Competitors

Competitors describe Oscar Health, Inc.'s market in their own filings and calls. These verified passages and visual pages show where their strategies meet, using source documents preserved in Sources.

Centene Corporation (Ambetter Health) (CNC)

The largest carrier in the ACA Individual Marketplace and the peer whose book sits closest to Oscar's in both size and shape — 3.58 million members at the end of Q1 2026 against Oscar's 3.2 million, in a 29-state footprint that overlaps Oscar's almost everywhere. Only the Commercial/Marketplace discussion is used here; Centene's Medicaid and Medicare (PDP and MA) segments, which are the bulk of its revenue, are outside the comparison. Centene also built the industry data infrastructure — the interim Wakely market report — that both companies now price and reserve against, and its 10-K carries the ICHRA thesis Oscar has made central to its own strategy.

Centene's read of the first post-subsidy plan year, from the April 2026 call, and the origin of the interim Wakely report that every carrier in this tab now cites. Two claims sit inside it. The market-level one — contraction smaller than expected, healthier members staying, a silver-to-bronze migration — is corroborated by Elevance and Molina elsewhere in this tab and is the same directional read Oscar gave. The company-level one is contested by construction: Centene argues its retained silver block is more acute than the market and should therefore draw a risk-adjustment receivable. Risk adjustment is a zero-sum transfer, so a receivable claimed by the largest carrier in a state has to be funded by the other carriers in that state. Centene had not booked the full amount as of this call.

Sarah London (Chief Executive Officer): After last year's unexpected volatility, Centene committed to finding ways to create additional and earlier visibility into this market to support long-term stability. Last fall, we reached out to many of our peers, all of whom were receptive to submitting earlier data on membership demographics. Wakely, the independent actuarial firm that calculates interim risk transfer estimates for the market throughout the year, agreed to aggregate and publish that data at the end of March. As a result of that collaboration, the industry has more visibility than it has ever had at this time of the year about overall market dynamics. […] First, the overall market contracted as expected in a post-APTCs environment. That said, market-by-market membership loss was in almost every market less than we expected, which suggests that more healthy members stayed in the market in aggregate and that our pricing was appropriate relative to the overall market morbidity. Second, the Wakely data confirmed a meaningful market-wide shift from Silver members into Bronze and to a lesser degree, Gold, consistent with our expectations and with a directional shift in our own metal distribution. Finally, and perhaps most importantly, this data, when combined with our final Q1 paid membership and a full quarter's worth of claims experience, strongly supports the view that Ambetter retains Silver membership with higher acuity relative to the market and that this membership will ultimately receive a meaningful risk adjustment offset.

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Elevance Health, Inc. (Anthem Blue Cross / Wellpoint) (ELV)

The scaled Blues competitor that stayed in the individual market and expanded into it. Elevance sells on-exchange in nearly all of its Anthem service areas and pushed into Florida, Maryland and Texas in 2025 under the Simply Healthcare and Wellpoint brands — three states central to Oscar's footprint. Only the Individual/ACA discussion is used here; Elevance's employer group, Medicaid, Medicare and Carelon services businesses are outside the comparison, and the company does not break out individual ACA membership or margin separately, so the exhibits are management's qualitative reads plus the sizing of quarterly outperformance.

Elevance's stated exchange footprint from its FY2025 Form 10-K. The commercially relevant sentence is the second paragraph: while Aetna was exiting and Cigna was shrinking, Elevance added Florida, Maryland and Texas service areas in 2025 under non-Blue brands. Florida and Texas are the two largest states in the federal Marketplace and core Oscar geographies. The filing gives no membership or premium figure for the Individual book, so this establishes direction and geography, not scale — Elevance's disclosed medical membership of 44.9 million is overwhelmingly employer group, Medicaid and Medicare.

In the Individual markets, we offer on-exchange products through state- or federally-facilitated marketplaces (the “Public Exchange”) in compliance with the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010, as amended (collectively, the “ACA”) and off-exchange products. Federal subsidies are available for certain members, subject to eligibility, who purchase Public Exchange products.

We continue to participate in the Public Exchange in nearly all of our Anthem Blue Cross and Anthem Blue Cross and Blue Shield service areas. In 2025, we expanded our operations into select service areas in Florida, Maryland, and Texas through our Simply Healthcare and Wellpoint brands. Going forward, we expect the Public Exchange to be influenced by policy and regulatory changes, particularly around federal subsidies, compliance requirements and market stability.

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Answering an analyst who asked where Elevance sits versus the industry on the new Wakely data. This is a second independent carrier confirming the silver-to-bronze migration Centene described, and adding a caveat worth carrying: the March report does not capture retroactive cancellations, non-payment or cohort maturation. Those are exactly the effectuation dynamics that determine whether first-quarter membership counts hold — relevant to reading Oscar's own 3.2 million enrolled versus roughly 3.0 million paid at the start of Q2.

Mark Kaye (Chief Financial Officer): The early Wakely report has been a helpful input because it provides visibility into market size, metal mix and enrollment patterns. The report supports our view of a greater shift towards bronze and a greater share of new sales, which has implications for relative risk in the market. I would caution it's still early; the report does not fully capture retro cancellations, nonpayment behavior or maturing cohorts. […] We feel comfortable with our pricing and positioning for sustainability in the ACA market this year. We are seeing a much more balanced bronze-silver mix this year based on new sales.

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UnitedHealth Group (UnitedHealthcare exchange business) (UNH)

The one large national carrier that repriced across the board and stayed in every state it served, rather than exiting. Its posture matters to Oscar twice over: as the pricing benchmark in overlapping states, and because UnitedHealthcare voluntarily pledged to rebate its 2026 ACA profits to customers — a political marker on how much margin the individual market is expected to bear while subsidies are contested. Only the UnitedHealthcare exchange discussion is used here; Medicare Advantage, Medicaid, employer group and the entire Optum business are outside the comparison.

UnitedHealthcare's stated 2026 exchange posture: reprice nearly every state, keep the full state footprint, and hand back the resulting profit. The rebate pledge is the item with implications beyond United's own P&L — the largest US health insurer publicly conceding that earning a margin on ACA plans is politically untenable in a year when subsidy policy is unresolved. That is a reference point analysts and policymakers can apply to any carrier reporting strong individual-market margins in 2026, Oscar included. It is a voluntary commitment for one year, not a regulatory constraint, and it does not change the statutory 80% minimum loss ratio that already applies to the individual market.

Timothy Noel (President, UnitedHealthcare): In the individual ACA market, we re-priced nearly all states in response to higher medical trends and the elevated needs of ACA beneficiaries in 2025. These actions were necessary to ensure a sustainable foundation in these plans and enable us to maintain our participation in all the states we served in 2025. We are working with CMS on solutions to address consumer affordability challenges given the unfolding dynamics in the ACA marketplace. As we announced last week, we have voluntarily pledged to rebate ACA market profits back to our ACA customers this year as policymakers work to determine how to improve affordability in this marketplace. We expect both fully insured group and individual enrollment to contract and be partially offset by continued momentum in our group self-funded offerings.

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Answering an analyst who asked how United's 1.3–1.4 million commercial risk-life decline splits between group and exchanges. Two disclosures matter here. United expects to shed more than 500,000 exchange members in 2026 — supply that has to land somewhere, and Oscar grew members 56% year over year in the same open enrollment. And management sets its own 2026 exchange margin expectation at roughly 1%, plus or minus 1%, while describing more than a decade in the market as never a significant earnings contributor. That is United's economics on its own book, not a market-wide margin ceiling; it does establish what the largest national carrier thinks the business is worth after repricing.

Dan Schumacher (Executive): On membership pertaining to the risk-based decline, the largest share of that membership decline is connected to our exchange business for 2026, where we continue to expect meaningful decline between now and the end of the year. […] So to parse that out specifically, 500,000 plus is attributable to the exchange business, and the remainder, to those three factors. Moving to margins, and first addressing the exchange business; over the course of the decade plus in which we have operated in that market, it has never been a significant contributor of earnings for us. Our pricing posture for 2026 coming out of 2025 is going to return that market to a positive margin business for us. However, I would expect those margins in the exchange business for 2026 to be in about the 1% range, plus or minus 1% for that business.

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The Cigna Group (Cigna Healthcare individual exchange) (CI)

The peer that ran the margin-over-growth strategy first and then left. Cigna cut its individual exchange book from nearly 1 million customers in 2023 to under 400,000 by mid-2025 while the market grew, and in April 2026 announced it will exit the business entirely at the end of the year. That sequence is the clearest peer articulation of the trade Oscar is on the other side of, and Cigna's own numbers are the most usable market-growth datapoint in this set. Only the Cigna Healthcare individual exchange discussion is used here; Evernorth (PBM, specialty pharmacy, care services), stop-loss and international are outside the comparison.

The most direct market-sizing statement any peer makes in this set: Cigna's management puts industry individual-exchange enrollment up nearly 50% from 2023 to mid-2025, against its own book falling from nearly 1 million to under 400,000, after two consecutive pricing cycles at roughly double the industry average increase. "Some of our competitors showed meaningful growth" is the unnamed reference — Oscar roughly tripled membership over the same window. Read level-headed, this is a competitor explaining why it declined share that Oscar took, and asserting the share was unprofitable; the 2025 industry-wide risk-adjustment shock that followed is the argument for its side of the case.

Brian C. Evanko (President and Chief Operating Officer): I think it's important to step back and rewind the clock a couple of years to 2023. At that point in time, we served nearly 1 million customers in the individual exchanges, albeit with mixed financial performance. Based upon our performance as well as our forward view of the market, we made the strategic choice to prioritize margin over growth, which included adjustments to product and network strategies, refinements to our geographic footprint, and increased prices where necessary. And this decision to prioritize margin over growth in the individual exchanges has helped us to navigate some of the industry-wide pressures that have emerged here in 2025. And we now serve fewer than 400,000 customers in this business, down materially from the nearly 1 million we served in 2023. Additionally, across both the 2024 and 2025 pricing cycles, our nationwide price increases were roughly double the industry average in each of those years. So as a result of those actions, some of our competitors showed meaningful growth in their individual exchange businesses, while we chose to reposition our portfolio, which resulted in fewer individual exchange customers for Cigna Healthcare. […] Meanwhile, across the industry, individual exchange enrollment is up nearly 50% over that same time period.

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Cigna's 2026 membership plan as given in February 2026 — flat total medical customers, with individual exchange declining and employer and international growing. Two months later the company announced it would leave the exchange business altogether, so this is the last statement of the shrink-but-stay posture before it became an exit. The 18.1 million figure is total Cigna Healthcare medical customers across all lines, the large majority of it employer-sponsored; the individual exchange book was under 400,000.

Brian Evanko (President and Chief Operating Officer): So as it relates to the Cigna Healthcare membership outlook, as you saw in the press release, we expect flat year over year at about 18.1 million lives. And really, you can think of that big picture as we expect growth in our US Employer and international health businesses offset by a decline in individual exchange customers.

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The exit announcement, made on Cigna's Q1 2026 call by the incoming CEO and framed as portfolio discipline rather than a judgment on the market's economics — it is presented alongside a strategic review of eviCore as part of the same tidying. For Oscar the mechanical consequence is on the 2027 open enrollment: under 400,000 Cigna members will need new carriers, in a market where Aetna has already gone and Molina is deliberately shrinking. Cigna gives no state-level breakdown, so how much of that book overlaps Oscar's footprint is not determinable from this document.

Brian Evanko (President and Chief Operating Officer, incoming Chief Executive Officer): On the other end of the spectrum are the businesses we have divested where the assets no longer support our strategic direction or have reduced management focus from our core growth platforms. […] In keeping with this portfolio shaping discipline, today, we are announcing two additional actions. First, we are planning to exit our individual exchange business at the end of this year. We did not make this decision lightly and appreciate the importance of ensuring patients have continuity through the transition. There are no changes to coverage or networks related to this announcement, and we will support members through their open enrollment transitions into 2027.

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Molina Healthcare, Inc. (Marketplace segment) (MOH)

The clearest counter-case to Oscar's strategy. Molina is deliberately pricing itself out of the Marketplace — roughly 30% average rate increases for 2026, a book cut to 280,000 members, and a stated plan to shrink again in 2027 — and its management explains, in unusual mechanical detail, the adverse-selection dynamic it believes makes a shrinking individual book dangerous. Only the Marketplace segment is used here; Molina's Medicaid business (the large majority of its $42 billion premium) and its Medicare duals business are outside the comparison.

Molina's Marketplace scale as of Q1 2026, for reference against Oscar's 3.2 million: 305,000 members declining to a planned 250,000 by year end, 70% of it renewals. Molina describes the shrinkage as intended. The comparison is one of strategy rather than of like books — Molina is a Medicaid-first company for which Marketplace is a small adjacency, while it is essentially all of Oscar.

Mark Keim (Chief Financial Officer): Meanwhile, Marketplace sold moderately higher paid renewals, ending the first quarter at 305,000. With normal market attrition, we expect membership in our Marketplace segment to end the year at approximately 250,000. Renewing members now represent 70% of our book.

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Molina's July 2026 guidance cut on Marketplace — a $1.50 per share swing from gain to loss, medical cost ratio taken to 90%, and an explicit commitment to shrink the footprint again for 2027. The stated cause is not weak pricing but member acuity mix, which management attributes to the shrinking itself. This is a peer treating the individual market as a business to allocate capital away from in the same quarter Oscar is guiding to $18.7–19.0 billion of revenue in it; the segment is small enough for Molina that exiting is cheap in a way it is not for a pure-play.

Joseph Zubretsky (President and Chief Executive Officer): In Marketplace, our full year MCR guidance is now 90%. We are reducing our marketplace guidance by $1.50 per share from a gain of approximately $0.75 to a loss of $0.75 due to prior year items and current year unfavorable member acuity mix. Looking forward, we plan to again reduce our footprint and volumes in 2027 to minimize our exposure to this segment. […] However, marketplace guidance decreases by $1.50 of earnings per share as our process of deemphasizing and downsizing this business in the portfolio bears the cost of higher member acuity mix.

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The mechanics behind Molina's write-down, and the most transferable piece of analysis any peer offers here. Management's account: price to be uncompetitive, the healthy leave first, the chronically ill stay for network and formulary continuity even at $50–100 a month more, and their spending shows up as high-cost drug utilization without matching HCC diagnosis codes — so risk adjustment does not fund it. Note the direction of the argument runs against a carrier that is losing share, not gaining it, and Molina concedes the market-wide acuity shift was milder than it priced for. Whether the same coding-versus-cost gap appears in a growing book is the open question it raises for Oscar.

Joseph Zubretsky (President and Chief Executive Officer): But as you recall, coming into 2026, we put on average 30% rate increases into the market, ranging from around 30% up to higher levels depending on the state, all with the sole purpose of allocating less capital to the business and reducing our footprint. Recall that we positioned the product to be #1 or #2 priced in only a handful of markets. And we were successful in doing that, now at $2.5 billion of premium and 280,000 members. We did include an element in pricing to account for the potential for an acuity shift. Now the Wakely reports are showing that acuity shift is probably less in the entire market, but we're not a microcosm of the entire market. At 280,000 members, we had more adverse selection, if you will, or member acuity mix than the rest of the market. […] It's really a simple case: as the book shrinks in size consciously due to our positioning of the product and the pricing, the old adage in insurance is people that need coverage are going to seek it. So we certainly priced for an acuity shift. Many of these members are on high-cost drug therapies — HIV, oncology and the like. And even with a $50, $75 or even $100 per month price difference, they tend to stay with the health plan that they're comfortable with, that their drug therapies will be prescribed and paid for. So we're seeing a lot of that. We're seeing high-cost drug utilization without corresponding HCCs to drive risk adjustment, which is creating an imbalance.

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CVS Health Corporation (Aetna individual exchange) (CVS)

The largest single block of supply removed from the 2026 risk pool. Aetna exited the individual exchange business entirely for 2026 after a $448 million premium deficiency reserve on the 2025 coverage year, and CVS quantifies the resulting membership loss in its own results. That exit is part of the market structure behind Oscar's 56% membership growth in the same open enrollment. Only the Aetna/Health Care Benefits individual exchange discussion is used here; Caremark, retail pharmacy, Oak Street and Signify are outside the comparison.

CVS's CEO characterising the Aetna exchange exit, on the Q3 2025 call. The framing is worth noting for what it is: the exit is listed as a portfolio decision alongside an acquisition, with no market-level judgment attached. Elsewhere on the same call the CFO attributes part of the quarter's 92.8% medical benefit ratio to higher acuity in the individual exchange product line and to worsening exchange risk-adjustment expectations based on the Wakely data — the underlying reason, stated separately from the decision.

David Joyner (President and Chief Executive Officer): In my first year as CEO, I have pushed our team to act with urgency and focus as we execute on opportunities to improve our business. This means making thoughtful and difficult decisions, such as exiting our individual exchange business or taking advantage of market opportunities like our acquisition of the Rite Aid assets.

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The exit quantified in CVS's own Q1 2026 results: roughly 600,000 medical members lost sequentially, attributed primarily to leaving the exchange business. Combined with UnitedHealthcare's expected 500,000-plus exchange decline and Centene's move from about 5.0 million to 3.5 million, this is the supply side of the 2026 individual market — members displaced by exits and repricing at the same time the subsidy expiration was shrinking the pool. Oscar added members through that open enrollment; how much of the gain is displaced Aetna membership is not determinable from these documents, since neither company publishes state-level or carrier-to-carrier switching data.

Brian Newman (Chief Financial Officer): In Health Care Benefits, we generated nearly $36 billion of revenue in the quarter, an increase of over 3% from the prior year. This increase was primarily driven by our government business, partially offset by our exit from the Individual Exchange business in 2026. We ended the quarter with approximately 26 million medical members, which declined sequentially by approximately 600,000 members. This decrease was primarily driven by our exit from the Individual Exchange business in 2026, partially offset by growth in our commercial fee-based membership.

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Competitors

Centene Corporation (Ambetter Health) (CNC)

Elevance Health, Inc. (Anthem Blue Cross / Wellpoint) (ELV)

UnitedHealth Group (UnitedHealthcare exchange business) (UNH)

The Cigna Group (Cigna Healthcare individual exchange) (CI)

Molina Healthcare, Inc. (Marketplace segment) (MOH)

CVS Health Corporation (Aetna individual exchange) (CVS)

More peer documents