Oscar Health Predicts Return to Profitability Despite $137 Million Third Quarter Loss

Oscar Health, one of the nation’s largest providers of individual coverage under the Affordable Care Act, reported a $137 million third-quarter loss but remains optimistic about its future profitability. The company, which has over 2 million health plan members, saw its total revenue increase by 23% to nearly $2.9 billion in the third quarter, with total membership up 28% to more than 2.1 million compared to the same period last year.

Despite the third-quarter loss of $137.5 million, Oscar Health is confident in its ability to achieve a positive net income next year by focusing on balancing membership and profitability. The company, like many other health insurers, has been grappling with higher costs and a challenging policy environment in Washington, leading to lower profit forecasts and plans to increase rates next year.

Oscar’s rate filings for 2026, covering close to 99% of its current membership, reflect elevated cost trends, higher market morbidity in 2025, the expiration of enhanced premium tax credits, and program integrity initiatives. The company believes that these adjustments will help it navigate the evolving healthcare landscape and position itself for future growth.

Looking ahead, Oscar sees an opportunity to gain market share as other insurers exit the market. With companies like CVS Health’s Aetna pulling out of Obamacare and UnitedHealth Group’s UnitedHealthcare scaling back in certain markets, Oscar’s CEO, Mark Bertolini, sees a chance to capture a larger share of the individual market.

“The individual market aligns with major macroeconomic, workforce, and consumer trends. More Americans work in the service economy than ever before,” Bertolini said in a statement. “More businesses want affordable benefit options. More people want greater choice. Oscar is ahead of the demand and we are creating the future of individual healthcare for all Americans.”