OSCRNYSEHospital & Medical Service PlansUS GAAP · USD

Oscar Health, Inc.

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.

Kysy yhtiöstä
Liikevaihto11,7mrd USD
+27,5 %v/v
Liikevoitto (EBIT)−396milj. USD
−792,1 %v/v
EBIT-marginaali−3,4%
−4,0 %-yks.v/v
Nettotulos−443milj. USD
−1 842,5 %v/v
Vapaa kassavirta1 095milj. USD
+11,9 %v/v

Tilikausi 2025 · muutos edellisvuodesta

Kehitys 2020–2025

−2,50,02,55,07,510,012,5mrd USD2020: 0,46 mrd USD2020: EBIT −0,40 mrd USD20202021: 1,8 mrd USD2021: EBIT −0,54 mrd USD20212022: 4,0 mrd USD2022: EBIT −0,59 mrd USD20222023: 5,9 mrd USD2023: EBIT −0,24 mrd USD20232024: 9,2 mrd USD2024: EBIT 0,06 mrd USD20242025: 11,7 mrd USD2025: EBIT −0,40 mrd USD202511,7−0,40
LiikevaihtoLiikevoitto (EBIT)

Liiketoiminta

Osuus liikevaihdosta
Health insurance premiums90 %

ACA-compliant individual, family and employee health plans sold in selected U.S. states.

Technology and platform services5 %

+Oscar services, including Campaign Builder and administrative support for healthcare partners.

Brokerage and enrollment services3 %

Direct enrollment, brokerage and consumer marketplace services through acquired platforms.

Other revenue2 %

Consumer education, sublease income and other ancillary revenue streams.

Asiakkaat

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

Buy health plans on the individual market for themselves and dependents, primarily for regulated medical coverage and access to provider networks.

ICHRA-enrolled employees

Use employer-funded defined contributions to purchase individual market coverage, supporting Oscar's expansion beyond traditional ACA enrollment.

Providers and payors

Use +Oscar and Campaign Builder to improve member engagement, analytics and care coordination.

Brokers and consumers

Use Lucie and related enrollment tools to shop, compare and enroll in individual medical and supplemental products.

Strategia

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 marketplaceKeskipitkä aikaväli

A broader marketplace can increase plan choice, improve retention and support cross-sell across insurance and services.

Expand ICHRA participationKeskipitkä aikaväli

ICHRA can shift more employees into the individual market and create a new growth channel for Oscar plans.

Monetize technology through +OscarLyhyt aikaväli

Platform services diversify revenue and leverage Oscar's member engagement and analytics capabilities.

Maantiede

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.

Riskit

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.

Järjestetty vakavuuden mukaan
MatalaKohtalainenKorkeaMatalaKohtalainenKorkeaVaikutus →Todennäköisyys →Failure to execute growth strategy1Risk adjustment and reserve estimation2ACA and insurance regulation changes3Medical claims and utilization volatility4Corporate practice of medicine and fee-splitting5
Vaikutus on riskin vakavuus ja todennäköisyys sen toteutumisen todennäköisyys lähivuosina, molemmat arvioitu yhtiön raporttien perusteella. Numerot vastaavat listaa.
  1. Failure to execute growth strategyVaikutus: KorkeaTodennäköisyys: Korkea

    The business depends on acquiring and retaining members while expanding products and markets without losing operational control.

    KohdistuuMember growthMarket expansionNew products+Oscar monetization
  2. Risk adjustment and reserve estimationVaikutus: KorkeaTodennäköisyys: Korkea

    Premiums and liabilities depend on estimates of member health status and incurred-but-not-reported claims.

    Kohdistuu: Risk adjustment transfers and benefits payable

  3. ACA and insurance regulation changesVaikutus: KorkeaTodennäköisyys: Kohtalainen

    Premium approvals, minimum MLR rules, market participation and subsidies are governed by federal and state regulators.

    KohdistuuPricingProduct designMarket entryRevenue mix
  4. Medical claims and utilization volatilityVaikutus: KorkeaTodennäköisyys: Kohtalainen

    Higher-than-expected claims, catastrophic cases or utilization can raise benefit costs and affect plan performance.

    KohdistuuBenefits payableReinsurance coverageMLR
  5. Corporate practice of medicine and fee-splittingVaikutus: KorkeaTodennäköisyys: Matala

    Oscar Medical Group arrangements could be challenged by regulators or counterparties, creating legal and operational disruption.

    Kohdistuu: Medical group structure and provider operations

Kirjanpito

Harkinnanvaraiset erät
Benefits payable reserve

The company estimates ultimate medical claims costs, including incurred-but-not-reported claims, which can move earnings if actual claims differ.

Vaikutus: Medical expense and liabilities

Risk adjustment

Premiums include risk adjustment transfers based on member health status, making revenue and receivables sensitive to estimates and settlement timing.

Vaikutus: Premium revenue and balance sheet receivables/payables

Reinsurance accounting

Quota share and excess-of-loss arrangements affect gross and net premium presentation and claims expense.

Vaikutus: Revenue, medical costs and volatility

Revenue mix across insurance and services

Insurance premiums, platform fees, brokerage revenue and other services may follow different recognition patterns.

Vaikutus: Quarterly comparability and segment mix

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Päivitetty: 24.9.2026