Calls
Source: S&P Capital IQ transcripts via Xpressfeed · latest indexed call 2026-05-06 · generated 2026-07-28.
Latest call digest
Oscar Health, Inc., Q1 2026 Earnings Call, May 06, 2026 · 2026-05-06T12:00:00
Q1 2026 — May 6, 2026. Prepared remarks were a clean beat: revenue of $4.6 billion (+53%), MLR of 70.5% (490 bps better year-over-year), an SG&A ratio of 15.2%, earnings from operations of $704 million and net income of approximately $679 million on 3.2 million members (+56%). Full-year guidance was reaffirmed in full — revenue of $18.7 billion to $19 billion, MLR of 82.4% to 83.4%, SG&A of 15.8% to 16.3% and earnings from operations of $250 million to $450 million — with management saying results are ahead of plan and that Oscar is positioned to meet or exceed the guide. Mark Bertolini used the prepared section mainly for strategy: the Lucie Health Marketplace, ICHRA X, and an Investor Day on September 16.
The Q&A went somewhere else. Roughly half the questions were about one line item: risk adjustment. Oscar accrued risk adjustment at about 24% of premium in the quarter against a full-year guide of approximately 20%, and Andrew Mok (Barclays) and Jonathan Yong (UBS) both pressed on the gap. Richard Blackley's explanation is mechanical — seasonally low first-quarter claims suppress the denominator, and a heavier bronze mix pushes deductible-driven claims later in the year — with normalization expected as members engage. Asked what could still move 2026 EBITDA, Bertolini answered with the Wakely reports and risk adjustment, noting the accrual was 11% at this point last year versus 24.5% now.
What management chose not to book is the more interesting disclosure. Prior period development was $68 million net favorable, but that nets $85 million of adverse development on a couple of 2025 states against $150 million of favorable claims run-out; other states with positive development were left unrecognized pending the final report. Reserves remain set on the pricing-era market morbidity assumptions, so the favorability visible in the new Wakely report is described as a potential tailwind rather than something already in the numbers. Utilization was characterized as unremarkable, and the paid-membership walk (3.4 million to 3.2 million to roughly 3 million on April 1) tracked plan, with most of the drop-off members who never made a payment. The one question management declined to quantify was Lucie's financial contribution.
Participant coverage from the latest call.
| Group | Participants | Count |
|---|---|---|
| Management | Operator; Chris Potochar — Vice President of Treasury & Investor Relations, Oscar Health, Inc.; Mark Bertolini — CEO & Director, Oscar Health, Inc.; Richard Blackley — Chief Financial Officer, Oscar Health, Inc. | 4 |
| Analysts | Jessica Tassan — Director & Senior Research Analyst, Piper Sandler & Co., Research Division; John Ransom — MD of Equity Research & Director of Healthcare Research, Raymond James & Associates, Inc., Research Division; Andrew Mok — Director, Barclays Bank PLC, Research Division; Samuel Becker — Research Analyst, Goldman Sachs Group, Inc., Research Division; Jonathan Yong — Analyst, UBS Investment Bank, Research Division; Olivia Miles — Research Analyst, Robert W. Baird & Co. Incorporated, Research Division; Raj Kumar — Research Analyst, Stephens Inc., Research Division; Craig Jones — Research Analyst, BofA Securities, Research Division; Dillon Nissan — Research Analyst, Wolfe Research, LLC | 9 |
Curated latest-call exchanges; one row per analyst topic.
| Analyst | Firm | Topic | What changed in Q&A |
|---|---|---|---|
| Andrew Mok | Barclays Bank PLC, Research Division | Risk adjustment accrual vs. full-year guide | Pressed on why risk adjustment transfer is tracking around 24% of premium while the full-year expectation stays at approximately 20%. Blackley attributed it to seasonally low first-quarter claims mechanically lifting the accrual and to a higher share of new members in bronze plans, with normalization expected as deductibles are met. |
| Jonathan Yong | UBS Investment Bank, Research Division | Whether the accrual included 2025 cleanup | Asked directly whether any 2025 sweep sat inside the number. The answer surfaced the quarter's most specific disclosure: about $85 million of adverse development from a couple of states on the last 2025 Wakely report was recognized, other states with positive development were not, and $150 million of favorable claims run-out produced the $68 million net favorable PPD. |
| Jessica Tassan | Piper Sandler & Co., Research Division | Churned members and market morbidity | Asked whether the roughly 200,000 members who fell off between the first quarter and April 1 pulled utilization forward, and whether Oscar agrees with Wakely's market morbidity range. Blackley said the bulk never made a payment and that claims are not paid once a member is delinquent; on Wakely he would say only in line to favorable, this early. |
| Samuel Becker | Goldman Sachs Group, Inc., Research Division | Swing factors for 2026 EBITDA | Asked what could still materially shift the 2026 view. Bertolini named the Wakely numbers and risk adjustment, and framed the year-over-year comparison as 11% risk adjustment at this point last year against 24.5% now. His answer trails off in the transcript with no follow-up. |
| Olivia Miles | Robert W. Baird & Co. Incorporated, Research Division | Lucie Health Marketplace economics | Asked whether revenue or EBIT contribution from Lucie is in the 2026 guide, and for a revenue basis or long-term target. No figures were given: Bertolini described the model and deferred detail to September, and Blackley said standing-up costs are in guidance with a modest effect this year. |
| John Ransom | Raymond James & Associates, Inc., Research Division | SG&A trajectory and April membership | Asked why the SG&A ratio would rise if revenue gets a lift from lower risk adjustment. Blackley said SG&A dollars grew 46% against 53% revenue growth, called the first quarter the likely low point for the year, and guided to sideways-to-slightly-up with a fourth-quarter uptick for open enrollment. Confirmed roughly 3 million members as of April 1. |
| Craig Jones | BofA Securities, Research Division | Bronze mix and the risk adjustment payable | Asked how a mix shift toward bronze affects risk adjustment year-over-year. Blackley argued the formula's coefficients are designed to be roughly metal-neutral, and that Oscar's transfer is driven more by overall utilization levels and market and product selection than by metal mix. |
| Raj Kumar | Stephens Inc., Research Division | Effectuation rates and competitor exits | Asked about market-level effectuation and how a competitor exit flows into 2027 pricing. Blackley said effectuation has run as expected to modestly favorable and consistent with Wakely's assumptions; Bertolini credited broker preparation and product mapping done ahead of the subsidy sunset for the share gains. |
| Dillon Nissan | Wolfe Research, LLC | Economics in newer, smaller states | Asked for early reads on Arizona, North Carolina and New Jersey. Bertolini declined on the grounds that there are not yet enough claims to differentiate; Blackley added that growth in newer markets looks strong but that it is too early to get ahead of themselves. |
Theme tracker
Themes are curator-classified across supplied calls.
| Theme | Status | Quarters mentioned | Read-through |
|---|---|---|---|
| Risk adjustment estimation and market morbidity | persisted | Q2 2023, Q3 2023, Q4 2023, Q1 2024, Q2 2024, Q3 2024, Q4 2024, Q1 2025, Q2 2025, Q3 2025, Q4 2025, Q1 2026 | Present in every call in the set, but its character changed. Through 2023 and 2024 it was a modelling topic that mostly produced small true-ups; from the fourth quarter of 2024 it became the dominant earnings variable, with successive increases to the risk adjustment payable in 2025 and, in the latest call, an accrual running above the full-year guide. Management has consistently called it the hardest estimate it makes. |
| AI and technology-driven administrative leverage | persisted | Q2 2023, Q3 2023, Q4 2023, Q1 2024, Q2 2024, Q3 2024, Q4 2024, Q1 2025, Q2 2025, Q3 2025, Q4 2025, Q1 2026 | The one line where the story has run in a straight line. The SG&A ratio is cited as improving every year across the set, and analysts have repeatedly treated it as the most credible part of the model. Notably, it is also the topic that draws the fewest sceptical follow-ups. |
| ICHRA as a growth vector beyond the ACA | persisted | Q2 2023, Q3 2023, Q1 2024, Q2 2024, Q3 2024, Q4 2024, Q1 2025, Q2 2025, Q3 2025, Q4 2025, Q1 2026 | Discussed on nearly every call for three years, and still not quantified. Management said in the fourth quarter of 2025 that it is not giving out ICHRA numbers by segment because they are not meaningful enough to move the dial. The framing has moved from a carrier product to a distribution and platform business. |
| Enhanced premium tax credit expiry and market contraction | persisted | Q4 2023, Q2 2024, Q3 2024, Q1 2025, Q2 2025, Q3 2025, Q4 2025, Q1 2026 | First raised as an analyst question, then adopted by management as the organizing assumption for pricing. The 20% to 30% market contraction estimate introduced in the third quarter of 2025 has been carried forward each quarter since; the latest call says contraction is tracking in line to favorable against it. |
| Medicaid redeterminations and special enrollment membership | dropped | Q2 2023, Q3 2023, Q4 2023, Q1 2024, Q2 2024, Q3 2024, Q4 2024, Q1 2025, Q2 2025, Q3 2025, Q4 2025 | A central topic for eleven consecutive calls — it drove both the 2024 growth story and the 2025 morbidity problem — and absent from the Q1 2026 call entirely. The continuous monthly special enrollment period ended in September 2025, and membership discussion has shifted to grace-period non-payment. The disappearance looks structural rather than evasive. |
| +Oscar and Campaign Builder as an external technology business | dropped | Q2 2023, Q3 2023, Q4 2023, Q1 2024, Q2 2024 | One of four stated strategic pillars in 2023, with named client wins and a lives-served count. It has not appeared in management's prepared remarks since the second quarter of 2024, and no call in the set explains the de-emphasis. Worth noting given the current pitch for Lucie rests on a similar platform-and-technology argument. |
| 2027 long-term targets (20% revenue CAGR, 5% operating margin) | dropped | Q2 2024, Q3 2024, Q4 2024, Q1 2025, Q2 2025, Q3 2025 | Repeated in prepared remarks or defended under questioning on six consecutive calls, including the second quarter of 2025 when Bertolini said 5% remains the target. Neither the fourth quarter 2025 nor the first quarter 2026 call restates it, and no analyst asked. Management now points to a September 16 Investor Day for the long-term plan. |
| Carrier-agnostic consumer marketplace (Lucie, ICHRA X) | emerged | Q2 2025, Q1 2026 | The building blocks were bought in the second quarter of 2025 — a brokerage, the INSXCloud direct enrollment platform and healthinsurance.org — and described then as not meaningful to near-term results. The first quarter of 2026 is the first call where they are presented as a named, launched business with an unregulated, higher-margin economic pitch. No revenue or margin figures have been attached to it yet. |
Guidance ledger
Quotes, calls, and speakers are source-verified; outcomes are curator-classified.
| Verbatim guidance | Call | Speaker | Curator outcome | Outcome note |
|---|---|---|---|---|
| “We continue to expect to achieve total company adjusted EBITDA profitability this year and are raising our estimate to a range of $160 million to $210 million.” | Oscar Health, Inc., Q2 2024 Earnings Call, Aug 07, 2024 · 2024-08-07T12:00:00 | Richard Blackley | kept | The Q4 2024 call reported full year 2024 adjusted EBITDA of $199 million, inside the range. |
| “We are raising our guidance for total revenue by another $200 million to a range of $9.2 billion to $9.3 billion, reflecting higher membership, driven by SEP member additions and more favorable lapse rates as compared to our expectations.” | Oscar Health, Inc., Q3 2024 Earnings Call, Nov 07, 2024 · 2024-11-07T13:00:00 | Richard Blackley | kept | The Q4 2024 call reported full year total revenue of $9.2 billion, at the low end of the range. |
| “We expect our medical loss ratio to be in the range of 80.7% to 81.7%, representing a 50 basis point year-over-year improvement at the midpoint.” | Oscar Health, Inc., Q4 2024 Earnings Call, Feb 04, 2025 · 2025-02-04T22:00:00 | Richard Blackley | missed | The Q4 2025 call reported a full year 2025 MLR of 87.4%, well above the range. Management attributed the gap primarily to higher market morbidity and the resulting risk adjustment payable. |
| “We expect earnings from operations to be in the range of $225 million to $275 million, representing a significant $193 million improvement year-over-year at the midpoint.” | Oscar Health, Inc., Q4 2024 Earnings Call, Feb 04, 2025 · 2025-02-04T22:00:00 | Richard Blackley | missed | The Q4 2025 call reported a full year 2025 loss from operations of approximately $396 million against guidance for a $225 million to $275 million profit. The guide was cut to a loss range in July 2025. |
| “We expect a loss from operations in the range of $200 million to $300 million and an adjusted EBITDA loss of approximately $120 million less than the loss from operations.” | Oscar Health, Inc., Q2 2025 Earnings Call, Aug 06, 2025 · 2025-08-06T12:00:00 | Richard Blackley | missed | Reaffirmed on the Q3 2025 call, then exceeded: the Q4 2025 call reported a full year loss from operations of approximately $396 million and an adjusted EBITDA loss of approximately $280 million. |
| “We expect these actions will eliminate approximately $60 million in administrative costs for 2026.” | Oscar Health, Inc., Q2 2025 Earnings Call, Aug 06, 2025 · 2025-08-06T12:00:00 | Mark Bertolini | unknown | Repeated on the Q3 2025 call. No subsequent call in the set quantifies realization against the $60 million figure, though the 2025 SG&A ratio improved 160 basis points year-over-year. |
| “We continue to expect a full year MLR in the range of 86.0% to 87.0%.” | Oscar Health, Inc., Q3 2025 Earnings Call, Nov 06, 2025 · 2025-11-06T13:00:00 | Richard Blackley | missed | Full year 2025 MLR came in at 87.4% per the Q4 2025 call, above the top of the range, driven by a $275 million fourth quarter risk adjustment true-up. |
| “For 2026, we expect risk adjustment as a percentage of direct premiums to be approximately 20% based on our updated membership mix and 2025 risk adjustment experience.” | Oscar Health, Inc., Q4 2025 Earnings Call, Feb 10, 2026 · 2026-02-10T13:00:00 | Richard Blackley | pending | The Q1 2026 accrual ran around 24% of premium, which management attributes to seasonally low claims and expects to converge on 20% over the year. This is the single most load-bearing assumption in the 2026 guide. |
| “We expect earnings from operations to be in the range of $250 million to $450 million, a significant improvement of nearly $750 million year-over-year, implying an operating margin of approximately 1.9% at the midpoint.” | Oscar Health, Inc., Q4 2025 Earnings Call, Feb 10, 2026 · 2026-02-10T13:00:00 | Richard Blackley | pending | Reaffirmed on the Q1 2026 call, which reported $704 million of earnings from operations in the first quarter alone under the company's stated MLR seasonality. |
| “Total revenues are still expected to be in the range of $18.7 billion to $19 billion in 2026.” | Oscar Health, Inc., Q1 2026 Earnings Call, May 06, 2026 · 2026-05-06T12:00:00 | Richard Blackley | pending | Unchanged from the initial 2026 guide given on the Q4 2025 call. First quarter revenue was $4.6 billion. |
| “MLR remains in the range of 82.4% to 83.4%, with MLR lowest in the first quarter and highest in the fourth quarter.” | Oscar Health, Inc., Q1 2026 Earnings Call, May 06, 2026 · 2026-05-06T12:00:00 | Richard Blackley | pending | First quarter MLR was 70.5%, consistent with the stated seasonality. The full-year range assumes claims and risk adjustment normalize over the balance of the year. |
Q&A pressure map
Question counts and firms are curator tallies; analyst coverage shown above.
| Topic | Questions | Firms | Pressure / response |
|---|---|---|---|
| Risk adjustment accrual and market morbidity | 7 | Piper Sandler & Co., Research Division, Barclays Bank PLC, Research Division, Goldman Sachs Group, Inc., Research Division, UBS Investment Bank, Research Division, Robert W. Baird & Co. Incorporated, Research Division, BofA Securities, Research Division | Counts are for the Q1 2026 call, where this topic took most of the Q&A. Six firms circled the same gap from different angles: the quarter accrued near 24% of premium against a 20% full-year guide. Management's answers were consistent and mechanical, and each disclosed something the prepared remarks did not — the bronze-mix seasonality, the $85 million of unrecognized state-level offsets, and the decision to hold reserves at pricing-era morbidity assumptions. The topic has led the Q&A on every call since Q2 2025. |
| Membership churn, effectuation and paid members | 3 | Piper Sandler & Co., Research Division, Raymond James & Associates, Inc., Research Division, Stephens Inc., Research Division | Q1 2026 counts. Analysts are testing whether the 3.4 million to 3 million walk holds and whether the members who left were costly on the way out. Answers were specific and matched what was guided on the prior call. This line of questioning has run for four consecutive quarters, since the subsidy sunset became the base case. |
| New-market and competitor-exit economics | 2 | Stephens Inc., Research Division, Wolfe Research, LLC | Q1 2026 counts. Both questions asked for early state-level or cohort-level reads on newly acquired members; both were answered with a claims-maturity argument rather than data. Reasonable this early in a policy year, but it means the quality of the 56% membership growth is still unverified externally. |
| Lucie Health Marketplace economics | 1 | Robert W. Baird & Co. Incorporated, Research Division | Q1 2026 count. The question asked for revenue or EBIT contribution in 2026, the scaling path, and any long-term revenue basis or targets. The answer covered the strategic rationale and network economics and stated that costs are inside guidance with a modest effect, but none of the three quantitative items asked for were addressed; they were deferred to the September Investor Day. Worth flagging conservatively, since Lucie was the main new item in the prepared remarks. |
| SG&A trajectory and operating leverage | 1 | Raymond James & Associates, Inc., Research Division | Q1 2026 count. A single question, answered directly with the SG&A dollar growth rate against revenue growth and a clear statement that the first quarter is likely the low point for the year. The historic pattern holds: this is the one topic where management volunteers more than it is asked for. |
| Utilization and seasonal cost drivers | 1 | UBS Investment Bank, Research Division | Q1 2026 count. Asked whether flu or weather drove the beat. Management said neither was abnormal, that experience has been better than anticipated, and — importantly — that not all of that favorability has been booked. |
Language shifts
Only language evidence verified against the referenced component is shown.
| Observation | Verbatim evidence | Call ID | Component |
|---|---|---|---|
| Conservatism is being stated explicitly in prepared remarks rather than left to the Q&A. The phrasing echoes the reserving language used in 2023, which had largely disappeared from prepared commentary across 2024 while results were running ahead. | “We took a cautious approach to risk adjustment in the first quarter.” | 1993764732 | 2 |
| Management is now describing asymmetric recognition on the record: adverse state-level development taken in the quarter, favorable development held back. That is a deliberate framing of reserve conservatism as a stored tailwind, and it is new language in this set. | “We chose not to recognize those and wait for the final report.” | 1993764732 | 28 |
| The tone on medical cost trend has moved from problem-description to non-event. A year earlier the same executive opened prepared remarks by naming a market-wide morbidity shift; here utilization is characterized as notable for being unremarkable. | “I think the most insightful thing about utilization patterns is the lack of interesting utilization patterns.” | 1993764732 | 32 |
| Confidence expressed in mid-2025 about morbidity having stabilized preceded further deterioration. The Q3 2025 call recorded a $130 million increase to the risk adjustment payable and the Q4 2025 call a further $275 million true-up. Useful calibration for how much weight to place on similar in-line-to-favorable language now. | “But we don't see anything in our statistics through the second quarter that caused us to think that there's another leg that's going to drop in terms of market morbidity.” | 1954169326 | 52 |
| Hedging vocabulary entered the Q4 2025 call around member behavior after the subsidy sunset, in place of the firmer retention language used in prior years. The Q1 2026 call retires it: payment rates are described as consistent year-over-year and modestly favorable to plan. | “So we're not – we're hedging our bets on the level of disenrollment that will occur as a result.” | 1977980145 | 31 |
| Guidance language stepped up from reaffirming to a stated bias to the upside, a formulation that does not appear in the 2025 calls in this set. It sits somewhat awkwardly beside the decision to hold reserves at pricing-era morbidity assumptions. | “Our strong results in the first quarter are ahead of plan, and we are well positioned to meet or exceed our current guidance.” | 1993764732 | 2 |
Three years of calls point the debate at one number. Operating leverage has compounded without interruption and the underwriting commentary has been broadly reliable; what has repeatedly broken the guide is the estimate of other carriers' books. The 2026 setup differs in that the conservatism now sits in disclosed, unrecognized favorability rather than in tone, which makes the June Wakely report the checkpoint that matters more than any operating metric.