Sen. Sanborn introduces bill to require dental insurers to spend more on patient care

AUGUSTA – On Wednesday, Sen. Heather Sanborn, D-Portland, introduced a bill that would require dental insurance plans to dedicate a greater percent of spending on paying patient bills and services that improve the quality of dental care. The bill, LD 1266, “An Act to Improve the Value of Dental Insurance,” was the subject of a public hearing before the Legislature’s Committee on Health Coverage, Insurance and Financial Services. 

“The truth is, dental insurance is a bad deal, financially, for most people. With dental coverage today, you’ll likely have to chip in around 40 or 50 percent of the cost of any filling or root canal you need done. And even then, the maximum that your dental policy will pay each year is capped, oftentimes at a low number like $1000 or $1500,” said Sen. Sanborn. “This bill would force dental insurers to be more efficient, to design plans that provide better value to Mainers, and enable us to purchase dental insurance knowing it has some value. That would be a win for Mainers.”

Under the Affordable Care Act (ACA), health insurers are required to have an 80 percent medical loss ratio (MLR), meaning that they spend 80 cents out of every dollar on paying customers claims and items that improve the quality of care. The ACA did not require the same for dental insurers, however, leaving them free to spend premium dollars they take in as they see fit. Sen. Sanborn’s bill would require dental insurance providers to meet an 80 percent MLR, and in addition, insurers would need to report their MLR to the state each year and rebate consumers with the difference if they do not meet the 80 percent threshold.

Kathy Kilrain del Rio, director of campaigns and Healthcare Advocacy for Maine Equal Justice, testified in support of the bill:

“While insurance companies are businesses that seek to make a profit, the priority should be investing in the health needs of their enrollees rather than high salaries for their management or other administrative costs that don’t benefit those paying the premiums,” said del Rio. “By requiring dental insurers have a Medical Loss Ratio of 80 percent, Maine could significantly reduce the out-of-pocket costs our residents spend on dental care. In turn that could increase Mainers use of dental services for needed preventive and more complicated, expensive procedures. Improving the oral health of Mainers should be our collective goal.”

The bill faces further action in committee.

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