Breaking Down Oscar Health, Inc. (OSCR) Financial Health: Key Insights for Investors

You're looking at Oscar Health, Inc. (OSCR) and seeing a paradox: massive top-line growth but a bottom line that's still deep in the red, and honestly, that's the right way to frame the investment question right now. The company's full-year 2025 guidance projects total revenue hitting the midpoint of an impressive $12.1 billion, which shows their tech-forward approach is defintely resonating and driving market share. But, the reality check is the reaffirmed full-year guidance for Loss from Operations, which sits at a roughly $250 million midpoint, and that's a direct result of the high Medical Loss Ratio (MLR)-the percentage of premium revenue spent on clinical services-which management expects to land around 86.5%. Here's the quick math: high medical costs are eating up the premium dollars, so the path to profitability, which they are targeting for 2026, hinges entirely on their ability to manage that MLR down. The growth story is solid, but the cost story is the one that matters now.

Revenue Analysis

You need to know if Oscar Health, Inc. (OSCR) can sustain its rapid expansion, and the answer is yes-for now. The company's revenue engine is firing on all cylinders, with management projecting a full-year 2025 total revenue between $12.0 billion and $12.2 billion. This top-line growth is a powerful signal, but you defintely need to understand where that money is coming from and what's driving the pace.

Understanding Oscar Health, Inc.'s Revenue Streams

The vast majority of Oscar Health, Inc.'s revenue comes from health insurance premiums, which is the money members pay for their coverage. This isn't a complex product mix; it's a high-growth, volume-based business. The primary driver is the Individual Market, specifically the Affordable Care Act (ACA) marketplaces. This market focus has been the core of their strategy, and it's where they are gaining significant market share.

The revenue is segmented by the type of plan, but the story is all about the individual consumer. Membership growth, which hit 1.8 million as of early 2025, is the direct precursor to premium revenue. Simply put, more members mean more premiums, and their tech-driven model is helping them acquire and retain those members better than competitors.

• Primary Source: Health insurance premiums from members.
• Key Segment: Individual Market (ACA marketplaces).
• Growth Driver: High membership acquisition and retention.

Year-over-Year Revenue Growth and Key Trends

The growth rate shows a company in aggressive expansion mode. Based on the 2024 total revenue of approximately $9.2 billion, the midpoint of the 2025 guidance at $12.1 billion implies a year-over-year revenue growth rate of roughly 31.5%. That's a massive jump, and it shows their disciplined pricing and geographic expansion are working. Here's the quick math on recent revenue history:

What this estimate hides is the strategic shift. The growth is fueled by membership, but the company is also making moves to diversify its offerings within the health insurance ecosystem. For example, they are launching a new Individual Coverage Health Reimbursement Arrangement (ICHRA) product and acquiring assets like an individual market brokerage and a direct enrollment technology platform. These are small changes now, but they signal a commitment to capturing more of the consumer journey, which could become a significant revenue stream later. You can find a deeper dive into the valuation and strategy in our full post, Breaking Down Oscar Health, Inc. (OSCR) Financial Health: Key Insights for Investors.

Profitability Metrics

You're looking at Oscar Health, Inc. (OSCR) to see if the growth story is finally translating into real profits. The short answer for the 2025 fiscal year is: not yet. The company is still in a high-growth, pre-profit phase, but the underlying operational efficiency is defintely showing significant improvement, even as their core business faces market-wide cost pressures.

For the full year 2025, Oscar Health, Inc. is guiding to a substantial operating loss and a negative net profit margin, but the focus should be on the gross margin and expense control. Here's the quick math based on the reaffirmed guidance, which projects total revenue between $12.0 billion and $12.2 billion.

Gross Profit and Operational Efficiency

In the health insurance world, your gross profit is determined by the Medical Loss Ratio (MLR), which is the percentage of premium revenue paid out in medical claims. The lower the MLR, the higher your gross profit margin. For 2025, Oscar Health, Inc. anticipates an MLR between 86.0% and 87.0%.

This means their projected Gross Profit Margin is a tight 13.0% to 14.0%. This is your first critical number. This margin is what's left to cover all administrative, technology, and selling costs. The company is managing this cost base well, projecting a Selling, General, and Administrative (SG&A) expense ratio between 17.1% and 17.6%.

• Gross Profit Margin: 13.5% (Midpoint)
• Medical Loss Ratio (MLR): 86.5% (Midpoint)
• SG&A Ratio: 17.35% (Midpoint)

Operating and Net Profit Margins

When you look at the bottom line, the company still expects a loss. Oscar Health, Inc. forecasts a full-year Loss from Operations between $200 million and $300 million. This translates to an Operating Profit Margin of approximately -2.07% (based on the $12.1 billion revenue midpoint and $250 million loss midpoint). The Net Profit Margin will be slightly worse, as the Net Loss is typically higher than the Operating Loss due to interest and taxes. For example, in the third quarter of 2025, the Net Loss was $137.45 million, compared to a Loss from Operations of $129.25 million.

Here's a snapshot of the full-year 2025 profitability outlook:

Industry Comparison and Trends

To be fair, the entire health insurance sector is facing headwinds. The average MLR for the Individual segment across the industry was already high at 86.7% in the second quarter of 2025. Oscar Health, Inc.'s projected MLR of 86.5% is right in line with the current market reality, which is a significant improvement from their earlier years when their MLR was often higher than peers.

Still, the large, established players are profitable. The unweighted average Net Profit Margin for four major public health insurers was 5.3% in the first quarter of 2025. Oscar Health, Inc.'s negative margin shows the cost of their high-growth strategy and the challenge of scaling a tech-forward insurer. The good news is the trend: management is confident in achieving profitability in 2026, driven by disciplined pricing for 2026 plans and continued operational efficiencies. They are doing a great job on cost management, with the SG&A ratio improving year-over-year.

This efficiency focus is critical. You can dive deeper into the forces driving their valuation in Exploring Oscar Health, Inc. (OSCR) Investor Profile: Who's Buying and Why?. The key takeaway is that the current story is about the path to profit, not the presence of profit.

Next Action: Model a 2026 scenario where the MLR hits 85.0% and the SG&A ratio hits 16.0% to test the management's profitability target.

Debt vs. Equity Structure

You're looking at Oscar Health, Inc. (OSCR)'s balance sheet to understand how they fund their operations and growth, and the Debt-to-Equity (D/E) ratio is the first place to start. The good news is that Oscar Health, Inc. is not overly reliant on debt, but the structure is changing quickly. As of September 2025, the company's D/E ratio stood at 0.67. That means for every dollar of equity-the money shareholders have invested-the company has 67 cents of debt. To be fair, this is only slightly higher than the average for the Life & Health Insurance industry, which is around 0.6264. That's a manageable level of financial leverage.

Here's the quick math on their financing mix as of the third quarter of 2025. Their balance sheet is relatively clean on the short-term side, but the long-term debt is the key figure.

• Short-Term Debt: $0 Million
• Long-Term Debt: $686 Million
• Total Stockholders Equity: $1,024 Million

The company is defintely balancing its funding needs, but the recent activity shows a strategic shift toward using convertible debt (a type of loan that can be turned into stock) to fuel expansion.

Recent Financing Activity and Strategy

In September 2025, Oscar Health, Inc. priced a significant private offering of 2.25% convertible senior subordinated notes due 2030, raising $355 Million. This is a smart move because convertible notes offer a lower interest rate than traditional debt, and they give the company flexibility. They are using the net proceeds, estimated at about $342.5 Million, for general corporate purposes, including strategic AI-driven initiatives and growth opportunities. They also spent approximately $29.8 Million on capped call transactions, which is a financial tool to help offset potential share dilution if the notes are converted into stock later.

This debt issuance is a clear signal that Oscar Health, Inc. is willing to take on low-cost debt to accelerate growth and technology investments while trying to manage the risk of diluting current shareholder value. The immediate impact of this issuance is reflected in the higher D/E ratio compared to the 0.22 reported earlier in March 2025.

The company is also actively managing its existing debt and equity mix. For example, in early November 2025, Oscar Health, Inc. executed a partial settlement of its 2031 Convertible Senior Notes. Approximately $187.5 Million in principal amount of notes were exchanged for about 23.3 million shares of Class A common stock. This action shows a willingness to swap debt for equity, which reduces future interest payments and strengthens the balance sheet, even if it slightly increases the share count. This kind of active management is exactly what you want to see.

Here is a snapshot of the key components and a look at the D/E ratio's recent movement:

What this estimate hides is the potential future dilution from the convertible notes. If the stock price rises significantly, those notes will convert, turning debt into equity but increasing the total number of shares outstanding. If you want a deeper dive into the company's financial trajectory, you can read the full post: Breaking Down Oscar Health, Inc. (OSCR) Financial Health: Key Insights for Investors.

Next Step: Portfolio Manager: Model the impact of a full conversion of the 2030 notes on the share count and earnings per share by the end of Q1 2026.

Liquidity and Solvency

You're looking at Oscar Health, Inc. (OSCR)'s ability to cover its near-term bills, and honestly, the picture is a mixed bag. The company's liquidity ratios for the 2025 fiscal year suggest a tight short-term position, but this is significantly buffered by a substantial cash reserve. Liquidity is tight, but solvency is not an immediate crisis.

The core liquidity metrics, the Current Ratio and Quick Ratio (acid-test ratio), are both sitting below the critical 1.0 mark as of November 2025. Specifically, the Current Ratio, which measures current assets against current liabilities, is approximately 0.92. The Quick Ratio, which excludes less liquid assets like inventory (not a major factor for a health insurer), is also around 0.92. A ratio below 1.0 means that, on paper, current liabilities exceed current assets. This is defintely a yellow flag.

Here's the quick math on what that means for working capital (Current Assets minus Current Liabilities): a ratio of 0.92 implies a negative working capital position. You have less than a dollar of liquid assets for every dollar of short-term debt. This trend is a reversal from previous years, and it means the company relies on cash flow generation or its existing cash stockpile to meet obligations, rather than a healthy buffer of net current assets. For a high-growth insurer, this isn't uncommon, but it increases operational risk.

The cash flow statement for 2025 shows the real stress point: operating cash flow (OCF). For the full 2025 fiscal year, Oscar Health, Inc. reported a negative operating cash flow of approximately $-964.66 million. This is a dramatic drop from the prior year's positive OCF and signals that core business activities are consuming cash, not generating it. This is the primary liquidity concern you should focus on.

The other cash flow sections tell a story of capital management:

• Operating Cash Flow: A significant outflow of $-964.66 million for FY 2025, driven partly by higher-than-expected claims and a $130 million increase in the risk adjustment payable in Q3 2025.
• Investing Cash Flow: This is generally an outflow as the company invests. In Q1 2025, Oscar Health, Inc. had a net cash outflow from investing activities, primarily for the purchase of investments, which is standard for an insurer managing its float.
• Financing Cash Flow: This section often reflects debt and equity movements. The company is actively managing its capital structure, including actions like the partial settlement of its 2031 Convertible Senior Notes.

The saving grace and key strength here is the company's substantial cash position. As of Q3 2025, the insurance subsidiaries alone held approximately $1.2 billion of capital in surplus, including $564 million of excess capital, which provides a significant buffer against the negative operating cash flow. This cash acts as an emergency liquidity valve, but it's not a sustainable long-term solution. The company needs to turn that operating cash flow positive, and fast, to prove the long-term viability of its model. You can read more about this in Breaking Down Oscar Health, Inc. (OSCR) Financial Health: Key Insights for Investors.

The key takeaway is that the current liquidity ratios are a warning sign, but the significant cash on the balance sheet provides a temporary safety net. Finance: Model a 12-month cash burn rate based on the 2025 OCF to determine the runway by the end of the month.

Valuation Analysis

Based on current financial metrics and market sentiment as of November 2025, Oscar Health, Inc. (OSCR) appears to be overvalued relative to its core profitability, despite a compelling growth story. The market is pricing in significant future success, but the negative earnings and consensus analyst rating of 'Reduce' suggest the stock is trading above its near-term fundamental value.

You're looking for a clear signal, and honestly, the valuation ratios are flashing a warning sign. The company's focus on market share and growth is clear, but that comes with a high price tag for investors today. Here's the quick math on why.

Key Valuation Multiples: The Unprofitable Picture

When a company isn't profitable, traditional valuation tools like the Price-to-Earnings (P/E) ratio break down. Oscar Health, Inc. is in this camp, with a 2025 estimated P/E ratio of -11.3x, which is negative because the company is still reporting losses. This immediately flags it as a growth-at-all-costs play, not a value investment.

Still, we can look at other multiples:

• Price-to-Book (P/B): The estimated P/B ratio for 2025 is around 3.78x. This multiple is high for a health insurer, suggesting the market values the company at nearly four times its net asset value.
• Enterprise Value-to-EBITDA (EV/EBITDA): This metric is also negative, reported at approximately -27.95 as of October 2025. A negative EV/EBITDA ratio happens when the company has negative earnings before interest, taxes, depreciation, and amortization (EBITDA), which Oscar Health, Inc. did, reporting an Adjusted EBITDA loss of $101.5 million in Q3 2025. This is a defintely a clear sign of unprofitability.

What this estimate hides is the market's bet on the company's technology platform, +Oscar, and its long-term potential in the individual health insurance market, which is why the stock price is where it is despite the losses. For a deeper dive, you can check out the full analysis at Breaking Down Oscar Health, Inc. (OSCR) Financial Health: Key Insights for Investors.

Stock Trends and Analyst Consensus

The stock price trends over the last 12 months show significant volatility. The 52-week range for Oscar Health, Inc. has been between a low of $11.20 and a high of $23.80. Trading around the $14.00 mark in mid-November 2025, the stock is much closer to its 52-week low than its high, reflecting recent market skepticism following Q3 2025 earnings.

Wall Street analysts are not bullish right now. The consensus rating is a 'Reduce' or 'Moderate Sell,' with a mix of Hold and Sell ratings dominating the landscape. The average 12-month price target is approximately $13.14, which implies a slight downside from the current trading price. You should be cautious when the average price target is below the current market price; it means most professionals see a correction coming.

Dividend Policy

As a growth-focused company, Oscar Health, Inc. does not currently pay a dividend. The dividend yield is 0.00% and the payout ratio is 0.00%. This is standard for a business prioritizing reinvestment of capital back into operations and expansion, especially one still on the path to consistent profitability.

Actionable Insight: Next Step

If you're holding Oscar Health, Inc. stock, Finance should draft a scenario analysis that models the impact of a 15% reduction in the current stock price, aligning with the implied downside from recent analyst targets, to stress-test your portfolio's risk exposure by the end of the week.

Risk Factors

You're looking at Oscar Health, Inc. (OSCR) and seeing strong revenue growth, but the real question is whether they can translate that top-line expansion into sustainable profit. The short answer is: they haven't yet, and the path is full of near-term risks that are simply a reality of the Affordable Care Act (ACA) marketplace.

The core challenge is a high Medical Loss Ratio (MLR), which is the percentage of premium revenue spent on medical claims. For the $\mathbf{2025}$ fiscal year, Oscar Health, Inc. projects its MLR to be between $\mathbf{86.0\%}$ and $\mathbf{87.0\%}$. That's a thin margin, and it's why the company is guiding for a loss from operations between $\mathbf{\$200 \text{ million}}$ and $\mathbf{\$300 \text{ million}}$ for the full year. Honestly, they are still burning cash to grow.

Operational and Financial Risks: The Cost of Care

The biggest internal risk is the inability to accurately price their plans to cover the high cost of care for their members. The company's third-quarter $\mathbf{2025}$ results showed a net loss of $\mathbf{\$137.45 \text{ million}}$, a significant widening from the prior year. This is largely due to what the company calls increased market morbidity-meaning a higher proportion of sicker individuals entering their risk pool.

Here's the quick math on the operational pressure. In the third quarter of $\mathbf{2025}$, the loss from operations was $\mathbf{\$129 \text{ million}}$, which is about $\mathbf{2.6}$ times the loss reported in the same quarter last year. This points to a glaring inefficiency in their cost structure that needs swift correction. Still, their total revenue guidance for $\mathbf{2025}$ is strong, ranging from $\mathbf{\$12.0 \text{ billion}}$ to $\mathbf{\$12.2 \text{ billion}}$.

• High MLR: $\mathbf{86.0\%}$ to $\mathbf{87.0\%}$ for FY $\mathbf{2025}$.
• Operating Loss: $\mathbf{\$200 \text{ million}}$ to $\mathbf{\$300 \text{ million}}$ projected for FY $\mathbf{2025}$.
• Claims Volatility: Unexpected spikes in member utilization and acuity.

External and Regulatory Headwinds

The external environment is defintely a source of major risk, primarily due to the dependence on federal policy. The most critical near-term threat is the potential expiration of enhanced ACA subsidies at the end of $\mathbf{2025}$. If these subsidies lapse, millions of Americans could lose access to affordable coverage, which would not only shrink Oscar Health, Inc.'s potential member base but also shift the remaining risk pool toward higher-cost individuals.

Plus, the healthcare plans industry is intensely competitive, with established players having massive scale advantages. The company's stock volatility, indicated by a high beta of $\mathbf{2.79}$, tells you that investors are very sensitive to any news about regulatory changes or claims trends.

Mitigation and Actionable Strategy

To combat these risks, Oscar Health, Inc. is taking clear, aggressive actions. Their primary mitigation strategy is disciplined pricing. For the $\mathbf{2026}$ enrollment cycle, the company plans to resubmit rate filings in states covering approximately $\mathbf{98\%}$ of its current membership to better reflect the higher market risk scores. They are also planning a weighted average rate increase of about $\mathbf{28\%}$ in some markets to address elevated morbidity.

Strategically, they are shifting focus toward the higher-margin Individual Coverage Health Reimbursement Arrangement (ICHRA) business. This is an important pivot to diversify away from the most volatile parts of the ACA market. You can read more about their long-term focus here: Mission Statement, Vision, & Core Values of Oscar Health, Inc. (OSCR).

Growth Opportunities

You're looking at Oscar Health, Inc. (OSCR) and seeing a high-growth insurer that's still dealing with red ink, but the path to profitability is clearer now. The direct takeaway is this: Oscar Health is successfully driving massive top-line growth through technology and market expansion, but investors need to watch its ability to manage the higher-acuity risk pool in the Affordable Care Act (ACA) Marketplace.

For the full fiscal year 2025, the company has reaffirmed a total revenue projection in the range of $12.0 billion to $12.2 billion, a significant increase that underscores strong market share gains. This growth, however, comes with a revised full-year Loss from Operations projected between ($300 million) and ($200 million), reflecting higher-than-anticipated medical costs from the ACA market. The good news is management is targeting a return to profitability in 2026, which is the real inflection point to watch.

Key Growth Drivers and Product Innovation

Oscar Health's growth engine isn't just selling more policies; it's built on a technology-first model that drives both customer acquisition and operational efficiency. The proprietary +Oscar platform is the core competitive advantage, allowing for a more streamlined, lower-cost administrative structure.

• AI-Driven Efficiency: AI tools and Virtual Urgent Care have cut member response times by 90%.
• Operational Discipline: The Selling, General & Administrative (SG&A) expense ratio is expected to be between 17.1% and 17.6% for 2025, which is a sign of solid cost control.
• Targeted Plans: Condition-specific plans, like those for diabetes, have shown they can reduce costs by 25% or more by guiding members to better care pathways.

Honestly, the technology stack is what separates them from legacy insurers. It's defintely a key differentiator.

Market Expansion and Strategic Partnerships

The company is not sitting still on market share. For 2025, Oscar Health expanded its presence to 504 counties across 18 states, broadening its reach in the individual and small group markets. Also, they are making smart, culturally-aware moves, like launching Buena Salud, a Spanish-first solution tailored for Hispanic and Latino members.

The biggest strategic pivot, and a major future growth driver, is the move into the employer market through Individual Coverage Health Reimbursement Arrangements (ICHRA). This new channel creates a direct bridge between their individual market expertise and the enormous employer-sponsored coverage space. A concrete example of this strategy is the partnership with Hy-Vee, Inc., a Midwest-based grocery and pharmacy chain. This retail-integrated ICHRA plan aims to deliver 20-30% cost savings for employers and has the potential to unlock more than $10 billion in new revenue over time.

2025 Financial Outlook & Path to Profitability

Here's the quick math on the revised 2025 guidance. The company's Medical Loss Ratio (MLR), which is the percentage of premium revenue spent on medical claims, is now expected to be between 86.0% and 87.0%. This is up because the ACA Marketplace risk pool is getting sicker (higher average market morbidity), but Oscar Health is taking corrective actions. They are already resubmitting 2026 rate filings for states covering nearly all current membership to reflect this higher acuity, which is a clear action to ensure future pricing is accurate.

The table below summarizes the key financial metrics for the full 2025 fiscal year, based on the latest guidance. What this estimate hides is the operational leverage that comes with scaling the tech platform, which should help them achieve their 2026 profitability target.

To understand the core philosophy driving these strategic moves, you should review Mission Statement, Vision, & Core Values of Oscar Health, Inc. (OSCR).

Next Step: Finance should model the impact of a $12.1 billion revenue midpoint with an 86.5% MLR to stress-test the 2026 profitability target by the end of the month.