Oscar Health, Inc. Q1 FY2026 earnings call

Mark Bertolini mentioned Oscar's strong first quarter results with year-over-year improvement across core metrics. The company has 3.2 million members, up 56% year-over-year. They are rapidly evolving technology and deploying AI use cases, launched new transparency tools like real-time drug pricing, scaled bilingual voice agents, launched ICRAx and the Lucy Health Marketplace. Oscar is shaping the individual market to meet modern workforce needs and reaffirmed full-year guidance.

Oscar Health reported revenue of $4.6 billion in the first quarter of 2026, an increase of 53% year-over-year. The SG&A ratio improved 60 basis points year-over-year to 15.2%. The medical loss ratio (MLR) improved 490 basis points year-over-year to 70.5%. Earnings from operations were $704 million, an increase of nearly two and a half times compared to the same period last year. Membership ended the quarter with approximately 3.2 million members, a 56% increase year-over-year.

Oscar is reaffirming its full-year 2026 guidance. Total revenues are expected to be in the range of $18.7 billion to $19 billion in 2026. MLR remains in the range of 82.4% to 83.4%. SG&A expense ratio guidance is unchanged at 15.8% to 16.3%. Earnings from operations are expected to be in the range of $250 to $450 million, with adjusted EBITDA roughly $115 million higher than earnings from operations.

Actual results may differ materially from forward-looking statements due to various factors including those discussed in the annual report on Form 10-K and quarterly report on Form 10-Q filed with the SEC. Risk adjustment and market morbidity are factors that could impact results. The company also faces risks related to market dynamics and competition in the individual market.

Q: Jessica Tassan asked about the behavior of members who fell off between 1Q and April 1st and accounting for their expenses.

A: Members who churned off had no unusual utilization patterns, and those who didn't pay had no claims covered.

Q: John Ransom asked about SG&A and membership in 2Q.

A: SG&A ratio likely to move sideways to slightly up, and 2Q started with 3 million paid members.

Q: Andrew Monk asked about risk adjustment transfer.

A: Higher now due to seasonally low claims and higher bronze mix, expected to moderate as claims normalize.

Q: Scott Fidel asked about key swing factors for 2026 EBITDA.

A: Largely weekly numbers and risk adjustment.

Q: Jonathan Young asked about risk adjustment and Lisi Health Marketplace.

A: Risk adjustment driven by claims experience, and Lisi's financial impact to be detailed in September.

Q: Raj Kumar asked about market level color.

A: Effectuation rates as expected.

Q: Craig Jones asked about member mix impact on risk adjustment payable.

A: Risk adjustment not entirely driven by metal mix but overall utilization.

Q: Justin Lake asked about growth in smaller states.

A: Early in the year, too early to get ahead of ourselves with not enough claims for big differentiation