Oscar Health (OSCR) investor relations material

Utilization and membership trends

• Utilization trends moderated through Q2 and into Q3, nearly returning to expected risk levels.

• Membership loss from dual enrollment and FTR populations was modest and had a neutral to slightly positive impact on market morbidity.

• Member months are expected to be higher in the second half of the year, supporting revenue guidance.

• Membership by year-end will be modestly below Q2 levels, but overall member months will increase.

Medical loss ratio (MLR) and cost management

• MLR is expected to rise in Q3 and Q4, with seasonality resembling 2023 more than 2024.

• Less SEP pressure is anticipated in the second half due to the end of continuous SEP for certain income levels.

• Guidance includes expectations for increased Q4 utilization due to potential subsidy expirations, but the impact is expected to be limited.

• Affordability initiatives and resource reallocation have helped offset elevated utilization, with a focus on fraud, waste, and abuse controls.

Pricing, regulatory, and market positioning

• 2026 pricing incorporates high-end trend expectations, potential subsidy expirations, and program integrity effects.

• Risks are stacked in pricing rather than precisely overlapped, providing visibility into changing factors.

• States with significant Medicaid redetermination are likely to see higher price increases.

• Enhanced subsidies are assumed to expire, but extension would be financially positive.

• Market positioning is balanced between competitiveness and profitability, with some markets expected to gain share as competitors exit.