Mass. votes for dental insurance reform

Massachusetts voters overwhelmingly supported reforming dental insurance medical loss ratios, requiring carriers to spend at least 83% of revenues on members’ dental expenses and improvements instead of administrative costs. The law will be effective in 2024.

About 71% of constituents in the Bay State voted in favor of Question 2, while about 29% voted against it, according to unofficial results with 89% of votes counted. The success of the measure could lead other states in the U.S. to craft similar dental reform legislation.

Passing this measure means that the Commissioner of the Massachusetts Division of Insurance can approve or disapprove the rates of dental benefits plans and require dental insurance companies to meet an annual aggregate medical loss ratio of at least 83%. If a medical loss ratio falls below 83%, the carrier would be obligated to refund excess premiums to its covered individuals and groups. The law takes effect on January 1, 2024, according to the ballot measure.

The ballot question had widespread support in organized dentistry. The American Association of Endodontists (AAE) endorsed it, and the ADA funneled about $5 million into efforts to get the measure passed.

ADA president Dr. George Shepley said in a press release issued on November 9 that passage of this measure “sent a powerful message across the country.”

“By working together and engaging with our patients and our communities, dentists can help achieve significant reforms in dental insurance so that our patients are protected and are assured greater value from their dental insurance plans,” Shepley said.

Andrew Smith, executive director of the Association of Dental Support Organizations, said in a statement that he was thrilled to see voters in Massachusetts cast their ballots for better dental care and more fair and transparent dental insurance practices.

"Healthy mouths are key to healthy bodies," Smith said. "With the passing of Question 2, voters have charted a course toward a healthier future defined by better oral care for patients and lower health care costs overall."

Smith also told DrBicuspid.com that he expects other states to implement similar laws, although he doesn't have any predictions on which states may be among the first to emulate Massachusetts.

"Medical Loss Ratio for dental is a priority issue for both patients and dental care providers," Smith said. "Establishing the controls as seen in Question 2 is essential to improving the cost and quality of dental care across the country."

Additionally, this law applies to dental benefit plans whether they are issued directly by a carrier, through the connector, or through an intermediary. However, it does not apply to dental insurance plans issued, delivered, or renewed to a self-insured group or where a carrier is acting as a third-party administrator.

In addition to submitting current and projected medical loss ratio information to the commissioner, insurers have to submit administrative expenses and other financial data to the commissioner. Carriers must file the prior year's product base rates by July.

Furthermore, carriers are required to submit yearly comprehensive financial statements, itemized by market groups size and line of business, to the state insurance division. Carriers that provide administrative services to one or more self-insured groups must file an appendix to their annual financial statement with information about its self-insured business. A carrier that does not file its annual report on or before April 1 face late penalties, according to the measure.

"This is a win for dentistry, and it is an especially big win for patients,” AAE President Dr. Stefan I. Zweig said in a statement released by the association on November 9. “We are confident that more teeth will be saved as a result of this outcome.”