(Illustration by Mohamed Hassan via Pixabay) field_54b3f951675b3

DESPITE THE CLEAR link between oral health care and an individual’s overall health, approximately one-third of all American adults between the ages of 19 and 64 lack dental insurance. As a practicing dentist in Quincy, I am fortunate to see many patients who do have coverage, though barely a day goes by when I do not hear an insurance war story.

Fortunately, this month, the Massachusetts Division of Insurance (DOI) released a draft rule – set to take effect in the new year – that aims to address many of the issues preventing people from accessing the dental care they need. The rule is result of the overwhelming passage of a ballot measure last November seeking to rein in dental insurance providers.

As one might imagine on issues related to insurance, there’s a good deal of fine print and the rule is quite complicated. But at the most basic level, the new standard requires dental insurance carriers to report the portion of their revenues spent on patient care versus revenues that go towards administrative costs and profits, commonly known as “medical loss ratio” (MLR). The standard also requires that a minimum of 83 percent of premiums go towards actual patient care and clearly delineates between what can and cannot be considered an administrative cost.

Essentially, the standard will weed out waste and abuse, provide full transparency to people seeking dental insurance, and ensure that the vast majority of the premiums the policy holder pays actually goes to dental care.

To be sure, navigating one’s health insurance benefits, including dental, can be complicated and confusing. And unfortunately, many insurance providers appear to be using dental plans to bolster their profits. Current estimates indicate that unused dental premium dollars constitute 40 percent or more of premiums. These unused benefits are kept by insurance companies rather than going to the actual cost of care.

For comparisons sake, Massachusetts currently maintains an 88 percent medical loss ratio for medical plans, meaning no more than 12 percent of premiums can go towards administrative costs or profits. However, unlike medical insurance, no such percentage existed for dental plans until voters made themselves clear and the Division of Insurance stepped in.

Dental insurers are certainly entitled to make a fair profit and, of course, need to cover their administrative costs. They would not be in business if they failed to do so. But it is clear that dental insurance plans have become a cash cow for insurance providers. More transparency into how these premiums are being used is essential to ensure that consumers can make informed coverage decisions and, ultimately, access dental care services they need.

With the release of the draft rule, the Division of Insurance is now accepting public comments before releasing the final rule sometime before the close of the year. The insurance oversight office will undoubtedly hear from health care advocates, dental providers and,  insurers as they prepare the final regulation. While there are tweaks that can be made to the draft rule, the intent is there: expanding access to quality dental care.

By establishing this rule, Massachusetts will become the first state to truly tackle the challenges associated with dental care insurance. Much like how “Romney Care” in 2006 led to a broader discussion on health insurance and, ultimately, the federal Affordable Care Act, Massachusetts can again serve as a model for all other states seeking to improve access to much-needed dental services.

David Lustbader is a practicing dentist at South Shore Oral Surgery Associates based in Quincy. He is also director of clinical affairs at 42 North Dental, chief of oral and maxillofacial surgery at Milton Hospital, a clinical instructor at Boston Medical Center, and past president of the Massachusetts Dental Society.