontics?
If I must say, it is healthy that you are in search of knowledgeable solutions and that’s why we are here to give you all the information you need for you to know exactly what your out-of-pocket costs are after your insurance coverage comes in during your endodontic procedures.
Let’s get started.
Table of Contents
Does Dental Insurance Cover Endodontics?
Absolutely, Yes. Many dental insurance plans offer some degree of coverage for endodontics commonly called root canals. Some plans offer to cover a part of the cost leaving you responsible for the rest, few other plans, however, may offer to cover the cost fully.
Fortunately, this makes you totally free from all out-of-pocket worries. Some other plans unfortunately may offer you very minimal or no coverage at all for endodontic treatments.
Whichever the case may be, the extent of coverage you receive for endodontics is highly dependent on the type of plan you subscribed to because the level of coverage you get for endodontics varies across the different dental insurance plans and the specific policies and conditions they come with.
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Types of Dental Insurance Plans and How They Cover Endodontics
Below are the types of dental insurance plans and how they cover endodontics:
#1. PPO Plans:
PPO plans are the best type of plans and the most flexible. They afford you the freedom to choose your dental providers. PPO plans cover around 50% to 80% of endodontics.
However, the coverage you get for molars is usually lower coupled with higher deductibles. You’re advised to go for in-network providers for PPO plans because that choice earns you higher coverage for endodontics.
#2. HMO Plans:
HMO plans are just the opposite of PPO plans. They’re not flexible enough to give you the freedom to choose your dental providers. You may need referrals or prior authorization before you can access specialists. The coverage HMO offers comes with restrictions, additional costs, and lower percentage coverage, unlike PPO plans.
#3. Dental Indemnity Plans:
This plan has a predetermined amount in dollars which it will cover for dental services you get. If the endodontic treatment cost exceeds this amount you’ll be responsible for the remaining cost. You may get full, partial, or no coverage for endodontics depending on the amount left in your indemnity plans.
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Conditions That Determine How Much Coverage You Get For Endodontics
The extent of coverage you get for endodontics or root canals depends on some essential factors including:
- Your plan type
- The network providers of your choice
- The complexity and severity of your case
- Dental mandates in your state
- Exclusions and Limitations involved in your plan
- How much out-of-pocket costs come with your plan
- The maximum coverage you can get per year
#1. Your Plan Type:
Your plan type will determine how large or limited your coverage for endodontics will be.
As we have earlier established, the above dental insurance plans cover endodontics but at different levels.
PPO plans give you the largest coverage for endodontics at a percentage range of 50% to 80% but if you have an HMO or indemnity plan you may just have to lower your expectations because HMOs come with lower coverage amounts, and higher deductibles and they even restrict you to specific specialist. You should expect out-of-pocket costs if you have having indemnity plan.
#2. The Network Providers of choice:
Over time, we have observed from experience that choosing in-network providers is your way out of out-of-pocket costs. Your insurance company has negotiated lower rates with this set of in-network endodontists on your behalf resulting in higher coverage levels and lowering the amount of Co-pay you may have to pay.
However, if you go for out-of-network providers you are liable to having more out-of-pocket costs with low coverage.
#3. How Complexity and severity of your case:
Usually, you get coverage for routine endodontics or root canals because they fall under major procedures which are one of the benefits you get from some plans but even at that, if your case is severe and complicated requiring you to get additional procedures like crowns or post placements then you may not be covered.
#4. Dental Mandates In your state:
Depending on your location some federal regulations do not make it compulsory for specific plans to cover endodontics but in some states, some laws mandate that certain plans must offer a minimum amount of coverage for major procedures like endodontics or root canals.
Study and research the regulation of your state to find out if it mandates you get coverage for endodontics.
#5. Exclusions and Limitations involved in your plan:
Some limitations and exclusions are specific to certain plans and they affect your level of coverage for endodontics. Some of them are:
- Specific Teeth:
Some plans only offer you coverage if the position of the teeth in question is the incisors or canines but if your case is located at the premolars or molars most plans may not offer you any coverage at all because those sets of teeth are more complex and will require more complex procedures so they’re totally excluded. So you should be prepared for out-of-pocket costs.
- Pre-existing conditions:
If you already had an issue that requires endodontic treatment before getting an insurance plan then you may be denied coverage for endodontics.
- Waiting Periods:
You may have to wait for a specific period after enrolling for your plan before you start getting coverage for major procedures such as root canals or endodontics.
#6. How much Out-of-pocket Costs come with your plan:
- Premium:
Premiums are the monthly fees you pay to access coverage for a dental service.
- Deductibles:
Deductible is the amount of money you have to pay before your insurance company comes in. Unless you pay your deductible for your plans your insurance provider will not offer you no coverage.
- Coinsurance:
Coinsurance is the Percentage left for you to take responsibility for after your insurance has covered a certain part of the percentage cost. For instance, if your insurance provider covers 70% of endodontics, the 30% uncovered costs are yours to take care of out of pocket.
#7. The Maximum Coverage you can get per year:
Some plans can only offer you coverage for dental services for a limited amount for one year. Once you have exceeded these limits of coverage you may get little or no coverage for endodontics even if you’re supposed to get an 80% coverage for it.
But if you have not exceeded this limit you stand a chance of getting a good coverage percentage.
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Percentage Coverage Levels For Endodontics
You may get 100% coverage for endodontics or root canals after paying your deductibles but that depends on your plan. In-network providers are the best plugs for this kind of coverage.
Other plans only offer you a partial coverage of 50% to 80% that is with PPO plans. HMO and indemnity plans may give you only a very limited coverage of 20% and in exceptional cases you get 90% coverage.
Estimated Cost For Endodontics With or Without Dental Insurance
If you don’t have dental insurance you should expect to pay an average of $600 to $1600 depending on the location of the tooth you want to treat and how complex it is. Molars which are the most complex will cost you as much as $2000.
But if you have dental insurance you might Just pay within $200 to $1200 which the amount you pay within range depends on the out-of-pocket costs that come with your plan.
Proactive Options You Can Opt For If Your Dental Insurance Plan Does Not Cover Endodontics
Dental Insurance may not be the only intervention possible to get Endodontics or root canals at an affordable rate. Here are some options available to you:
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Use Dental Payment Plans:
You can get Endodontics at very affordable prices from dental offices that offer you financing options at low-interest rates.
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Go for CareCredit:
Get yourself a healthcare credit card that has flexible repayment terms. This will aid you in settling both medical and dental expenses.
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Opt for HSAs/FSAs:
They’re tax-advantaged accounts that you can use to take care of medical and dental expenses if you’re eligible for such service.
4 Tips to Help You Get The Best Dental Coverage For Endodontics Regardless of Your Plan Type.
The following are tips that will help you get the best dental insurance coverage for Endodontics irrespective of your plan type:
- Carefully study your plan benefits
- Call your insurance provider and ask questions
- Consider pre-treatment estimates
- Always go for in-network dentists
#1. Carefully Study your plan Benefits:
There’s a session in your plan documents that gives details about the benefits you stand to get for dental services. It is called the Summary of Benefits and Coverage.
Ensure you carefully review the SBC session and look out for where the words major procedures, endodontics, and root canals are mentioned, and pay close attention to what they say about your coverage for endodontics or root canals.
#2. Call Your Insurance Provider and Ask Questions:
Your dental insurance providers are the best means to clarify yourself how much coverage you get for endodontics. Don’t wait until you are embarrassed with shock at the dentist’s chair before you understand how much to prepare for.
Ask them relevant questions such as Does this plan offer coverage for major procedures, and what percentage of coverage should I expect? Are there out-of-pocket costs I should prepare for? What are the limitations that come with this plan?
#3. Consider Pre-treatment Estimates:
Ensure you get pre-treatment estimates for root canals and endodontics in writing from your dentist. Communicate with your dentist and be transparent if you know your case is a complex one your dentist knows how to help you.
Confirm with your insurance provider to get a clear picture of how much Out-of-Pocket expenses you should be ready to pay. This will save you from surprises related to coverage later.
#4. Always Go for In-Network Dentists:
In-network dentists are the most friendly options for your pocket. No matter the plan you have to make in-network endodontists your preference because they’re your surest means to higher coverage, especially for expensive major procedures like endodontics or root canals.
Is Tooth Extraction a Better Alternative To Endodontics?
Well, some people think tooth extraction is an easier way to get rid of the troublesome tooth so people say instead of endodontics you can consider teeth extraction. But from experience, we have seen over the years that though tooth extraction may seem like a simpler means for you to rid yourself of the burden of endodontics, it comes with its own complications.
The gap left in your mouth after extraction can cause the remaining teeth to start shifting, it may also cause you speech impediments, difficulty, or hinder a free flow when you chew because, with all these observations, tooth extractions should not be an option for you.
So before you go for that extraction we’d advise you to weigh the long-term benefits of endodontics with the challenges that come with tooth extraction and see which is worth a try.
How To Minimize The Need For Endodontics
Maintain good oral hygiene by brushing twice a day, and make regular flossing your habit. Regularly visit your dentist as they help you to detect anomalies in your tooth before they become major problems that will cost you a fortune to fix.
Prevention is the surest means to save yourself the need for endodontics in the first place.
Frequently Asked Questions
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Important Recommendation
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Conclusion
Endodontics helps preserve your natural teeth in the long run. So getting that treatment is worth it. Don’t forget to study your plan to see the benefits you stand to get. Contact your insurance provider for clarifications on how much coverage your plan offers for endodontics.
Preventive dental care is your best alternative to dental issues so always make good oral hygiene your priority to save you from the financial anxiety of expensive procedures like endodontics.
Thanks For The Read!