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MLR: Let’s work together to improve access to dental care

By Jeremy Bowen, DDS

January 5, 2024

In a December 12 Missouri Times op-ed, Sen. Tracy McCreery and Rep. Bob Christ got a lot of things right.

They’re absolutely right that dental care is essential for not just oral health, but overall physical, academic and economic health. They’re also right that many people lack access to the oral healthcare they need, often due to cost: Kaiser Family Foundation has found that dental care is the most common type of care adults report putting off due to cost. As any dentist will tell you, when patients delay dental care, their oral health inevitably worsens, which can lead to substantial complications.

It’s important to note, however, that having dental insurance does not always mean having access to dental care if the insurance does not offer good value. In fact, a 2021 study found that nearly half of insured Americans skip dental visits or procedures due to cost. The study further found that for consumers with insurance, their main issue with the dental plans is that “not enough services or procedures are covered.” I experience and hear from my colleagues regularly about frustration from our patients who can’t afford the care they need, despite having dental insurance.

That is why establishing a medical loss ratio for dental insurance (also known as a dental loss ratio) is important for Missourians. But dental insurance companies don’t want this to happen. They want to keep the status quo in place because it has been very profitable for them.

What is a Medical Loss Ratio, or MLR, and why are the insurance companies so scared of it? It is a percentage determining the portion of insurance premiums that are spent on patient care, rather than overhead costs such as marketing, CEO pay and administration. For example, if the MLR in Missouri is 85 percent, 85 cents of every dollar the insurance companies collect must be spent on your care. This is a commonsense policy that has been in effect for medical insurance companies for more than a decade. But dental insurers are not held to the same standards in most states, including Missouri.

As with any reform, the first thing insurers claim is that it will increase their costs, no mater how much it benefits patients. Keeping insurance premiums affordable is important, and we support measures to prevent unjustified increases. However, with the majority of Americans receiving their dental insurance through their employers, focusing only on premium rates means the dental insurance companies compete only on keeping employer costs low, rather than meeting the needs of those who really mater, the patients. Keeping employer premiums at rock-bottom for an insurance product that doesn’t provide meaningful access to care is a waste of everyone’s money, with real impacts on people’s health and well- being.

Missouri’s legislative session has not even begun, and already dental insurers in the state are sounding the alarm, trying to scare people that establishing an MLR for dental insurance will lead to loss of access. Their claims couldn’t be further from reality.

How do we know? For one thing, medical insurers made the same claims prior to the implementation of MLR in 2011. Yet, thirteen years later, the uninsured rate in the U.S. is at a historic low, and health insurance companies continue to post profits in every state.

We also know that, in the states where data is available, many dental insurers are already meeting the 85% MLR we recommend in Missouri. It is clearly possible to operate within this standard. However, there are some insurers spending as little as 11% of premiums on actual dental care. Setting an MLR standard is meant to prevent this kind of mismanagement of premium dollars.

It’s heartening to see strong, bipartisan support for improving access to oral healthcare. When the Missouri General Assembly gavels in on January 3, we hope we can all work to advance an MLR standard in Missouri that ensures Missourians get good value and actual access to care from their dental insurance.


Dr. Jeremy Bowen, a general practitioner in Independence, is the MDA president. 

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