Does Medicaid Cover Root Canals [Get The Facts]

Are you looking for the best option to treat a root canal or another dental condition and wondering if Medicaid would cover it? You don’t need to look any further since we have all the answers.

Because Medicaid can be rather complicated depending on which state you live in, we investigated the subject and compiled only the most critical information you need in one location.

Continue reading; you might be surprised to discover all facts about root canals and Medicaid.

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What is Medicaid?

Medicaid is a federal program that assists low-income families and individuals who have a medical condition and require care. It is designed to give special care to people who are young, pregnant, or have a handicap, although most adults receive some form of medical support if they require it.

Medicaid can be confusing since certain benefits are mandated while others are totally dependent on your state’s legislation. This is why we always advise Medicaid recipients to keep all contact information for their healthcare insurance companies on hand.

Types of Dental Coverage with Medicaid

When it comes to dental coverage, there are a variety of treatments and perks that can be covered, such as:

  • Preventative care – Preventative care often refers to general oral health and routine exams. Cleanings, sealants, and X-rays are all possible. This care is normally subject to a yearly cap for each Medicaid participant.
  • Restorative care – Another Medicaid-supported service is restorative care, which involves restoring a portion or the entire tooth. Crowns, root canals, and fillings are all examples of this.
  • Emergency care – This sort of benefit is for severe pain and/or bleeding that requires immediate attention.
  • Periodontal care – Medicaid covers part of the costs associated with gum disorders and procedures such as gum cleaning, scaling, and root planing.
  • Dentures – Medicaid may fund complete or partial dentures in several states.

Does Medicaid Cover Root Canal?

The short answer is yes, but it’s not quite that straightforward.

Depending on where you reside, a root canal may be covered totally, with a co-payment, or not at all. So, we’ll go through all of the states that are most likely to authorize this dental surgery, along with any extra limitations you may face.

Because a root canal involves an infection of the soft tissue in your teeth, it is typically painful, urgent, and can create other complications. Medicaid frequently covers such medical issues, especially for youngsters and pregnant women.

Which states cover root canals?

Different states’ dental services provide a range of options. Some states have substantial coverage, while others do not. 

Check the list of states we will offer and call your local Medicaid staff to ensure you will be covered for a root canal. Because they have all of the additional information, you will know how much money, if any, you will need to save for co-payment.

Here is the list of countries and their Medicaid coverage for dental services:

1. Extensive Benefits:

  • California
  • Colorado
  • Connecticut
  • District of Columbia
  • Idaho
  • Illinois
  • Iowa
  • Massachusetts
  • Montana
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • North Dakota
  • Ohio
  • Oregon
  • Rhode Island
  • Washington
  • Wisconsin

2. Limited Benefits:

  • Arkansas
  • Hawaii
  • Indiana
  • Kansas
  • Kentucky
  • Louisiana
  • Michigan
  • Minnesota
  • Mississippi
  • Missouri
  • Nebraska
  • Pennsylvania
  • South Carolina
  • South Dakota
  • Vermont
  • Wyoming

3. Emergency-only Benefits

  • Alaska
  • Arizona
  • Florida
  • Georgia
  • Maine
  • Nevada
  • New Hampshire
  • Oklahoma
  • Texas
  • Utah 
  • Virginia
  • West Virginia

4. No benefits at all

  • Alabama
  • Delaware
  • Tennessee

If your country is on the first list and provides comprehensive dental insurance, you will most likely be covered for all dental treatments, including root canals.

What are the restrictions with root canals and Medicaid?

Even if your Medicaid covers the expense of a root canal, there may be some limitations. This is dependent on your country of residency, so verify with your health insurance provider or Medicaid representatives.

Here are a few examples of such restrictions:

  • You can have one root canal ever, meaning one in a lifetime;
  • Your second or third molars can be excluded from the procedure;
  • You can have a limit on the amount spent on root canal;
  • Or, you could do this procedure only on the front incisors teeth;

The root canal operation is rather intricate, and various states will have different restrictions. Before you plan an appointment, make sure you have all of the necessary information.

What dental procedures does Medicaid cover?

In addition to endodontic therapy or a root canal, there are certain procedures that are covered by Medicaid. Again, this is dependent on the nation in which you and your family members reside, so double-check with Medicaid.

In general, Medicaid will fund any medically required procedures, which are often assessed by your dentist. In the event of severe pain, infection, or another emergency, most states will pay the expenses of treatment through Medicaid.

What dental procedures Medicaid doesn’t cover?

While dental procedures are one of the most demanding disciplines in healthcare insurance, and Medicaid does an excellent job of covering the majority of treatments, there are some limitations. 

The majority of the time, it is for treatments that are not deemed medically required or urgent, such as:

  • Ortithontics for adults (with some exceptions);
  • Implanted teeth;
  • Permanent bridgework except when it’s about cleft palate;
  • Surgery for remodeling gums or jaw bone;
  • Replacement of the dentures before the 5-year mark;
  • Cosmetic surgeries to enhance the appearance only;

How do I find a Medicaid dentist?

Finding a dentist who is trained and willing to perform a root canal is simple; just make sure the facility takes Medicaid. In certain countries, you can search for the best dentist online, or you can contact customer service at your health insurance carrier.

Furthermore, Medicaid agents in your state will have a list of accessible doctors that take Medicaid and may provide you with additional information if necessary.

Final Thoughts

Endodontic therapy, often known as a root canal, is one of the most crucial procedures if you want to keep your teeth. It’s called a restorative treatment for a reason, and as such, it’s frequently covered in states that allow for broad Medicaid coverage.

With a few limitations in mind, you can schedule an appointment with your preferred dentist and receive treatment right away.

David Duford
Author: David Duford