Yes on Question 2: Massachusetts passes dental insurance regulations

Massachusetts is the first state in the nation to mandate consumer dental protections.

People fill out their ballots at Cathedral High School in Boston, Massachusetts on November 8, 2022. Joseph Prezioso / AFP via Getty Images

Massachusetts voters have passed ballot Question 2, making the state the first in the country to introduce a uniform rule for a “medical loss ratio” for dental insurance.

The Associated Press called the race early Wednesday morning, with “Yes” at 71.3% of the vote.

The Yes on Massachusetts Question 2 campaign declared victory around 10:45 p.m. Tuesday night.

“Together, we put patients first over profits. We thank the voters of Massachusetts and our over 5,000 member dentists of the MDS who worked hard to inform engage their communities, as well as all the individuals and organizations in the commonwealth and across the country who provided support to assist with this measure’s passage,” Meredith Bailey, DMD, president of the Massachusetts Dental Society, said in a statement.


The measure will create new dental insurance regulations, notably a requirement that insurance companies spend at least 83% — 83 cents of every dollar — of premiums on patient expenses. The remaining 17 cents of every dollar can be directed toward administrative costs. Insurers who fail to meet the percentage will have to issue rebates to patients.

Similar loss ratios are already used in health insurance. Nationally, insurers are required under the Affordable Care Act to spend at least 80 percent or 85 percent of premium dollars on medical care. In Massachusetts, medical insurers must spend either 85 or 88 percent of premium dollars on care. 

The measures will also require dental insurers to send information about their “current and projected medical loss ratio, administrative expenses, and other financial information” to the state each year.  

Proponents of the question argued that insured patients will pay less in dental fees and get more protections. Mouhab Rizkallah, a Somerville dentist who originated the ballot question, told Boston.com that Question 2 “redirects the enormous waste and misappropriation of patient premium funds back to patients.” The measure was backed by both the Massachusetts Dental Society and the American Dental Association.

Pushback to the question revolved mainly around fears of increased dental costs and a potential loss of dental care for some residents. However, experts such as Evan Horowitz, executive director of the Center for State Policy Analysis at Tufts University, told Boston.com that the measures will not create large changes for patients. 


“It is not the kind of ballot question that will transform dental care as we know it,” said Horowitz, who conducted an analysis of the ballot question last month. “It’s not going to drive dental insurers out of state, it’s not going to dramatically change the price of premiums, it’s not going to make care more affordable. It may make the price that you pay at the dentist a little bit higher, but maybe not even a noticeable amount. Not that much.”

The measures Question 2 contains will go into effect in 2024. Until then, there is no minimum threshold for the portion of premiums dental insurers must direct toward patient care.


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