Massachusetts uses a state-based health insurance exchange called Massachusetts Health Connector for the sale of certified individual/family dental plans as well as small group dental options.
All insurers that offer medical plans through the Massachusetts exchange include pediatric dental coverage with their health plans, and a few offer limited adult coverage. Stand-alone dental plans are available for both children and adults through the Connector all year.
Massachusetts voters pass ballot measure to create medical loss ratio rules for dental plans
In the 2022 election, Massachusetts voters overwhelmingly supported Question 2, which will impose medical loss ratio rules on dental plans in the state as of 2024. Advocates in the state are hoping that the new rules will serve as a model for other states to create similar rules.
Under the terms of Question 2, dental plans in Massachusetts will have to spend at least 83% of premiums on members’ dental care and quality improvements, and will be allowed to spend no more than 17% of premiums on administrative costs. The ACA imposed medical loss ratio rules for health insurance, but did not address dental coverage (Massachusetts has medical loss ratio rules that are more strict than those imposed by the ACA).
Massachusetts Question 2 was supported by dentists and dental associations, including the American Dental Association, who noted that the passage of the measure will help to bring dental insurance regulations in line with medical insurance regulations, and help to eliminate administrative waste and excessive salaries for executives. It was opposed by major dental insurers in the state, who argued that it will result in higher premiums and less access to dental insurance.
It’s true that one of the criticisms of the ACA’s medical loss ratio (for health insurance) is that it doesn’t put a lid on overall premiums, since higher total premiums allow for higher administrative costs. But most of the state’s large dental carriers already spend close to 83% of premiums on dental care and quality improvements, and experts project that premiums are not likely to rise by excessive amounts.
Question 2 also authorizes the Massachusetts insurance commissioner to reject dental carriers’ proposed rates if they’re deemed excessive. (Many states have a similar provision for medical insurance rates, although some states’ rate review processes do not allow insurance commissioners to reject premium increase, even if they find them to be unjustified.)
