Navigating Changes To The Dental And Vision Health Insurance Landscape

By 2030, compliance will be shaped by three forces: 

• New federal and state mandates
• Oversight of emerging technologies
• A stronger emphasis on value-based care

Companies will need to perform a fundamental reassessment of their health insurance plan design and administration to adapt to these changes.

Adapting To The New Era Of Federal And State Mandates

Federal and state laws are quickly changing dental and vision insurance compliance. For employers, it’s a good time to evaluate their carriers. Businesses should be sure their payer is prepared to evaluate any upcoming changes and adjust proactively.

Proposed expansions of federal programs could bring unprecedented standardization that will have repercussions for employers. For example, the Medicare Dental, Hearing, and Vision Expansion Act of 2025 (S. 939) would create a new federal benefit for seniors, establish frequency limits for preventive services, and introduce payment models like bundled payments for dentures — likely influencing private markets. At the state level, additional mandates will create another array of compliance requirements for employers and carriers. 

The changes will likely be complicated and disruptive for dental and vision plans. Employers will want to have trusted partners to interpret and address any new regulations.

Regulating Technology And Data Integrity

Digital health tools are shaking up all health sectors. Telemedicine, once a temporary solution during the COVID-19 pandemic, is becoming a permanent alternative to in-person visits. Methods such as teledentistry will likely lead to permanent regulatory frameworks around state licensure, privacy standards, and reimbursement models.

Artificial intelligence (AI) for healthcare presents another layer. Increasingly used in diagnostics and treatment planning, AI tools are raising regulatory questions about oversight and accountability. Also, as AI becomes integrated into benefits administration and clinical workflows, compliance will require a balance between efficiency and patient safety. Automated benefits administration is also reshaping compliance practices. Advanced systems that integrate HIPAA, ERISA, and ACA requirements can streamline reporting and improve data accuracy. These technologies are not just efficiency tools — they are critical for avoiding penalties for noncompliance. For dental and vision plans, the integrity of data will be a regulatory priority for carriers and employers as electronic reporting becomes the norm.

The technology is moving under our feet. Employers will need carriers that can anticipate and react to challenges tech creates.

Value-based Care And Network Transparency Mandates

Regulatory shifts toward value-based care and care provider network transparency are significant. The Centers for Medicare and Medicaid Services (CMS) Innovation Center has outlined a strategic direction to embed preventive care and move beneficiaries into accountable care arrangements, where care providers assume global downside financial risk. For dental and vision plans, this translates to new compliance requirements for tracking outcomes and measuring quality.

Network adequacy standards are also tightening. Stand-alone dental plans on federal exchanges must submit templates demonstrating care provider distribution and access. Price transparency is equally central to compliance. CMS has made it clear that publishing care provider and service data will become standard. Market-driven price transparency tools, already emerging in medical benefits, will likely extend to dental and vision, requiring issuers to make cost and quality data easily accessible to consumers.

Get A Head Start By Preparing For The Future Now

By 2030, compliance in dental and vision benefits will no longer be a reactive process but will require an ongoing, adaptive strategy. Federal and state expansions, new technologies, and regulatory demands for value-based care and transparency will reshape the compliance landscape. Employers and carriers that engage proactively with policy, invest in compliance technologies, and redesign plans with preventive, data-driven strategies will be best positioned for success. 

The future of compliance will be about aligning health insurance benefit design with an evolving healthcare ecosystem. Partnering with a benefits care provider, like Anthem, that anticipates change can help your organization stay compliant, competitive, and connected to the future of employee care.