Oscar Health, Inc. (OSCR) Business Profile

What it does

Oscar Health sells health insurance to individuals, families and employees who buy their own coverage. Its plans are offered in the individual market, including through Affordable Care Act (ACA) marketplaces and outside those marketplaces. Employees can also use an employer-funded Individual Coverage Health Reimbursement Arrangement (ICHRA) to buy an Oscar plan. The company was founded in 2012, and Mark T. Bertolini is its chief executive officer.

Oscar offers plans across the ACA’s Catastrophic, Bronze, Silver, Gold and Platinum categories. These differ in monthly premiums and in how medical costs are shared between Oscar and members. Some products include benefits aimed at people with particular needs, including diabetes, asthma or menopause. Members have access to contracted doctors and hospitals and a Care Team that helps them find care and navigate costs.

Oscar also sells technology services through +Oscar. Its Campaign Builder platform helps healthcare providers and insurers use data to identify opportunities to contact people and deliver personalized interactions. Beyond insurance and technology, Oscar operates Lucie, an enrollment marketplace; IHC Specialty Benefits, a brokerage; and Healthinsurance.org, a consumer education website. Its insurance operations use a company-built platform covering functions such as billing, benefits, member data and claims management.

How it makes money

Oscar generates the vast majority of its revenue from health insurance premiums. These are recurring payments for coverage, collected from members and from the Centers for Medicare & Medicaid Services (CMS) through the advance premium tax credit program. For the year ended December 31, 2025, 93% of premiums were earned directly from CMS and 7% were from members. Premium rates and rate changes require applicable state and federal regulatory approval.

Plans offer different combinations of premiums and member cost sharing. Oscar pays covered medical claims under the terms of each plan, while members pay their contractual share. Federal risk adjustment also changes plan revenue based on the health status of Oscar’s members relative to others in a given state or market. Oscar revises its estimates as new information arrives, with final reporting arriving in later periods.

The company also has revenue outside insurance premiums. Its +Oscar Campaign Builder serves providers and insurers, while Lucie lets brokers and consumers shop, buy and enroll in individual medical and supplemental products. IHC Specialty Benefits offers individual medical and supplemental products across carriers. Total revenue includes premium revenue, investment income and other revenues.

In the second quarter of 2026, revenue was $4.9 billion and earnings from operations were $389 million. Oscar reported $1.1 billion in earnings from operations and $1 billion in net income for the first half of 2026. Its medical loss ratio measures medical expenses against net premiums before quota share reinsurance; the measure includes the effect of federal risk adjustment.

Customers and how it sells

Oscar’s insurance customers include individuals and families buying coverage through federal or state marketplaces or outside them. Employees whose employers offer an ICHRA can also buy Oscar plans. Separately, providers and insurers use the +Oscar platform, and brokers and consumers use Lucie to shop and enroll in coverage.

Oscar ended the second quarter of 2026 with 2.96 million members. At December 31, 2025, it had 2,042,449 effectuated members: people actively enrolled whose required premiums had been paid or were within the payment grace period. Florida accounted for 1,179,934 members and Texas for 358,910 at that date. Oscar offered individual and family coverage in 18 states for the 2025 policy year and expanded to 20 states for 2026.

The company acquires the vast majority of its membership through brokers. It also acquires members directly through health insurance marketplaces and its digital platform, and partners with ICHRA platforms to enroll employees. IHC Specialty Benefits offers products across carriers in all 50 states; that brokerage reach is separate from the states in which Oscar offers its own plans.

Suppliers and costs

Oscar contracts with physicians, hospitals and other providers to furnish care to its members. Contract terms differ by market and provider and can include fee-for-service payments, value-based incentives or capitation payments. Oscar generally uses selected healthcare systems and providers rather than contracting with every provider in an area.

Medical expenses are a principal cost of the insurance business. They vary with members’ use of care, prescription drugs, the health of the enrolled population and the plan mix. As members meet deductibles and out-of-pocket maximums during the policy year, Oscar generally pays a higher proportion of covered claims in the second half. The company also pays brokers commissions and bonuses and incurs selling, general and administrative expenses.

Oscar uses quota share and excess-of-loss reinsurance. Under quota share arrangements, a reinsurer assumes a specified portion of losses in exchange for a corresponding portion of premiums; reinsurance does not remove Oscar’s primary obligation to pay medical claims. The company also relies on technology vendors, including Amazon and Google, to support its information systems. Oscar had 2,305 employees at December 31, 2025.

Competitive position

Oscar competes for individual-market members against plans offered by national and regional carriers, Medicaid-focused insurers offering marketplace products, and local Blue Cross plans. The identity of its principal competitors varies by market and geography; no individual competing company is named in Oscar’s competition description. Oscar competes directly and through independent intermediaries to enroll and retain members.

Competition depends on plan prices and choices, provider networks, benefits, service and member experience. Oscar also competes to establish provider networks. Providers consider factors including member volume, reimbursement rates, claims payment and administrative services when deciding whether to contract with an insurer. Brokers are another competitive channel: Oscar pays commissions and bonuses to partners who bring in members.

Oscar’s technology spans insurance functions including claims, billing and member data, and it uses digital tools for member support and care navigation. Our reading: the integrated platform can help Oscar operate and engage members, but its competitive protection is limited by the possibility that rivals replicate its products or technology. Oscar relies on copyright, trademarks, trade secrets and contracts to protect its intellectual property and had no issued patents or pending patent applications as of December 31, 2025. Our reading: those protections support its technology position, but the absence of patents limits protection against competitors independently developing similar tools.

Growth opportunities

Oscar’s growth strategy includes expanding its individual insurance business, entering or exiting markets as it evaluates their fit, and developing products for different member needs. It expanded its plan offerings to 20 states for 2026. In the second quarter of 2026, membership reached 2.96 million, up 46% year-over-year. Oscar attributed the membership level to open enrollment growth and retention.

The company is also pursuing employers that fund individual coverage through ICHRA. It partners with ICHRA platforms so employees can choose Oscar products where its plans are available. Oscar said demand from small businesses in healthcare and professional services was growing steadily. Its 2025 acquisitions of Lucie and IHC Specialty Benefits added enrollment and brokerage capabilities to support that strategy.

Oscar has built ICHRAx from an approved electronic enrollment platform acquired in 2025. The company says the platform has agreements to include competing insurers, allowing employees to select coverage with the network they need. Lucie is connected to ICHRAx.

For providers and insurers, Oscar offers Campaign Builder through +Oscar. The platform uses predictive analytics and personalized interactions, with reporting to measure outcomes. Oscar also continues to add care-navigation tools for its own members: in the second quarter of 2026, it piloted a radiology program using its Oswell Agent and said it would expand the capability to additional procedures.

Structural risks

• Subsidies and regulation: Enhanced advance premium tax credits expired at the end of 2025. Oscar said that, if they are not renewed in 2026, coverage could become unaffordable for some people and reduce marketplace participation and its future membership. Eligibility and enrollment rules can also affect enrollment.
• Medical costs and risk adjustment: Changes in members’ health, use of services or drug costs can affect expenses. Oscar increased its estimated risk adjustment transfer payable during 2025 after receiving information about market and company risk scores.
• Member and broker retention: Oscar depends on brokers for the vast majority of its membership. It could lose members or fail to grow if brokers cannot market its products effectively or if it loses broker relationships.
• Capital and reinsurance: Insurance subsidiaries must meet regulatory capital requirements and may need more capital as membership, medical costs or risk adjustment estimates change. The company uses quota share reinsurance to help meet those requirements; unsuccessful renewals could affect its capital position.
• Technology and data: Disruptions to Oscar’s digital platform can affect members, providers and partners. A cyberattack or privacy breach involving Oscar or a third party could also harm the business.

Bottom line

Our reading

Oscar is principally an individual health insurer, with enrollment, brokerage and technology businesses alongside its plans. Its company-built platform and broker network help it reach and serve members, while premiums remain the center of the business. The main exposures are the cost and health of the people it insures, regulatory changes affecting enrollment and subsidies, and the capital needed to support insurance growth.