With 2025 marking a "reset year for the industry," Oscar Health put a focus throughout the year on setting the company up for the future, its top brass told investors Tuesday.
Oscar's insurance business is concentrated in the Affordable Care Act exchange market, and CEO Mark Bertolini said during the company's fourth-quarter earnings call that plans across this space felt the squeeze as more Medicaid lives entered the pool and integrity measures drove changes in market dynamics.
With that backdrop, Oscar priced its plans for 2026 to account for those program integrity changes, elevated utilization trends and higher morbidity among its membership, Bertolini said. He said the team also baked in an expectation that the advanced premium tax credits would run out as scheduled, which they did Jan. 1.
"We took decisive actions with a disciplined pricing, distribution and product strategy to go after profitable growth as competitors pulled back or exited the market," he said.
He said the latest data from the Centers for Medicare & Medicaid Services indicate that about 23 million people are enrolled in the exchanges as of mid-January, and that decline of about 5% is lower than was anticipated. That said, there are likely individuals who were reenrolled automatically that will see higher premiums and drop out at the end of the grace periods, he added.
Bertolini said full data will come from the feds midyear to paint the complete picture of what enrollment looks like. However, he said the current enrollment data suggest market contraction will come in at the lower end of the company's 20% to 30% estimate window.
"The individual market stability underscores the priority consumers place on maintaining health coverage," Bertolini said. "More small business owners, working Americans and gig workers are running the market as group insurance fails to meet their affordability needs."
The company posted a $352.6 million loss in the fourth quarter, growing its losses from a $153.5 million loss in the fourth quarter of 2024. Oscar Health also reported a loss for the full year of $443.6 million after posting a $25.4 million profit in 2024.
Revenue in the fourth quarter was $2.8 billion, up from $2.4 billion in the fourth quarter of 2025. Full-year 2025 revenues were $11.7 billion, growing from $9.2 billion in 2024.
Oscar Health also boasted just over 2 million members at the end of the fourth quarter. Bertolini said the open enrollment window was a record setter for Oscar, with the insurer having 3.4 million members as of Feb. 1.
He said the insurer expects to enter the second quarter with about 3 million paying members, a 58% increase year over year. With that growth, the insurer grew its market share from 17% of its footprint in 2025 to 30% in 2026.
Membership growth also reflects momentum in the individual coverage health reimbursements arrangements, or ICHRAs, which saw expansion in new markets as well as existing regions like Arizona, Florida, New Jersey and Texas.
Elevated medical costs were reflected in the company's medical loss ratio for the year, which was 87.4%. By comparison, Oscar's MLR in 2024 was 81.7%. The company said in the earnings report that risk adjustment payments were not high enough to offset the elevated utilization trends.
Bertolini said the company expects its efforts in 2025 to react to the evolving state of the marketplaces will propel it back to profitability in 2026. Oscar Health expects revenues of between $18.7 billion and $19 billion for 2026, as well as earnings from operations of between $250 million and $450 million.
The company also projects an MLR of between 82.4% and 83.4% in 2026, according to the earnings report.