Massachusetts orders $8.4 million in dental insurance rebates under loss ratio law

State first to require, enforce dental insurance rebates

Massachusetts dental insurers are now required to return $8.4 million to consumers after failing to meet the state’s dental loss ratio standard, the first rebates required under the law approved by voters in 2022. 

Gov. Maura Healey announced in a news release that six dental insurers will issue the rebates as part of $14.5 million being returned to Massachusetts health and dental insurance consumers and businesses. $6.1 million will come from three health insurers under the state’s separate medical loss ratio requirements. 

According to the Healey administration, Massachusetts is the first state in the country to require and enforce dental insurance rebates based on a minimum dental loss ratio. 

“People deserve to know that when they're paying for health and dental insurance, their money is actually going toward care,” Gov. Healey said in announcing the rebates. 

The dental insurers issuing rebates are Blue Cross and Blue Shield of Massachusetts, Guardian Life Insurance Company, Harvard Pilgrim Health Care Insurance Company, Reliance Standard Insurance Company, Standard Insurance Company and Starmount Life Insurance Company. 

The amount individual policyholders receive will depend on their carrier and the premiums they paid. Rebates will be provided by check or as a credit toward future premiums, with insurers expected to begin issuing them later in August. 

Massachusetts voters resoundingly approved the dental loss ratio requirement in November 2022. The law, which took effect Jan. 1, 2025, requires commercial dental insurers to spend at least 83% of adjusted premium revenue on patient care and certain quality improvement activities. Plans that do not meet the threshold must return a portion of premiums to individuals and groups. 

The ADA and Massachusetts Dental Society supported the 2022 ballot initiative and campaigned for its passage. The measure helped spur dental loss ratio efforts around the country, and to date, 13 additional states have adopted dental loss ratio laws with the latest passage taking place in Mississippi this year. The ADA supports dental loss ratio policies aimed at increasing transparency and ensuring that more premium dollars are spent on patient care rather than administrative costs and other company expenses. 

Massachusetts Insurance Commissioner Michael Caljouw said in the news release that the rebate requirements are intended to ensure consumers receive value from their insurance premiums. 

“Massachusetts has some of the strongest consumer protections in the country to ensure that the money people pay for health and dental insurance is spent on patient care — not administrative costs or profits,” he said. 

Recent research from the ADA Health Policy Institute offers an early look at how the Massachusetts dental insurance market responded to the loss ratio requirement before it was fully implemented. 

Published in Health Services Research, the study examined dental claims data from Massachusetts and five comparison states, including Connecticut, Maryland, New Jersey, New York and Rhode Island, from the first quarter of 2022 through the second quarter of 2025. 

HPI researchers Kamyar Nasseh, Ph.D., and Marko Vujicic, Ph.D., found that allowed prices for dental procedures in Massachusetts increased 5.2% relative to the comparison states following passage of the ballot initiative. By the first quarter of 2025, allowed prices were 7.4% higher relative to the comparison states. 

The researchers also found that the discount insurers applied to dentists’ submitted charges declined by an average of 2.8 percentage points relative to the comparison states, indicating dentists were being reimbursed closer to their submitted fees. 

“In anticipation of having to meet an 83% [dental loss ratio] threshold, dental insurers in Massachusetts have increased allowed prices for dentists relative to dental insurers in neighboring states,” the researchers wrote. 

The researchers said their analysis suggests dental insurers began responding to the loss ratio requirement by the second half of 2023, before it took effect in 2025. They noted that insurers typically negotiate dental fee schedules annually, meaning changes in payment rates can take time to implement. 

The study did not determine whether premiums changed in response to the law and did not have insurer-specific data, meaning researchers could not identify which insurers changed reimbursement or determine how individual carriers responded. The authors said additional research is needed to examine the law’s longer-term effects on premiums, benefit design, out-of-pocket costs, insurer participation and quality of care. 

“One of the ADA’s overall goals is improving the dental insurance experience for patients and providers. I’m excited to see these victories in Massachusetts and around the country bearing fruit, and research showing positive trends,” said ADA President Richard Rosato, D.M.D. "I had the privilege of working closely with the Massachusetts Dental Society and ADA during the passage of Question 2. It was a big win for dentistry, a huge step forward, and I’m so excited about what the tripartite can accomplish next.”