Here are 10 updates pointing to shifts in how dentists are interacting with insurers and how the industry is holding payers more accountable:
1. Eighteen states have passed a total of 37 dental insurance reform laws so far this year, according to the American Dental Association. The most common insurance issues addressed this year include dental loss ratios, virtual credit cards, assignment of benefits and improvements to provider credentialing processes. Overall, more than 120 legislative proposals have been filed this year.
2. The ADA said Oct. 7 that it will support states and dental providers addressing downcoding in response to increased reports of the practice. The ADA Council on Dental Benefit Programs urged state dental associations and dentists to raise concerns about reimbursements directly with their local Delta Dental member companies to help ensure fair claims processing. It also recommended providers continue to appeal payer decisions that involve downcoding. The ADA’s stance aligns with a policy the agency adopted in 2016 opposing claims payment abuse.
3. About 25% of dentists have dropped out of insurance networks so far this year, according to the American Dental Association’s “Economic Outlook and Emerging Issues in Dentistry” report for the third quarter of 2025. Although 25.7% of dentists said they have already dropped insurers, 24.2% of respondents said they may drop out of networks later this year. Fifty percent said they do not plan on dropping out of networks this year.
4. California Gov. Gavin Newsom signed SB 386 into law, which requires dental plans to provide dentists with clear and easy ways for dentists to opt in and out of virtual credit card payments. Under the law, dental plans cannot use any payment method that includes a fee as the default payment when reimbursing dentists. In addition, dental plans are now required to inform dental practices of alternative payment methods, how to select which payment option they want and any fees associated with each method. The law goes into effect April 1, 2026.
5. Nearly 66% of dentists have increased their fees this year, according to new data from the ADA. About 34% of dentists said they have not increased their fees. The average increase was 6.7%, according to the ADA’s report.
6. The West Virginia Dental Association is lobbying for the state to pass a dental loss ratio for insurers. The WVDA launched a campaign to advocate for legislation during the state’s upcoming regular session. The dental organization is pushing for a DLR that will require insurers to allocate at least 85% of premium dollars toward patient care, or refund the difference to patients.
7. The ADA is advocating for operational improvements for dental service payments under Medicare. The ADA wrote a letter Sept. 12 in response to CMS’ proposed physician fee schedule, asking the organization to continue working on ensuring proper enrollment of providers, timely claims adjudication, and measurement of health outcomes before expanding the list of qualifying conditions. While praising CMS’ proposal to include oral health risk assessments by primary care providers as a merit-based incentive payment system improvement activity, the ADA also noted that this change would not result in improved outcomes without stronger referral requirements, better data sharing and dental visits.
8. A new report from the ADA’s Council on Advocacy for Access and Prevention found that only seven states are meeting network adequacy standards for Medicaid. The ADA council conducted a survey of Medicaid networks and analyzed CMS’ enforcement of provisions under the Medicaid Act which state that payments should be sufficient to enlist enough providers. The report concluded that CMS has not enforced compliance, attributing this to different interpretations of the law between presidential administrations and managed care organizations. Council Chair Jessica Robertson, DMD, said increased reimbursements and reduced administrative burden can incentivize more providers to participate in Medicaid, allowing more beneficiaries to access treatment.
9. Stevens Point-based Delta Dental of Wisconsin’s recent acquisition of Madison, Wis.-based DSO Cherry Tree Dental could violate federal antitrust laws, according to the American Economic Liberties Project and the Alliance of Independent Dentists. The two groups wrote a letter addressing their concerns to the U.S. Department of Justice’s Antitrust Division, the Federal Trade Commission and Wisconsin Attorney General Josh Kaul. The letter asked them to investigate the acquisition and states that the deal may violate Section 7 of the Clayton Act, which prohibits mergers and acquisitions that could reduce competition. Both groups also allege that the acquisition goes against merger guidelines set by the Justice Department’s ATR Division and the FTC in 2023.
10. Sen. Angela Alsobrooks introduced a bill earlier this year that would expand coverage of dental, hearing and vision care under Medicare and Medicaid. The Medicare and Medicaid Dental, Vision, and Hearing Benefit Act of 2025 would require Medicare to cover various dental services, such as routine cleanings, exams, fillings, crowns, root canals, extractions and emergency care. The payment for such services would gradually increase each year, capping at 80% of coverage by the eighth year. The bill would also encourage states to provide optional dental, hearing, and vision services under Medicaid by increasing the associated Federal Medical Assistance Percentage rate to 90 percent.
