Across the dental industry, carriers, practices, and policymakers are facing a new reality. Dental loss ratio requirements are no longer theoretical. They are here. As carriers adjust to these rules, many providers are asking an important question.
Does dental loss ratio make it harder to join a PPO network? Is this already happening with carriers like Ameritas?
The short answer is yes. Dental loss ratio pressure is influencing how carriers build and manage PPO networks. Some of these changes are already showing up in 2026.
This matters even more in states like Nebraska, where dental loss ratio legislation has passed. It also matters for practices trying to join PPO networks with large carriers such as Ameritas. PPO profit and network access are now closely linked.
What Dental Loss Ratio Is: Quick Refresher
Dental loss ratio laws require dental insurers to spend a set percentage of premium dollars on patient care instead of admin costs, marketing, or profit. Medical insurance has followed this model for years under the Affordable Care Act. Several states are now applying similar rules to dental plans.
In Nebraska, lawmakers passed a dental loss ratio law that requires carriers to meet a minimum 85 percent threshold. This means at least 85 cents of every premium dollar must be spent on care and related claims. Compliance begins in 2026.
This is one of the first clear state-level dental loss ratio mandates in the country. It sets a strong signal for how other states may move in the future.
How Carriers Like Ameritas Are Adjusting
Dental loss ratio laws do not directly block dentists from joining a PPO network. However, they create financial pressure that affects network strategy in real and practical ways.
Ameritas, one of the largest dental carriers in the country, is already adjusting how it manages PPO networks and plan offerings. These changes are happening even in states without formal dental loss ratio laws. Rising costs and tighter margins are shaping carrier decisions.
Here is how this is showing up.
Ameritas Has Been More Selective with Provider Expansion
Rather than broad network growth, Ameritas has shifted toward a more controlled approach to PPO network participation, especially in tighter markets. This has included:
✅ Prioritizing contracts with high-volume practices or established groups
✅ Slower onboarding in areas with lower utilization
✅ More focus on providers with predictable care patterns
This trend is not tied to one rule alone. It reflects the financial discipline that dental loss ratio laws encourage. Carriers are trying to control admin spend while keeping claim payouts within required limits.
Network Contracting Has Shifted Toward Efficiency
Carriers like Ameritas are also tightening credentialing and focusing on network adequacy instead of network size. In practice, this can lead to:
✅ Fewer open PPO network contract offers
✅ More scrutiny during credentialing
✅ Preference for practices with stable utilization
These steps allow carriers to maintain access while controlling costs under dental loss ratio pressure.
Plan Design Changes Signal Loss Ratio Awareness
Ameritas’ 2026 plan designs show continued focus on preventive care, higher annual maximums in some plans, and stronger in-network incentives. These designs push spending toward patient care instead of cost categories carriers cannot control.
While these changes are not always labeled as a dental loss ratio response, they clearly reflect the environment that loss ratio rules are creating.
What Nebraska’s Law Means for PPO Participation
Nebraska’s dental loss ratio law, now passed and active for 2026 plan years, adds a regulatory layer to these trends. Key features include:
✅ An 85 percent minimum dental loss ratio for carriers
✅ Annual reporting to the Department of Insurance
✅ Refunds or corrective action if targets are missed
This type of oversight increases pressure on carriers. As a result:
✅ Administrative costs face closer review
✅ PPO network expansion may slow
✅ Credentialing pipelines may tighten
For practices in Nebraska, this can mean carriers become more selective with PPO network invites. Smaller or low-utilization practices may face more review before approval.
In other words, providers are not blocked from joining PPO networks, but the pace and criteria for joining may become more strict.
Why This Matters for Practices
Even in states without formal dental loss ratio laws, carriers like Ameritas are already acting as if cost pressure exists. They are tightening participation rules, focusing on network efficiency, and favoring practices that drive claims into care instead of admin spend.
When a state like Nebraska passes a formal dental loss ratio law, these pressures increase:
✅ PPO network availability could shrink
✅ Contracting criteria could tighten
✅ Negotiations may change
✅ Smaller or solo practices may face more scrutiny
What Practices Should Do Now
If your practice is considering joining a PPO network, especially Ameritas, or reviewing current participation, planning matters more than ever.
Practices should:
✅ Monitor carrier behavior and policy changes
✅ Track patient volume and utilization
✅ Engage with state dental associations when possible
✅ Evaluate PPO networks based on real PPO profit, not access alone
Dental loss ratio is not just a policy idea. It is already shaping how PPO networks operate. Carrier behavior is changing now, not later.
If you want to understand how dental loss ratio rules affect PPO profit and your ability to join a PPO network, contact PPO Advisors. We help practices review carrier behavior, network access, and contract risk so they can move forward with clarity in 2026 and beyond.
✍️ Shelley DeGroff
Founder, PPO Advisors