Maine considers ‘medical loss ratio’ for dental insurers

Maine lawmakers are debating a plan that would require private dental insurers to spend more money to care for patients by setting new rules on medical loss ratios.

The legislation, which was approved by the Senate on Tuesday, would require dental insurance companies to spend at least 80% of their revenues on dental care and quality improvements as opposed to administrative costs.

Under the federal Affordable Care Act, medical insurers are required to operate with a medical loss ratio of at least 80%, requiring 80 cents of every dollar to be spent on improving patient care. But there is no such requirement, either on a state or federal level, for dental insurers.

The bill’s primary sponsor, Sen. Heather Sanborn, D-Portland, said in remarks on the Senate floor Tuesday that the changes would “improve dental benefits in a meaningful way.”

Groups that advocate for preventative oral services say the plan could make dental coverage more affordable and accessible for Mainers by reducing co-payments and out-of-pocket costs.

“Lack of dental insurance can be a deterrent to seeking routine preventive care and may result in individuals delaying care until more serious oral health conditions develop,” the nonprofit Maine Coalition for Oral Health said in recent testimony on the bill. “But for those with coverage, premium costs and co-payments can result in high out-of-pocket costs that make utilizing the insurance they pay for a hardship at best.”

Insurers oppose the plan, arguing that it would set unnecessary mandates on the dental industry that will ultimately drive up costs for patients and dental providers.

During a recent hearing on the bill, Katherine Pelletreau of the Maine Association of Health Plans’ said the plan would “negatively impact Maine consumers as their premiums will have to rise to cover administrative costs.

“Particularly for those purchasing the lowest cost coverage, those prices will no longer be available,” she told members of the Legislature’s Health Coverage, Insurance and Financial Services Committee during a hearing. “As with health insurance, purchasers of dental insurance are extremely cost sensitive, and it is likely that some will drop coverage.”

Insurance industry officials argue that dental coverage is structured differently than medical insurance, which is one of the reasons monthly premiums are lower.

The proposal now heads to the state House of Representatives, which also must approve the plan before it lands on Gov. Janet Mills desk for consideration.

This article was originally posted on Maine considers ‘medical loss ratio’ for dental insurers