Oscar Health is expecting to operate at a loss in 2025 as costs climb in the individual market.
The company reported preliminary results for the second quarter of 2025 on July 22, expecting a loss from operations of $200 million to $300 million in 2025, according to a company news release.
In February, Oscar Health said it expected between $225 million and $275 million in net earnings in 2025.
The insurer said it received data from independent consulting firm Wakely indicating overall morbidity in the individual market had increased higher than expected. Earlier in July, Centene, another large individual ACA insurer, withdrew its earnings guidance, citing higher morbidity in the market.
Oscar expects a net loss of about $230 million in the second quarter. The insurer also expects a much higher medical loss ratio for 2025 than it predicted in February. According to the release, Oscar expects a full-year medical loss ratio of 86% to 87%, up from the 80.7% to 81.7% range it projected earlier in the year.
The company expects to resubmit rate requests in most markets to account for rising morbidity in the market, according to the report.
In 2026, ACA insurers are requesting the highest premium increases since 2018, according to KFF.
“We are taking appropriate pricing actions for 2026 that reflect higher acuity in the individual market, and we will continue to take steps to deliver for our members, partners and shareholders,” Oscar Health CEO Mark Bertolini said.
Several other insurers have pulled or cut their earnings guidance as medical costs continue to climb. In May, UnitedHealth Group suspended its 2025 outlook. Elevance Health cut its guidance in July, citing elevated costs in both the individual market and Medicaid.
