Total Revenue

+67% (from $1,431,658 thousand in Q4 2023 to $2,392,436 thousand in Q4 2024)

Total Revenue grew dramatically driven by factors such as higher membership enrollments and rate increases, which built on previous period growth and suggest strengthened market positioning and effective pricing strategies. " " "

Operating Income (EBIT)

Deepened slightly from –$145,477 thousand to –$147,731 thousand

Operating losses marginally worsened, indicating that while revenue growth was substantial, higher operating costs and persistent margin pressures, compared to the prior period, partly offset the revenue improvements. " " "

Net Income

More negative from –$149,838 thousand to –$153,547 thousand

Net Income saw a marginal decline, reflecting that increased operating expenses or cost escalations outpaced the revenue gains, leading to further deterioration in profitability from the previous year. " " "

Earnings Per Share (Basic)

Improved modestly from –$0.67 to –$0.64

Basic EPS improved slightly as the reduction in per-share losses suggests that despite overall higher net losses, factors such as share dilution and effective cost management helped spread the loss over a larger share base. " " "

Net Change in Cash

Shifted to a positive increase of $585,486 thousand

Net Change in Cash reversed sharply from a steep cash outflow in Q3 2024 to a robust inflow in Q4 2024, mainly due to a turnaround in operating activities and improved financing results, notwithstanding heavy investing outflows. " "

Total Revenue

FY 2025

$9.2 billion to $9.3 billion "

$11.2 billion to $11.3 billion "

raised

Medical Loss Ratio

FY 2025

80.5% to 81.5% "

80.7% to 81.7% "

raised

SG&A Expense Ratio

FY 2025

19.4% to 19.6% "

17.6% to 18.1% "

lowered

Adjusted EBITDA

FY 2025

$160 million to $210 million "

$365 million to $415 million " "

raised

Net Income

FY 2025

net income profitability "

positive "

no change

Earnings from Operations

FY 2025

no prior guidance

$225 million to $275 million "

no prior guidance

Quota Share Reinsurance

FY 2025

no prior guidance

approximately 50% "

no prior guidance

SEP Membership Dynamics

Consistently discussed from Q1 through Q3 with emphasis on strong membership growth, initial MLR headwinds, risk adjustment nuances, and evolving plan selection dynamics. " " " " " " "

Q4 emphasized solid retention, noted that risk scores for SEP members will mature in 2025, and highlighted a shift in plan selection in certain populations. There is acknowledgement that SEP growth created a headwind for 2024 MLR but is expected to be a tailwind in 2025. " "

Recurring with a nuanced shift toward improved retention outlook and maturation of risk scores, positioning SEP members as a future advantage.

Medical Loss Ratio Trends and Challenges

Q1 highlighted robust MLR improvements driven by disciplined pricing and cost management " " " ; Q2 noted further improvement via favorable prior period development " " " ; Q3 described MLR headwinds from higher SEP membership and temporary COVID effects. " " "

Q4 noted a slight Q4 MLR increase driven by updated risk transfer payables and adjustments, but provided guidance for a 50 basis point improvement in 2025. " " "

Consistently monitored; recent period shows short-term pressure but maintains an optimistic outlook for improvement in 2025.

Disciplined Pricing Strategy and Margin Improvement

Q1 underscored disciplined pricing as a driver for reducing MLR and enhancing margins " " " ; Q3 noted a 6% average rate increase and stressed balancing competitiveness with profitability. " "

Q4 reinforced the strategy by highlighting margin gains, net income profitability, stable MLR, and improved SG&A ratios, bolstering confidence in achieving future operating margin targets. " " "

Consistently positive sentiment with evolving success in expanding profitability and margin improvements over time.

SG&A Efficiency Improvements and AI Deployment

Q1 reported significant SG&A ratio improvements (870bps drop to 18.4%) and introduced AI for risk adjustment and operational efficiencies " " " ; Q3 mentioned a 360bps SG&A improvement and anticipated further AI-driven cost reductions. " "

Q4 reported over 500bps improvement in SG&A (down to 19.1%) and detailed broader AI deployment in areas such as follow-up care and urgent care onboarding, reinforcing operational efficiency. " " "

Steady improvement with increasing integration of AI, indicating ongoing efficiency gains and technology-driven cost management.

Market and Geographic Expansion Opportunities

Q1 described robust membership growth and new product launches (e.g., Hola Oscar for Hispanic markets) " " ; Q2 focused on doubling market footprint and broad geographic coverage " " ; Q3 detailed expansion into new markets and product innovations (including ICRA initiatives). " "

Q4 emphasized strong market share gains in key states (Florida, Tennessee, Texas) and highlighted growth in ICRA membership across several markets, signaling broad geographic progress. "

Consistently positive and expanding, with a strategic focus on capturing larger market shares and exploring new geographies.

ACA Market Growth, Medicaid Redeterminations, and Subsidy Dependence

Q1 painted the ACA as a permanent, attractive option for diverse populations " ; Q2 expected 15% market growth aided by Medicaid redeterminations and enhanced subsidies " ; Q3 projected double-digit growth influenced by redeterminations and subsidy stability. " "

Q4 reported 37% membership growth (outpacing a 13% market rate), noted completion of Medicaid redeterminations reducing SEP additions, and discussed the impact of the file-to-reconcile process on subsidies. " "

Robust and growing, though recent commentary introduces caution regarding subsidy reconciliation and its potential impact, adding a layer of regulatory risk.

CMS Policy Impacts and Payment Integrity Initiatives

Q1 and Q2 had minimal discussion; Q3 introduced commentary on CMS policy tightening leading to potential downward pressure on growth and noted initial payment integrity initiatives. " "

Q4 provided detailed insights on the file-to-reconcile process, verification challenges, and the impact of rate changes on effectuated versus paying membership, with risks built into full-year revenue guidance. "

Increased focus in the current period, signaling growing concern over regulatory impacts and the need for tighter payment integrity and operational controls.

Risk Adjustment Payments and Risk Transfer Costs

Q1 mentioned that SEP membership would drive higher risk transfer costs and stressed reliance on internal estimates " " ; Q2 described risk adjustment remaining consistent (mid-teens percentage of premiums) with SEP impacting MLR " " ; Q3 discussed stable yet complex risk adjustment dynamics influenced by SEP and COVID factors. " "

Q4 indicated a similar risk transfer percentage with an increase in Q4 MLR due to updated risk adjustment payables, yet expects risk adjustments to remain largely consistent into 2025. " " "

Steady with mild fluctuations; recent periods show normalization expectations in risk scores and a stable outlook for risk adjustment payments.

Leadership and Executive Team Changes

Not mentioned in Q1, Q2, or Q3 earnings calls.

Q4 introduced a significant leadership change with the appointment of Janet Liang as President of Oscar Insurance, emphasizing her operational expertise and market growth background. "

Emerging new topic, reflecting strategic leadership reinforcement that could have a large impact on the company’s future performance.

Capital Generation for Organic Growth

Q2 and Q3 discussions highlighted a strong capital position with healthy cash and surplus, along with capital distributions from subsidiaries " " ; Q1 lacked focused discussion on this topic.

Q4 highlighted an even stronger balance sheet with $4 billion in cash and investments and significant capital and surplus in insurance subsidiaries, projecting adequate funding for 2025 organic growth with minimal reliance on parent cash. "

Continuously positive, with increasing strength in balance sheet support underscoring the company’s ability to fund future growth organically.

Emerging ICRA Opportunities

Q1 underscored ICHRA’s vast potential by accessing over 70 million lives " " ; Q2 detailed strategies focusing on small and mid-sized businesses and noted regulatory facilitators in states like Indiana and Texas " " ; Q3 reported modest membership enrollment (3,700 members) and efforts to position Oscar as a preferred carrier via ICRA. " "

Q4 reported emerging opportunities with notable ICRA membership growth across multiple markets, complemented by new services (convenience shop buy-and-enroll, personal care guides) to onboard employees, indicating a ramp-up in ICRA initiatives. "

Progressively expanding, suggesting a growing focus on ICRA as a vital future growth engine.

Exiting Non-Core Business Lines and Diversification Risks

Q1 discussed the strategic exit from Medicare Advantage and the Cigna + Oscar small group offering due to profitability and alignment issues, with a shift toward pursuing ICHRA opportunities. "

Q2, Q3, and Q4 earnings calls did not mention exiting non-core business lines or diversification risks.

No longer mentioned, indicating that the strategic exits have been completed or are no longer a focal point in current discussions.