A grassroots campaign initiative in the November ballot in Massachusetts could represent a first step toward national dental insurance reform, supporters say.
“It’s sort of the barometer for everyone across the country,” Brian Monteiro, director of government affairs and public relations at the Massachusetts Dental Society, said in an American Dental Association podcast. “The eyes are on us.”
If passed by voters Nov. 8, the measure would require dental insurance companies to spend at least 83% of premium dollars on patient care or refund unspent portions to policyholders.
Under the Affordable Care Act, medical insurers are required to operate at a minimum of 85% medical loss rate for large carriers and 80% for small health insurers. In 2006, Massachusetts became the first state to implement a medical loss rate that keeps medical plans at an 88% standard. Dental insurance companies, however, are exempt from these provisions.
The efforts of other states
States have toyed with similar efforts to force dental insurers to reveal loss ratios and set minimums. A Maine bill signed into law last March establishes a minimum medical loss ratio of 80% for dental plans, but the requirement that reimbursements be made each year in which the medical loss ratio of ‘a dental plan is less than the minimum’ was removed from the law after successful lobbying by insurers.
A California law, the Dental Plan Transparency Act, required insurers to report loss ratios after it found the average dental loss ratio was 61%, well below the national average of 76%, with some plans spending only 4% for patient care. .
“If medical plans can achieve an 88% medical ratio, we believe there’s no reason dental insurers can’t achieve that 83% figure,” said Dr. Andrew S. Tonelli, DMD, co-chair of government affairs for the Massachusetts Dental Society. Committee in the ADA podcast. “If this bill passes, I will have the assurance, as a provider, that my patients are getting a fair price for their money. And I can’t say that right now, which is kind of frustrating as a supplier.
The ADA supports the ballot initiative, which was started by a single orthodontist in the state who spent his own millions collecting signatures from voters for the referendum, contributing $5 million to the Massachusetts campaign.
“We support the issue and anticipate it becoming a nationwide push,” said Chad Olsen, director of the ADA’s Government Affairs Department.
Unsurprisingly, dental insurers lined up against the proposal. So far, seven donors have said they have contributed $5 million to the “No” campaign, almost all of it coming from giant Delta Dental. Others, such as Sun Life, Concordia and MetLife, participated with smaller amounts.
Cited fundamental differences
Insurers argue that dental insurance is fundamentally different from medical insurance. Potential losses to dental insurance companies for patient benefit payments are more actuarially predictable, they say. Most dental insurance companies impose annual maximum payments limited to around $1,000 to $1,500, where medical insurance can be liable for unlimited sums.
Dental insurance plans mostly cover low-cost preventative care and barely cover more complex care like crowns and bridges.
Medical insurance is almost the opposite, paying minimal amounts for basic services but actually covering critical illnesses, expensive diagnostic tests, and rehabilitation.
Even the ADA admits that dental insurance is in a separate category.
“Dental plans are basically gift cards with dental care done in the back through treatment policies,” Olsen said. “We would like dental insurance companies to adhere more closely to being a true insurance product and I think MLR would force them to take a hard look at their product design and perhaps get closer to major medical insurers.”
Olsen said dental plans are designed to make money if patients don’t go to the dentist.
“I think we would see things like dental plans start to fit into and be part of mainstream medical plans,” he said. “I could see differences in the design of the plans where they start to look better, because insurance companies want patients to go get coverage.”
Delta Dental of Massachusetts, which reported a 74% wastage rate in 2019, close to the national average, argues that the Massachusetts proposal does not allow carriers to exclude investments in online customer portals, disease or fraud prevention loss rate calculations. – that health insurers can – and could discourage dental insurers from investing in these programs. He also warns that bonuses could rise significantly if the referendum passes.
An analysis by Tufts University’s Center for State Policy Analysis was in the middle of his assessment. Reports indicate that insurers can actually reduce premiums and streamline administrative functions, or reduce profits. They could also start covering more procedures, which would allow dentists to charge higher prices.
Overall, according to Tufts reports, the ballot issue is unlikely to have a significant impact on consumers.
“I think the Tufts study had its good qualities, but it was looking at the short-term effect,” Olsen said. “Our vision is long-term and we believe there would be changes that would be incremental and beneficial.”
The ADA’s Olsen said he thinks similar bills will be introduced in a handful of states next year. “Eyes are on Massachusetts to see what’s going on,” he said.
Doug Bailey is a freelance journalist and writer who lives outside of Boston. He can be reached at [email protected].
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