MMIT Payer Portrait: Oscar Health

Founded in 2012, Oscar Health Inc. calls itself “the first health insurance company built around a full stack technology platform.” Since its founding, Oscar has grown to serve more than 500,000 members in 18 states, largely via the Affordable Care Act (ACA) exchanges and off-exchange individual and family plans. Oscar also offers Medicare Advantage (MA) plans in three states and in 2020 partnered with Cigna Corp. to offer co-branded small group commercial products in California, Connecticut, Georgia, Missouri and Tennessee. CVS Caremark serves as Oscar’s pharmacy benefit manager.

Following years of buzz and more than $1 billion in venture capital raised, Oscar became a public company in March 2021, trading at $36 per share. While the company’s second-quarter earnings were relatively solid, industry experts have expressed skepticism that the startup will ever become profitable, pointing to its reliance on venture-backed funding, overrepresentation of members receiving ACA-backed subsidies and outsized marketing budget. As of Nov. 1, 2021, Oscar was trading at $17 per share.

Like other exchange insurers, Oscar’s enrollment has grown considerably amid the COVID-19 pandemic (see timeline). In 2022, Oscar will bring its individual and family plans to three new states — Arkansas, Colorado and Illinois — and 146 new counties overall. In recent weeks, the insurer revealed it will partner with local health systems for its Chicago, Colorado and Miami expansions, leveraging localized networks and “care guide” provider teams to enhance its offerings. Oscar currently enrolls 3.6% of all exchange enrollees, with its largest markets in California, Florida and Texas.

Perhaps in search of a more stable source of premium revenue as the exchanges experienced volatility in the late 2010s, Oscar threw its hat into the MA ring for the first time in 2020, offering plans in New York and Texas. It has since expanded to Florida, but uptake has been slow. Oscar had just 3,700 MA members as of October 2021, and the company has not emphasized Medicare in materials on its 2022 expansion plans.

SOURCE: AIS’s Directory of Health Plans as of October 2021; MMIT Analytics as of 3Q 2021.

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