Protecting Access to Affordable Dental Care

Dental Loss Ratio (DLR) proponents claim that their goal is to make sure patients receive timely, quality care. In fact, the DLR legislation risks making dental coverage less affordable and less accessible for the very families it aims to help. 

Dental insurance is structured differently

Unlike major medical plans, which are built around high-cost and catastrophic events, dental plans are low-premium, prevention-focused products. Applying an 80–85% medical-style loss ratio to dental plans simply doesn’t fit the economics of how these products work. Dental premiums are far smaller, which means the remaining percentage available for essential operations (customer service, claims review, provider contracting, fraud prevention) is already limited. Forcing medical-level ratios onto dental plans risks making the product financially unsustainable.

Dental insurance is working

Nearly 75% of workers with dental benefits visit a dentist for preventive care at least once a year, compared to just 37% without coverage. Preventive care, typically covered at 100%, is essential to avoiding more costly and painful problems down the road. Oral health isn’t just about teeth, it’s linked to overall health, including heart disease and diabetes. But affordability is the foundation that keeps those preventive gains within reach.

Affordability is key

Premiums for dental insurance average just $31 per month nationally, thanks to efficient administration and negotiated discounts. Imposing rigid DLR requirements would upend this balance. Studies show that similar proposals could raise premiums by 13% to 266%, depending on the plan. For a price-sensitive product, that’s devastating. Nearly half of uninsured individuals cite cost as the reason they go without coverage. If premiums spike, many families will drop their plans, leading to more untreated dental issues and higher long-term health costs.

Proposals for DLR mandates that mirror the Affordable Care Act’s requirements for major medical plans, create a flawed comparison. Because dental premiums are much lower, the same percentage requirement allows far fewer dollars to support plan operations. As a result, insurers would likely need to raise premiums to comply, putting affordable dental coverage out of reach for more families.

The truth: patients value dental insurance

Surveys consistently show about 90% of policyholders are satisfied or very satisfied with their coverage, citing easy access to care as a top benefit. Policymakers should build on this success—not undermine it. Instead of adding mandates that drive up costs, we should focus on preserving affordability and expanding access to preventive care.

Artificial limits on how insurers can budget for operations could also restrict investments that improve patient experience, such as network expansion, care coordination, and customer service. These functions directly support access to care, yet they would be squeezed under rigid DLR mandates.

Getting it right

Importantly, higher DLR requirements don’t guarantee more appointments, shorter wait times, or better oral health outcomes. They only change how dollars are labeled, not how care is delivered. Patients benefit most when plans can invest flexibly in both care and the administrative tools that make that care accessible. They are hurt most when innovation and choice are taken away by ill-conceived ideas such as DLR legislation. Legislators across the country have seen this and have rejected these DLR ideas.

In fact, Massachusetts legislators rejected DLR so many times that a ballot initiative went around their wisdom and they became the only state to implement a medical-style loss ratio on dental coverage. Since then, they have seen several carriers serving individual and small group customers exit the market in Massachusetts because they could not administer the products under such an unrealistic loss ratio. This has decreased choices in the same way it will for any states that implement such a loss ratio requirement.

Dental insurance is a proven tool for protecting health and household budgets. Let’s keep it that way by rejecting policies that would make coverage harder to afford.