Key Legislative Trends for 2026: Dental and Med Supp Insurance

As state legislative sessions open, here are some key trends we are seeing in the Dental and Medicare Supplement insurance markets.

Dental

After the National Council of Insurance Legislators approved dental loss ratio model legislation in April 2024, states have moved forward with their own bills.

What is a dental loss ratio?

A dental loss ratio is the percentage of insurance premium dollars that dental insurance companies spend on patient care rather than on administrative costs or profits.

State legislation generally addresses the following elements:

• The methodology for calculating the dental loss ratio;

• A specified minimum loss ratio;

• Annual reporting obligations for insurers; and

• Mandatory annual rebates to policyholders when the required loss ratio is not met.

In 2025, ten states introduced bills, and four of them (Louisiana, Montana, North Dakota, and Washington) ultimately passed legislation.

So far in 2026, nine states (Alaska, Alabama, Hawaii, Missouri, Mississippi, Nebraska, New York, Washington, and West Virginia) have introduced or carried over legislation.

Medicare Supplement

In 2025, nine states passed legislation implementing under age 65 requirements, an annual enrollment period, or a “birthday” rule.  Read more here.

Under Age 65 Requirements

Most people qualify for Medicare at age 65, but those with disabilities or conditions like ESRD may qualify earlier. Some states require insurers to offer Medicare Supplement plans to these under-65 beneficiaries.

So far in 2026, four states (Arizona, Illinois, Tennessee, and Utah) have introduced or carried over similar legislation.

Annual Enrollment period

Federal law gives people one 6‑month window to buy Medicare Supplement insurance without health questions.  This window starts the month they turn 65 and enroll in Medicare Part B.  During this time, they can choose any Medigap plan, and companies must accept them.

After this 6‑month window ends, people might still qualify for guaranteed coverage in certain situations.  Some states offer additional enrollment periods, such as an annual window around a person’s birthday, when they can switch Medicare Supplement policies without medical underwriting.

So far in 2026, four states (Nebraska, New Jersey, Tennessee, and Washington) have introduced or carried over similar legislation.

Bill activity is reviewed and tracked monthly in our Insurance Regulatory Insights newsletter.