Does Dental Insurance Cover Root Canals?

Dental insurance can be a complex topic. You might be wondering what exactly it covers and whether it’s really worth the cost. But one question that's on a lot of people's minds is, Does dental insurance cover root canals?

One thing to think about when considering a dental insurance plan is what coverage the plan offers. Root canals are a common procedure, but some dental insurance policies may have limited benefits for the service. Other dental insurance providers may not offer coverage for root canals at all. Here’s what you need to know.

Does Dental Insurance Cover Root Canals?

Dental insurance — like many other forms of insurance — has varying levels of coverage. It’s not always easy to tell exactly what your dental insurance covers. In these cases, it’s important to review policy documents so you know what to expect. Here are some situations in which dental insurance might and might not cover root canals:

Some dental insurance plans only offer coverage for preventative matters, such as routine cleanings. These policies may also offer coverage for basic restorative dental care, such as a filling. However, root canals are likely considered to be in a different category. If your dental insurance offers coverage for major restorative services, it will probably cover root canals.

Dental insurance plans come with annual limits for how much the dental insurance provider will pay for your dental care. Any dental service you receive throughout the year counts toward your maximum if it was paid for by your insurance provider. This includes cleanings, preventative treatments and other restorative services. If you’ve reached your policy’s maximum for the year before getting a root canal, your root canal will not be covered. If you haven’t reached the policy’s annual maximum yet but you’re close to it, your insurance provider may pay for part of your root canal.

Dental insurance policies often have waiting periods, meaning you can’t benefit from your coverage for a specified period of time after your policy becomes effective. Some dental insurance policies may only have waiting periods for certain procedures, including root canals. If you need a root canal and you’re not past the waiting period, your dental insurance provider will not cover it.

Does Dental Insurance Cover Implants?

Like root canals, implants are usually considered a major restorative service. Some dental insurance plans might offer some coverage for implants, while others might not offer any coverage for them at all.

Here are some instances where it might and might not be covered:

No. 1 Yes: If your plan includes implants

If your policy offers coverage for major procedures, it may offer coverage for implants. Be sure to consider whether your policy has a waiting period, because implants are one of the procedures that is likely included. You’ll also need to consider whether you’ve met your policy’s annual maximum limit.

This is where things get a little complicated. Just because a dental insurance plan offers coverage for implants, that doesn’t mean it will cover implants in every circumstance. For example, if you are in an accident that makes it so that you need dental implants, this is likely to be covered. However, if you’re getting dental implants for other reasons, your plan may consider it to be a cosmetic procedure and exclude it from your coverage.

Is There a Waiting Period for Root Canal Coverage?

Dental insurance plans often have a waiting period for some major procedures, including root canals and implants. Waiting periods typically last anywhere from a few months after your coverage begins to a full year after your coverage begins.

Not every dental insurance plan has a waiting period, though. When shopping for dental insurance coverage, you should consider whether you’re OK with your plan having a waiting period. If you expect you may need a root canal or other major dental procedures, it’s best to look for a plan without a waiting period. 

If you already have dental insurance, check with your provider to see what waiting periods may apply to your coverage.

Can Root Canals Exceed Your Yearly Maximum? 

Dental insurance plans come with an annual maximum. This is the total amount of money your dental insurance provider will pay for your dental care within your plan year. The annual maximum does not include the money you pay out of pocket for your dental services, such as your copays and coinsurance. Most dental insurance plans have annual maximums that range between $1,000 and $2,000.

It is possible that the cost of a root canal could exceed your yearly maximum. The costs of a root canal vary based on which tooth is getting the root canal. On average, a root canal can cost anywhere from $600 to $1,500. Depending on the dental insurance plan, the root canal alone could exceed your yearly maximum. If you’ve had other dental procedures throughout the year, the root canal could also be the tipping point that puts you over your yearly maximum.

Compare Dental Insurance

If you’re thinking that you might need coverage for root canals in the future, it’s good to plan ahead. This can help ensure your coverage is available when you need it. To get you started, here are some dental insurance providers to consider. Be sure to look for waiting periods, deductibles and annual maximum limits when choosing a dental insurance policy.

Do I Need to Have Dental Insurance?

There’s no requirement that you have dental insurance, nor is there a tax penalty for not having dental insurance. The Affordable Care Act (ACA) mandates that dental insurance coverage must be available to you if you have children in your household. However, there is no such requirement for adults. That being said, you may be able to find dental insurance plans through your state’s insurance marketplace.

From a personal standpoint, whether or not you have dental insurance is up you. It may be a good idea to ask your dentist for estimates so you can compare what the cost would be if you didn’t have dental insurance. When reviewing the dental insurance options, you should pay attention to the deductible, waiting periods and copays. Considering these factors will help you evaluate whether it’s a better deal to have dental insurance or not.

Another thing to consider is what kind of dental care you expect to need for the year. If you usually only need dental cleanings and don’t have a history of dental problems, you probably won’t need to pay much for dental services in a given year. In these cases, dental insurance may not be worth it because you’ll be paying for the insurance policy in addition to paying for your dental services until you meet your deductible. However, if you do have a history of dental issues that require additional dental care, dental insurance may be worth the money. It’s important to consider all of the costs associated with dental insurance so you can compare and determine whether dental insurance is right for you.

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