# Oscar Health, Inc. > Clarifo company profile — qualitative business description generated from > the company's filings. Financial statements, charts and ratios are > available on Clarifo (https://www.clarifo.com/en/companies/Oscar Health, Inc.). ## Overview Oscar Health, Inc. is a U.S. health insurance company built around ACA-compliant individual and family health plans, with additional coverage offerings for employees in select markets. The company also operates a healthcare technology platform, +Oscar, and related enrollment and brokerage businesses that support insurance distribution and member engagement. ## Products & services • ACA individual and family health plans • Catastrophic, Bronze, Silver, Gold and Platinum plans • +Oscar technology platform for providers and payors • Campaign Builder engagement and analytics tools • Direct enrollment, brokerage and consumer education services - **Health insurance premiums** (90%) — ACA-compliant individual, family and employee health plans sold in selected U.S. states. - **Technology and platform services** (5%) — +Oscar services, including Campaign Builder and administrative support for healthcare partners. - **Brokerage and enrollment services** (3%) — Direct enrollment, brokerage and consumer marketplace services through acquired platforms. - **Other revenue** (2%) — Consumer education, sublease income and other ancillary revenue streams. - ACA individual and family health plans - Catastrophic, Bronze, Silver, Gold and Platinum plans - +Oscar technology platform for providers and payors - Campaign Builder engagement and analytics tools - Direct enrollment, brokerage and consumer education services ## Customers Oscar sells primarily to individuals and families buying ACA marketplace coverage, with some employee coverage tied to ICHRA arrangements. It also serves brokers, consumers, providers and payors through its technology and enrollment platforms, which are designed to improve acquisition, engagement and care navigation. - **ACA individual and family members** (primary) — Buy health plans on the individual market for themselves and dependents, primarily for regulated medical coverage and access to provider networks. - **ICHRA-enrolled employees** (secondary) — Use employer-funded defined contributions to purchase individual market coverage, supporting Oscar's expansion beyond traditional ACA enrollment. - **Providers and payors** (secondary) — Use +Oscar and Campaign Builder to improve member engagement, analytics and care coordination. - **Brokers and consumers** (secondary) — Use Lucie and related enrollment tools to shop, compare and enroll in individual medical and supplemental products. - Individuals and families buying ACA marketplace coverage - Employees enrolling through ICHRA-funded individual coverage - Members seeking plan selection, care navigation and support - Brokers and consumers using direct enrollment tools - Providers and payors using +Oscar engagement software ## Geography Oscar operates in the United States and offered individual and family coverage in 18 states for the 2025 policy year, expanding to 20 states for 2026. Its business is shaped by state-by-state insurance regulation, local provider contracting and market selection, so geography directly affects product availability, pricing and network design. - Operates only in the United States - Individual and family plans offered in 18 states for 2025 - Expanded to 20 states for 2026 - State regulation affects pricing, approvals and market entry - Local provider networks and contracts vary by market ## Strategy Oscar's strategy centers on building a consumer health marketplace around individual coverage, with choice, affordability and member experience as core differentiators. It is also extending its technology and distribution capabilities through +Oscar, ICHRA-related tools and brokerage/enrollment assets to broaden the addressable market and deepen its role in the insurance value chain. - **Build a consumer health marketplace** (medium-term) — A broader marketplace can increase plan choice, improve retention and support cross-sell across insurance and services. - **Expand ICHRA participation** (medium-term) — ICHRA can shift more employees into the individual market and create a new growth channel for Oscar plans. - **Monetize technology through +Oscar** (short-term) — Platform services diversify revenue and leverage Oscar's member engagement and analytics capabilities. - Grow the individual consumer health marketplace - Expand into ICHRA-enabled employer coverage - Use +Oscar to monetize technology beyond insurance - Improve local market execution and network quality - Add enrollment and brokerage capabilities to widen distribution ## Risks Oscar's results depend on successful member acquisition, retention and market execution in a heavily regulated insurance business. Its model is exposed to ACA policy changes, state-by-state approval processes, medical cost trends, risk adjustment volatility, provider contracting complexity and legal or regulatory challenges around its affiliated medical group and distribution businesses. - **Failure to execute growth strategy** [high] — The business depends on acquiring and retaining members while expanding products and markets without losing operational control. - **ACA and insurance regulation changes** [high] — Premium approvals, minimum MLR rules, market participation and subsidies are governed by federal and state regulators. - **Medical claims and utilization volatility** [high] — Higher-than-expected claims, catastrophic cases or utilization can raise benefit costs and affect plan performance. - **Risk adjustment and reserve estimation** [high] — Premiums and liabilities depend on estimates of member health status and incurred-but-not-reported claims. - **Corporate practice of medicine and fee-splitting** [high] — Oscar Medical Group arrangements could be challenged by regulators or counterparties, creating legal and operational disruption. - ACA and state regulation can change pricing, eligibility and market access - Medical cost inflation and claim severity can pressure plan economics - Risk adjustment and reserve estimates can move reported results - Provider contracting and network design are market-specific and complex - Corporate practice of medicine and fee-splitting rules create legal risk ## Accounting Oscar's most important accounting judgments are insurance-specific: estimates of benefits payable for incurred-but-not-reported claims and risk adjustment transfers can materially change reported results. Revenue also depends on premium recognition, federal subsidies collected through CMS, reinsurance accounting and the timing of service revenue from platform and enrollment businesses. - **Benefits payable reserve** — Medical expense and liabilities - **Risk adjustment** — Premium revenue and balance sheet receivables/payables - **Reinsurance accounting** — Revenue, medical costs and volatility - **Revenue mix across insurance and services** — Quarterly comparability and segment mix - Benefits payable depends on estimates of unpaid and IBNR claims - Risk adjustment can materially change premium revenue and liabilities - CMS-collected subsidies affect premium recognition and cash timing - Reinsurance accounting changes reported premiums and claims expense - Platform and enrollment revenue may be recognized differently from premiums --- *Last updated: 2026-04-29T04:44:36.255192+00:00*