Oscar Health’s fourth quarter results drew a positive market response, despite revenue and earnings missing Wall Street expectations. Management attributed the miss to higher claims costs and increased risk adjustment payables, which reflected broader shifts in the Affordable Care Act (ACA) market. CEO Mark Bertolini cited the influx of Medicaid members and industry-wide changes in market morbidity as primary drivers, emphasizing that the company’s disciplined pricing and operational efficiency, including expanded AI deployment, helped offset some of these external headwinds. Bertolini stated, "Oscar embraced the change and positioned the company for strong top line growth and margin expansions in 2026."
Is now the time to buy OSCR? Find out in our full research report (it’s free for active Edge members).
Oscar Health (OSCR) Q4 CY2025 Highlights:
- Revenue: $2.81 billion vs analyst estimates of $3.12 billion (17.3% year-on-year growth, 10.2% miss)
- Adjusted EPS: -$1.24 vs analyst expectations of -$0.92 (34.6% miss)
- Adjusted EBITDA: -$307.8 million (-11% margin, 173% year-on-year decline)
- Operating Margin: -11.9%, down from -6.2% in the same quarter last year
- Market Capitalization: $3.99 billion
While we enjoy listening to the management's commentary, our favorite part of earnings calls are the analyst questions. Those are unscripted and can often highlight topics that management teams would rather avoid or topics where the answer is complicated. Here is what has caught our attention.
Our Top 5 Analyst Questions From Oscar Health’s Q4 Earnings Call
- Joshua Raskin (Nephron Research) asked about membership quality and risk adjustment assumptions. CFO Richard Blackley explained the use of third-party clinical data to improve risk forecasting and noted that increased market share may reduce volatility, but full visibility remains a challenge.
- Jessica Tassan (Piper Sandler) inquired about utilization trends and market contraction. Blackley clarified Q4 care pull-forward effects and noted that most utilization increases were linked to members losing subsidies, with limited carryover expected into 2026.
- Jonathan Yong (UBS) questioned the impact of the shift from silver to bronze and gold plans. Blackley confirmed that bronze has historically performed well for Oscar and expects the new mix to generate comparable margins, although higher deductibles may increase churn.
- John Ransom (Raymond James) probed broker-driven enrollment and passive member retention. CEO Mark Bertolini stated that 90% to 95% of members enroll through brokers, and highlighted uncertainty around coverage retention for members facing higher out-of-pocket costs post-subsidy.
- Michael Hall (Baird) asked about transparency and reform in risk adjustment. Blackley discussed ongoing collaboration with industry partners to improve reporting and market insight, but admitted that external market trends remain difficult to forecast precisely.
Catalysts in Upcoming Quarters
In the coming quarters, the StockStory team will be monitoring (1) the stability of paid membership following the expiration of enhanced premium tax credits, (2) the effectiveness of new product launches in sustaining member growth and retention, and (3) progress in AI-driven operational efficiency as a lever for margin improvement. Additional focus will be given to the company’s ability to manage risk adjustment volatility and adapt to evolving ACA market dynamics.
Oscar Health currently trades at $13.55, up from $12.66 just before the earnings. Is the company at an inflection point that warrants a buy or sell? Find out in our full research report (it’s free).
Our Favorite Stocks Right Now
The market’s up big this year - but there’s a catch. Just 4 stocks account for half the S&P 500’s entire gain. That kind of concentration makes investors nervous, and for good reason. While everyone piles into the same crowded names, smart investors are hunting quality where no one’s looking - and paying a fraction of the price. Check out the high-quality names we’ve flagged in our Top 5 Growth Stocks for this month. This is a curated list of our High Quality stocks that have generated a market-beating return of 244% over the last five years (as of June 30, 2025).
Stocks that have made our list include now familiar names such as Nvidia (+1,326% between June 2020 and June 2025) as well as under-the-radar businesses like the once-small-cap company Comfort Systems (+782% five-year return). Find your next big winner with StockStory today.
