The Medical Loss Ratio (MLR) ballot initiative offered to Massachusetts voters passed by an overwhelming margin, receiving 71% of the vote on November 8 with support from the AAO and other dental coalition partners. The AAO contributed financially and provided ongoing campaign consulting support to help get out the “YES” vote to bring better dental benefits to patients.

The vote outcome requires dental insurance companies in Massachusetts to spend at least 83% of premium dollars collected on dental services or refund the difference to patients, as opposed to insurance companies using the money for executive salaries or other administrative costs. This Medical Loss Ratio is already in effect in Massachusetts for medical health insurance.

When the Affordable Care Act (ACA) became law in 2010, it did not include Medical Loss Ratio for dental insurance. The ACA does require health insurance issuers to submit data on the proportion of premium revenues spent on clinical services and quality improvement. It also requires them to issue rebates to enrollees if this percentage does not meet minimum standards.

Under the ACA health insurers must spend at least 80% (smaller carriers) or 85% (large carriers) of premium dollars on medical care, with the rate review provisions imposing tighter limits on health insurance rate increases. The absence of Medical Loss Ratio for dental insurance in the ACA created a need for states to take a deeper look at this issue.

This successful campaign in Massachusetts paves the way for more states to make a Medical Loss Ratio change to benefit patients over dental insurance companies.

The AAO was pleased to work with the Massachusetts Association of Orthodontists (MAO) to support the success of this Medical Loss Ratio campaign,” said Dr. Norman J. Nagel, AAO president. “It will not only benefit dental patients in Massachusetts but help set a dental insurance standard for other states to consider moving forward.” 

Special thanks to Dr. Andrew Chase (MAO Public and Professional Relations Chair), Dr. Jamie Kane (MAO President) and AAO members in Massachusetts for helping to organize this ballot effort. Thanks also to the Massachusetts Dental Society, the American Dental Association, and other coalition partners for the leadership and hard work at creating success on this MLR campaign in Massachusetts. 

To learn more about this Massachusetts campaign and the Medical Loss Ratio issue, please visit