Oscar Health, Inc. (NYSE: OSCR)

Oscar is a leading healthcare technology company that operates a full stack technology platform and offers health insurance plans under the Affordable Care Act to individuals families and employees. The company focuses on member experience and uses its proprietary technology to drive engagement and deliver high value clinical care. As of December 31 2024 Oscar had approximately 1.68 million effectuated members who were actively enrolled in its plans and had either paid their premium or were within the grace period. In addition to its insurance business Oscar powers providers and payors through its +Oscar platform which provides engagement and recommendation tools. Oscar’s mission is to make a healthier life accessible and affordable for all by combining insurance coverage with innovative digital solutions that reduce friction in the healthcare system. The platform encompasses member data utilization management claims processing billing and benefits administration all built on a cloud native architecture that allows rapid scaling and continuous improvement.

Oscar generates the majority of its revenue from health insurance policy premiums that are collected directly from the Centers for Medicare & Medicaid Services as part of the advanced premium tax credits program and from its members through direct payments. The company also earns revenue from its +Oscar platform by offering services such as Campaign Builder to providers and payors who use the platform for population identification personalized interactions and real time reporting and analytics. Premium revenue is supplemented by risk transfer payments received under the federal risk adjustment program which redistributes funds based on the relative health risk of enrolled members. Oscar’s financial results reflect the combination of premium income risk adjustment and fees from its technology services. For the year ended December 31 2024 premiums earned from the Centers for Medicare & Medicaid Services totaled 9,512.3 million dollars while premiums earned directly from members amounted to 799.3 million dollars.

The company operates through the following segments.

• Oscar's insurance business offers health plans in the individual market under the five metal plan categories defined by the Affordable Care Act namely catastrophic bronze silver gold and platinum. These plans vary in monthly premium and cost sharing between the company and its members. The business designs products that aim to improve health outcomes increase affordability and close gaps in benefits for consumers. It includes programs that target chronic conditions such as diabetes and asthma by offering reduced cost sharing for high value services. The insurance segment relies on risk adjustment calculations that adjust premiums based on the health status of its members relative to the overall state market. It must also meet medical loss ratio requirements set by state and federal regulators which dictate the minimum share of premium revenue that must be spent on clinical care and quality improvement activities. The insurance segment maintains exclusive provider organization EPO plans in most markets and offers health maintenance organization HMO plans in selected areas. It contracts with large health systems and provider groups to create networks that emphasize quality care and cost effectiveness. These contracts may include fee for service arrangements value based incentives or capitated payments depending on the market and the provider.

• The +Oscar platform provides technology solutions to providers and payors through its Campaign Builder product which leverages predictive analytics to identify high value opportunities for engagement and to deliver personalized interactions with real time reporting and analytics to measure outcomes. As of December 31 2024 the platform served nearly 500000 client lives in addition to the approximately 1.68 million members enrolled in Oscar health insurance. The platform supports care management workflows by helping users identify gaps in care automate outreach and track key performance indicators such as hospitalization rates and medication adherence. It also enables providers to integrate Oscar’s data insights into their clinical decision making processes and offers payors a tool to monitor population health and evaluate the effectiveness of intervention programs. The platform also supports integration with electronic health record systems enabling seamless data exchange between Oscar and its provider partners. It allows users to schedule virtual visits send medication reminders and track wellness goals through a unified dashboard.

Oscar occupies a competitive position in the individual health insurance market where it faces competition from national carriers regional carriers Medicaid focused insurers that offer Marketplace products and local Blue Cross plans. The company differentiates itself through its end to end technology platform that enables superior member engagement personalized interactions and efficient care navigation. Its ability to combine insurance operations with data driven insights and tools such as Campaign Builder creates a barrier for competitors that rely on legacy systems. Oscar also benefits from a strong brand reputation for member experience as evidenced by a net promoter score of 66 in the fourth quarter of 2024 which exceeds the industry average. The company has achieved profitability on both an adjusted EBITDA and net income basis in 2024 demonstrating that its technology driven model can generate sustainable earnings while scaling membership across multiple states. Oscar has steadily expanded its geographic footprint by entering new states where it sees favorable regulatory environments and sufficient provider networks. This expansion has been accompanied by improvements in operating efficiency that have lowered the administrative expense ratio and contributed to positive adjusted EBITDA.

Oscar serves individuals families and employees who obtain coverage through the individual market including those who use Individual Coverage Health Reimbursement Arrangements offered by their employers. Through its +Oscar platform the company also provides services to providers and payors who seek to improve member engagement and care management. The company offers coverage in eighteen states as of December 31 2024 with a presence that includes large markets such as Florida Georgia Texas and Ohio as well as smaller states such as Iowa Missouri and Tennessee. Its customer base consists of a diverse set of consumers seeking affordable health care and healthcare organizations looking to leverage technology for better outcomes. Employers who adopt Individual Coverage Health Reimbursement Arrangements can offer their employees a defined contribution to purchase Oscar plans directly through the individual market. Brokers and agents also play a role in enrolling individuals through health insurance exchanges and Oscar compensates them through standard commission structures. The company’s focus on digital acquisition complements these traditional channels by allowing consumers to shop and enroll directly via its website and mobile app.