In all age groups, dental care is the main health service that is overlooked due to its cost. There are several reasons, but two stand out.
First, MaineCare, Maine’s Medicaid program, does not cover comprehensive dental care for adults, leaving thousands of people in Maine without coverage for the dental care they need. Second, many people with private dental insurance cannot afford care due to high deductibles and very low annual benefit ceilings that result in high out-of-pocket expenses. A new bill, LD 1266, An Act to improve the value of dental insurance, would address these inequalities in private dental insurance.
An important difference between medical and dental insurance is that, under the Affordable Care Act (ACA), medical plans are required to spend at least 80% of premium income on health care claims and insurance. ‘improvement in quality, leaving no more than 20% to spend. on administration, marketing and profit.
This requirement is known as the Medical Loss Ratio (MLR). The MLR holds insurance companies accountable and helps ensure that the money people spend on premiums is actually used to provide patient care. Maine lawmakers recognized the importance of the MLR requirement when the last legislature voted almost unanimously to codify the ACA’s 80 percent MLR standard for health plans into Maine law. However, under ACA and Maine law, dental insurance plans can bypass this requirement.
But patients deserve better from their dental plans. Recognizing this, California passed a law in 2014 that requires dental insurers to report MLRs to the state, which are made public online. The data revealed by these reports is alarming. As recently as 2018, one diet had an MLR of 4%. This means that for every dollar that individuals paid in premiums, the insurer spent only 4 cents on patient care. While California has led the nation in MLR transparency, no state requires dental insurers to spend as much of their premiums on patient care as medical plans are required to do under the ACA.
In 2016, dental insurers paid 46% of dental expenses in the United States, or about $ 50 billion per year. In California, a report released in 2018 showed that only 57% of dental plans spent at least 60 cents of every dollar collected in premiums for patient care.
Across the country, billions of dollars are spent each year on executive salaries and administrative costs rather than on patient care. Requiring dental insurers to have an MLR of 80% could dramatically reduce the amount patients pay out of pocket for dental care and insurance costs.
The Maine legislature has an opportunity to address the disparity between premiums and spending on patient care. State Senator Heather Sanborn submitted a bill, LD 1266, that would require dental insurers to report MLRs to the Maine Bureau of Insurance, and set a minimum MLR of 80 percent for dental plans. Dental plans that spend less than 80% of premium income on patient care and quality improvement should reimburse the difference to their registrants.
LD 1266 is a common sense solution that would force dental insurers to meet the same standards as other health insurance companies. A dental MLR requirement would mean dental insurers would spend less on executive salaries and corporate profits and more on what matters: providing dental benefits to Mainers and reducing their out-of-pocket dental costs.
Maine is expected to lead the country in requiring dental insurers to report their annual MLR and spend more of their premiums on patient care.
After all, dental care is health care.
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