Oscar Health, Inc. (OSCR) SEC Filings & Earnings Calls

Regulatory risk from ACA program integrity changes

“As of July 1, 2026, there were approximately 250 thousand to 300 thousand members who we expect will be retroactively disenrolled in connection with CMS program integrity requirements or fraud, waste and abuse laws and regulations.” · word for word

Risk adjustment estimation uncertainty

“Our risk transfer estimates are subject to a high degree of estimation and variability, and are affected by the relative risk of our members, and in the case of the ACA, that of other insurers.” · word for word

No significant new risks identified; prior period reserve development may not recur.

“Favorable prior period reserve development of $164M contributed to MLR improvement; may not be sustainable.”

No new risks identified; reaffirmation suggests no material change.

“No new risk factors disclosed.”

Key technology leader moves to advisory role; potential loss of technical leadership.

“transition from President of Technology and Chief Technology Officer to Co-Founder & Advisor”

ACA Subsidy Expiration and Regulatory Tightening

“We expect that the expiration of the eAPTCs, and the implementation of the Program Integrity Rules and the OBBBA could continue to negatively impact the size of the Health Insurance Marketplaces and our membership in future years.” · word for word

Risk Adjustment Estimation Uncertainty

“Our risk transfer estimates are subject to a high degree of estimation and variability, and are affected by the relative risk of our members, and in the case of the ACA, that of other insurers.” · word for word

Favorable prior period reserve development of $68M in Q1 2026 vs $31M unfavorable in Q1 2025; reserve development can be volatile.

“The Company had $68 million of favorable development in the first quarter of 2026 compared to $31 million of unfavorable development in the first quarter of 2025.” · word for word

Market morbidity headwind

“The industry-wide increase in market morbidity, driven by factors such as Medicaid lives entering the market and program integrity initiatives, was a significant headwind throughout the year” · word for word

Regulatory uncertainty in ACA marketplace

“current dynamics in the Patient Protection and Affordable Care Act ('ACA') marketplace, including the regulatory environment, present considerable challenges in setting reliable three-year financial targets” · word for word

APTC Fraud Investigation

“On February 9, 2026, we received a subpoena from the Congressional Committee on the Judiciary requesting certain documents in connection with their examination of potential APTC fraud in the Health Insurance Marketplace.” · word for word

Profitability Uncertainty

“we did not achieve profitability in 2025, and we may not be able to do so again in the future.” · word for word

Regulatory Dependency

“Because we rely on the Health Insurance Marketplaces, any significant changes to the ACA, or other changes in state or federal healthcare law and regulation, could materially and adversely impact our business, financial condition, and results of operations.” · word for word

Credit agreement includes standard representations and warranties; no material adverse change clause.

“Section 3.06. No Material Adverse Change” · word for word

CEO retention risk mitigated by extended contract and enhanced compensation

“A&R Employment Agreement extends term to April 2029 with automatic renewal, increased base salary and bonus, and $45M equity grant.”

Risk adjustment estimation uncertainty

“Our risk transfer estimates are subject to a high degree of estimation and variability, and are affected by the relative risk of our members, and in the case of ACA, that of other insurers.” · word for word

Enhanced APTC expiration risk

“If Congress does not take action, the enhanced APTCs will expire at the end of 2025. If the enhanced APTCs are not renewed, insurance coverage could become unaffordable for certain individuals.” · word for word

Tariff impact on medical costs

“If such tariffs are imposed, the potential impact could include, among other things, higher costs for medical providers and facilities, higher pharmaceutical prices, higher costs of medical devices, and supplies and shortages of certain medicines and medical supplies.” · word for word

Medical loss ratio increase due to higher risk adjustment transfers may persist.

“MLR 88.5% vs 84.6% YoY; $130M net risk adjustment accrual.”

Cigna+Oscar partnership decline indicates channel risk.

“Cigna+Oscar members dropped from 51,291 to 5,168 YoY.”

Net loss widening despite revenue growth; path to profitability uncertain.

“Net loss $(137.5)M vs $(54.6)M YoY.”