Dear ADA: Insurance premiums
Premiums, reimbursement do not keep pace with inflation, rising practice costs
Dental insurance issues are often cited as one of dentists’ biggest challenges.
In response to an ADA Health Policy Institute poll in late 2025, more than half of dentists reported that one of their top concerns looking ahead to 2026 was related to insurance, including low insurance reimbursement rates and delayed or denied payments.
This ADA News series aims to address some of those challenges. “Dear ADA” will feature answers to common insurance-related questions the American Dental Association receives from members to help provide clarity and direct members to additional resources.
The answer to this month’s question is provided by Bertram Hughes, D.M.D., vice chair of the ADA Council on Dental Benefit Programs.
Dear ADA: I keep hearing that dental insurance premiums have remained relatively stable for employers and employees, but if that’s the case, then why are so many dental practices feeling increased financial pressure?
Dr. Hughes: Dentists and employers are often looking at different sides of the same equation. While premiums have remained relatively stable, the cost of providing care has not.
According to the National Association of Dental Plans’ 2025 Dental Premium Report, dental premiums have increased at rates well below inflation for nearly a decade, with the report showing average premium increases of less than 1% between 2023 and 2024. ADA Health Policy Institute data also demonstrates that reimbursement rates have failed to keep pace with rising practice expenses, creating what HPI has described as a growing “fiscal squeeze” on dental practices.
The failure of reimbursement rates to keep up with inflation is creating a fundamental financial imbalance for dental practices. Employers, who are often paying the premiums, want predictable premiums, and many dental benefit plans are offering rate guarantees that limit premium increases over multiple years. However, with reimbursement rates remaining stagnant, dentists are being forced to absorb the cost increases in wages, supplies, equipment, rent, compliance, continuing education, technology and more associated with running a practice. The ADA has created a flowchart to help illustrate how premium dollars move through an employer-sponsored dental plan.
These economic pressures have serious consequences for dentists. While the obvious ones include how best to allocate their time, resources and investments into their practices, the more troublesome ones include the constant pressure to do more with less as well as work stress and professional burnout.
A typical dental practice today faces significantly higher labor costs than it did just a few years ago. HPI data continues to show that dentists find recruiting dental hygienists, dental assistants and administrative team members to be difficult. Sustained reimbursement pressure may contribute to workforce shortages by making it harder for practices to expand capacity, hire additional personnel, offer competitive compensation packages and create long-term career opportunities for dental team members.
The long-term goal should be a reimbursement environment that supports high-quality care, independent professional judgment and sustainable practice operations. While no single practitioner can solve systemic reimbursement issues alone, there are several steps you can take:
• Engage employer decision-makers: Employers often hear from insurance carriers and brokers but may rarely hear directly from dental professionals. Dentists have an opportunity to use real-world examples to explain how reimbursement levels affect provider participation, network adequacy and patient access to care. The ADA has created a toolkit to help employers understand and evaluate their current or proposed dental benefit plans, available at ADA.org/employerbenefittoolkit. Do not be afraid to meet with HR personnel of city governments or large employers. They would value your input.
• Review participation agreements regularly: Every practice should periodically evaluate whether specific plans align with their clinical, operational and financial objectives. Watch for policies that may shift administrative costs for payers onto practices. The recent issue with payers wanting to stop issuing paper checks is a way for them to reduce their administrative costs while shifting the burden to dental practices. The ADA has long encouraged dentists to understand their contracts and make informed decisions about network participation. The Association also provides educational resources to help dentists address contract-related issues and evaluate participation agreements.
• Participate in organized dentistry: The ADA, together with state and local dental societies, plays a critical role in advancing policy discussions around reimbursement, transparency and benefit reform. Collective engagement often has a greater impact than individual efforts alone. We encourage every dentist stakeholder to get involved.
While affordable dental coverage is a worthwhile goal, it should not come at the expense of the participating dentists, the dental team or the patients they serve. Maintaining a well-balanced system that supports quality healthcare, a sustainable workforce and an environment committed to the wellness of all healthcare workers should be the goal of our healthcare system.
