Does Medicaid Cover Root Canals?
- Does Medicaid cover root canals? Find out how Medicaid dental coverage for root canals works and how many states cover root canals for children and adults.
If the pulp inside one of your teeth is infected or damaged, your dentist may recommend root canal treatment. There are several reasons you might need a root canal, including tooth decay or a chipped tooth. During treatment, a dentist removes the damaged pulp, cleans inside the tooth cavity and seals the tooth to restore it.
Root canal treatment is expensive, and many people can't afford to pay the costs out of pocket. So, does Medicaid cover root canals? Below, you can find out how Medicaid dental coverage varies across states and how many states cover root canals through Medicaid.
Does Medicaid Cover Root Canals?
Whether Medicaid covers root canals depends on where you live. Each state has its own list of dental treatments covered by Medicaid, and 26 states currently cover restorative procedures such as root canals.
Eighteen states provide Medicaid coverage for emergency dental treatment only. This means that you may be able to have an infected tooth extracted and receive emergency pain relief but you won't be covered for root canal treatment to restore the tooth.
However, usual restrictions to Medicaid dental coverage don't apply to child enrollees. Every state must cover pain and infection treatment, tooth restoration, and dental health treatments for child beneficiaries. Furthermore, states are obliged to cover any medically necessary dental treatments to children enrolled with Medicaid, even if the treatment isn't included in its general dental coverage. Therefore, your child may be covered for root canal treatment through Medicaid even if your state doesn't fund the treatment for adults.
Does Medicaid Cover Dental for Adults in 2021?
Medicaid covers dental care for adults in every state, except for Delaware, Maryland and Tennessee. Coverage varies widely between states, from basic emergency care to extensive coverage.
Many states have mandatory limits on the amount of dental work Medicaid will cover. Some states cap the annual funding per beneficiary, and limits range between $500 and $2,500. Other states limit the number of dental procedures that can be covered by Medicaid each year or over the course of a lifetime. For example, Connecticut and Illinois only fund one root canal per tooth over the beneficiary's lifetime. Most state Medicaid plans only pay for one dental examination or hygiene treatment per year.
If you are pregnant or have certain disabilities that make dental problems more likely, you may be entitled to more extensive dental coverage through Medicaid than most adults in your state. Roughly half of all states offer enhanced Medicaid dental coverage to pregnant women.
You'll usually require authorization before Medicaid will cover planned dental treatment. However, the requirement for authorization is often waived if you need emergency treatment or pain relief.
How Much Is Root Canal Out of Pocket?
How much a root canal costs out of pocket depends on which tooth requires treatment, the extent of the work required and whether you need emergency treatment.
Generally, you should expect to pay somewhere between $900 and $1,100 for root canal treatment on a front, bicuspid or premolar tooth. Meanwhile, root canal therapy for a back molar usually costs between $1,000 and $1,300. These prices include the cost of diagnostic X-rays before treatment.
Several factors could make root canal treatment more expensive than average. Many dental clinics charge a premium for emergency short notice treatment or treatment on the weekend. You may also need to pay to have the tooth capped with a dental crown, which usually costs between $500 and $3,000 per tooth.