Does Health Insurance Cover Root Canals?
Health insurance does not typically cover dental procedures, which include everything from a simple teeth cleaning to a more complicated root canal. Root canal coverage would be the job of dental insurance.
Even with dental insurance, however, you may have to pay some of the expenses of your root canal out of your own pocket. Forbes reports that root canals can run anywhere from $300 to more than $1,000, and dental insurance often has very low limits.
Does dental insurance work the same as health insurance?
Dental insurance and health insurance generally work in very different ways. Health insurance allows you to pay a deductible and, once you meet that deductible, it covers the rest of the cost up to the predetermined maximum limit. With dental insurance, your plan gives you a set amount of money it will pay for a procedure, and you have to pay the rest out of your own pocket.
This can get very costly if your dental insurance limits are particularly low. If it only offers $200 worth of coverage for a root canal and your final root canal bill is $1,000, you are responsible for the remaining $800.
Dental insurance also has an annual maximum amount it will pay out, regardless of any procedure. If you had already hit your annual maximum amount of coverage by the time you needed the $1,000 root canal, you would be responsible for the full amount of bill.
Some dental insurance companies say that dental insurance is not insurance per se, but rather set up as a system of “dental benefits.” You pay a set amount each month to receive whatever benefits are outline in your plan. If you go above and beyond your set benefits, you are on your own.
Dental benefits remain low so the premiums remain low. While a root canal could cost $1,000, adding a crown to the root canal procedure could cost an additional $1,500, for a total procedural cost of $2,500.
If a dental insurance company were to factor such costs into a plan for all its members, it would have to set the premiums very high to ensure they don’t lose money with their system. Keeping coverage low, on the other hand, puts the risk of extensive procedures and high costs back on the consumer.
How would I know if I need a root canal?
Pain is a great indicator that some type of dental work needs to be done, and pain can definitely be a symptom of needing a root canal. Your dentist or endodontist would make the final call on the necessity of a root canal by examining the state of your tooth.
Root canals are generally suggested when the inside of the tooth, or the pulp, has died. The Mayo Clinic notes this can come about if the tooth’s outer enamel ends up cracked or with a cavity and bacteria and debris invades the soft, inner pulp.
If bacteria and debris are left to thrive and fester inside the pulp, it can develop an infection that kills off all the blood vessels, nerves, and tissues that make up the pulp. Once the pulp is dead, it’s usually only a matter of time before the tooth falls out and more serious conditions can arise. These include an infection in the jaw bone, loss of bone, pain and inflammation in the gums, and a highly sensitive area in your mouth.
Cavities and cracks are not the only way a tooth’s pulp could become infected. The American Dental Association’s MouthHealthy website says infection can also come from having a series of dental procedures in the same area or an injury to the tooth. Pulps can become infected even if no cavity or cracks are readily apparent on the outer enamel of the tooth.
What happens with root canal treatment?
The goal of a root canal is to remove the dead pulp from inside the tooth. If the outer enamel of your tooth is in good shape, you may be able to keep the original outer coating of the tooth for the exterior.
If your tooth’s outer enamel is badly damaged, you may have to get a fake tooth or part of a tooth to restore its functioning and appearance. That’s where the crown would come in.
Root canal treatments usually consist of two visits. The first visit starts with a local anesthetic to numb the area, followed by the insertion of a rubber dam to isolate the area that requires a root canal, the ADA explains. The dentist or endodontist then makes an opening in the enamel to enter and remove the dead pulp material.
Your tooth’s root gets cleaned up, additional medication may be used to kill off all bacteria and eliminate future infection, and a temporary filling is put in place.
The second visit involves removing the temporary filling, filling the hollowed-out tooth, and putting a permanent filling in place. If your tooth is damaged badly enough to require a crown, your dentist makes a mold of the area that needs a crown and can put it in place as the final step of your root canal procedure.
Your final step is simply to practice good oral hygiene, with regular brushing, flossing, and dental visits. Provided no further infections or issues come up, you may not need additional procedures on that particular tooth and the restoration work can last for the rest of your life.