{ legislative & regulatory }


Missouri Dental Loss Ratio: Educating Lawmakers, Patients


T


his session, the MDA has legisla- tion to pass Dental Loss Ratio as one form on ongoing insurance reform efforts to help Missouri


dentists and patients.


Missouri does not currently regulate the al- location of dental insurance premiums. This means dental insurers can spend any amount of monthly premium dollars on marketing, overhead expenses, or even C-suite bonuses instead of improving patient care. Both House Bill 439 and Senate Bill 680 aim to require dental insurance companies to spend at least 85 percent of patient premiums on patient care, a commonsense policy that has long existed for medical insurance.


To support this effort, the MDA created a webpage for both lawmakers and patients and promoted it at this year’s Dental Day at the Capitol. MDA also has been running so- cial ads on Facebook, Instagram and Linked In, targeted at Missouri legislators and the public.


The following language is from the website; we encourage you to visit to learn more and download a summary sheet you can refer to and print for your office.


MISSOURI DENTAL LOSS RATIO: ENSURING YOUR INSURANCE IS WORKING FOR YOU


More Care for Your Money: Missourians deserve dental insurance that provides real value for their money.


WHAT IS DENTAL LOSS RATIO (DLR)?


Dental Loss Ratio (DLR) is a percentage that outlines the portion of dental insurance pre- miums that are spent on patient care, rather than overhead costs. If the DLR in Missouri is 85 percent, 85 cents of every dollar an


12 focus | SPRING 2025 | ISSUE 1


insurance company collects must be spent on your dental care.


Establishing a DLR in Missouri would:


• Increase Access to Care: The value of dental insurance has significantly de- creased over time. With DLR, patients, and employers who pay insurance premiums would be guaranteed good value for their money with more oppor- tunities for patient care added back into dental plans.


• Encourage Fair Premium Allocation: Re- duces out-of-pocket costs and ensures better value for consumers.


• Hold Insurance Companies Accountable: Rebate requirements would incentivize companies to meet the 85 percent threshold and return money to patients and employers if they are overcharged for their premiums.


Without a Dental Loss Ratio, insurance companies are free to continue keeping any amount of unspent premiums for overhead rather than patient care.


How Much are Dental Insurers Currently Spending on Patient Care? While some dental insurance companies currently meet the 85 percent DLR we recommend in Missouri, other insurers are spending as little as 11 percent on actual dental care. There is no consistency from insurer to insurer.


Can Dental Insurance Companies Operate under DLR? In the states where data is avail- able, many dental insurers already maintain a DLR of 85 percent or higher. It is possible to operate, prioritize patients, and make a profit within this standard.


Is There Precedent for DLR? Yes! Four states have already successfully established a Dental Loss Ratio, resulting in increased access to


care and greater transparency from dental insurance companies. Similar legislation is being presented in nine other states in 2025.


Medical Loss Ratio (MLR) has been in effect for medical insurance companies nationwide since 2011. The U.S. uninsured rate is at a historic low and health insurance companies continue to post profits in every state.


WHAT ARE THE ECONOMIC BENEFITS OF IMPLEMENTING A DLR?


• Encourages Preventive Care: By ensur- ing that a larger share of premiums is spent on patient care, DLR encourages insurers to focus on preventive services. This can reduce the need for costly emergency treatments, leading to long- term savings for both patients and the healthcare system.


• Better Value for Employers: Requiring dental insurers to issue rebates for ex- cess premiums spent on administrative costs ensures that employers get more value from their dental plans, improving care for employees while lowering costs.


• Increased Market Competition: Cur- rently, the dental insurance market is limited by a lack of competition, with most plans purchased through employ- ers and premiums largely driven by price rather than value. DLR fosters an environment where insurers must offer more patient-centered plans, encourag- ing innovation and flexibility similar to traditional health insurance. This shift not only increases access to quality care but also ensures better value for consumers, while benefiting employers by offering more effective and affordable dental plans.


For questions, contact Halie Payne at the MDA, halie@ modentalmail.org.


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