Oscar Health Inc
NYSE:OSCR
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Oscar Health Inc
NYSE:OSCR
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Oscar Health Inc
Oscar Health Inc., a pioneer in the health insurance industry, was founded with a mission to simplify healthcare by aligning technology with the needs of its members. Emerging out of the tech-savvy environment of New York City in 2012, Oscar took a bold step towards modernizing a traditionally stagnant industry. By utilizing data-driven insights and an intuitive digital platform, Oscar reimagined the insurance experience, making it more transparent and user-friendly. Focused on individual and family plans, Oscar offers its members round-the-clock telemedicine services, real-time claim tracking, and a comprehensive network of healthcare providers. This tech-forward approach not only enhances the customer experience but also enables Oscar to streamline its operations, reducing overhead costs and increasing efficiency.
The company's business model revolves around a few key levers: premium collection, risk selection, and rigorous cost management. Oscar generates revenue primarily through premiums paid by its members. To ensure financial viability, the company employs sophisticated risk assessment technologies designed to select and price plans based on accurate estimations of patient healthcare needs. With significant investments in technology, Oscar is able to better predict healthcare costs and manage its risk pool effectively. Additionally, its emphasis on preventive care and patient engagement further distinguishes its model, encouraging healthy lifestyles that may reduce long-term healthcare expenses. Through these strategies, Oscar aims not only to drive profitability but also to reshape the health insurance landscape by placing greater emphasis on customer experience and cost transparency.
Oscar Health Inc., a pioneer in the health insurance industry, was founded with a mission to simplify healthcare by aligning technology with the needs of its members. Emerging out of the tech-savvy environment of New York City in 2012, Oscar took a bold step towards modernizing a traditionally stagnant industry. By utilizing data-driven insights and an intuitive digital platform, Oscar reimagined the insurance experience, making it more transparent and user-friendly. Focused on individual and family plans, Oscar offers its members round-the-clock telemedicine services, real-time claim tracking, and a comprehensive network of healthcare providers. This tech-forward approach not only enhances the customer experience but also enables Oscar to streamline its operations, reducing overhead costs and increasing efficiency.
The company's business model revolves around a few key levers: premium collection, risk selection, and rigorous cost management. Oscar generates revenue primarily through premiums paid by its members. To ensure financial viability, the company employs sophisticated risk assessment technologies designed to select and price plans based on accurate estimations of patient healthcare needs. With significant investments in technology, Oscar is able to better predict healthcare costs and manage its risk pool effectively. Additionally, its emphasis on preventive care and patient engagement further distinguishes its model, encouraging healthy lifestyles that may reduce long-term healthcare expenses. Through these strategies, Oscar aims not only to drive profitability but also to reshape the health insurance landscape by placing greater emphasis on customer experience and cost transparency.
Revenue Growth: Oscar Health reported total revenue of $11.7 billion for 2025, up 28% year-over-year, with continued strong membership gains.
Losses Driven by Risk Adjustment: The company reported a net loss from operations of $396 million in 2025, primarily due to higher market morbidity and a substantial risk adjustment payable.
Turnaround for 2026: Management expects a nearly $750 million improvement in earnings from operations in 2026 and a return to profitability, with projected operating earnings between $250 million and $450 million.
Membership Surge: Record open enrollment resulted in 3.4 million members as of February 2026; paid membership is expected to be around 3 million by Q2, a 58% year-over-year increase.
Margin Expansion: Medical loss ratio (MLR) is forecasted to improve by 450 basis points at the midpoint in 2026, with a projected range of 82.4% to 83.4%.
AI-Driven Efficiency: Administrative expense ratio improved by 160 basis points in 2025 and is expected to further improve to 15.8%–16.3% in 2026, reflecting AI and tech-driven cost controls.
Market Dynamics: Management noted a 5% market contraction so far and expects total market decline to the lower end of their original 20%–30% projection.
Strategic Product and Pricing: The company introduced new product offerings and adjusted rates to respond to shifting market conditions post-enhanced premium tax credits.