ADA urges FTC Healthcare Task Force to scrutinize dental insurance markets, improve transparency 

The ADA is calling on the Federal Trade Commission to more closely examine competition and transparency in dental insurance as the agency’s Healthcare Task Force begins its work. The FTC launched the Healthcare Task Force in March to coordinate the agency’s health care competition and consumer protection work. 

In an April 29 letter to the FTC Healthcare Task Force leadership, the ADA voiced support for the task force’s mission while stressing that dental coverage presents distinct challenges that are often overlooked in broader health policy discussions.  

“We welcome the Task Force’s focus on protecting patients, health care workers and taxpayers through coordinated competition and consumer protection efforts in health care,” wrote ADA President Richard Rosato, D.M.D., and Executive Director Nader Nadershahi, D.D.S., in the letter.  

The letter emphasized that dental insurance markets directly affect patients’ access to care, dentists’ ability to sustain practices and purchasers’ ability to obtain meaningful value. 

The ADA raised concerns about market concentration, citing recent federal analysis finding that the combined market share of the three largest stand-alone dental insurers in the group market ranged from 38% to 97% across states and reached 80% or more in 11 states. 

Such concentration can affect patients and providers beyond premium costs, Drs. Rosato and Nadershahi said. Patients may encounter narrow networks, reduced provider choice and administrative barriers that delay care, while dentists face “take-it-or-leave-it contracts” and limited practical alternatives.  

The letter also highlighted regulatory features that may limit competition, including the effects of ERISA preemption on self-funded dental plans, which the ADA said can create accountability gaps in self-funded dental coverage. Differences in protections between fully insured and self-funded plans may leave some consumers without comparable safeguards, Drs. Rosato and Nadershahi emphasized.  

In addition, the letter pointed to concerns with Medicare Advantage supplemental dental benefits, which may be marketed aggressively despite limited transparency or comparability for beneficiaries. The letter cited ADA Health Policy Institute-authored research finding that only 8.4% of Medicare Advantage plans offered a comprehensive dental benefit and only 4.1% of beneficiaries were enrolled in such a plan. 

Drs. Rosato and Nadershahi urged the task force to examine evolving business practices, including network leasing, opaque contracting arrangements and forms of vertical integration or affiliation that may affect contracting, network design, patient steering or provider choice. Network leasing can occur when one entity allows other payers, administrators or affiliated entities to access a provider network and associated contracted rates, raising concerns when dentists do not have clear disclosure or affirmative consent. 

“ADA is not suggesting that all leasing or shared-network arrangements are unlawful or harmful,” they wrote. “Rather, ADA is concerned that certain opaque arrangements, particularly those that extend contracted rates to additional entities without clear disclosure and affirmative provider consent, may reduce transparency, weaken independent negotiation and make it harder for dentists and patients to understand how dental benefits operate in practice.” 

They called on the task force to include dental insurance in its competition agenda, examine concerns related to opaque contracting practices and use its convening authority to gather facts and engage stakeholders. The letter also underscored transparency as a key safeguard, noting that clearer information can improve consumer choice.   

“ADA supports legitimate, transparent arrangements that expand access, foster innovation and allow purchasers and patients to benefit from meaningful competition,” the letter concludes. “ADA’s concern is with market structures and practices that may weaken independent negotiation, reduce accountability or make it harder for patients and providers to understand how dental benefits actually operate in practice.”