Does Dental Insurance Cover Root Canal? #1

53% of Americans experience a toothache each year, and unfortunately, some escalate to needing a root canal. This demand fuels a $7.5 billion root canal market, making it a crucial aspect of dental insurance coverage.

If you need a root canal then you might also be interested in the answer to the question “Does dental insurance cover root canals?.

Well, yes, but the type of coverage differs. Let’s talk about that and more as we go on. Ready?

Table of Contents

What is a Root Canal?

A root canal is a dental procedure that extracts an inflamed or infected pulp from inside a tooth, cleans and disinfects the root canal space, and then fills and seals the space to prevent reinfection. The pulp is the soft tissue inside the tooth that contains nerves and blood vessels.

Root canal entails:

Infiltration: The dentist drills a tiny access point to reach the inflamed pulp.
Extermination: The infected pulp is carefully removed, along with any malicious bacteria.
Sealing: The empty canals are disinfected and filled to prevent future invaders.

You will love to read this: Does Dental Insurance Cover Wisdom Teeth Removal?

Why is a Root Canal Important in Dental Care?

A root canal procedure saves your tooth from total extraction thereby keeping your smile intact and also saves you from further tooth devastation. In the long run, it’s often a cost-effective option compared to losing your tooth totally and needing to replace it which will cost you a heavy sum of cash.

Symptoms that may indicate you need a root canal:

Severe toothache, especially when eating or drinking
Sensitivity to hot and cold temperatures
Swelling and tenderness around the tooth
Discoloration of the tooth
Drainage from the tooth

Does Dental Insurance Cover Root Canal?

Yes, most dental insurance plans offer coverage for some portion of root canals, as they also recognize its importance in saving teeth and preventing further complications. This coverage typically falls between 50% and 80% of the cost of a root canal procedure.

The factors that determine whether your dental insurance will cover root canals include:

Your specific dental plan
Your deductible and out-of-pocket maximum
Network type

1. Your Specific Dental Plan:

Some plans have specific coverage amounts for root canals, while others may cover only a certain percentage of the cost for you.

2. Your Deductible and Out-Of-Pocket Maximum:

You may need to meet your deductible before coverage kicks in, and there might be an out-of-pocket maximum for covered services.

Some potential out-of-pocket costs include:

Deductibles: You might need to meet your annual deductible before insurance kicks in.
Co-pays: These are fixed amounts you pay for covered services, like root canals.
Complexity variations: Molar root canals with multiple canals cost more than simpler front tooth procedures.

3. Network Woes:

Is your dentist in-network? If you choose a dentist outside your insurance network, you might pay more.

What Types of Dental Insurance Plans Offer Coverage For Root Canals?

Below are different types of dental insurance plans that offer varying degrees of coverage for root canals:

PPO
DMHO
EPO
POS
Indemnity Plans

#1. Preferred Provider Organization (PPO):

PPO plans generally offer the most flexibility in choosing your dentist, both in-network and out-of-network.

Note that, In-network dentists provide the highest coverage percentage for root canals, typically around 80%. Out-of-network coverage is usually lower, around 50%, and you’ll likely face higher co-pays and deductibles.

#2. Dental Health Maintenance Organization (DHMO):

DHMO has a limited provider network which restricts you to in-network dentists for coverage. Root canal coverage can be high, sometimes even 100%, for in-network procedures.

Remember, there is no out-of-network coverage available, so if you want to choose a dentist outside the network, it means you’ll pay the entire cost yourself.

#3. Dental Preferred EPO (Exclusive Provider Organization):

EPOs are Similar to PPOs in offering choice between in-network and out-of-network dentists. However, out-of-network benefits are minimal, so for root canal coverage, it’ll be best if you stick to in-network providers. In-network coverage for root canals can be comparable to PPOs, which cover about 80%.

#4. Point-of-Service (POS) Plans:

POS plans to combine the features of PPOs and DHMOs, offering both in-network and out-of-network coverage. In-network coverage for root canals is typically higher than out-of-network, but still good, around 70-80%. Out-of-network coverage is lower, and similar to a PPO, with higher co-pays and deductibles.

#5. Indemnity Plans:

Indemnity Plans offer reimbursement for a percentage of your dental expenses, regardless of whether you see an in-network or out-of-network dentist. You choose your provider freely, but coverage for root canals might be lower than other plans, around 50-60%.

You’ll likely need to pay your deductible and significant co-pays before receiving any reimbursement.

Check this out – Does Dental Insurance Cover Cavities?

What Are The Factors Impacting Dental Insurance Coverage For Root Canal?

Here are the factors that impact dental insurance coverage for root canals:

Type of dental plan
Waiting period
Pre-existing conditions
Policy exclusions and limitation
Annual maximums
In-Network vs Out-of-Network Providers
Treatment complexity

1. Type of Dental Plan:

Dental insurance is in two categories. Basic dental plans can only provide you coverage for preventive care. Major dental plans cover more complex procedures such as root canals. So you have to review your policy to understand the extent of your coverage.

2. Waiting Period:

You may be imposed with long waiting periods by some dental insurance plans before covering a procedure like a root canal. You must be aware of these waiting periods because you might not get immediate coverage after enrolling in a new insurance plan.

3. Pre-Existing Conditions:

A tooth that requires a root canal may be considered as a pre-existing condition especially if you had the issue before getting the insurance coverage. In such a case your coverage might be subjected to waiting periods or limitations.

4. Policy Exclusions and Limitations:

Your root canal coverage might also be limited by some insurance policies which come with certain limitations and exclusions. Certain procedures, tooth surfaces, or treatment alternatives might warrant certain limitations. Be very sure you understand policy limitations to avoid unexpected expenses.

5. Annual Maximums:

The amount you could pay for dental procedures per year might also be limited because dental insurance plans often have annual maximums you can pay for a particular calendar year.

So you have to be aware of this because you may be responsible for covering your expenses if the amount for getting a root canal exceeds the stated annual maximum.

6. In-Network vs. Out-of-Network Providers:

In-network dental providers will often provide you with more favorable coverage because your insurance plans have negotiated rates with the in-network dentist reducing your prospective out-of-pocket expenses.

Treatment Complexity:

The kind of technique implored during a root canal can influence your coverage. So if the technique is quite complex you should be prepared for potential cost variations.

What Are The Costs Associated With Root Canal Treatment?

It’s quite challenging to provide you with exact figures for root canal treatment, as expenses can vary significantly depending on some factors such as location, time, dentist’s fees, and how complex your root canal case may be. Still, we will give you a general breakdown of the typical expenses associated with root canal treatment in the United States:

1. Diagnostic and Consultation Fees:

Initial examination and diagnosis, including X-rays: $75 – $200

2. Endodontic Treatment (Root Canal Therapy):

Front teeth (incisors and canines): $500 – $1,500
Bicuspid teeth: $700 – $1,800
Molar teeth: $1,000 – $2,500

3. Dental Crown:

Porcelain-fused-to-metal crown: $800 – $1,500
All-ceramic crown: $1,000 – $3,000
Gold crown: $800 – $2,500

4. X-rays and Imaging:

Periapical X-rays: $20 – $250
Cone Beam Computed Tomography (CBCT): $100 – $500 (if needed)

5. Medications:

Antibiotics and pain relievers: $10 – $50

6. Follow-Up Visits:

Post-treatment check-ups: $50 – $150 (each visit)

7. Dentist’s Experience and Location:

Based on the dentist’s experience and the region your fees can vary. Specialists may Charge you higher fees.

8. Additional Procedures (if needed):

Retreatment of a previous root canal: $500 – $1,500
Apicoectomy (surgical root canal): $500 – $2,000

9. Dental Insurance Coverage:

Coverage percentage (commonly 50% – 80%) and annual maximums will influence out-of-pocket costs. Deductibles and copayments may also apply.

You should also contact your dental insurance provider to understand your coverage and potential out-of-pocket expenses.

What Strategies Can Help One Get The Best Dental Insurance Coverage For Root Canals?

Here are some key strategies to help you get the best possible coverage for your root canal:

Know your policy
Communicate with your dentist
Utilize in-network providers
Pre-authorization Password
Ask questions.

#1. Know Your Policy:

You have to be an insurance detective! Read your policy carefully, making sure you scrutinize details like coverage percentages, limitations, and exclusions because these have a large impact on your final decision.

#2. Communicate with Your Dentist:

Before you proceed, discuss your treatment options and insurance coverage with your dentist. They will help you to understand which procedures are covered and what out-of-pocket expenses you will pay for.

#3. Utilize In-Network Providers:

You can opt for plans that provide better coverage at lower cost services. For you to maximize that benefit, we’d suggest in-network providers as the best option for you.

#4. Pre-authorization Passwords:

Well, make sure you are not a defaulter. Some plans require you to get a pre-approval before you can be granted access to root canal coverage. Ensure you are acquainted with the policy and make sure you follow it.

#5. Ask Questions:

Are you feeling skeptical about a coverage plan? Then, you should not delay contacting your Insurance company. They have your answers intact.

Tips for Smooth Wisdom Tooth Removal Insurance Claim Process

Ask your dentist for electronic claim submission. This speeds up the process and reduces paperwork.
Ensure you pay promptly to avoid being charged for late payment. Constantly check your EOB for due dates and payment options.
Use online portals offered by your insurance company to your own advantage. These portals allow you to track claims and view coverage details easily.

Expert Advice On How To Potentially Reduce Your Need For Root Canal Procedures

I’m sure you don’t want to endure the drilling sounds and hefty bills that come with root canals. So how can you avoid the root canal journey altogether?

Below are ways to potentially reduce your need for root canals:

Good oral hygiene
Regular mouthwash
Choose what goes in wisely
Visit your dentist regularly
Use mouthguards
Don’t smoke
Manage stress

Let’s talk about them:

#1. Good Oral Hygiene:

You must have a healthy oral routine as it will help you to stay protected from the bacteria that cause infections that in turn require a root canal.

#2. Regular MouthWash:

We recommend you brush at least twice a day for two minutes, targeting all tooth surfaces with fluoride toothpaste. Flossing and tongue scraping should be an essential part of your brushing routine.

#3. Choose What Goes In Wisely:

We advise that you avoid sugary drinks and sticky snacks that feed oral foes. Water, fruits, and vegetables are the best-known foods that will always fortify your smile anytime.

#4. Visit Your Dental Dentist Regularly:

You should regularly go for check-ups and cleanings to identify potential threats early, preventing larger dental issues and procedures like root canals.

#5. Use Mouth Guards:

If you are an athlete, or you’re involved in high-contact sports, mouth guards are essential to protect your tooth from fractures and potential nerve damage.

#6. Don’t Smoke:

This habit weakens your teeth and gums, increasing your risk of gum disease and tooth loss, both root canal triggers.

#7. Manage Stress:

We also found that Chronic stress can negatively impact your oral health. So you should consider relaxation techniques and stress management practices that will safeguard your smile.

Frequently Asked Questions

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Important Recommendations

Conclusion

Having a root canal procedure is not always a pleasant experience. This is why we encourage you to implement all that you have learned from this article. If you still need to do a root canal, talk with your dentist about your concerns and explore all available options before making any decisions.

Thanks for reading!

We look forward to seeing you again!