Oscar Health Announces 2025 Market Expansion to Put Health Insurance in the Hands of More Americans

Rhea-AI Summary

Oscar Health (NYSE: OSCR) announced its 2025 market expansion, bringing affordable health insurance to 504 markets across 18 states. The company is introducing new solutions including:

1. Buena Salud: A Spanish-first solution for Hispanic and Latino members.

2. Employee choice plans: Allowing employees to select from Oscar's suite using employer contributions.

3. Multi-condition plan: For members with diabetes, pulmonary, and cardiovascular disease.

4. Guided Care HMO: Offering lower premiums and out-of-pocket costs with managed care.

CEO Mark Bertolini emphasized Oscar's focus on giving people control over their healthcare choices, while Chief Insurance Officer Alessa Quane highlighted the company's commitment to meeting diverse needs in the ACA market.

Positive

• Expansion to 504 markets across 18 states in 2025
• Introduction of Buena Salud, a Spanish-first solution with an industry-leading NPS of 87
• Launch of employee choice plans, allowing workers to use employer contributions for Oscar plans
• New multi-condition plan for diabetes, pulmonary, and cardiovascular disease, potentially lowering costs by 25% or more
• Introduction of Guided Care HMO with lower premiums and out-of-pocket costs

Negative

• None.

Insights

Healthcare Industry Analyst

Oscar Health's 2025 market expansion signals a significant strategic move to capture a larger share of the ACA marketplace. The introduction of tailored solutions like Buena Salud for Hispanic and Latino members addresses a important demographic, potentially driving growth in a fast-expanding segment. The expansion to 504 markets across 18 states represents a substantial increase in Oscar's footprint, which could lead to significant revenue growth. The company's focus on tech-savvy, customizable plans and the introduction of employer-focused options through StretchDollar partnership shows adaptability to market demands. However, the success of this expansion will depend on Oscar's ability to manage costs and maintain quality service across a broader network. Investors should monitor member acquisition rates and retention in new markets, as well as the impact on the company's financials in the coming years.

Health Insurance Market Analyst

Oscar's 2025 strategy demonstrates a keen understanding of market gaps and consumer needs. The multi-condition plan for diabetes, pulmonary and cardiovascular diseases targets a high-cost segment of the ACA population, potentially improving health outcomes while reducing expenses. This could lead to better risk management and profitability. The Guided Care HMO with its integrated approach and cost-saving features may appeal to price-sensitive consumers, possibly increasing market share. The expansion of individual plan options to employees through employer contributions is an innovative approach that could disrupt traditional group insurance models. However, this rapid expansion and diversification of offerings may strain Oscar's operational capacity and require significant investment in infrastructure and customer support. Investors should watch for metrics on customer satisfaction, medical loss ratios and operational efficiency as indicators of successful implementation.

NEW YORK--(BUSINESS WIRE)-- Oscar Health, Inc. (“Oscar”) (NYSE: OSCR), a leading healthcare technology company, today announced it will bring the Oscar experience to more individuals, families, and businesses through the ACA marketplace in 2025. Oscar is introducing affordable health insurance products that empower people to pursue a healthy life on their terms with:

Oscar Health's 2025 Open Enrollment market expansion. (Graphic: Business Wire)

• Services built around personal health needs and preferences.
• Established networks providing multiple paths to high-value clinical care.
• Technology solutions to help members manage their health and make informed choices.

The Oscar experience will be available in 504 markets across 18 states in 2025.

“Oscar makes shopping for healthcare easy with plans that fit every budget,” said Mark Bertolini, CEO of Oscar Health. “People have control over the products they buy and use in every part of their life, except healthcare. Oscar is changing that. We give people the freedom to select plans that work best for them. Our members understand what they are buying, what it costs, and how it compares to other products.”

Oscar is giving its fast-growing and diverse membership better health insurance choices. The following solutions will be available across select states in the 2025 Open Enrollment period¹.

Building Solutions for Communities
Oscar is introducing Buena Salud, a Spanish-first solution for Hispanic and Latino members. Individuals meet Oscar in Español and are connected to an Oscar care team, primary care provider, and healthcare community that share their cultural heritage. The solution prioritizes the preferences of Hispanics and Latinos, who are more inclined to seek care when providers speak Spanish².

Buena Salud builds on the Hola Oscar experience, which has an industry-leading NPS of 87³ and is available across Oscar plans. The program, developed by native Spanish-speakers at Oscar, accounts for cultural, linguistic, and regional differences among Hispanic and Latino communities. These communities make up nearly one-third of Oscar’s membership and are the fastest-growing populations in the ACA⁴.

Expanding the ACA to Employees and Employers
Employees can now choose from Oscar’s suite of affordable, tech-savvy solutions using their employer contributions. Individuals can select from dozens of plans with high-quality networks that align with their schedules, neighborhoods, and health needs. Oscar has a dedicated concierge team for employees that is available 24/7 to help them maximize their new benefits.

Oscar is working with StretchDollar to help businesses with less than 50 employees instantly offer pre-tax contributions that employees can use to buy individual health insurance. Businesses can visit StretchDollar.com/Oscar to set up a free account in less than 10 minutes⁵.

Oscar's plans offer much-needed relief for the growing number of employers that are new to insurance or struggling with double-digit increases from small group plans.

Making Multiple Chronic Conditions Easier to Manage
Oscar is launching a multi-condition plan for members with diabetes, pulmonary, and cardiovascular disease – three common conditions impacting ACA members⁶. Managing these conditions together can lower costs by 25% or more⁷. Benefits include: $0 cardiologist, pulmonologist, and endocrinologist visits; $0 screenings and labs; $0 primary and behavioral care; and $0 medications.

Members can enroll in Oscar’s single-condition plans, Diabetes Care and Breathe Easy, in select states.

Introducing Solutions for People Who Want a Healthcare Guide
Oscar is introducing Guided Care HMO with lower premiums and out-of-pocket costs. Individuals select a primary care provider who manages their care with a network of specialists for an exceptional experience. The solution delivers urgent and real-time referrals, addressing pain points of most HMOs. Benefits include: $0 virtual urgent care; $0 medications; and low-cost labs and integrated virtual-first speciality care.

Members can access Oscar’s Diabetes Care and multi-condition plan through Guided Care HMO. Visit HiOscar.com/GuidedCare for more information.

Alessa Quane, Chief Insurance Officer, Oscar Health added: “Oscar’s solutions acknowledge cultural and health differences to best meet the needs of individuals and families. Our offerings this open enrollment embody what Oscar will continue to bring to growing populations in the ACA – making the individual market the chosen solution for all Americans.”

About Oscar Health

Oscar Health, Inc. (“Oscar”) is a leading healthcare technology company built around a full stack technology platform and a relentless focus on serving our members. We have been challenging the status quo in the healthcare system since our founding in 2012, and are dedicated to making a healthier life accessible and affordable for all. Oscar offers Individual & Family plans and health technology solutions that power the healthcare industry through +Oscar. Our technology drives superior experiences, deep engagement, and high-value clinical care, earning us the trust of approximately 1.6 million members, as of June 30, 2024.

Cautionary Note Regarding Forward-Looking Statements

This press release contains forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. All statements other than statements of historical fact contained herein are forward-looking statements. These statements include, but are not limited to, statements about our business prospects, and our management’s plans and objectives for future operations, expectations and business strategy. In some cases, you can identify forward-looking statements by terms such as “may,” “will,” “should,” “expects,” “plans,” “anticipates,” “could,” “intends,” “targets,” “projects,” “contemplates,” “believes,” “estimates,” “predicts,” “potential,” or “continue” or the negative of these terms or other similar expressions. Accordingly, we caution you that any such forward-looking statements are not guarantees of future performance and are subject to risks, assumptions, and uncertainties that are difficult to predict and generally beyond our control. Although management believes that the expectations reflected in these forward-looking statements are reasonable as of the date made, there are or will be important factors that could cause our actual results to differ materially from those indicated in these forward-looking statements, including, but not limited to, the factors set forth under the caption “Risk Factors” in our Quarterly Report on Form 10-Q for the quarterly period ended June 30, 2024, filed with the Securities and Exchange Commission (“SEC”), and our other filings with the SEC. You are cautioned not to place undue reliance on any forward-looking statements made in this press release. Any forward-looking statement speaks only as of the date as of which it is made, and, except as otherwise required by law, we do not undertake any obligation to publicly update or review any forward-looking statement, whether as a result of new information, future developments or otherwise. New factors emerge from time to time, and it is not possible for us to predict which will arise.

^{__________________________________________
1}Buena Salud: GA and off-exchange in FL. Multi-Condition Plan: FL, TX, OH, AZ, GA. Guided Care HMO: TX and GA HMO.
²Pew Research Center. "Hispanic Americans' Experiences with Health Care." June 14, 2022.
³Spanish-speaking net promoter score (NPS) for Oscar members as of 1Q24.
⁴U.S. Department of Health and Human Services. "Health Insurance Marketplace Enrollment by Race and Ethnicity 2023." March 22, 2024.
⁵Applicable for employers with less than 50 employees, especially those that are new-to-insurance.
⁶Oliver Wyman. "Premium Tax Credit Ending: Chronic Conditions at Risk." September 2024.
⁷2024 Oscar internal clinical analysis of average course of treatment for Diabetes, pulmonary related conditions and CKM conditions.

View source version on businesswire.com: https://www.businesswire.com/news/home/20241021600325/en/

Media Contact:

Kristen Prestano

VP, Communications

press@hioscar.com

Source: Oscar Health, Inc.

FAQ

What is Oscar Health's 2025 market expansion plan?

Oscar Health (OSCR) plans to expand its affordable health insurance products to 504 markets across 18 states in 2025, offering solutions tailored to diverse communities and health needs.

What is Buena Salud by Oscar Health?

Buena Salud is Oscar Health's new Spanish-first health insurance solution for Hispanic and Latino members, offering culturally tailored care and an industry-leading NPS of 87.

How is Oscar Health expanding its offerings for employees and employers?

Oscar Health is introducing employee choice plans, allowing workers to select from Oscar's suite of plans using employer contributions. They're also partnering with StretchDollar to help small businesses offer pre-tax contributions for individual health insurance.

What is Oscar Health's new multi-condition plan?

Oscar Health is launching a multi-condition plan for members with diabetes, pulmonary, and cardiovascular disease, offering $0 specialist visits, screenings, labs, primary and behavioral care, and medications, potentially lowering costs by 25% or more.

What is Guided Care HMO by Oscar Health?

Guided Care HMO is Oscar Health's new solution offering lower premiums and out-of-pocket costs. It includes managed care with a primary care provider, $0 virtual urgent care, $0 medications, and low-cost labs and integrated virtual-first specialty care.