Why Dental Insurance Reform Is Long Overdue

Dental Insurance Is Broken—Here’s Why Reform Is Long Overdue

Most people assume dental insurance works like medical insurance—but it doesn’t. In fact, it’s not really insurance at all. Dental plans were originally created as limited benefit plans in the 1950s, and the annual maximum back then? Around $1,000. The problem? In many cases, that same $1,000 cap still exists today.

Meanwhile, the cost of dental care, supplies, staff wages, and technology has skyrocketed—but reimbursement rates haven’t budged. That means patients are paying more out of pocket and dental providers are expected to do more with less. To listen for more, visit my podcast 👇

Why Dental Insurance Reform Is Urgently Needed

• Stagnant Reimbursement Rates

  While everything else has inflated—rent, wages, instruments, lab fees—dental insurance reimbursements have stayed frozen in time. Offices are being paid the same for a prophy today as they were decades ago.

  
  

• Coverage ≠ Care

  Patients often think, “If it’s not covered, I must not need it.” This mindset delays treatment, impacts oral health, and puts providers in tough positions trying to explain gaps in coverage.

  
  

• The OPA Controversy & Workforce Tension

  New workforce models—like the Oral Preventive Assistant (OPA)—are being introduced to ease staffing shortages, but not without controversy. Many hygienists feel their roles are being devalued or replaced, while assistants feel overwhelmed and undertrained for expanded duties. The underlying issue? Dentists are trying to stay profitable while reimbursements stay low. It’s creating tension between team members who should be collaborating—not competing.

  
  

• Why Wages Can’t Keep Up

  Hygiene wages have become a flashpoint, but most practice owners aren't unwilling to pay—they're unable to, because they're locked into contracts that don’t reflect today’s economic reality. The root cause? Low insurance reimbursements.

  
  

• Ethical Dilemmas

  Clinicians shouldn’t have to choose between what’s covered and what’s best for the patient. Yet, it happens every day.

  
  

What Can Be Done?

• Educate patients about how dental benefits work (and don’t work).

• Consider fee-for-service models to prioritize quality over quantity.

• Support legislative change and dental organizations fighting for reimbursement reform.

• Drop low-paying plans that no longer serve the practice or its patients.

Want to dive deeper into this topic? Visit the full video 👇