Oscar Health CEO Mark Bertolini told investors the insurer is "optimistic" lawmakers will reach an agreement on the enhanced premium tax credits for Affordable Care Act (ACA) plans even as it braces for a "reset moment for the individual market."
Oscar released its third-quarter financial report Thursday morning, and Bertolini said on the company's earnings call that the team is working with legislators on both sides of the aisle "to ensure Americans have access to the coverage they need."
The enhanced subsidies are at the center of the ongoing government shutdown, with Democrats continuing to refuse to sign off on a budget agreement that does not include an extension for these tax credits. Open enrollment on the exchanges opened Nov. 1, with many people seeing significant price increases for their plans.
Bertolini said people who enroll in ACA plans and receive tax credits generally do not have access to employer-sponsored plans, and the subsidies are critical in filling access gaps for them.
For example, a person who makes $60,000 per year on average pays $75 each month for a health plan with the enhanced tax credits in place. Without those subsidies, their monthly costs would rise to $300, Bertolini said.
"Limiting access to affordable coverage in the individual market undermines Main Street and rural America," he said. "This market is critical regardless of policy changes."
The looming expiry of the subsidies isn't the only factor in play that's set to drive up costs on the exchanges, he said. Bertolini said the weighted average rate increase for Oscar in 2026 is 28%, according for program integrity changes as well as worsening morbidity that the team attributes to Medicaid enrollees joining the market.
He said Oscar resubmitted rate filings that cover about 99% of its current member base, and the insurer is actively working to point members toward affordable coverage during this enrollment window.
"Looking ahead, we see rational pricing in the 2026 open enrollment period," Bertolini said. "We also see the overall market to contract due to the expiration of enhanced premium tax credits and program integrity efforts."
For the quarter, Oscar reported a $137.5 million loss, compared to a $54.6 million loss in the third quarter of 2024. The company has posted a $90.5 million loss through three quarters in 2025, reversing a $179 million profit through the first nine months of 2024.
Revenues were just shy of $3 billion in the quarter, up from $2.4 billion in revenue in the third quarter of 2024. Revenue through the first nine months of the year was $8.9 billion, growing from $6.8 billion through three quarters in 2024.
Oscar's medical loss ratio in the third quarter was 88.5% compared to an 84.6% rate in the prior-year quarter. Through the first three quarters of the year, medical loss ratio was 84.8%, per the earnings report.
Total membership for Oscar's plans was 2.1 million as of Sept. 30, growing from 1.7 million individuals.
Based on the results, Oscar reaffirmed its full-year guidance and expects between $12 billion and $12.2 billion in revenue for the year. It also anticipates medical loss ratio to be between 86% and 87% and a loss from operations of between $200 million and $300 million.