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Written by Shelley DeGroff, Founder & CEO of PPO Advisors

Last Updated: September 28, 2026

Dental insurance reform is finally on the table in Washington. The American Dental Association has asked Congress to take a hard look at how dental insurance markets operate, from market consolidation to leased networks to Medicare Advantage.

The states are not waiting. 16 states enacted 30 new dental insurance laws in 2026 alone. PPO Advisors, a PPO negotiation and credentialing company for dental practices, hears the frustrations behind those laws every day, because they show up at the front desk every morning.

I want this oversight. I also want the right kind. Here is what is moving, what the ADA asked for, and what dental insurance reform means for your practice right now.

What Is the ADA Asking Congress to Do About Dental Insurance?

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The ADA has asked Congress to include dental insurance in its review of healthcare competition and fraud, covering market consolidation, contracting practices, and Medicare Advantage. The comments went to a House Judiciary subcommittee ahead of a September hearing, and ADA News covered the request directly. It is the strongest federal signal yet that dental insurance reform has real momentum.

My first reaction when I read the letter was: finally. My second reaction was: be careful what you ask for.

Both reactions come from the same place. At PPO Advisors we talk with dental practices every day, and the frustrations the ADA describes are not abstract policy issues to our clients. They are Monday morning at the front desk.

 

What Problems Is Dental Insurance Reform Trying to Fix?

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Dental insurance reform is aimed at problems practices report every week: benefit information that does not hold up, networks that share contracts without consent, fees charged just to receive payment, and denials nobody can explain. Carriers run large, capable organizations serving a huge volume of plans and members. The problems still land on your team.

• Information that does not hold up. Your team verifies benefits, schedules treatment based on the answer, then gets an EOB that tells a different story. The office ends up explaining the gap to a patient who did everything right.
• Plans too complicated for anyone to follow. Between employer customizations, frequency limits, downgrades, waiting periods, and leased networks, often neither the patient nor the practice can say with confidence what is covered or at what fee.
• Networks you never agreed to. A patient comes in with a card the team barely recognizes. The claim comes back with a network discount, applied through a leased or rental arrangement the practice never negotiated directly.
• Fees just to get paid. Virtual credit card processing fees and, more recently, charges for paper checks take money off the top of payments the practice already earned.
• Denials no one can explain. More claims decisions are automated, and it keeps getting harder to reach a person who can explain why a claim was denied or reduced.

None of this is new. What is new is that regulators are paying attention.

 

What Would the ADA’s Dental Insurance Reform Agenda Cover?

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The ADA’s dental insurance reform asks cover five areas that land directly on independent practices: market concentration, network leasing, self-funded plans, Medicare Advantage, and AI in claims decisions. The full agenda sits on the ADA’s dental insurance reform advocacy page.

• Market concentration. A GAO analysis cited in the ADA’s letter found that the three largest stand-alone dental insurers held between 38% and 97% of the group market depending on the state. When a few carriers control that much of a market, a small practice has very little bargaining power.
• Network leasing. The ADA wants dentists to receive advance notice of material contract and fee schedule changes, and to affirmatively opt in to new network arrangements instead of discovering them on an EOB.
• Self-funded plans. The ADA says carriers and third-party administrators have sometimes used ERISA preemption to avoid state dental insurance protections. It wants Congress to make clear that state laws still apply when a carrier administers a self-funded plan. A state protection does not help you if the plan in front of you is exempt from it.
• Medicare Advantage. According to the ADA’s letter, 52% of Medicare Advantage members picked their plan partly because it included dental. The ADA wants standardized electronic eligibility and benefit verification, since checking every plan design by hand is a burden on practices.
• AI in claims. The ADA said AI and automated claims reviews should come with validation, transparency, appeal rights, and human review, and that AI should never be the only basis for denying a claim or a prior authorization.

 

Which States Have Already Passed New Dental Insurance Laws?

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16 states enacted 30 new dental insurance laws in 2026, and three of them show exactly where dental insurance reform is heading. States are not waiting for Congress. They are writing the rules now, one pain point at a time.

State	New Law	What It Means for Practices
Colorado	Carriers must get a dentist’s consent before leasing that dentist’s contract, and cannot drop dentists who decline	Your fee schedule stops traveling to networks you never agreed to
Utah	Banned fees for paper checks	You stop paying a carrier for the privilege of receiving your own money
Wisconsin	Limited carriers from paying exclusively by virtual credit card	You keep the choice of payment method instead of eating processing fees

Leasing consent, payment fees, network rules. Each one takes something practices have complained about for years and turns it into law. Expect more states to copy all three as dental insurance reform spreads.

 

Where Could Dental Insurance Reform Go Wrong?

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Dental insurance reform goes wrong when the compliance burden lands on the practices it was meant to protect. I want oversight. I do not want oversight that ends up as one more thing a small practice has to manage.

When lawmakers go after fraud and market power, the tools they reach for tend to be audits, attestations, reporting requirements, and payment holds. Those tools are built for large health systems with compliance departments. A four-operatory practice with two people at the front desk does not have a compliance department.

The ADA made the same point. It told Congress that independent dental practices are mostly small businesses and should not be treated like large, consolidated health systems when lawmakers design remedies for provider market power. I could not agree more.

There is a market side to this as well. Dental plans run on much smaller premiums than medical insurance, and rules written with medical plans in mind do not always fit dental. If new requirements push carriers’ costs too high, they may raise premiums, cut back plan options, or pull out of certain markets such as small employer groups. When that happens, patients lose coverage and practices lose contract options. Dental insurance reform only works if the markets it regulates survive it.

 

What Does Good Dental Insurance Oversight Look Like?

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Good dental insurance oversight puts the responsibility for clarity on the carrier and adds zero paperwork for the practice. If I had a few minutes with the people writing these rules, here is what I would ask for:

• Consent before your contract travels. No practice should find out on an EOB that its fee schedule has been leased to a carrier it never agreed to work with.
• Notice before terms change. Fee schedule and contract changes should arrive in writing, with enough lead time for the practice to decide what to do.
• One standard for eligibility and benefits. Clear, electronic verification that matches how claims actually pay.
• A person behind every denial. Automation can speed things up, but a practice should always be able to reach someone who can explain the decision and review it.
• Getting paid should not cost you. Practices should be able to choose how they receive payment without paying a fee for it.
• Protections that reach self-funded plans. A state law is only useful if it applies to the patients you actually see.

Every item on that list makes the carrier be clear. None of them hands the practice a new form to fill out. That is the test any dental insurance reform proposal should have to pass.

 

What Can Your Practice Do Before Any Law Changes?

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You do not need to wait for Congress to act on dental insurance reform. The four moves below protect your practice under today’s rules, and every one of them gets easier once the new laws arrive.

• Step 1: Know which contracts you actually have. Your list of signed contracts and the list of payers actually paying you at contracted rates may not match. Your EOBs will show you the difference. PPO Advisors’ Credentialing Access Point (CAP) keeps every contract and effective date visible in one system.
• Step 2: Look at how you are getting paid. Check whether you are losing money to card processing or paper check fees, and whether your state gives you a way out.
• Step 3: Learn your state’s protections. Leasing opt-outs, payment method choice, and assignment of benefits rules differ a lot from state to state.
• Step 4: Do not make network decisions in a hurry. Frustration is a fair reason to reevaluate a PPO. It is not a strategy. Leaving or joining one contract can change how the rest of your portfolio pays, so run a full PPO analysis before you act.

Across 2,870+ dental practices, PPO Advisors has seen the same pattern the ADA is describing to Congress: the practices that hold their ground are the ones that know exactly what every contract pays. PPO Advisors will keep following the ADA’s advocacy and state reform efforts on the PPO Advisors blog, and if a carrier change has you unsure where you stand, get the numbers before you sign anything new. Dental insurance reform will change the rules over time, but your own numbers protect you today.

 

The Bottom Line

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• The ADA has asked Congress to include dental insurance in its review of healthcare competition, covering consolidation, contracting practices, and Medicare Advantage.
• 16 states enacted 30 new dental insurance laws in 2026, covering leasing consent, payment fees, and network rules.
• The three largest stand-alone dental insurers control at least 80% of the group market in 11 states, according to a GAO analysis cited by the ADA.
• Good dental insurance reform puts the burden of clarity on carriers and adds zero paperwork for small practices.
• No practice needs to wait for Congress: your EOBs already show which networks are paying you and at what rates.

 

Frequently Asked Questions About Dental Insurance Reform

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What is dental insurance reform and why is it happening now?

Dental insurance reform is the push, at both the state and federal level, to regulate how dental insurers handle consolidation, network leasing, payment methods, and claim denials. It is accelerating because 16 states passed 30 new dental insurance laws in 2026 and the ADA has now asked Congress to examine the market directly.

 

Can an insurance company lease my contract to another network without asking me?

In most states, yes, a carrier can lease or share your contracted fee schedule with other networks under the terms you signed, and many practices only discover it on an EOB. Colorado now requires carriers to get a dentist’s consent before leasing that dentist’s contract and prohibits dropping dentists who decline, and the ADA wants that opt-in standard applied nationwide as part of dental insurance reform.

 

Do state dental insurance laws apply to self-funded employer plans?

Often they do not, because carriers and third-party administrators have used ERISA preemption to keep self-funded plans outside state dental insurance protections. The ADA has asked Congress to make clear that state laws still apply when a carrier administers a self-funded plan, which would close the gap for the patients you actually see.

 

Can a dental insurance company charge my practice a fee just to get paid?

Today, many carriers do take fees off the top of payments through virtual credit card processing charges and, in some cases, fees for paper checks. Utah banned paper check fees and Wisconsin limited carriers from paying exclusively by virtual credit card, so whether you have a way out currently depends on your state.

 

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✍️ Shelley DeGroff
Founder, PPO Advisors