$OSCR Path to Recovery and Leading Indicators to Watch Ahead
As OSCR is closing in on a 52 week high, its been a painful ride so far and the question has always been are finally out of the consolidation phase and out of the subsidy overhang and unexpected market morbidity that messed up the sector in H2 last year.
I was trying to reconcile and see see how the path might look like for OSCR for rest of 2026, I want to provide a quick glance on what happened, what OSCR did to navigate this and what are the leading indicators that we can observe to see if we are finally out consolidation and overhang to realize the true value of business and valuation it deserves.
1) What Happened in the Broader Health Insurance Industry (Especially for Oscar) in H2 2025
After the big Medicaid redeterminations wrapped up in 2024, a lot of healthier folks dropped coverage or stayed out of the ACA individual market, while higher-acuity people shifted in from Medicaid. That messed up the risk pools across the industry.For Oscar it hit pretty hard in the back half of the year:Q2 2025 MLR jumped to 91.1% (from 79.0% the year before).
Net risk adjustment payable shot up by $316 million.
Full-year 2025 MLR came in at 87.4% (vs 81.7% in 2024).
Ended up with an operating loss of $396.4 million even though revenue grew to $11.7 billion.
Pretty much the whole industry saw higher MLRs and bigger risk adjustment outflows because of the worsening morbidity.
2) What the 2025 Wakely Report Said
Wakely’s July 2025 “2025 Individual Market Risk Pool Considerations” (plus the later updates) laid it out clearly. Demographic-normalized relative risk scores rose more than 8% compared to 2023/2024 levels, with jumps as high as 11.6% in non-expansion FFE states. They tied it straight back to the Medicaid redetermination inflows. That report basically confirmed exactly why everyone, including Oscar, was seeing the MLR pressure in the second half of 2025.
3) What $OSCR Did to Navigate It
Oscar didn’t just sit there. They resubmitted 2026 rate filings in states covering ~98% of their membership to properly account for the higher market risk scores. They doubled down on disciplined pricing, pushed more affordable Bronze options, leaned on their broker tools and tech platform for retention and acquisition, and kept tight control on utilization and costs. Solid moves that set them up much better heading into 2026.
4) Recent Conference Call: Favorable Early Signs and Waiting on Wakely
Management said the market contraction is tracking in line to favorable versus their 20–30% estimate, and claims plus third-party data are showing market morbidity in line to favorable with their pricing. They’re being conservative on risk adjustment accruals (~24% of premiums vs a ~20% full-year target) and specifically mentioned waiting for more Wakely clarity.Q1 2026 results looked strong:Revenue up 53% YoY to about $4.6 billion.
MLR improved big-time to 70.5% (490 bps better YoY), helped by pricing, the Bronze/new-member seasonality, and $68 million in favorable prior-period development.
5) Leading indicators to watch for
The upcoming 2026 Wakely report on enrollment, payments, and morbidity trends is the big one to watch. If it confirms stable or lighter-than-feared market morbidity, better risk adjustment dynamics, and member mix that lines up with Oscar’s assumptions, it should de-risk the year and open the door to upside.
Oscar has reaffirmed full-year 2026 guidance: Revenue $18.7–19.0 billion, MLR 82.4–83.4%, and operating earnings $250–450 million. Tailwinds from continued membership/share gains in a smaller but stabilizing market, already-baked rate increases, normalizing risk adjustment, and SG&A leverage should help drive that.
As I compile this post, I was reminded of the below reply from
@mtbert to one of the questions around the earnings call, when mark was replying to puzzles which shows, why they are able to navigate this better than what all the analysts could think off.
@investingwithac @obfuscated_id @degeninvestor7 @Couch_Investor @TheRonnieVShow @dannycheng2022 @sheslee would love to hear your thoughts as I try out my first shot at long post, hope to keep sharing more !!