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Oscar Health (OSCR) investor relations material
Oscar Health Wells Fargo 20th Annual Healthcare Conference 2025 summary
Complete event summary combining all related documents: earnings call transcript, report, and slide presentation.
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.
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