Oscar Health expects between 250,000 and 300,000 of its marketplace members to be retroactively disenrolled in connection with CMS program integrity initiatives and fraud, waste and abuse enforcement, the insurer disclosed Aug. 7.
The expected disenrollments represent roughly 8% to 10% of Oscar’s total membership, which stood at approximately 2.96 million as of June 30. The company has added nearly 1 million members over the past year alone.
Oscar said during its Aug. 6 second quarter earnings call that monthly membership churn, previously expected to land around 1% to 2%, will likely be closer to twice that rate in the second half of 2026 as CMS eligibility reviews accelerate. CEO Mark Bertolini said the company is actively reviewing the file it received from CMS.
“There are a number of cases where we know that people were authorized appropriately,” he said on the earnings call. “There are a number of cases where we’ve actually had contact with people. So [CMS’] list was based on a set of assumptions that they went through on the file. The actual result will depend on our ability to go through those files.”
Mr. Bertolini added that any financial impact from disenrollments is already reflected in the company’s full-year guidance, which includes revenue of $18.7 billion to $19 billion and earnings from operations of $500 million to $700 million.
The disclosure comes amid a broader federal push to root out improper ACA enrollments. CMS has estimated that as many as 5.6 million individuals were improperly enrolled in marketplace plans as of 2025 and has removed approximately 1.5 million of those enrollees to date.
Provisions of the agency’s 2025 ACA integrity rule were paused last year by a federal court in Maryland, though HHS has appealed that decision.
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