Business

What This Tab Establishes

Oscar Health is a single-segment US health insurer selling ACA individual-market plans in 20 states, $11.7 billion of FY2025 revenue, 93% of premiums paid by CMS. It lists Class A common stock on the NYSE — the geography screen is clean. Market capitalisation is $7.44 billion against the $10 billion universe line, and misses on every share-count convention. No auto-OEM exposure, no China exposure, no consensus saturation.

What Oscar Sells

Oscar sells individual health insurance. A person without employer or government coverage buys an Oscar plan on a federal or state ACA marketplace, the federal government pays most of the premium as an advance premium tax credit, and Oscar pays that person's medical claims out of the premium. That is the whole economic engine; everything else the company describes is in service of it.

The company was incorporated in Delaware in 2012 as Mulberry Health [1] and describes itself as "a leading healthcare technology company built around a full stack technology platform," serving approximately 2.0 million effectuated members at 31 December 2025 [2]. Plans are sold in the five ACA metal tiers — Catastrophic, Bronze, Silver, Gold, Platinum — through exclusive-provider-organisation networks in most markets and HMO networks in a few [3]. Alongside the insurer, Oscar licenses its engagement software to other payors and providers as +Oscar, and in 2025 bought three small distribution assets — Lucie (a direct-enrolment platform, one of only 11 CMS-approved solutions), IHC Specialty Benefits (an individual-market brokerage), and Healthinsurance.org — to build a position in Individual Coverage Health Reimbursement Arrangements, the mechanism by which employers fund individual-market coverage instead of buying a group plan [4].

The revenue split shows how much of this is decoration. Oscar reports as one segment [5], and of FY2025's $11,701.4 million of total revenue, $11,469.9 million (98.0%) was insurance premium, $202.9 million (1.7%) was investment income on the float, and $28.6 million — 0.24% — was everything else, including +Oscar and the new brokerages [6].

Sources: FY2023 Form 10-K consolidated statements of operations for FY2021–FY2023 [7]; FY2025 Form 10-K for FY2024–FY2025 [8]; FY2026 guidance of $18.7–19.0 billion from the Q4 FY2025 earnings call [9].

Revenue has compounded at 58.8% a year since FY2021 and the company guides to another 61% in FY2026. Profit has not followed. Earnings from operations were negative in four of the five years, positive only in FY2024, and swung back to a $396.4 million loss in FY2025 as medical loss ratio rose 570 basis points to 87.4% and the risk-adjustment payable grew [10].

Sources: FY2023 Form 10-K for FY2021–FY2023 [11]; FY2025 Form 10-K for FY2024–FY2025 [12]. The FY2026 bar is derived: the FY2025 loss of $396.4 million plus the "nearly $750 million" year-on-year improvement management guided to at the midpoint [13].

The first quarter of 2026 came in well ahead of that path: revenue of $4.6 billion, up 53%, earnings from operations of $704 million, and net income of $679.0 million, or $2.07 per diluted share — the highest quarter in the company's history [14]. Individual-market earnings are heavily front-loaded within a policy year — members meet deductibles and out-of-pocket maxima as the year runs, shifting claims into the second half [15] — so a strong Q1 is a normal shape, not an annualisable run rate.

At 31 December 2025 Oscar employed approximately 2,305 people [16] — $5.1 million of revenue per employee, which is what a business that collects premiums and pays claims looks like, not what a technology licensor looks like.

The Universe Screen

Geography and instrument (U1) — clean. Oscar Health, Inc. is a Delaware corporation headquartered at 75 Varick Street, New York. Its Class A common stock, par $0.00001, is registered under Section 12(b) and listed on the New York Stock Exchange under OSCR; SEC file number 001-40154 [17]. This is a US operating company with a US primary listing — not an ADR, not a foreign private issuer, and with no Chinese domicile or China-listed parent. A dual-class structure sits behind it: Class B common stock exists but has no public trading market, and as of 31 January 2026 there were 12 holders of record of Class A and 11 of Class B [18]. The company has never declared or paid a dividend and does not intend to [19].

Market capitalisation (U2) — misses, and not narrowly. The deterministic feature file puts market capitalisation at $7.436 billion: 262,388,000 shares at the 27 July 2026 close of $28.34. That sits $2.56 billion, or 25.6%, below the $10 billion line.

The share count deserves a check, because the feature file uses the FY2025 weighted-average basic count, and holders of the 2031 convertible notes converted $270.0 million of principal into approximately 32.4 million Class A shares in the fourth quarter of 2025, with a further 0.7 million shares issued as an inducement payment [20]. Actual shares outstanding at 31 March 2026 were 263,552 thousand Class A plus 35,591 thousand Class B — 299.1 million in total [21]. Correcting for that raises the figure, and the line still holds.

Sources: shares outstanding from the Q1 FY2026 Form 10-Q balance sheet [22], weighted-average diluted shares from the earnings-per-share note [23]; closing price from the daily price series; the first row is fit_features.market_cap.usd. Derived: shares times close.

The widest reasonable measure — every share the diluted count contemplates, including the converts — reaches $9.35 billion, $655 million short. On the 299.1 million shares actually outstanding, the price would need to be $33.43 to clear the bar, 18.0% above the 27 July close. Third-party market-capitalisation trackers (accessed 28 July 2026, outside the filing record) put OSCR between $8.25 billion and $8.76 billion across June and mid-July 2026, consistent with the middle row. The 10-K's own cover states that non-affiliates held approximately $4.5 billion of common stock at 30 June 2025, at a $21.44 close [24]. Under no convention available in the record does Oscar clear $10 billion today. The company is a mid-cap, and the analysis below proceeds on that basis.

Where the Revenue Comes From

Two facts define the revenue base. The first is who actually pays. Oscar collects 93% of its premiums directly from CMS through the advance-premium-tax-credit programme and only 7% from members [25]. The economic customer is the federal government; the member chooses the plan but funds a small slice of it. That subsidy structure changed on 1 January 2026: the enhanced advance premium tax credits in place since 2021 expired at the end of 2025 and the pre-ARPA credit structure was reinstated, raising what members pay [26]. The size and pricing of the whole market moved with it, and the anatomy of that repricing belongs to Dislocation and Damage Math.

The second is geography — all of it domestic, and most of it in one state. Oscar offered coverage in 18 states for the 2025 policy year and expanded to 20 for 2026 [27]. Florida alone held 57.8% of members at the end of 2025.

Source: FY2025 Form 10-K, Membership by State [28]. Share of total is derived from the same table.

Three states carry 86.0% of the book. The year-on-year column shows how quickly the footprint moves: Texas grew from 141,000 members to 358,910 while Georgia fell from 379,680 to 218,746, and California and Connecticut went from 10,981 and 7,658 members respectively to zero [29]. The filing is explicit about why: "We elect to participate in a given individual market on an annual basis" [30]. Both the company and its competitors re-underwrite their state footprints every twelve months.

All operations, members, and regulated subsidiaries are in the United States. The investment portfolio consists of US Treasury and agency securities, corporate notes, and certificates of deposit [31].

Market Structure

Shape: a fragmented national market that is oligopolistic inside each state, with annual entry and exit. The individual market held a record 24 million lives after the 2025 open enrolment [32] and 23 million after the 2026 one [33], a decline of 5% that management called better than expected against its own 20–30% contraction estimate [34].

Against that denominator, the two largest carriers are identifiable from primary filings. Centene states plainly: "We are the largest Marketplace carrier, serving 5.5 million members across 29 states as of December 31, 2025," under the Ambetter brand [35] — roughly 24% of a 23 million-life market. Oscar served 3.4 million members as of 1 February 2026, about 15% of the same market [36], and describes itself as "the largest carrier fully dedicated to the individual market" [37]. Inside its own footprint the concentration is much higher: management put Oscar's share across the states it serves at 17% in 2025, rising to 30% in 2026 [38].

Oscar's own 10-K names the competitor set generically rather than by company: "plans offered by national carriers, regional carriers, Medicaid-focused insurers offering Health Insurance Marketplaces products, and local Blue Cross plans" [39]. The filing also states that "the identity of our principal competitors for members and providers varies by market and geography" — which is the accurate description of a market whose structure is set state by state, not nationally.

The direction of travel is toward fewer national carriers, not more. Peer filings make this concrete rather than anecdotal:

CVS Health: "The Company exited the states in which Aetna operated on the Public Exchanges effective January 2026" [40]. It had booked a $448 million premium deficiency reserve on the individual exchange line in Q1 2025 [41], after $270 million on the same line in Q3 2024 [42].

The Cigna Group: Individual and Family Plan premiums fell from $5,088 million in 2023 to $3,951 million in 2024 to $3,371 million in 2025 — down 33.7% over two years [43].

Oscar's CEO framed the 2026 open enrolment in exactly these terms: "We took decisive actions with disciplined pricing, distribution, and product strategy to go after profitable growth as competitors pulled back or exited the market" [44]. That is the mechanism behind the 17%-to-30% footprint share step. The counter-fact sits in the same sentence: carriers left because the line lost money, and Oscar lost $443.2 million in 2025 in the same market [45]. Share taken from retreating competitors and share taken on superior economics look identical for a year or two and are not the same thing.

Regulatory entry barriers are real and named. Each Health Insurance Subsidiary must obtain and maintain regulatory approval in every state where it sells; state insurance departments hold broad administrative authority over rate and product filings, network adequacy, licensing, and financial reporting; the subsidiaries are subject to statutory risk-based capital minimums under the NAIC Risk-Based Capital For Health Organizations Model Act; and insurance holding-company acts require prior regulatory approval before any person acquires 10% or more of the voting securities [46]. Premium rates must be approved by state and federal regulators, and risk adjustment transfers money between carriers based on the relative morbidity of their books [47]; the ACA's minimum medical-loss-ratio provision forces rebates to members when the threshold is missed [48].

The counter-evidence on that barrier is Oscar itself. A company founded in 2012 cleared every one of those requirements and reached 3.2 million members by March 2026 [49]. The regime is a filter on capital and compliance capability, not on entry as such.

Capital intensity is low in the physical sense and moderate in the regulatory sense. Oscar's Health Insurance Subsidiaries held aggregate statutory capital and surplus of approximately $1.0 billion at 31 December 2025, down from $1.2 billion a year earlier [50] — $11.7 billion of revenue supported on roughly $1.0 billion of regulated surplus, an 11.7-times ratio. Property, equipment and capitalised software, net, stood at $94.2 million against total assets of $9,289.6 million at 31 March 2026, or 1.0% [51]. The binding constraint on growth is statutory surplus and the regulator's tolerance, not plant.

Operating history is short. Incorporated 2012, first ACA plans when the law created the direct-to-consumer channel in 2014 [52], IPO on the NYSE in March 2021 [53] — thirteen years of operating history and five as a public company, against a framework anchor of thirty to fifty years for the kind of durability conviction Durability has to test. The product is essential in the ordinary sense — people need medical coverage — but the demand for this product is created and sized by a federal subsidy that Congress adjusted at the end of 2025 and could adjust again [54].

First-Pass Exclusions

Auto OEM (X1) — not applicable. Oscar is classified under SIC 6324, Hospital and Medical Service Plans, reports a single insurance segment, and derives 98.0% of revenue from health insurance premium [55]. No vehicle manufacturing, no automotive supply exposure.

China dependence (S1) — absent. The words "China" and "Chinese" do not appear anywhere in the FY2025 Form 10-K. Every member, every regulated subsidiary, and every licensed market is in the United States: 18 states in 2025, 20 in 2026 [56]. Revenue exposure to China: 0%. Asset exposure: 0% — the investment portfolio is US Treasury and agency securities, corporate notes, and certificates of deposit [57].

Consensus-saturated positioning (X4) — not on the multiple, borderline on the chart. On multiple-to-sales, Oscar is the second-most expensive name in its own competitive set, though the absolute level is nothing like a story-stock multiple.

Sources: FY2025 total revenue from each company's Form 10-K — Oscar $11,701m [58]. UnitedHealth $447,567m [59]. Elevance $199,125m [60]. CVS $402,067m [61]. Cigna $273,854m [62]. Molina $45,426m [63]. Centene $194,777m [64]. Market caps derived from 27 July 2026 closing prices and latest reported share counts.

At 0.64 times sales — 0.72 times on the 299.1 million shares actually outstanding — Oscar carries a higher price per dollar of revenue than every peer except UnitedHealth, and four times Centene's 0.16. Managed-care revenue is largely premium pass-through, so these ratios say more about expected margin than about growth optimism; the exclusion Ruchir's framework aims at is the ten-to-twenty-times-sales story stock, and Oscar is not that.

Sell-side positioning does not look saturated either. Eleven analysts carry a consensus of Hold; the mean target price is $24.20 against a $28.34 close, so the stock trades 17% above where the sell side marks it, and the rating distribution as at 28 July 2026 is three strong buys, seven holds and one strong sell, with no plain buys. Consensus is behind the price, not driving it.

Source: consensus analyst estimates as at 28 July 2026 — mean target $24.20, eleven ratings (three strong buy, seven hold, one strong sell). Analyst estimates do not appear on any filing page; the $28.34 comparison close is the 27 July 2026 daily price.

The chart shape is the one place where the darling test bites. Oscar closed its first day of NYSE trading at $34.80 on 3 March 2021, reached an all-time closing high of $36.77 a week later, fell to $2.15 in 2022 — a 94% decline — recovered to $23.28 in May 2024, sold off to $10.85 on 30 March 2026, and closed at $28.34 on 27 July 2026. That is 161% above the March 2026 trough, 89% above the 2026 open of $14.97, and 22.9% below the 2021 high.

Source: daily closing prices, March 2021 to 27 July 2026, as reported. The 2026 series runs to 27 July.

The relevant fact for the framework is not the multiple but the timing: the point of maximum fear in this name was 30 March 2026 at $10.85, and the price has since gone up 2.6 times. Whether that leaves a dislocation to buy is measured on Dislocation and Yield, not here.

Promotional CEO (X2) and structural decline (X3) belong to Self-Help and Durability. Two facts surfaced in this tab bear on them and are recorded rather than argued: management's public framing leans heavily on the technology and AI narrative while 98.0% of revenue is insurance premium and 0.24% is platform and brokerage revenue [65]; and revenue has risen every year since FY2021, so the framework's three-consecutive-years-of-decline disqualifier is not engaged on the reported record [66].

Limitations

The fit_features.revenue_trajectory series is built on the wrong income-statement line. It reports FY2025 revenue of $28.6 million, which is Oscar's Other revenues line, not the $11,701.4 million of total revenue in the same filing [67]. Every figure in this tab uses the filed total-revenue line. The feature file's conclusions on that field happen to survive the correction — consecutive_decline_years of 0 and three_year_hsd_decline of false are both still right on the corrected series — but the inputs are not usable and are recorded as a gap.

fit_features.market_cap.usd of $7.436 billion uses the FY2025 weighted-average basic share count, which understates shares outstanding by 36.8 million versus the 31 March 2026 balance sheet. The universe conclusion is unchanged under every alternative, so the feature figure is carried forward as the record with the alternatives shown above.