ADA calls for stronger dental benefits, transparency measures in Senate cost review

The ADA is urging lawmakers to prioritize oral health as they examine strategies to address rising health care costs.

In a Dec. 3 letter to the Senate Committee on Health, Education, Labor and Pensions, the Association stressed that rising costs place a strain on patients, families, employers and taxpayers. Oral health, the ADA said, is inseparable from overall health, and the design and financing of dental benefits have a direct impact on whether individuals can obtain appropriate care when it is needed or must wait to be treated until their oral health  problems grow even more serious, often leading to increased pain and higher overall costs. This problem is especially felt by  low-income and medically vulnerable populations.

“Oral health is inseparable from overall health, and the design and financing of dental benefits have a direct impact on whether individuals can obtain timely, appropriate care or instead delay treatment until problems become more serious, painful, and costly, especially among low-income and medically vulnerable populations,” the letter stated. It was signed by ADA President Richard Rosato, D.M.D., and Interim Executive Director Elizabeth Shapiro, D.D.S., J.D.

Drs. Rosato and Shapiro told the committee that sustainable cost containment must begin with prevention and early intervention. Because dental disease is largely preventable, they said that avoiding financial barriers to routine care and supporting public health measures such as community water fluoridation and school-based prevention programs can significantly reduce the need for expensive emergency treatment and restorative procedures.

Addressing the growing burden of out-of-pocket expenses, Drs. Rosato and Shapiro reiterated that insurance should not be used in a way that creates cost barriers, noting that low annual maximums, high deductibles and excessive coinsurance often leave patients with chronic conditions exposed to the highest costs. They encouraged Congress to support clearer, more comparable summaries of dental benefits and stronger standards for supplemental dental coverage in Medicare Advantage so consumers can better understand what their plans actually provide.

The Association also highlighted the importance of improving value and transparency through dental loss ratios. In the letter, the ADA explained that requiring dental plans to report how premium dollars are spent, including the portion going to patient care versus administration or profit, would give families, employers and policymakers a clearer sense of value. The letter urged lawmakers to extend such transparency to employer-sponsored plans governed by the Employee Retirement Income Security Act, which often lack state-level consumer protections.

“Better transparency around where premium dollars go is an essential tool for tackling health care costs without reducing needed care,” Drs. Rosato and Shapiro wrote.

To expand affordable care options, the letter encouraged Congress to support in-office dental membership plans and Direct Reimbursement arrangements, both of which emphasize prevention, patient choice and administrative simplicity. It also pressed for strengthened adult dental benefits in Medicaid, along with payment rates that support sustained dentist participation and reduce avoidable emergency department visits.

Finally, the ADA asked Congress to preserve and enhance Health Savings Accounts and Flexible Spending Arrangements while avoiding new taxes on dental services or essential oral health products. The letter emphasized that well-designed tax policy can help families manage out-of-pocket costs and avoid financial shocks associated with needed dental care.

“We encourage the Committee to ensure that any proposals to address rising health care costs recognize that ignoring oral health ultimately raises, rather than lowers, overall spending. When patients can access affordable, preventive-focused dental care, they are less likely to require expensive emergency treatment, hospitalizations, or complex interventions that strain families and public programs alike,” the letter concluded.