Oscar Health, Inc.

What they do

Oscar sells ACA-compliant individual health plans — Catastrophic, Bronze, Silver, Gold and Platinum — through Health Insurance Marketplaces and off-exchange, including to employees whose employers offer an ICHRA. It also runs +Oscar, which provides Campaign Builder, an engagement and recommendation platform using data and AI, to providers and payors. In 2025 it acquired Lucie, Inc. (a direct enrollment technology platform), IHC Specialty Benefits, Inc. (an individual market brokerage) and Healthinsurance.org, LLC (a consumer education website). It reported approximately 2.0 million effectuated members as of December 31, 2025.

Revenue drivers

• Individual market premiums — The core insurance business, selling ACA individual plans on and off the Health Insurance Marketplaces, with effectuated membership of 2,963,002 as of June 30, 2026. Total revenue was $4.88 billion in Q2 2026 and $9.53 billion in the first half of 2026.
• ICHRA and brokerage services — Acquired in 2025: Lucie, Inc. (direct enrollment technology), IHC Specialty Benefits, Inc. (individual market brokerage) and Healthinsurance.org, LLC (consumer education), aimed at ICHRA and diversifying beyond core insurance.
• +Oscar platform — Licenses Oscar's technology — including Campaign Builder, an engagement and recommendation platform — to providers and payors, monetizing the platform built for Oscar's own members.
• Investment income — Cash invested in U.S. Treasuries, federal and state agency securities, investment grade corporate bonds and asset backed securities. Net investment income was $84.8 million in Q2 2026 and $145.4 million for the first half of 2026.

Recent performance

For Q2 2026, total revenue was $4,880,220 thousand versus $2,863,945 thousand in Q2 2025, and net income attributable to Oscar Health was $361,808 thousand versus a loss of $228,361 thousand a year earlier. The medical loss ratio improved to 79.2% in Q2 2026 from 91.1% in Q2 2025, and the SG&A expense ratio fell to 14.2% from 18.7%. First half 2026 revenue was $9,527,414 thousand with net income of $1,040,804 thousand, compared with $5,910,208 thousand and $46,910 thousand in the first half of 2025. Adjusted EBITDA was $415,349 thousand in Q2 2026 versus negative $199,404 thousand in Q2 2025. Net cash provided by operating activities was $4.7 billion for the six months ended June 30, 2026, compared with $1.4 billion a year earlier.

Strategy

Oscar describes itself as a healthcare technology company built around a full stack technology platform and member experience, competing in the ACA individual market since its 2012 founding. Management says it is executing on disciplined pricing and scalable technology, and CEO Mark Bertolini points to a durable individual market driven by movement between full-time, part-time, gig and retirement work. The company expanded in 2025 by acquiring Lucie, IHC Specialty Benefits and Healthinsurance.org to support ICHRA and diversify. It also monetizes its platform externally through +Oscar, offering Campaign Builder to providers and payors. In February 2026 it entered a $475.0 million secured three-year revolving credit facility, with no borrowings outstanding as of June 30, 2026.

Risks

• Execution and growth management — Oscar states its business, financial condition and results may be harmed if it fails to execute its strategy and manage growth effectively, including integrating strategic acquisitions.
• Member retention and expansion — The 10-K's summary risk factors cite the company's ability to retain and expand its membership as a principal risk.
• Regulatory approvals and market participation — Entering new markets or lines of business requires licenses and certificates of authority, adequate provider networks, and annual Marketplace recertification, with significant pre-revenue expense.
• Premium rate and MLR regulation — Oscar's premium rates and rate changes must be approved by state and federal regulators under the ACA, and federal and state minimum Medical Loss Ratio requirements apply.

Outlook

With Q2 2026 results, Oscar raised its full-year 2026 guidance: it now expects earnings from operations of $500 million to $700 million (up from $250 million to $450 million), an MLR of 81.5% to 82.5% (down from 82.4% to 83.4%), and an SG&A expense ratio of 15.6% to 16.1% (down from 15.8% to 16.3%). Total revenue guidance was left unchanged at $18.7 billion to $19.0 billion. CEO Mark Bertolini said the company delivered record profitability in the first half of 2026 and that its consumer products, disciplined pricing and scalable technology platform position it for long-term profitable growth.