Oscar Health, Inc. (OSCR): History, Ownership, Mission, How It Works & Makes Money

Oscar Health, Inc. (OSCR) is a tech-driven insurer, but can a company that projects $12.0 billion to $12.2 billion in 2025 revenue still be considered a disruptor, or is it just another major player navigating the Affordable Care Act (ACA) marketplace? You see the massive top-line growth-membership hit 2.1 million by the end of Q3 2025-but you also know the challenge: they reported a $137.5 million net loss in that same quarter, largely due to a high Medical Loss Ratio (MLR) of 88.5%. Honestly, their story is the perfect case study in how the promise of healthtech meets the reality of insurance costs, so understanding their history, ownership, and how they defintely make money is critical for your investment thesis.

Oscar Health, Inc. (OSCR) History

You're looking for the foundational story behind Oscar Health, Inc., the tech-driven insurer that emerged from the Affordable Care Act (ACA) marketplace. The direct takeaway is that Oscar Health was born in 2012 out of frustration with complex healthcare, and after years of massive venture funding and losses, the company finally achieved its first full year of net income profitability in 2024, setting the stage for significant revenue growth to an expected $11.2 billion to $11.3 billion in 2025.

Oscar Health, Inc.'s Founding Timeline

Year established

The company was established in 2012, capitalizing on the new market dynamics created by the Affordable Care Act.

Original location

Oscar Health was originally based in New York City, where it also launched its first health plans.

Founding team members

The founding team included three Harvard Business School classmates: Mario Schlosser, Josh Kushner, and Kevin Nazemi.

Initial capital/funding

Initial capital included a $40 million Series A funding round in 2012, led by General Catalyst Partners. Total funding raised before its IPO reached over $1.6 billion.

Oscar Health, Inc.'s Evolution Milestones

Oscar Health, Inc.'s Transformative Moments

The company's history is a story of a tech startup trying to become a profitable insurer, and a few key decisions truly changed its trajectory. The first major shift was the realization that technology alone wasn't enough; you also needed disciplined underwriting and cost management.

The appointment of former Aetna CEO Mark Bertolini as CEO in March 2023 was a massive, transformative moment. His leadership immediately focused the company on achieving profitability, which they hit in 2024 with a full-year net income of $25.4 million. That's a huge psychological and financial win after years of losses.

Another game-changer is the strategic focus on the ACA marketplace, which continues to see strong enrollment. This led to a projected full-year 2025 revenue guidance of $11.2 billion to $11.3 billion, with expected earnings from operations between $225 million and $275 million. Here's the quick math: that revenue guidance is a nearly 23% jump from the $9.1 billion in revenue reported for 2024.

The 2025 product launches show a clear, data-driven strategy to capture specific, high-growth segments. They are defintely not sitting still.

• Launched 'Buena Salud,' a Spanish-first health insurance plan, recognizing that nearly one-third of their members are Hispanic or Latino.
• Introduced a multi-condition plan for members with diabetes, pulmonary, and cardiovascular diseases, aiming to lower costs by 25% or more for managing these common chronic conditions.
• Expanded its footprint to offer individual plans in 504 markets across 18 states in 2025, ensuring continued membership growth.

You can see the direct result of this focus on the balance sheet. For a deeper dive into the numbers, check out Breaking Down Oscar Health, Inc. (OSCR) Financial Health: Key Insights for Investors.

Oscar Health, Inc. (OSCR) Ownership Structure

Oscar Health, Inc. is a publicly traded healthcare technology company, meaning its ownership is distributed among a mix of institutional, insider, and retail investors, with major financial institutions holding the largest stake and influencing its strategic direction.

Oscar Health, Inc.'s Current Status

The company is publicly traded on the New York Stock Exchange (NYSE) under the ticker symbol OSCR, having completed its Initial Public Offering (IPO) in March 2021. This public status subjects the company to rigorous reporting and transparency requirements from the Securities and Exchange Commission (SEC), which is crucial for you, the investor, to track its performance.

For the full-year 2025, Oscar Health's financial guidance projects total revenue to be in the range of $12.0 billion to $12.2 billion, reflecting a strong top-line growth story. However, the company is still navigating its path to consistent profitability, expecting an operating loss between $200 million and $300 million for the fiscal year 2025. You need to watch those medical loss ratio (MLR) trends closely; they are guiding for an MLR of 86.0% to 87.0% for 2025.

You can find a deeper dive into the company's long-term strategy and foundational principles here: Mission Statement, Vision, & Core Values of Oscar Health, Inc. (OSCR).

Oscar Health, Inc.'s Ownership Breakdown

As of November 2025, the majority of the company's shares are held by institutional investors, which is typical for a growth-stage public company. This concentration means large firms like BlackRock, Inc. and Vanguard Group Inc. hold significant voting power. Here's the quick math on who controls the float:

Institutional ownership is high, which defintely adds a layer of stability, but it also means that a sudden shift in sentiment from a few major funds can create volatility, so keep an eye on those 13F filings.

Oscar Health, Inc.'s Leadership

The company is steered by a seasoned executive team that blends co-founder vision with deep industry experience, a necessary mix for navigating the complex US healthcare system.

• Mark Bertolini, Chief Executive Officer (CEO): Appointed in April 2023, Bertolini brings significant gravitas, having previously served as Chairman and CEO of Aetna Inc. His focus is on driving the company toward profitability and leveraging the technology platform.
• Mario Schlosser, Co-Founder & President of Technology: As a co-founder, Schlosser previously served as CEO and now leads the product and engineering teams, focusing on the core technology platform and the +Oscar business segment.
• R. Scott Blackley, Chief Financial Officer (CFO): Blackley oversees treasury, financial reporting, and investor relations, bringing a focus on capital management and financial discipline.

The average tenure for the management team is around 4.4 years, suggesting a relatively experienced and cohesive leadership group guiding the company's strategy. Co-founder Joshua Kushner also remains highly involved as the Vice Chairman of the Board of Directors.

Oscar Health, Inc. (OSCR) Mission and Values

Oscar Health, Inc.'s core purpose transcends simply selling health plans; it's about using technology to fundamentally simplify a complex, frustrating healthcare system for consumers. The company's cultural DNA is rooted in making a healthier life both accessible and affordable for everyone, which is a massive challenge in the US market.

Oscar Health, Inc.'s Core Purpose

You need to know what drives a company beyond its quarterly earnings, and for Oscar Health, Inc., that's their mission to be a consumer-centric disruptor. This focus is why, even while projecting a full-year 2025 Loss from Operations midpoint of roughly $250 million, they are still aggressively growing their top line, aiming for a Total Revenue of up to $12.2 billion.

Official mission statement

Oscar Health, Inc.'s official mission is a straightforward promise to its members and the broader market, reflecting its founding principle of dismantling complexity.

• Make a healthier life accessible and affordable for all.
• Simplify a traditionally complex and frustrating healthcare system.
• Empower members with the tools and information needed to make informed health decisions.

This isn't just corporate jargon; it's a strategic mandate that guides their product design, like offering $0 virtual primary and urgent care on most plans.

Vision statement

While Oscar Health, Inc. doesn't publish a single, rigid vision statement, their actions and communications clearly map out a future state where they are a leader in a transformed healthcare landscape. Their vision is a patient-centric system where technology is the main driver.

• Create a consumer-centric, technology-driven healthcare system.
• Leverage data and innovation to provide more efficient, affordable, and personalized care.
• Disrupt traditional healthcare models by prioritizing user-friendly experiences.

To be fair, this vision is why they've expanded their reach in 2025 into 504 counties across 18 states, pushing for market share even with an expected Medical Loss Ratio around 86.5%. That's a defintely high-growth, high-stakes strategy. You can see how this strategy impacts their bottom line in Breaking Down Oscar Health, Inc. (OSCR) Financial Health: Key Insights for Investors.

Oscar Health, Inc. slogan/tagline

The company's taglines capture their core value proposition in plain English, focusing on clarity and innovation in a sector notorious for opacity.

• Healthcare that makes sense.
• Smarter healthcare.
• Oscar is a new kind of health insurance company.

The message is simple: they want to be the easy button for health insurance. By Q2 2025, they had grown to more than 2 million members, which suggests that 'easy' is resonating with consumers. Finance: monitor MLR trends for Q4 2025 to check cost management against the growth strategy.

Oscar Health, Inc. (OSCR) How It Works

Oscar Health, Inc. operates as a technology-driven health insurer, fundamentally simplifying the complex process of finding and using health coverage by leveraging a proprietary full-stack technology platform to manage everything from enrollment to care navigation. The company makes money primarily by collecting premiums from its members, aiming to keep medical costs (claims) lower than premium revenue through disciplined pricing and technology-guided care, despite facing a projected full-year 2025 net loss between $200 million and $300 million from operations due to market morbidity trends.

Oscar Health, Inc.'s Product/Service Portfolio

The company's offerings are built around a consumer-first philosophy, targeting markets often underserved by traditional, less technologically agile insurers. Their strategy is to offer highly specific, affordable plans while also diversifying revenue by licensing their core technology.

Oscar Health, Inc.'s Operational Framework

Oscar Health, Inc.'s operational framework centers on its proprietary 'full-stack' technology platform, which integrates all core insurance functions-from pricing and claims processing to member engagement-into a single system. This is where they create value, by making the process more efficient and personalized than traditional insurers. You can see more about their core beliefs in the Mission Statement, Vision, & Core Values of Oscar Health, Inc. (OSCR).

Here's the quick math: their technology helps them drive down the Selling, General, and Administrative (SG&A) expense ratio, which was 17.3% for the first nine months of 2025, down from 19.0% in the prior year period. That's a clear efficiency gain.

• AI-Powered Member Navigation: They use an AI agent named Oswell, powered by OpenAI, to give members instant, on-demand support for questions about medications, test results, and plan benefits, reducing the need for costly human-led service calls.
• Concierge Care Teams: Each member is assigned a dedicated Care Team (a nurse and a care guide) who proactively manage care, helping members find in-network doctors and coordinating complex care, which is a major driver of member satisfaction and retention.
• Data-Driven Underwriting: The platform ingests vast amounts of data to price plans more accurately than competitors, a critical function given the full-year 2025 Medical Loss Ratio (MLR) guidance of 86.0% to 87.0%, indicating a tight margin between premiums and medical claims.
• Virtual-First Integration: They have offered virtual urgent care since 2014, making it a core part of their offering to quickly address low-acuity issues and potentially reduce expensive emergency room (ER) visits-some AI-powered tools have reduced ER visits by 20%.

Oscar Health, Inc.'s Strategic Advantages

Oscar Health, Inc.'s competitive edge isn't just about being a health insurer; it's about being a technology company that sells health insurance. They are defintely a tech-forward disruptor.

• Full-Stack Technology Moat: Licensing their technology via +Oscar creates a dual-revenue model, but more importantly, it validates their platform as a core operational system for other healthcare entities, reinforcing its value and scalability.
• First-Mover Advantage in ICHRA: Oscar Health, Inc. is strategically focused on the Individual Coverage Health Reimbursement Arrangement (ICHRA) market, leveraging their digital infrastructure to offer a customizable, cost-effective alternative to traditional group plans, positioning them to outpace rivals like Centene.
• Rapid Geographic Expansion: For 2025, the company expanded into 504 markets across 18 states, demonstrating a scalable model that can quickly enter new regions and compete on price and plan design, often being among the lowest or second lowest in price in 30% of their markets for Silver plans.
• Superior Member Engagement: Their mobile app boasts a 66 Net Promoter Score (NPS), which is high for the healthcare industry, indicating strong user-centric design that helps drive retention and reduces churn risk in the volatile ACA market.

Oscar Health, Inc. (OSCR) How It Makes Money

Oscar Health primarily makes money by collecting insurance premiums from its members, which are individuals and small groups purchasing plans largely through the Affordable Care Act (ACA) marketplaces.

This premium revenue, net of risk adjustment transfers, constitutes nearly all of the company's income, while a small but growing portion comes from investment income and its technology platform, +Oscar, which licenses its administrative and clinical services to other health plans.

Oscar Health's Revenue Breakdown

To understand Oscar Health's financial engine, you have to look at the latest numbers. Here's the quick math based on the Q3 2025 results, which put total revenue at approximately $3.0 billion for the quarter.

The vast majority, 97.92%, comes from Premium Revenue, which grew significantly year-over-year in Q3 2025, driven by a 28% increase in total membership to 2.1 million members.

Business Economics

For a health insurer, the core business economics boil down to two ratios: the Medical Loss Ratio (MLR) and the Selling, General, and Administrative (SG&A) expense ratio. The MLR is the most critical number here; it tells you how much of the premium dollar is spent on actual medical care for members.

• Medical Loss Ratio (MLR): For Q3 2025, Oscar Health reported an MLR of 88.5%, an increase from 84.6% in the prior year. This jump is a key near-term risk, largely attributed to higher average market morbidity (sicker members) entering the ACA marketplace. The full-year 2025 guidance pegs the MLR lower, between 86.0% and 87.0%.
• Administrative Efficiency (SG&A): The SG&A expense ratio improved to 17.5% in Q3 2025, down from 19.0% a year ago. This is a direct benefit of fixed cost leverage-more members sharing the same technology platform and administrative base. That's the tech-driven model working.
• Pricing Strategy: Management has taken 'disciplined pricing actions' for the 2026 plan year, including a weighted average rate increase of approximately 28% across its markets to offset the elevated medical cost trend and higher market morbidity observed in 2025. This is a necessary, albeit aggressive, step to ensure pricing matches risk.
• +Oscar Platform: The 'Other Revenues' stream, while small at 0.30% of total revenue, represents the +Oscar technology business. This is the long-term growth opportunity, licensing Oscar Health's full-stack technology to other payers and providers. It's a low-margin revenue stream now, but it diversifies the business model away from pure insurance risk.

The entire model hinges on maintaining an MLR below 100% and driving the SG&A ratio down further to achieve a sustainable operating margin. You can read more about their long-term goals here: Mission Statement, Vision, & Core Values of Oscar Health, Inc. (OSCR).

Oscar Health's Financial Performance

While revenue growth is strong, the company is still navigating a challenging market environment, which is reflected in its bottom line for 2025.

• Total Revenue Forecast: Oscar Health reaffirmed its full-year 2025 revenue guidance, expecting to land between $12.0 billion and $12.2 billion. This top-line growth is defintely robust.
• Operating Loss: The full-year 2025 guidance projects a Loss from Operations between $200 million and $300 million. This is a significant revision from earlier expectations and is primarily due to the higher-than-expected medical costs and risk adjustment transfers.
• Q3 2025 Net Loss: The net loss attributable to Oscar Health, Inc. for Q3 2025 was $137.5 million, widening from a loss of $54.6 million a year prior. Here's the quick math: the operational loss for the quarter was $129.3 million.
• Path to Profitability: Despite the 2025 loss projections, management remains confident in achieving profitability in 2026, citing the ~28% rate increases for 2026 and targeted administrative cost cuts of approximately $60 million.

The key takeaway is that Oscar Health is a high-growth, high-revenue company that is still working to translate scale into consistent profitability in a volatile, highly regulated market. The next few quarters will show if those aggressive 2026 pricing actions stick.

Oscar Health, Inc. (OSCR) Market Position & Future Outlook

Oscar Health is navigating a challenging transition in 2025, moving from a pure growth-at-any-cost model to a disciplined focus on underwriting profitability, even as the Affordable Care Act (ACA) Marketplace faces structural headwinds. The company has successfully scaled its membership to approximately 2 million members, but its revised full-year 2025 guidance projects a Loss from Operations of between ($200 million) and ($300 million) due to higher-than-expected medical costs. Your immediate focus should be on their ability to execute the planned cost reductions and 2026 pricing actions to stabilize the Medical Loss Ratio (MLR).

Competitive Landscape

Oscar's competition is fierce and dominated by giants who benefit from massive scale and diversification across government and commercial markets. Oscar's primary battleground is the ACA Marketplace, where it competes directly with Centene Corporation and the individual plan offerings of the larger insurers. Here's the quick math: with a record 24.3 million people enrolled in the ACA Marketplace for 2025, Oscar's 2 million members give it an approximate 8.2% share of its core market.

Opportunities & Challenges

The biggest opportunity is proving the tech-enabled model can deliver lower costs, but the biggest risk is regulatory uncertainty. The ACA Marketplace is defintely a high-growth area, but it's also a high-volatility one right now.

Industry Position

Oscar Health is fundamentally a technology company that sells health insurance, which is its core differentiator. While it is a minor player in the overall U.S. health insurance market, it has carved out a significant, high-growth niche in the Individual & Family Plan segment of the ACA Marketplace. The company's 2025 strategy centers on aggressive pricing adjustments for the 2026 plan year, coupled with a goal of achieving $60 million in administrative cost reductions to improve its SG&A ratio. This is a pivot to profitability, not just growth. The company is actively expanding its geographic footprint, offering plans in 504 counties across 18 states in 2025. This is a critical year for execution; the market is waiting to see if its technology advantage can finally translate into sustainable underwriting profits, a goal management is targeting for 2026. For a deeper dive into who is betting on this turnaround, you should read Exploring Oscar Health, Inc. (OSCR) Investor Profile: Who's Buying and Why?

• Focus on disciplined pricing: Resubmitting 2026 rates to reflect the higher medical acuity in the individual market.
• Technology-driven efficiency: The +Oscar platform continues to drive lower SG&A expenses compared to peers.
• Financial stability: Management is guiding for total revenue between $12.0 billion and $12.2 billion for the full year 2025.