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Premium growth narrows Oscar Health’s year-over-year losses 9{f771d91d784324d4be731abc64bffe0d1fd8f26504ceb311bcfd8e5b001778f4} in Q1

Oscar Health’s net loss narrowed 9{f771d91d784324d4be731abc64bffe0d1fd8f26504ceb311bcfd8e5b001778f4} year-over-year, with an increase in policy premium revenue squeezing the New York City-based insurtech’s losses to $87.3 million during the first quarter of 2021.

During the first quarter ended March 31, Oscar generated $369.3 million in revenue, up 319{f771d91d784324d4be731abc64bffe0d1fd8f26504ceb311bcfd8e5b001778f4} from $88.1 million during the same period last year. Much of the revenue was driven by policy premium growth, which increased 44{f771d91d784324d4be731abc64bffe0d1fd8f26504ceb311bcfd8e5b001778f4} year-over-year to $823 million. The company credited the growth to an increase in membership, and a decline in reliance on reinsurance.

During the call, CEO Mario Schlosser said the company was on a path to achieve profitability by 2023. The pandemic’s disruption of care delivery models, combined with a heightened interest in risk-bearing relationships, would be key for helping the company grow going forward, he said.

“Post-pandemic, you’ve got the shift to virtual delivery of care, but you’ve also got the shift towards a more value-based care, more risk-taking,” Schlosser said. “Obviously, this is starting in government business, Medicare Advantage, but I think it’s making its way more and more into the commercial business as well.”

Membership grew to 542,220, up nearly 29{f771d91d784324d4be731abc64bffe0d1fd8f26504ceb311bcfd8e5b001778f4} from 420,552 during the same time in 2020. Medicare Advantage enrollees more than doubled year-over-year to 3,628, and the startup’s new Cigna+Oscar partnership also counted nearly 3,600 beneficiaries since the start of the year. The lion’s share of the company’s membership continues to lie in individual and small group, however, with total enrollees in this sector coming to about 535,000.

Here are five things to know from the company’s first-quarter earning call:

1. Schlosser credited the ACA’s special enrollment period with helping add 50,000 new members during the first quarter, and he anticipates the advance premium tax credits will help grow membership even further going forward. Florida, Texas and California now represent the areas with the largest number of Oscar enrollees. So far, new members are not sicker than previously expected, and the company has not yet experienced adverse selection, he said. These members are also generally coming to Oscar directly, rather than through a broker, and are choosing the startup even though it does not often offer the cheapest plan in a market.

“In terms of the shift towards higher premium plans, that genuinely makes us think that it’s important to have a model where you deliver a great member experience, where people love model more than price,” Schlosser said.

2. After the company’s initial public offering in March, and increasing profitability, Oscar cut its reliance on reinsurance partners for the year, Chief Financial Officer Scott Blackley said. Reinsurers essentially take a portion of a member’s premium for assuming some of their risk. In 2020, Oscar passed on 77{f771d91d784324d4be731abc64bffe0d1fd8f26504ceb311bcfd8e5b001778f4} of its premiums to reinsurers; during the first quarter, the company ceded 44{f771d91d784324d4be731abc64bffe0d1fd8f26504ceb311bcfd8e5b001778f4} of policy premiums.

“We’re not saying that we won’t go back and use quota share, but I think in the near-term we’re comfortable having a lower percentage,” Blackley said. “I’d expect that we would dynamically manage that going forward.”

3. Oscar plans to start next year with at least 72,000 enrollees on its +Oscar insurance technology services business. In addition to including members from third-party customers, like Health First Health Plans and Cigna+Oscar, the company will also count its own members as customers on this platform, which represents a strategic departure from the partnership strategy outlined in its S-1. The company will count 37,000 new Medicare Advantage members through its partnership with Health First, and 20,000 individual market lives on this platform.

Schlosser added that the company has built provider-sponsored health plans with the Cleveland Clinic, ACHN in South Florida and Montefiore.

“The next phase of growth, for the +Oscar business, will come from arrangements with providers looking to be at-risk either through provider-sponsored health plans, or from dedicated payers, particularly in Medicare Advantage, individual and small employer,” Schlosser said.

4. Oscar has now scaled its virtual primary care product across 82 counties. When its members use the Oscar Medical Group providers on the platform, Schlosser said they are 10{f771d91d784324d4be731abc64bffe0d1fd8f26504ceb311bcfd8e5b001778f4} more likely to retain Oscar as their insurer, compared with those who did not use the digital program. The company incentivizes members to sign up for the virtual care program by offering them “dynamic discounts” on primary care services, and often free recommended secondary services, like lab tests.

5. The company’s medical loss ratio, or MLR, which measures how much of every dollar an insurer spends on its members’ care, came in at 74.4{f771d91d784324d4be731abc64bffe0d1fd8f26504ceb311bcfd8e5b001778f4}. Schlosser said he expected to end the year with an MLR closer to 80{f771d91d784324d4be731abc64bffe0d1fd8f26504ceb311bcfd8e5b001778f4}, as non-COVID-19 utilization picks up during the second half of 2021. Low utilization was offset by high COVID-19 costs that peaked in January, Schlosser said.


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