Key Takeaways
- Oscar Health forecasts strong revenue of $12.1 billion for 2025, significantly above consensus, but projects an adjusted EBITDA loss of $130 million against expectations of a profit.
- The profitability miss is primarily driven by a higher-than-expected Medical Loss Ratio (MLR) of 86%-87%, indicating rising medical costs and increased member utilisation.
- While the company’s technology-driven model has attracted a growing member base, it has not yet proven effective at controlling claims costs at scale.
- Despite the projected loss, Oscar maintains a solid cash position of $2.3 billion, providing a buffer to recalibrate pricing and operations for 2026.
The latest financial guidance from Oscar Health ($OSCR) for the full year 2025 paints a complex picture: robust revenue growth paired with a significant shortfall in profitability. The company projects total revenue of $12.1 billion for 2025, surpassing consensus estimates by a notable margin. However, an anticipated adjusted EBITDA loss of $130 million, against expectations of a $151 million profit, signals underlying pressures in the form of elevated medical costs and utilisation rates. This divergence between top-line success and bottom-line struggles warrants a closer examination of the health insurer’s operational dynamics and the broader industry context.
Revenue Growth: A Bright Spot in a Competitive Sector
For the full year 2025, Oscar Health’s revenue forecast of $12.1 billion reflects a substantial increase over the $9.2 billion reported for 2024, representing a year-on-year growth of approximately 31.5%. This figure aligns with the company’s historical trajectory of aggressive expansion, driven by its technology-centric approach to member engagement and a growing membership base, which stood at approximately 2 million as of March 31, 2025. The ability to exceed market expectations on revenue suggests that demand for Oscar’s individual and family plans remains strong, even in a highly competitive health insurance landscape dominated by larger incumbents.
However, revenue alone does not tell the full story. The health insurance sector is notoriously sensitive to cost structures, and Oscar’s latest guidance indicates that topline gains are being eroded by operational inefficiencies. A projected medical loss ratio (MLR) of 86% to 87% for 2025, up from 81.7% in 2024, points to rising medical claims relative to premiums earned. This metric, a critical indicator of underwriting profitability, suggests that the company is grappling with higher-than-expected utilisation of healthcare services among its members, compounded by elevated risk scores that reflect a sicker or costlier member pool.
Profitability Pressures: Unpacking the EBITDA Miss
The stark reversal in adjusted EBITDA guidance, from an expected profit of $151 million to a loss of $130 million for 2025, underscores the challenges of balancing growth with profitability in a sector where margins are razor-thin. For context, Oscar achieved an adjusted EBITDA of $199.2 million in 2024, a milestone that marked its first year of profitability on this metric. The projected loss in 2025 represents a significant step backwards, driven primarily by the aforementioned increase in MLR. This raises questions about the sustainability of the company’s business model, particularly as it scales operations.
A deeper dive into the drivers of this loss reveals two key factors: higher utilisation rates and adverse risk score adjustments. Utilisation, or the frequency and intensity of healthcare service usage by members, appears to be outpacing the company’s actuarial assumptions. Meanwhile, risk scores, which are used to adjust premiums under government-sponsored programmes like the Affordable Care Act marketplace, indicate that Oscar’s member base may be skewing towards higher-cost individuals. These dynamics are not unique to Oscar; industry-wide trends in 2025 suggest that post-pandemic normalisation of healthcare demand, coupled with inflationary pressures on medical costs, are squeezing insurers across the board.
Strategic Implications and Industry Context
Oscar Health’s situation is emblematic of the broader tension within the insurtech space: the promise of technology-driven efficiency often collides with the messy realities of healthcare economics. The company’s proprietary platform, which focuses on steering members towards cost-effective care options, has been touted as a differentiator. Yet, the latest figures suggest that such innovations have not yet translated into consistent cost control at scale. It is worth noting that sentiment on platforms like X, including commentary from accounts such as StockSavvyShay, has highlighted the potential for Oscar’s routing engine to redefine claims management if scaled effectively. However, the current financial outlook indicates that this potential remains unrealised.
Looking at the competitive landscape, peers such as UnitedHealthcare and Centene are also navigating cost pressures in 2025, though their larger scale and diversified revenue streams provide a buffer that Oscar lacks. For instance, Centene recently revised its guidance downwards due to similar utilisation trends, though it still projects profitability for the year. Oscar, with its narrower focus on individual and family plans, appears more exposed to these headwinds.
Financial Snapshot: 2024 vs. 2025 Outlook
| Metric | FY 2024 (Actual) | FY 2025 (Guidance) |
|---|---|---|
| Revenue | $9.2 billion | $12.1 billion |
| Adjusted EBITDA | $199.2 million | ($130 million) |
| Medical Loss Ratio | 81.7% | 86%–87% |
Looking Ahead: Risks and Opportunities
Moving into the latter half of 2025, Oscar Health faces a critical juncture. The projected EBITDA loss, while concerning, does not necessarily signal a structural failure. Management has indicated plans to recalibrate pricing for 2026, which could mitigate some of the current cost pressures. Additionally, the company’s cash reserves, reported at $2.3 billion in unrestricted cash as of recent updates, provide a runway to weather short-term losses. However, sustained increases in utilisation or further deterioration in risk scores could exacerbate the situation, potentially necessitating capital raises or strategic pivots.
On the opportunity side, the revenue outperformance suggests that Oscar retains a strong value proposition for consumers, particularly in the individual market. If the company can leverage its technology platform to drive down claims costs over the long term, it may yet carve out a defensible niche. For now, though, the 2025 outlook serves as a sobering reminder that growth in healthcare insurance is rarely a straight line. The numbers speak for themselves, and they are not entirely flattering.
References
Biztoc. (2025). Oscar Health (NYSE:OSCR) revises 2025 outlook as medical costs climb. Retrieved from https://biztoc.com/x/285c4b4063be1252
Centene Corporation. (2025, July 10). Centene Reports Second Quarter 2025 Results and Updates Guidance [Press Release]. Retrieved from https://investors.centene.com/news/press-release-details/2025/Centene-Reports-Second-Quarter-2025-Results-and-Updates-Guidance/default.aspx
DirectorsTalk Interviews. (n.d.). Oscar Health, Inc. ($OSCR) Stock Analysis: Exploring a 30%+ Potential Upside Amid Strong Revenue Growth. Retrieved from https://directorstalkinterviews.com/oscar-health-inc-oscr-stock-analysis-exploring-a-30-potential-upside-amid-strong-revenue-growth/4121208480
Finimize. (n.d.). Oscar Health (OSCR) Snapshot. Retrieved from https://finimize.com/content/oscr-asset-snapshot
NASDAQ. (n.d.). Oscar Health, Inc. (OSCR) Earnings Date & History. Retrieved from https://www.nasdaq.com/market-activity/stocks/oscr/earnings
Oscar Health Inc. (2025, February 4). Oscar Health Announces Fourth Quarter and Full Year 2024 Results; Introduces Full Year 2025 Outlook [Press Release]. Retrieved from https://ir.hioscar.com/news-events-presentations/news-press-releases/news-details/2025/Oscar-Health-Announces-Fourth-Quarter-and-Full-Year-2024-Results-Introduces-Full-Year-2025-Outlook/default.aspx
Oscar Health Inc. (2025, July 18). Quarterly Financial Supplement Q2 2025. Retrieved from https://ir.hioscar.com/financial-information/quarterly-results
Oscar Health Inc. (n.d.). Investor Relations Overview. Retrieved from https://ir.hioscar.com/overview/default.aspx
Reporter.am. (2025, July 22). Critical Contrast: Oscar Health (NYSE:OSCR) And ACMat (OTCMKTS:ACMTA). Retrieved from https://reporter.am/2025/07/22/critical-contrast-oscar-health-nyseoscr-and-acmat-otcmktsacmta.html
StockSavvyShay [@StockSavvyShay]. (n.d.). [Post on X]. X. Retrieved from https://x.com/StockSavvyShay/status/1943667438434095275
StockSavvyShay [@StockSavvyShay]. (n.d.). [Post on X]. X. Retrieved from https://x.com/StockSavvyShay/status/1940338956492746818
StockSavvyShay [@StockSavvyShay]. (n.d.). [Post on X]. X. Retrieved from https://x.com/StockSavvyShay/status/1932893011320643793
StockSavvyShay [@StockSavvyShay]. (n.d.). [Post on X]. X. Retrieved from https://x.com/StockSavvyShay/status/1884539553060647149
StockSavvyShay [@StockSavvyShay]. (n.d.). [Post on X]. X. Retrieved from https://x.com/StockSavvyShay/status/1894494303764062391
StockTitan. (2025, July 22). Oscar Health Projects $230M Q2 Loss, Cuts 2025 Guidance on Rising Medical Costs. Retrieved from https://www.stocktitan.net/news/OSCR/oscar-health-announces-preliminary-financial-results-for-second-vw6hsd6emup3.html
Yahoo Finance. (2025, July 21). Oscar Health revises 2025 outlook as medical costs climb. Retrieved from https://finance.yahoo.com/news/oscar-health-revises-2025-guidance-medical-costs-152000169.html
Yahoo Finance. (n.d.). Oscar Health, Inc. (OSCR) Stock Price, News, Quote & History. Retrieved from https://finance.yahoo.com/quote/OSCR/
