Oscar Health, Inc. (“Oscar” or the “Company”) (NYSE: OSCR) announced today its financial results for the second quarter ended June 30, 2026 and updates to its full year 2026 guidance.

“Oscar delivered record profitability in the first half of the year and we are raising our full-year 2026 guidance,” said Mark Bertolini, CEO of Oscar Health. “Our superior operating performance and execution against the fundamentals of our strategy are accelerating the individual market. More people are moving between full- and part-time jobs, gig work, and retirement – a shift AI will accelerate. A durable individual market gives them greater choice and will power the future of American healthcare. Oscar’s consumer products, disciplined pricing, and scalable technology platform will capture this opportunity and position us for long-term profitable growth.”

Second Quarter 2026 Financial Highlights

 

Three Months Ended June 30,

 

Six Months Ended June 30,

(in thousands, except percentages)

2026

 

2025

 

2026

 

2025

Total revenue

$4,880,220

 

$2,863,945

 

$9,527,414

 

$5,910,208

Medical loss ratio (“MLR”)

79.2%

 

91.1%

 

75.0%

 

83.0%

Selling, general, and administrative (“SG&A”) expense ratio

14.2%

 

18.7%

 

14.7%

 

17.2%

Earnings (loss) from operations

$388,635

 

$(230,483)

 

$1,092,720

 

$66,640

Net income (loss) attributable to Oscar Health, Inc.

$361,808

 

$(228,361)

 

$1,040,804

 

$46,910

Adjusted EBITDA (1)

$415,349

 

$(199,404)

 

$1,142,421

 

$129,424

(1) Adjusted EBITDA is a non-GAAP measure. See “Key Operating and Non-GAAP Financial Metrics – Adjusted EBITDA” in this release for a reconciliation to net income, the most directly comparable GAAP measure, and for information regarding Oscar’s use of Adjusted EBITDA.

 

As of June 30,

 

Effectuated Membership by Offering

2026

 

2025

 

Individual and Small Group (1)

2,963,002

 

2,017,058

 

Cigna+Oscar (2)

 

10,090

 

Total Members (3)

2,963,002

 

2,027,148

 

(1) Membership includes members enrolled through an Individual Coverage Health Reimbursement Arrangement (“ICHRA”). 2025 membership includes small group members. The Company no longer offers small group plans effective December 15, 2024.

(2) Represents total membership for our former co-branded partnership with Cigna. We did not renew the Cigna+Oscar Small Group arrangement after its initial term ended on December 31, 2024.

(3) Represents effectuated members. Effectuated members are those who are actively enrolled in one of our plans and whose required premium payments have either been made or are within the payment grace period. A member covered under more than one of our health plans counts as a single member for the purposes of this metric.

2026 Financial Guidance Summary

 

 

 

 

 

 

 

 

 

 

 

Prior Full Year 2026 Outlook

 

Updated Full Year 2026 Outlook

(in thousands, except percentages)

 

Low

 

High

 

Low

 

High

Total Revenue (1)

 

$18.7 billion

 

$19.0 billion

 

$18.7 billion

 

$19.0 billion

Medical Loss Ratio (2)

 

82.4%

 

83.4%

 

81.5%

 

82.5%

SG&A Expense Ratio (3)

 

15.8%

 

16.3%

 

15.6%

 

16.1%

Earnings from Operations (4)

 

$250 million

 

$450 million

 

$500 million

 

$700 million

(1) Total revenue includes premium revenue (net of risk adjustment transfers), investment income, and other revenue. We believe total revenue is an important metric to assess the growth of our business, as well as the earnings potential of our investment portfolio.

(2) Medical loss ratio (MLR) is a metric used to calculate medical expenses as a percentage of net premiums before ceded quota share reinsurance. We believe MLR is an important metric to demonstrate the ratio of our costs to pay for the healthcare of our members to the net premiums before ceded quota share reinsurance.

(3) Selling, general, and administrative (SG&A) expense ratio is calculated as selling, general and administrative expenses as a percentage of total revenue (net of risk adjustment transfers). We believe the SG&A expense ratio is useful to evaluate our ability to manage our overall selling, general, and administrative cost base.

(4) Earnings from operations is the Company’s total revenue less Total operating expenses. We believe earnings from operations is an important primary metric for assessing operating performance.

Second Quarter 2026 Key Metrics and Non-GAAP Financial Metrics

  • Total revenue was approximately $4.9 billion for the second quarter of 2026 compared to $2.9 billion for the second quarter of 2025. The increase was driven by higher membership and rate increases, partially offset by an increase in the net risk adjustment transfer accrual.

  • The medical loss ratio was 79.2% for the second quarter of 2026 compared to 91.1% for the second quarter of 2025, which included the entire first half impact of 2025 risk adjustment true-up driven by higher average market morbidity. The decrease was primarily driven by our disciplined pricing strategy and $164 million of favorable prior period reserve development.

  • The SG&A expense ratio was 14.2% for the second quarter of 2026 compared to 18.7% for the second quarter of 2025. The decrease was primarily due to disciplined expense management, greater fixed cost leverage, and the impact of lower risk adjustment as a percentage of premium.

  • Earnings from operations were $388.6 million for the second quarter of 2026 compared to a loss from operations of $230.5 million for the second quarter of 2025. The significant increase reflects strong operating performance driven primarily by improved underwriting performance and favorable prior period development.

  • Net income attributable to Oscar Health, Inc. was $361.8 million, or $1.10 of diluted earnings per share, for the second quarter of 2026 compared to Net loss attributable to Oscar Health, Inc. of $228.4 million, or $(0.89) of diluted earnings per share, for the second quarter of 2025.

  • Adjusted EBITDA was $415.3 million for the second quarter of 2026 compared to an Adjusted EBITDA loss of $199.4 million for the second quarter of 2025.

Quarterly Conference Call Details

Oscar will host a conference call to discuss its financial results today, August 6, 2026, at 8:00 a.m. (ET). Investors and other interested parties are invited to listen to the conference call by dialing 1-855-761-5600 and entering the following conference ID: 7768132. A live audio webcast will also be available via the Investor Relations page of Oscar’s website at ir.hioscar.com. A replay of the webcast will be available for on-demand listening shortly after the completion of the call, at the same web link, and will remain available for approximately 90 days.

Non-GAAP Financial Information

This release presents Adjusted EBITDA, a non-GAAP financial metric, which is provided as a complement to the results provided in accordance with accounting principles generally accepted in the United States of America (“GAAP”). A reconciliation of historical non-GAAP financial information to the most directly comparable GAAP financial measure is provided in the accompanying tables found at the end of this release. For more information regarding Adjusted EBITDA, please see “Key Operating and Non-GAAP Financial Metrics” below.

Cautionary Note Regarding Forward-Looking Statements

This press release contains forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. All statements other than statements of historical fact contained herein are forward-looking statements. These statements include, but are not limited to, statements about our financial outlook and estimates, including Total revenue, Medical loss ratio, SG&A expense ratio, Earnings (loss) from operations, and other financial performance metrics, and the related underlying assumptions, our business and financial prospects, including management’s plans and objectives for future operations, expectations and business strategy, such as our 2026 margins and profitability, and industry and market dynamics and expected trends. In some cases, you can identify forward-looking statements by terms such as “may,” “will,” “should,” “expects,” “plans,” “anticipates,” “could,” “intends,” “targets,” “projects,” “contemplates,” “believes,” “estimates,” “forecasts,” “predicts,” “potential,” or “continues” or the negative of these terms or other similar expressions. Accordingly, we caution you that any such forward-looking statements are not guarantees of future performance and are subject to risks, assumptions, and uncertainties that are difficult to predict and generally beyond our control.

Although we believe that the expectations reflected in these forward-looking statements are reasonable as of the date made, there are or will be important factors that could cause our actual results to differ materially from those indicated in these forward-looking statements, including, but not limited to, the following: our ability to execute our strategy and manage our growth effectively (including our ability to successfully integrate strategic acquisitions); our ability to retain and expand our member base; our ability to accurately estimate our incurred medical expenses or overall market morbidity, or effectively manage our medical costs or related administrative costs; unanticipated results of, or changes to, risk adjustment programs or our estimates thereof; evolving federal or state laws or regulations (including any changes in the interpretation or enforcement of existing laws and regulations), including changes with respect to the Patient Protection and Affordable Care Act (“ACA”) and any regulations enacted thereunder, the expiration of the enhanced Advanced Premium Tax Credits (“eAPTCs”), the implementation of new program integrity rules, including pursuant to the Notice of Benefit and Payment Parameters (“NBPP”) for policy year 2027, the potential funding of a cost-sharing reduction (“CSR”) program, or other government actions, such as the imposition of tariffs; our ability to achieve or maintain profitability in the future; our ability to arrange for the delivery of quality care and maintain good relations with brokers and the physicians, hospitals, and other providers within and outside our provider networks; our ability to comply with ongoing, complex and evolving regulatory requirements, including capital reserve and surplus requirements and applicable performance standards; changes or developments in the regulation of health insurance markets in the United States; our, or any of our vendors’, ability to comply with laws, regulations, and standards related to the handling of information about individuals or applicable consumer protection laws, including as a result of our participation in government-sponsored programs; the ability of our health insurance and Health Maintenance Organization (“HMO”) subsidiaries (collectively, “Health Insurance Subsidiaries”) to make payments of dividends or distributions to us, including to fund our business strategy; our ability to utilize quota share reinsurance to meet our capital and surplus requirements and protect against downside risk on medical claims; adverse market conditions resulting in our investment portfolio suffering losses or reducing our ability to meet our financing needs; unfavorable or otherwise costly outcomes of lawsuits, audits, investigations, and other third party claims that may arise from the extensive laws and regulations to which we are subject, such as fraud, waste and abuse laws; incurrence of data security breaches of our or our partners’ information and technology systems; heightened competition in the markets in which we participate; our ability to attract and retain qualified personnel; uncertainties associated with our utilization of certain artificial intelligence (“AI”) and machine learning models; our ability to detect and prevent material weaknesses or significant control deficiencies in our internal controls over financial reporting or other failure to maintain an effective system of internal controls; adverse publicity or other adverse consequences related to our dual class structure or “controlled company” status; and the other factors set forth under the caption “Risk Factors” in our Annual Report on Form 10-K for the year ended December 31, 2025, filed with the Securities and Exchange Commission (“SEC”), and our other filings with the SEC.

You are cautioned not to place undue reliance on any forward-looking statements made in this press release. Any forward-looking statement speaks only as of the date as of which it is made, and, except as otherwise required by law, we do not undertake any obligation to publicly update or review any forward-looking statement, whether as a result of new information, future developments or otherwise. New factors emerge from time to time, and it is not possible for us to predict which will arise.

About Oscar Health

Oscar Health, Inc. is a leading healthcare technology company built on a full-stack platform and a relentless focus on member experience. Oscar Health helps make high-quality and affordable care more accessible for millions of people through Oscar’s Individual & Family plans and ICHRA solutions, Lucie Health Marketplace, and Trove Group. Consumers benefit from better choice, deeper engagement, and connection to high-value clinical care.

Oscar Health, Inc.

Condensed Consolidated Statements of Operations

(unaudited)

 

 

Three Months Ended June 30,

 

Six Months Ended June 30,

(in thousands, except per share amounts)

 

2026

 

 

2025

 

 

 

2026

 

 

2025

Revenue

 

 

 

 

 

 

 

Premium

$

4,789,331

 

$

2,803,444

 

 

$

9,370,193

 

$

5,799,265

Investment income

 

84,794

 

 

54,004

 

 

 

145,408

 

 

100,116

Other revenues

 

6,095

 

 

6,497

 

 

 

11,813

 

 

10,827

Total revenue

 

4,880,220

 

 

2,863,945

 

 

 

9,527,414

 

 

5,910,208

Operating Expenses

 

 

 

 

 

 

 

Medical

 

3,794,445

 

 

2,552,973

 

 

 

7,024,302

 

 

4,812,624

Selling, general, and administrative

 

691,080

 

 

534,485

 

 

 

1,397,314

 

 

1,017,244

Depreciation and amortization

 

6,060

 

 

6,970

 

 

 

13,078

 

 

13,700

Total operating expenses

 

4,491,585

 

 

3,094,428

 

 

 

8,434,694

 

 

5,843,568

Earnings (loss) from operations

 

388,635

 

 

(230,483

)

 

 

1,092,720

 

 

66,640

Interest expense

 

4,709

 

 

5,847

 

 

 

10,092

 

 

11,841

Other expenses (income)

 

915

 

 

(2,794

)

 

 

844

 

 

124

Earnings (loss) before income taxes

 

383,011

 

 

(233,536

)

 

 

1,081,784

 

 

54,675

Income tax expense (benefit)

 

21,183

 

 

(5,045

)

 

 

40,933

 

 

7,660

Net income (loss)

 

361,828

 

 

(228,491

)

 

 

1,040,851

 

 

47,015

Less: Net income (loss) attributable to noncontrolling interests

 

20

 

 

(130

)

 

 

47

 

 

105

Net income (loss) attributable to Oscar Health, Inc.

$

361,808

 

$

(228,361

)

 

$

1,040,804

 

$

46,910

 

 

 

 

 

 

 

 

Earnings (loss) per Share

 

 

 

 

 

 

 

Basic

$

1.20

 

$

(0.89

)

 

$

3.47

 

$

0.19

Diluted

$

1.10

 

$

(0.89

)

 

$

3.16

 

$

0.17

Weighted Average Common Shares Outstanding

 

 

 

 

 

 

 

Basic

 

302,220

 

 

255,531

 

 

 

300,197

 

 

253,417

Diluted

 

333,432

 

 

255,531

 

 

 

331,292

 

 

270,244

Oscar Health, Inc.

Condensed Consolidated Balance Sheets

(unaudited)

 

(in thousands, except per share amounts)

June 30, 2026

 

December 31, 2025

Assets

 

 

 

Current Assets:

 

 

 

Cash and cash equivalents

$

4,075,612

 

 

$

2,774,151

 

Short-term investments

 

4,479,906

 

 

 

1,216,461

 

Accounts receivable (net of allowance for credit losses of $55,298 and $7,226)

 

380,057

 

 

 

362,682

 

Reinsurance recoverable

 

196,544

 

 

 

99,750

 

Receivables from CMS

 

180,750

 

 

 

136,029

 

Other current assets

 

60,317

 

 

 

24,331

 

Total current assets

 

9,373,186

 

 

 

4,613,404

 

Long-term investments

 

1,600,770

 

 

 

1,470,987

 

Property, equipment, and capitalized software, net

 

101,494

 

 

 

88,350

 

Restricted deposits

 

29,178

 

 

 

32,951

 

Other assets

 

122,134

 

 

 

119,719

 

Total assets

$

11,226,762

 

 

$

6,325,411

 

 

 

 

 

Liabilities and Stockholders’ Equity

 

 

 

Current Liabilities:

 

 

 

Payables to CMS

$

6,095,289

 

 

$

2,730,095

 

Benefits payable

 

1,898,435

 

 

 

1,455,385

 

Accounts payable and other liabilities

 

525,709

 

 

 

507,325

 

Unearned premiums

 

167,505

 

 

 

166,203

 

Reinsurance payable

 

2,564

 

 

 

3,579

 

Total current liabilities

 

8,689,502

 

 

 

4,862,587

 

Long-term debt

 

431,629

 

 

 

430,095

 

Other liabilities

 

50,466

 

 

 

51,994

 

Total liabilities

 

9,171,597

 

 

 

5,344,676

 

Commitments and contingencies

 

 

 

Stockholders’ Equity

 

 

 

Class A common stock ($0.00001 par value; 825,000 thousand shares authorized, 273,410 thousand and 261,851 thousand shares outstanding as of June 30, 2026 and December 31, 2025, respectively)

 

3

 

 

 

3

 

Class B common stock ($0.00001 par value; 82,500 thousand shares authorized, 35,224 thousand and 35,838 thousand shares outstanding as of June 30, 2026 and December 31, 2025, respectively)

 

 

 

 

 

Treasury stock (315 thousand shares as of June 30, 2026 and December 31, 2025)

 

(2,923

)

 

 

(2,923

)

Additional paid-in capital

 

4,316,831

 

 

 

4,256,972

 

Accumulated deficit

 

(2,253,630

)

 

 

(3,294,434

)

Accumulated other comprehensive income (loss)

 

(8,250

)

 

 

18,030

 

Total Oscar Health, Inc. stockholders’ equity

 

2,052,031

 

 

 

977,648

 

Noncontrolling interests

 

3,134

 

 

 

3,087

 

Total stockholders’ equity

 

2,055,165

 

 

 

980,735

 

Total liabilities and stockholders’ equity

$

11,226,762

 

 

$

6,325,411

 

Oscar Health, Inc.

Condensed Consolidated Statements of Cash Flows

(unaudited)

 

 

Six Months Ended June 30,

(in thousands)

 

2026

 

 

 

2025

 

Cash Flows from Operating Activities:

 

 

 

Net income

$

1,040,851

 

 

$

47,015

 

Adjustments to reconcile net income to net cash provided by (used in) operating activities:

 

 

 

Change in provision for credit losses

 

48,072

 

 

 

(23,950

)

Stock-based compensation expense

 

36,623

 

 

 

49,084

 

Depreciation and amortization expense

 

13,049

 

 

 

13,700

 

Amortization of debt issuance costs

 

2,163

 

 

 

389

 

Net accretion of investments

 

(15,285

)

 

 

(15,667

)

Deferred taxes

 

(7,731

)

 

 

 

Net realized gain on sale of financial instruments

 

(1,732

)

 

 

(131

)

Changes in assets and liabilities:

 

 

 

(Increase) / decrease in:

 

 

 

Reinsurance recoverable

 

(96,794

)

 

 

98,839

 

Accounts receivable

 

(65,448

)

 

 

(51,666

)

Receivables from CMS

 

(44,721

)

 

 

(95,982

)

Other assets

 

(26,660

)

 

 

(26,512

)

Increase / (decrease) in:

 

 

 

Payables to CMS

 

3,365,194

 

 

 

1,127,430

 

Benefits payable

 

443,050

 

 

 

194,902

 

Accounts payable and other liabilities

 

20,408

 

 

 

103,024

 

Unearned premiums

 

1,302

 

 

 

(4,900

)

Reinsurance payable

 

(1,016

)

 

 

(27,966

)

Net cash provided by operating activities

 

4,711,325

 

 

 

1,387,609

 

Cash Flows from Investing Activities:

 

 

 

Sale of investments

 

983,943

 

 

 

15,761

 

Maturity and paydowns of investments

 

553,943

 

 

 

267,419

 

Change in restricted deposits

 

606

 

 

 

526

 

Purchase of investments

 

(4,942,801

)

 

 

(607,838

)

Purchase of property, equipment, and capitalized software

 

(20,556

)

 

 

(18,303

)

Net cash used in investing activities

 

(3,424,865

)

 

 

(342,435

)

Cash Flows from Financing Activities:

 

 

 

Proceeds from exercise of stock options and stock purchase agreement

 

29,904

 

 

 

29,295

 

Tax payments related to net settlement of share-based awards

 

(11,920

)

 

 

(2,289

)

Payments of debt issuance costs

 

(4,919

)

 

 

 

Earn-out Liability Payout

 

(3,370

)

 

 

 

Net cash provided by financing activities

 

9,695

 

 

 

27,006

 

Increase in cash, cash equivalents and restricted cash equivalents

 

1,296,155

 

 

 

1,072,180

 

Cash, cash equivalents, restricted cash and cash equivalents—beginning of period

 

2,804,123

 

 

 

1,551,118

 

Cash, cash equivalents, restricted cash and cash equivalents—end of period

 

4,100,278

 

 

 

2,623,298

 

Cash and cash equivalents

 

4,075,612

 

 

 

2,598,942

 

Restricted cash and cash equivalents included in restricted deposits

 

24,666

 

 

 

24,356

 

Total cash, cash equivalents and restricted cash and cash equivalents

$

4,100,278

 

 

$

2,623,298

 

Supplemental Disclosures:

 

 

 

Interest payments

$

6,000

 

 

$

11,360

 

Income tax payments

$

1,107

 

 

$

15,478

 

Key Operating and Non-GAAP Financial Metrics

We regularly review the following key operating and Non-GAAP financial metrics, to evaluate our business, measure our performance, identify trends in our business, prepare financial projections, and make strategic decisions. We believe these operational and financial measures are useful in evaluating our performance, in addition to our financial results prepared in accordance with GAAP.

Total Revenue

Total revenue includes premium revenue (net of risk adjustment transfers), investment income, and other revenues. We believe total revenue is an important metric to assess the growth of our business, as well as the earnings potential of our investment portfolio.

MLR

MLR is a metric used to calculate medical expenses as a percentage of net premiums before ceded quota share reinsurance. The impact of the federal risk adjustment program is included in the denominator of our MLR. We believe MLR is an important metric to demonstrate the ratio of our costs to pay for healthcare of our members to the net premium before ceded quota share reinsurance.

 

Three Months Ended June 30,

 

Six Months Ended June 30,

(in thousands, except percentages)

 

2026

 

 

 

2025

 

 

 

2026

 

 

 

2025

 

Net claims before ceded quota share reinsurance (A)

$

3,794,445

 

 

$

2,552,973

 

 

$

7,024,302

 

 

$

4,812,624

 

Net premiums before ceded quota share reinsurance (B)

$

4,789,331

 

 

$

2,803,444

 

 

$

9,370,193

 

 

$

5,799,265

 

Medical Loss Ratio (A divided by B)

 

79.2

%

 

 

91.1

%

 

 

75.0

%

 

 

83.0

%

SG&A Expense Ratio

The SG&A expense ratio reflects the Company’s selling, general, and administrative expenses, as a percentage of total revenue (net of risk adjustment transfers). We believe the SG&A expense ratio is useful to evaluate our ability to manage our overall selling, general, and administrative cost base.

Earnings (Loss) from Operations

Earnings (loss) from operations is the Company’s total revenue less total operating expenses. We believe earnings (loss) from operations is an important primary metric for assessing operating performance.

Net Income (Loss) Attributable to Oscar Health, Inc.

Net income (loss) attributable to Oscar Health, Inc. is net earnings (loss) allocated to the Company after net income (loss) attributable to noncontrolling interests. It is a key indicator of the Company’s profitability and operational efficiency, allowing management to evaluate performance and make informed decisions on strategic planning, cost management, and resource allocation.

Adjusted EBITDA

Adjusted EBITDA is defined as Net income (loss) for the Company and its consolidated subsidiaries before interest expense, income tax expense (benefit), and depreciation and amortization, as further adjusted for stock-based compensation and other items that are considered unusual or not representative of underlying trends of our business, where applicable for the period presented. We present Adjusted EBITDA because we believe it is frequently used by securities analysts, investors, and other interested parties in the evaluation of companies in our industry. Adjusted EBITDA is a non-GAAP measure. Management believes that investors’ understanding of our performance is enhanced by including this non-GAAP financial measure as a reasonable basis for comparing our ongoing results of operations. We caution investors that amounts presented in accordance with our definition of Adjusted EBITDA may not be comparable to similar measures disclosed by our competitors, because not all companies and analysts calculate Adjusted EBITDA in the same manner.

By providing this non-GAAP financial measure, together with a reconciliation to the most comparable U.S. GAAP measure, Net income (loss), we believe we are enhancing investors’ understanding of our business and our results of operations, as well as assisting investors in evaluating how well we are executing our strategic initiatives. Adjusted EBITDA has limitations as an analytical tool, and should not be considered in isolation, or as an alternative to, or a substitute for, net income (loss) or other financial statement data presented in our Condensed Consolidated Financial Statements as indicators of financial performance.

 

Three Months Ended June 30,

 

Six Months Ended June 30,

(in thousands)

 

2026

 

 

2025

 

 

 

2026

 

 

2025

Net income (loss)

$

361,828

 

$

(228,491

)

 

$

1,040,851

 

$

47,015

Interest expense

 

4,709

 

 

5,847

 

 

 

10,092

 

 

11,841

Other expenses (income)

 

915

 

 

(2,794

)

 

 

844

 

 

124

Income tax expense (benefit)

 

21,183

 

 

(5,045

)

 

 

40,933

 

 

7,660

Earnings (loss) from operations

 

388,635

 

 

(230,483

)

 

 

1,092,720

 

 

66,640

Depreciation and amortization

 

6,060

 

 

6,970

 

 

 

13,078

 

 

13,700

Stock-based compensation (1)

 

20,654

 

 

24,109

 

 

 

36,623

 

 

49,084

Adjusted EBITDA

$

415,349

 

$

(199,404

)

 

$

1,142,421

 

$

129,424

(1) Represents non-cash expenses related to equity-based compensation programs, which vary from period to period depending on various factors including the timing, number, and the valuation of awards. Additionally, these expenses are reported net of any stock-based compensation that has been capitalized for software development costs.

Appendix

Supplemental Financial Information

Premium

The Company records premium revenue net of premiums for reinsurance contracts accounted for under reinsurance accounting. The following table reconciles total reinsurance premiums ceded and reinsurance premiums assumed, which are included as components of total premium revenue in the Condensed Consolidated Statements of Operations:

 

Three Months Ended June 30,

 

Six Months Ended June 30,

(in thousands)

 

2026

 

 

 

2025

 

 

 

2026

 

 

 

2025

 

Direct policy premiums

$

5,666,469

 

 

$

3,482,764

 

 

$

11,696,744

 

 

$

6,832,435

 

Risk adjustment transfers

 

(871,470

)

 

 

(692,245

)

 

 

(2,314,281

)

 

 

(1,065,994

)

Reinsurance premiums ceded

 

(4,989

)

 

 

(2,690

)

 

 

(10,607

)

 

 

(5,232

)

Assumed premiums (1)

 

(679

)

 

 

15,615

 

 

 

(1,663

)

 

 

38,056

 

Premium

$

4,789,331

 

 

$

2,803,444

 

 

$

9,370,193

 

 

$

5,799,265

 

(1) The Company did not renew the Cigna+Oscar Small Group arrangement with Cigna Health and Life Insurance Company after its initial term ended on December 31, 2024. Following termination, the Company has been providing transition and run-off services, and will continue to provide such services through December 31, 2026. The Company also continues to share in premiums and claims for plans sold or issued prior to December 15, 2024.

Medical Expenses

The Company records medical expenses net of reinsurance recoveries for reinsurance contracts accounted for under reinsurance accounting. The following table reconciles total medical expenses to the amount presented in the Condensed Consolidated Statements of Operations:

 

Three Months Ended June 30,

 

Six Months Ended June 30,

(in thousands)

 

2026

 

 

 

2025

 

 

 

2026

 

 

 

2025

 

Direct claims incurred

$

3,872,861

 

 

$

2,562,117

 

 

$

7,166,698

 

 

$

4,830,401

 

Ceded reinsurance claims

 

(78,390

)

 

 

(22,203

)

 

 

(141,074

)

 

 

(53,215

)

Assumed reinsurance claims

 

(26

)

 

 

13,059

 

 

 

(1,322

)

 

 

35,438

 

Medical expenses

$

3,794,445

 

 

$

2,552,973

 

 

$

7,024,302

 

 

$

4,812,624

 

Risk Adjustment

The risk adjustment programs in the markets the Company serves are administered federally by CMS and are designed to mitigate the potential impact of adverse selection and provide stability for health insurers. Under these programs, each plan is assigned a risk score based upon demographic information and current year claims information related to its members. Plans with lower than average risk scores generally pay into the pool, while plans with higher than average risk scores generally receive distributions. The following table provides a rollforward of the Company’s beginning and ending risk adjustment receivable and payable balances for the six months ended June 30, 2026 and 2025:

 

Six Months Ended June 30, 2026

 

Six Months Ended June 30, 2025

(in thousands)

Risk Adjustment Receivable

 

Risk Adjustment Payable

 

Net Risk Adjustment Payable

 

Risk Adjustment Receivable

 

Risk Adjustment Payable

 

Net Risk Adjustment Payable

Beginning balance (1)

$

56,066

 

$

2,587,700

 

 

$

2,531,634

 

 

$

64,779

 

 

$

1,558,341

 

$

1,493,562

Change in accrual:

 

 

 

 

 

 

 

 

 

 

 

Current year

$

27,970

 

$

2,401,634

 

 

$

2,373,664

 

 

$

33,303

 

 

$

1,021,779

 

$

988,476

Prior years (2)

 

11,719

 

 

(47,432

)

 

 

(59,151

)

 

 

(10,465

)

 

 

67,067

 

 

77,532

Change in accrual, net

$

39,689

 

$

2,354,202

 

 

$

2,314,513

 

 

$

22,838

 

 

$

1,088,846

 

$

1,066,008

Ending balance:

 

 

 

 

 

 

 

 

 

 

 

Current year

$

27,970

 

$

2,401,634

 

 

$

2,373,664

 

 

$

33,303

 

 

$

1,021,779

 

$

988,476

Prior years

 

67,785

 

 

2,540,268

 

 

 

2,472,483

 

 

 

54,314

 

 

 

1,625,408

 

 

1,571,094

Ending balance

$

95,755

 

$

4,941,902

 

 

$

4,846,147

 

 

$

87,617

 

 

$

2,647,187

 

$

2,559,570

(1) The table includes risk adjustment data validation (“RADV”) receivables and payables. The balance at the beginning of each year presented pertains to prior policy years.

(2) Includes immaterial payments for prior policy years.

 

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