Proponents say a grassroots vote in the Massachusetts election in November could be an early step toward statewide dental insurance reform.
“It’s kind of a guide for everyone across the country,” said Brian Monteiro, director of government affairs and public relations at the Massachusetts Dental Society, on an American Dental Association podcast. “Eyes are on us”
If passed by voters on Nov. 8, the measure would require dental insurance carriers to spend at least 83% of premium dollars on patient care or give policyholders a rebate on the unspent portion.
Under the Affordable Care Act, health insurers are required to maintain a minimum medical claims ratio of 85% for large health insurers and 80% for smaller health insurers. In 2006, Massachusetts became the first state to introduce the Medicare Loss Ratio, which sets Medicare plans at the standard of 88%. However, this does not apply to dental insurance.
efforts of other states
States have toyed with similar efforts to force dental insurers to disclose claims ratios and set minimum amounts. A Maine bill enacted last March sets an 80% minimum medical loss rate for dental plans and requires waivers to be granted in any year that the dental plan’s medical loss rate is below the minimum.
After a California law, The Dental Plan Transparency Act, required insurers to report loss rates, it found that the average dental loss rate was 61%, much lower than the national average of 76%, with some plans in patient care lay. There was a drop of just 4%. ,
dr Andrew S. Co-President, Government Affairs of the Massachusetts Dental Society. “If Medicare plans can beat the 88% Medicare rate, we don’t think there’s any reason why dental insurers can’t reach that 83% figure,” Tonelli said. Committee on the ADA Podcast. “If this law is passed, I as a provider can be confident that my patients are getting a fair deal for their money. And I can’t say that just yet, which as a provider is a bit disappointing.” .
ADA supports the ballot initiative started by a single orthodontist in the state, who himself collected millions of voter signatures for the referendum and contributed $5 million to the Massachusetts campaign.
“For months, the MDS and ADA have been working together to develop a campaign strategy that will enter a more high-profile phase in the coming weeks,” ADA said in a press release announcing its support. “Both organizations plan to devote the necessary resources to support campaign activities to educate and engage voters on why they should vote “Yes to Question 2” in order to pass this important, patient-centric referendum. Should give.”
Not surprisingly, dental insurance companies have opposed the proposal. So far, seven donors have reported contributing $5 million to the “No” campaign, almost all from giant Delta Dental. Others, like Sun Life, Concordia, and MetLife, have invested in smaller amounts.
called fundamental differences
Insurers argue that dental insurance is fundamentally different from health insurance. They say the potential dental insurance claims are more realistic for paying patient funds. Most dental insurance companies cap annual maximum payments at around $1,000 to $1,500, although health insurance can be on the hook for an unlimited amount.
Dental insurance plans mostly cover low-cost preventative care and rarely cover more expensive care services like crowns and bridges.
Health insurance is almost the opposite, paying a minimum amount for basic care but actually covering serious illnesses, expensive diagnostic tests and rehabilitation.
Even the ADA recognizes that dental insurance falls into a separate category.
“Dental benefit plans are not really insurance in the traditional sense, but are designed to help you pay for your dental care,” ADA public documents state.
Massachusetts’ Delta Dental, which reported a 74% claim rate in 2019, closer to the national average of 74%, argues that Massachusetts’ offering allows carriers to eliminate claim rate calculations from investing in customer online portals, disease management, or fraud. not allowed. Withhold from claims ratio calculations while health insurers can. This, according to Delta Dental, could discourage tooth wearers from investing in these programs. It also warns that the premium could rise seriously if the referendum is passed.
An analysis by Tufts University’s Center for State Policy Analysis was in the middle of its assessment. According to reports, insurers can actually lower premiums and streamline administrative tasks or take a bite out of profits. They can also start covering more procedures, which allows dentists to charge higher prices.
Overall, according to the Tufts report, the voting issue is unlikely to impact consumers significantly.
Doug Bailey is a journalist and freelance writer based outside of Boston. he can be reached here [email protected],
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