Skip to main content
MENU
Login Join

Dental Loss Ratio

In November 2022, Massachusetts became the first state in the nation to pass Dental Loss Ratio (DLR) legislation, also known as Medical Loss Ratio (MLR). This regulation requires that dental insurance companies spend at least 83% of patient premium dollars on patient care.


The Division of Insurance also conducted a special examination in 2023 to gain a deeper understanding of the dental insurance market in Massachusetts. The report from this examination summarizes dental coverage as of 2022 and compares it to the results of a prior examination, which presented information as of 2012.


Since the passage of the ballot initiative, the following steps have been taken.

  • On April 4, 2024, the Division of Insurance (DOI) released the regulation to implement M.G.L. c. 176X, created under Chapter 287 of the Acts of 2022 (Question 2)
  • The regulation was filed with the Massachusetts Secretary of State and officially published on April 12, 2024, making it law. Dental insurers were required to begin reporting in January 2025.
  • Summer 2024, dental insurance companies provided the Massachusetts Department of Insurance (DOI) with their plan to meet the 83% ratio spending on patient care for 2025
  • Summer 2025, dental insurers will have access to customer rebate forms and DLR reporting templates for 2026
  • Summer 2025, dental insurers will submit to the DOI their plan to meet the 83% ratio for 2026 patient care.
  • 2026 (month TBD), dental insurers will submit rebates and reporting forms to the DOI for 2025 patient care


We’re proud that the Massachusetts landslide victory created a wave of change across the country. The American Dental Association recently reported that twenty-three states have taken steps to implement a version of dental loss ratio regulation (DLR) since 2023. North Dakota has become the most recent state to pass DLR regulations, and many others are considering moving forward with similar legislation. Each one of these victories puts patient care at the forefront!


MDS President Statement About DLR Law
The effective implementation of the new, first-in-the-nation law that provides critical consumer protections to dental patients is an impactful victory for advancing oral and community health in Massachusetts. The Massachusetts Dental Society remains immensely thankful to our partners and voters who advocated to assure dental patient premium dollars are spent on patient care, ultimately leading to the ballot measure’s overwhelming approval by every city and town in the commonwealth,” said Massachusetts Dental Society President Abe Abdul, DMD. “We also thank the author of the bill, Dr. Mouhab Rizkallah, as well as the Division of Insurance, for including key provisions like requiring an annual Dental Loss Ratio (DLR) analysis, protecting insurer accountability and transparency measures, and clarifying the DLR definition to include fraud recoveries. The society and its members stand ready to support policymakers and patients alike implement and experience the protections and benefits afforded by the new law.

History of Dental Loss Ratio in Massachusetts

The Ballot Initiative
The Massachusetts Dental Society (MDS) lobbied for a Dental Loss Ratio (DLR), formerly known as Medical Loss Ratio (MLR), policy for years. Through the perseverance and valiant efforts of a small group of dentists and patients, DLR dental reform appeared on the Massachusetts ballot as Question 2 in November 2022, winning in a landslide victory. This important reform increases accountability and transparency for dental insurers and puts patients first. 

The MDS and the American Dental Association (ADA) worked together to create the Massachusetts Dental Care Providers for Better Dental Benefits Committee. The Committee informed and engaged voters on the campaign message of "Voting Yes on Question 2" by developing a website, promotional materials, advertising, and other methods of communication to inform Massachusetts voters on the issue. Grassroots efforts by MDS members reaching out to voters also aided in the victory.

Note: An Act Relative to Transparency of Dental Benefits Corporations was sent to study in the 2021-2022 legislative session. This led the MDS Board of Trustees to support the MLR ballot initiative.


Regulatory Process
The Massachusetts Department of Insurance (DOI), whose responsibility was to create the regulation based on the ballot initiative, hosted several information sessions to solicit comments before making the draft. The MDS submitted written responses and attended the following sessions.

  • Section 1: Definitions, including dental loss ratios—held on January 18, 2023
  • Section 2(a) – (c): Rate filing submissions and rebate calculation submissions—held on February 1, 2023
  • Section 2(d) – (g): Rate filing reviews—help on February 15, 2023
  • Section 3: Reporting annual comprehensive financial—help on March 1, 2023
  • Additional Questions/Wrap-Up—held on March 15, 2023

The DOI then drafted the regulation based on the comments from the listening sessions and independently solicited feedback (e.g., an independent report from an actuary). The draft regulation was released to the public, and a meeting was held to gather input. In accordance with the process set forth by the DOI, the Massachusetts Dental Society submitted a formal response to the draft regulation and offered live comments at the meeting. Upon reviewing all comments, the DOI finalized the regulation, which was passed into law in April 2024. Dental insurers are required to begin reporting in January 2025.