Navigating Dental MLR Legislation: What Insurance Brokers Need to Know

As the dental insurance landscape evolves, we expect a flurry of legislative activity in 2026 around dental MLR — minimum loss ratio for dental plans. These proposed laws may change how you serve your clients, structure your business, and could impact your compensation. Here are some details about this critical development and actions you can take to influence positive outcomes for yourself and your clients.

Understanding dental MLR

Over the past three years, legislative proposals in several states have sought to establish an 85% minimum loss ratio for dental health plans. This means insurers would be required to spend at least 85% of premium dollars directly on patient care (claims) and quality improvement initiatives. When carriers fall short of this threshold, they must issue rebates to policyholders for the difference.

This set percentage approach is modeled after medical loss ratio and is meant to protect consumers by capping insurer profits and limiting premium hikes. But in practice, this approach actually forces dental carriers to increase premiums or discontinue offering dental plans. Here’s why.

Market realities and challenges

Medical plans collect more in premium than dental, but their administrative costs are similar. Most current dental plans operate below the proposed 85% dental MLR threshold, typically ranging from 64% to 68%. At the 85% ratio, dental plans would be left with little to pay for administrative costs and broker compensation.

Therefore, dental carriers must:

• Dramatically increase spending on claims
• Significantly increase premiums
• Reconsider their market participation entirely
• Consider lowering broker compensation

We’ve already seen the impact in states that have implemented dental MLR requirements. Following a 2022 ballot initiative establishing an 83% loss ratio in Massachusetts, many carriers responded by withdrawing from certain markets in that state — particularly individual and small group segments — while others increased rates and/or reduced broker compensation. Legislation has already passed to implement a new loss ratio in North Dakota, effective in 2027, and we will likely see significant legislative activity across multiple states in 2026.

Impact on your business and clients

With only 15% of premium dollars available for administrative costs, marketing, and profit, dental insurers may need to reduce commission structures, broker fees and marketing support budgets.

Your clients could be affected by:

Premium increases. These could be substantial. California projections suggest DHMO plans could see increases up to 166% and DPPO plans up to 38%.

Fewer product options. Carriers may consolidate dental product offerings or exit certain markets that are not profitable or financially sustainable.

Potential coverage gaps. Employers and consumers may not be able to afford higher priced dental plans. And fewer plans may be offered in specific areas. That could lead to oral health consequences and higher long-term medical costs.

Small rebates. While rebates are possible when carriers don’t meet dental MLR requirements, these will likely be modest compared to the premium increases clients may face.

Strategic response — Ameritas support

To navigate these changes effectively, you will need to consider client education, industry advocacy, and adjustments to your product and service portfolio. Ameritas can help.

Transparent communication builds trust during uncertain times. As state legislative proposals progress, be prepared to inform your clients about potential market shifts and premium adjustments. As your partner in this evolving landscape, Ameritas is committed to providing regular state-specific updates on legislative developments and educational resources to help you navigate these client conversations.

Engage with industry advocacy efforts through professional associations to ensure broker perspectives are represented in policy discussions. Ameritas can keep you up to date on state-specific opportunities to participate in advocacy efforts that represent broker interests.

Embracing change together

While dental MLR requirements present real challenges for insurance producers, they also create opportunities for those who adapt strategically. By staying informed, communicating proactively with clients, and evolving your business approach, you can continue to thrive even as the market transforms.

Ameritas stands ready to support you through these changes with the resources, products, and partnership you need to succeed. Look for updates in this blog to stay current. And as always, reach out to your Ameritas sales representative for additional information.