Frequently Asked Questions

Patients deserve to know that their dental insurance premiums are being used to support their oral health. Too often, money goes to profits and overhead instead of treatment. Dentists care about their patients, and we believe those dollars should fund actual care.

A Loss Ratio sets a minimum amount insurers must spend on health care services instead of administrative costs. Federal law already requires medical insurers to operate with an 85% Medical Loss Ratio for larger carriers and 80% for smaller carriers. Dental insurers are not held to that same standard in most states.

It varies widely. Some insurers already meet the 85% standard we are calling for, but others spend as little as 11% of premiums on care. That inconsistency leaves patients with unpredictable and often inadequate coverage.

Yes. In states where data is available, many dental insurance carriers already operate at or above 85%, demonstrating it is possible to operate, prioritize patients, and make a profit within this standard.

Ensuring transparency and value in dental insurance rates will help reduce out-of-pocket costs for dental patients, which will make access to dental care and procedures more affordable and encourage people who are reluctant to go to the dentist to receive dental care.

85% is the same standard established under the Affordable Care Act for large health plans. It has worked for nearly 15 years and provides a proven benchmark for fairness and accountability.

The Affordable Care Act included a Loss Ratio for major medical health plans but did not apply the same protection to stand-alone dental plans. Patients deserve that same level of accountability for dental coverage.

Since 2011, the MLR requirement has been one of the most important consumer protections in the ACA. It has saved patients money and required rebates when insurers failed to meet the standard. In 2022 alone, Kaiser Family Foundation estimates that insurers issued about $1 billion in rebates to 8.2 million people across the country.

Yes. In 2024, Ambetter was required to refund nearly $90 million to Missouri customers after failing to meet federal Medical Loss Ratio requirements for health insurance. This is proof that Loss Ratio laws work. When insurers don’t spend enough of your premium dollars on care, patients get money back. Dental insurance should be held to the same standard.

Dental insurers will be required to disclose how much of every premium dollar goes to patient care. That annual reporting will give patients, families, employers, and policymakers a clear picture of whether coverage is working as promised.

Yes. Several states have enacted DLR laws that improve access to care and increase transparency. At the national level, Medical Loss Ratio has been applied since 2011 with strong results for patients.

Insurance carriers oppose DLR, claiming it could reduce competition and raise premiums. The experience in states that have implemented DLR shows no evidence of those outcomes. Patients see better value and greater accountability when DLR is in place.

A loss ratio gives employers more transparency, accountability, and return on investment for the benefits they offer. It sets a minimum amount of premium dollars insurers must spend on health care services instead of administrative costs. Under Missouri's proposed DLR, 85 cents of every premium dollar would be required to be spent on patient care. If that threshold is not met, the difference must be returned to the payor of the premium. This means an employer or patient would receive their money back if it isn't used for its intended purpose.