Oscar Health, Inc. Earnings Recaps
Oscar shares fell 5.7% after earnings, suggesting investors focused on 2027 pricing and market risks despite the raised 2026 outlook. Management cited elevated medical-cost trend and higher market morbidity behind an approximately 14% weighted-average rate increase for 2027, while also pointing to competitor exits as a source of opportunity.
Key takeaways
- Oscar raised 2026 earnings-from-operations guidance for the third time, to $850 million–$950 million.
- Q3 revenue grew roughly 70% year over year to $5.1 billion; earnings from operations rose $307 million to $178 million, and adjusted EBITDA rose $308 million to $207 million.
- The medical loss ratio improved 450 basis points year over year to 84%; the SG&A expense ratio improved 350 basis points to 14%.
- Individual-market membership ended Q3 at 2.7 million, up 27% year over year. The company said its footprint is 24% larger, spanning 713 counties.
- For 2027, Oscar cited elevated trend and higher market morbidity in setting an approximately 14% weighted-average rate increase. The call did not provide further detail on how those pressures may affect results.
Oscar Health’s shares fell 7.3% following its second quarter 2026 earnings report, as investors reacted negatively to underlying pressures despite management’s positive framing. The market likely focused on caution around membership trends, deceleration in the ACA individual market, and lack of clarity on sustainable margin expansion amid evolving market dynamics.
Key takeaways
- Membership in the ACA individual market declined 12% year-over-year to 19.2 million, indicating ongoing market contraction despite growth in Oscar’s own membership.
- Oscar reported 2.96 million members, a 46% increase year-over-year, driven by above-market open enrollment growth and retention in its proprietary plans.
- Revenue grew 70% year-over-year to $4.9 billion, but the company did not provide detailed segment profitability or margin guidance that reassured investors.
- Medical loss ratio (MLR) improved 12 points to 79.2%, benefiting from moderately favorable utilization and pricing assumptions, though the market remains cautious with limited morbidity data.
- Management highlighted technology and AI-driven operational efficiencies, projecting tens of millions in cost savings, but these prospects may not offset concerns about overall market headwinds.
Oscar Health's shares surged 16.3% following a quarter that clearly outperformed expectations, driven by robust membership growth and significant margin expansion, with management reaffirming full-year guidance despite cautious risk assumptions.
Key takeaways
- Revenue grew 53% year-over-year to $4.6 billion, reflecting strong top-line expansion.
- Membership increased 56% year-over-year to 3.2 million, underscoring strong demand and retention in the individual market.
- SG&A ratio improved by 60 basis points to 15.2%, aided by disciplined expense management and growing AI efficiencies.
- Medical Loss Ratio (MLR) improved 490 basis points year-over-year to 70.5%, with utilization roughly in line with expectations.
- Operating earnings rose nearly 2.5x year-over-year to $704 million, supporting management’s outlook for meaningful profitability in 2026.
Oscar Health reported a 23% year-over-year increase in revenue for Q3 2025, although losses widened due to higher market morbidity. The company remains optimistic about profitability improvements in 2026.
Key takeaways
- Total revenue reached approximately $3 billion, with an adjusted EBITDA loss of $101 million.
- Membership increased by 28% year-over-year, surpassing 2 million members.
- The company implemented a disciplined pricing strategy for 2026, with a weighted average rate increase of about 28%.
- New innovative products, including HelloMeno, are designed to capture additional market share and cater to women's health.
- Oscar is integrating an AI health agent, Oswell, across its product offerings to enhance member engagement and support.