Oscar Health Sets Record Membership and Projects Return to Profitability in 2026

2025 Brought Record Membership but Operational Challenges Remained

Oscar Health closed 2025 with approximately 3.4 million members, the highest in the company’s history. This expanding member base fueled revenues, which surged from $9.2 billion in 2024 to $11.7 billion in 2025—a 27% year-over-year increase. Growth was driven by new affordable product offerings, fresh technology features, and a focus on customer experience. However, higher market morbidity (reflecting costlier healthcare needs across the population) and greater claims utilization weighed on Oscar’s bottom line.

Claims and Expenses Outpaced Revenues, Driving 2025 Losses

Though the top line grew, Oscar’s 2025 metrics reflect mounting cost pressures. The medical loss ratio (MLR) rose to 87.4% in 2025 from 81.7% in 2024, highlighting that more of each dollar earned was spent on member healthcare services. Operating expenses also increased, leading to a $396.36 million loss from operations for the year. Net loss widened sharply to $443.15 million, compared to a net income of $25.43 million in 2024. Adjusted EBITDA—a non-GAAP measure tracking core profitability—swung to a loss of $279.81 million after a $199.23 million gain the prior year.

*Year-end 2025 total is for combined offerings; 2024 number approximated from Individual & Small Group and Cigna+Oscar figures.

Expense Management Showed Positive Signals Despite Heavy Losses

While losses deepened, Oscar made headway reducing its selling, general, and administrative (SG&A) expense ratio to 17.5% from 19.1%—showing improved cost discipline amid scale. This improvement reflects better fixed cost absorption and effective cost controls, even as administrative spending rose in absolute terms.

Strong Membership Gains Powered Revenue — But Profitability Lags

Total membership in Oscar’s Individual and Small Group offerings jumped to 2.04 million from 1.68 million as the Cigna+Oscar small group partnership ended. The member increase directly contributed to higher revenues, but spikes in average medical claims continued to dilute profit margins. Management cited "higher average market morbidity" and "higher utilization that was not fully offset by risk adjustment" as principal factors driving up the MLR and dampening financial performance.

2026 Outlook: Turning the Corner with Massive Revenue and Profit Projections

Looking ahead, Oscar forecasts substantial improvement. The company’s 2026 guidance calls for revenues of $18.7 to $19.0 billion—up more than 60% from 2025—and, crucially, positive earnings from operations in the $250–$450 million range. The MLR is expected to moderate to 82.4–83.4%, and SG&A expense ratio to dip further to 15.8–16.3%. These projections, if achieved, would mark Oscar’s return to operating profitability after a challenging period.

Liquidity Enhanced by $475 Million Credit Facility

In February 2026, Oscar Health secured a new three-year, $475 million revolving credit facility. Management described this step as "opportunistic," noting that the facility was well supported by major banks and arranged on favorable terms. The additional liquidity should allow Oscar to meet near-term capital needs and support further growth and operational investments.

Takeaway: Can Oscar Deliver on Its Profitability Pivot?

Oscar’s 2025 set a high-water mark for membership and revenue, but also underscored persistent challenges containing claims costs. The company’s aim to transition from heavy losses to material operating profits in 2026 depends on keeping utilization in check and delivering on risk management. Investors and analysts will be closely watching how the membership base evolves, how the medical loss ratio responds to new product and underwriting strategies, and whether Oscar can sustain growth while achieving the targeted profitability inflection point. With new credit facility backing and ambitious 2026 goals, the spotlight is on execution in the coming quarters.

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