Oscar Health Guides $750M Improvement and 82.4%–83.4% MLR Target for 2026
Oscar Health reported Q4 EPS of -$1.24, missed estimates by 35%, and saw its medical loss ratio rise to 95.4% while membership reached 3.4 million. The company guides a $750 million year-over-year operational earnings improvement in 2026, targeting $250–$450 million profit alongside an 82.4%–83.4% loss ratio.
1. Q4 2025 Financial Misses and Stock Reaction
Oscar Health posted a fourth-quarter EPS of -$1.24, missing the consensus estimate of -$0.92 by nearly 35%. The medical loss ratio climbed to 95.4% from 88.1% year-over-year, membership grew to 3.4 million and shares rose 9.6% following the results.
2. 2026 Profitability Outlook
Management projects a $750 million improvement in operating earnings for 2026, shifting from a $396 million loss in 2025 to a targeted $250–$450 million gain. The company plans to reduce its medical loss ratio to 82.4%–83.4% next year to drive profitability.
3. Operational Efficiency and Pricing Levers
Oscar Health is leveraging agentic AI to cut care response times by 67% and Oswell bots now resolve 86% of member inquiries with high accuracy. The company also implemented a 28% average rate increase for 2026 and expects to gain market share after CVS Health exits the ACA exchange market.