Oscar Health Announces Results for Second Quarter 2024 and Raises Full Year Revenue and Adjusted EBITDA Outlook
Oscar Health (NYSE: OSCR) reported strong Q2 2024 results, with total revenue of $2.2 billion, up 46% year-over-year. The company saw improvements in key metrics:
- Medical Loss Ratio improved 90 bps to 79.0%
- SG&A Expense Ratio improved 260 bps to 19.6%
- Net income of $56.2 million, or $0.20 EPS, a $71.7 million improvement
- Adjusted EBITDA of $104.1 million, a $68.6 million improvement
Based on strong performance, Oscar raised its full-year 2024 outlook:
- Revenue projected at $9.0-$9.1 billion
- Adjusted EBITDA projected at $160-$210 million
- Lower SG&A Expense Ratio of 19.75-20.25%
- Slightly higher Medical Loss Ratio of 80.5-81.5%
Oscar Health (NYSE: OSCR) ha riportato risultati solidi per il secondo trimestre del 2024, con entrate totali di 2,2 miliardi di dollari, in aumento del 46% rispetto all'anno precedente. L'azienda ha registrato miglioramenti in metriche chiave:
- Il rapporto di perdita medica è migliorato di 90 punti base, portandosi a 79,0%
- Il rapporto delle spese SG&A è migliorato di 260 punti base, arrivando a 19,6%
- Reddito netto di 56,2 milioni di dollari, pari a 0,20 dollari di EPS, con un miglioramento di 71,7 milioni di dollari
- EBITDA rettificato di 104,1 milioni di dollari, un miglioramento di 68,6 milioni di dollari
Basandosi su questa performance positiva, Oscar ha alzato le previsioni per l'intero anno 2024:
- Entrate stimate tra 9,0 e 9,1 miliardi di dollari
- EBITDA rettificato previsto tra 160 e 210 milioni di dollari
- Rapporto delle spese SG&A inferiore, tra il 19,75% e il 20,25%
- Leggermente più alto il rapporto di perdita medica, tra il 80,5% e l'81,5%
Oscar Health (NYSE: OSCR) reportó resultados sólidos para el segundo trimestre de 2024, con ingresos totales de 2.2 mil millones de dólares, un aumento del 46% interanual. La compañía vio mejoras en métricas clave:
- El índice de pérdida médica mejoró en 90 puntos básicos, alcanzando 79.0%
- El índice de gastos SG&A mejoró en 260 puntos básicos, llegando a 19.6%
- Ingresos netos de 56.2 millones de dólares, o 0.20 dólares por acción, una mejora de 71.7 millones de dólares
- EBITDA ajustado de 104.1 millones de dólares, una mejora de 68.6 millones de dólares
Con base en un desempeño sólido, Oscar elevó su pronóstico para todo el año 2024:
- Ingresos proyectados entre 9.0 y 9.1 mil millones de dólares
- EBITDA ajustado proyectado entre 160 y 210 millones de dólares
- Índice de gastos SG&A más bajo del 19.75% al 20.25%
- Índice de pérdida médica ligeramente más alto, entre el 80.5% y el 81.5%
오스카 헬스 (NYSE: OSCR)는 2024년 2분기 실적을 발표하며 총 수익 22억 달러를 기록, 전년 대비 46% 증가했다. 회사는 주요 지표에서 개선을 보였다:
- 의료 손실 비율이 90bp 개선되어 79.0%에 도달했다.
- SG&A 비용 비율이 260bp 개선되어 19.6%에 도달했다.
- 순이익이 5,620만 달러, 주당 0.20달러 EPS로, 7,170만 달러 개선되었다.
- 조정된 EBITDA는 1억 410만 달러로, 6,860만 달러 개선되었다.
견고한 성과를 바탕으로 오스카는 2024년 전체 전망을 상향 조정했다:
- 예상 수익은 90억-91억 달러로 전망한다.
- 예상 조정 EBITDA는 1억 6000만-2억 1000만 달러이다.
- SG&A 비용 비율은 19.75%-20.25%로 낮아질 것이다.
- 의료 손실 비율은 80.5%-81.5%로 약간 높아질 것이다.
Oscar Health (NYSE: OSCR) a annoncé des résultats solides pour le deuxième trimestre 2024, avec des revenus totaux de 2,2 milliards de dollars, en hausse de 46 % par rapport à l'année précédente. L'entreprise a constaté des améliorations dans les indicateurs clés :
- Le ratio de perte médicale a été amélioré de 90 points de base pour atteindre 79,0 %
- Le ratio de dépenses SG&A a été amélioré de 260 points de base pour atteindre 19,6 %
- Le revenu net s'est élevé à 56,2 millions de dollars, soit 0,20 $ EPS, une amélioration de 71,7 millions de dollars
- L'EBITDA ajusté s'est élevé à 104,1 millions de dollars, soit une amélioration de 68,6 millions de dollars.
Sur la base de cette performance solide, Oscar a relevé ses prévisions pour l'année entière 2024 :
- Chiffre d'affaires prévu entre 9,0 et 9,1 milliards de dollars
- EBITDA ajusté prévu entre 160 et 210 millions de dollars
- Ratio de dépenses SG&A plus faible de 19,75 à 20,25 %
- Ratio de perte médicale légèrement plus élevé de 80,5 à 81,5 %
Oscar Health (NYSE: OSCR) hat starke Ergebnisse für das zweite Quartal 2024 berichtet, mit Gesamteinnahmen von 2,2 Milliarden Dollar, was einem Anstieg von 46 % im Vergleich zum Vorjahr entspricht. Das Unternehmen verzeichnete Verbesserungen in wichtigen Kennzahlen:
- Die medizinische Verlustquote verbesserte sich um 90 Basispunkte auf 79,0%
- Der SG&A-Kostenanteil verbesserte sich um 260 Basispunkte auf 19,6%
- Der Nettogewinn betrug 56,2 Millionen Dollar, oder 0,20 Dollar EPS, eine Verbesserung von 71,7 Millionen Dollar
- Das bereinigte EBITDA betrug 104,1 Millionen Dollar, eine Verbesserung von 68,6 Millionen Dollar.
Basierend auf der starken Leistung erhöhte Oscar die Prognose für das gesamte Jahr 2024:
- Prognostizierte Einnahmen zwischen 9,0 und 9,1 Milliarden Dollar
- Prognostiziertes bereinigtes EBITDA zwischen 160 und 210 Millionen Dollar
- Niedrigere SG&A-Kostenquote von 19,75-20,25%
- Leicht höhere medizinische Verlustquote von 80,5-81,5%
- Total revenue increased 46% YoY to $2.2 billion
- Medical Loss Ratio improved 90 bps to 79.0%
- SG&A Expense Ratio improved 260 bps to 19.6%
- Net income of $56.2 million, a $71.7 million improvement YoY
- Adjusted EBITDA of $104.1 million, a $68.6 million improvement YoY
- Raised full-year 2024 revenue outlook to $9.0-$9.1 billion
- Increased full-year 2024 Adjusted EBITDA outlook to $160-$210 million
- Total membership increased to 1,580,725, up from 970,543 in Q2 2023
- Slightly higher projected Medical Loss Ratio for full-year 2024 (80.5-81.5%)
Insights
Oscar Health's Q2 2024 results show impressive growth and profitability improvements. Total revenue surged 46% YoY to
The company's profitability metrics are particularly striking. Net income reached
Oscar Health's Q2 performance reflects a positive trend in the health insurance market, particularly in the individual and small group segments. The company's membership grew significantly to 1,580,725, up from 970,543 in the previous year. This
The improved Medical Loss Ratio suggests better risk management and potentially more accurate pricing of insurance products. The substantial reduction in SG&A Expense Ratio points to economies of scale and operational efficiencies as the company grows. These improvements, combined with the raised full-year outlook, position Oscar Health favorably in the competitive health insurance landscape, potentially attracting more investor interest and market share gains in the coming quarters.
Oscar Health's strong Q2 results and improved outlook for 2024 reflect broader trends in the U.S. healthcare market. The company's success in the individual and small group segments aligns with the ongoing shift towards more personalized, technology-driven health insurance options. The significant membership growth to over 1.5 million members suggests that Oscar's innovative approach is resonating with consumers seeking alternatives to traditional insurance models.
The improved Medical Loss Ratio of
-
For the quarter ended June 30, 2024:
-
Total Revenue of
, a$2.2 billion 46% increase YoY -
Medical Loss Ratio of
79.0% , a 90 bps improvement YoY -
SG&A Expense Ratio of
19.6% , a 260 bps improvement YoY -
Net income attributable to Oscar of
, or$56.2 million of diluted earnings per share, a$0.20 improvement YoY$71.7 million -
Adjusted EBITDA of
, a$104.1 million improvement YoY$68.6 million
-
Total Revenue of
“Oscar reported strong second quarter results, closing out the best six months in the company's history," said Mark Bertolini, CEO of Oscar Health. “We continued to report robust revenue growth, improved operating margin, and strong bottom line performance. Based on our outperformance in the first half of the year, we updated our full year 2024 guidance. We are well-positioned to deliver on our target for Adjusted EBITDA profitability this year.”
Total Revenue was
The Medical Loss Ratio improved 90 bps YoY to
Adjusted EBITDA of
Oscar is updating its full year 2024 outlook to reflect first half outperformance. The Company projects Revenue to be in the
Key Metrics and Non-GAAP Financial Metrics |
|||||||||||||||
|
|
|
|
|
|
|
|
||||||||
|
Three Months Ended June 30, |
|
Six Months Ended June 30, |
||||||||||||
(in thousands, except percentages) |
|
2024 |
|
|
|
2023 |
|
|
|
2024 |
|
|
|
2023 |
|
Total revenue |
$ |
2,219,341 |
|
|
$ |
1,521,535 |
|
|
$ |
4,361,646 |
|
|
$ |
2,991,220 |
|
Medical Loss Ratio (MLR) |
|
79.0 |
% |
|
|
79.9 |
% |
|
|
76.7 |
% |
|
|
78.2 |
% |
SG&A Expense Ratio |
|
19.6 |
% |
|
|
22.2 |
% |
|
|
19.0 |
% |
|
|
24.6 |
% |
Adjusted EBITDA(1) |
$ |
104,126 |
|
|
$ |
35,572 |
|
|
$ |
323,440 |
|
|
$ |
86,640 |
|
(1) |
Adjusted EBITDA is a non-GAAP measure. See “Key Operating and Non-GAAP Financial Metrics - Adjusted EBITDA” in this release for a reconciliation to net loss, the most directly comparable GAAP measure, and for information regarding Oscar’s use of Adjusted EBITDA. |
|
|
|
|
|
|
As of June 30, |
||
Membership by Offering |
2024 |
|
2023 |
Individual and Small Group |
1,522,432 |
|
900,228 |
Medicare Advantage |
— |
|
1,843 |
Cigna+Oscar (1) |
58,293 |
|
68,472 |
Total Members (2) |
1,580,725 |
|
970,543 |
(1) | Represents total membership for Oscar’s co-branded partnership with Cigna. |
|
(2) | A member covered under more than one of our health plans counts as a single member for the purposes of this metric. |
|
Quarterly Conference Call Details
Oscar will host a conference call to discuss the financial results today, August 7, 2024, at 8:00 a.m. (ET). A live audio webcast will be available via the Investor Relations page of Oscar’s website at ir.hioscar.com. A replay of the webcast will be available for on-demand listening shortly after the completion of the call, at the same web link, and will remain available for approximately 90 days.
Non-GAAP Financial Information
This release presents Adjusted EBITDA, a non-GAAP financial metric, which is provided as a complement to the results provided in accordance with accounting principles generally accepted in
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 financial outlook and estimates, including Total revenue, Medical Loss Ratio, SG&A Expense Ratio and Adjusted EBITDA and other financial performance metrics, and the related underlying assumptions, our business and financial 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 we believe 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 following: our ability to execute our strategy and manage our growth effectively; our ability to retain and expand our member base; heightened competition in the markets in which we participate; our ability to accurately estimate our incurred medical expenses or effectively manage our medical costs or related administrative costs; our ability to achieve or maintain profitability in the future; changes in federal or state laws or regulations, including changes with respect to the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010, as amended (collectively, the “ACA”) and any regulations enacted thereunder; our ability to comply with ongoing regulatory requirements, including capital reserve and surplus requirements and applicable performance standards; changes or developments in the health insurance markets in
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.
About Oscar Health
Oscar Health, Inc. (“Oscar”) is the first health insurance company built around a full stack technology platform and a relentless focus on serving its members. At Oscar, our mission is to make a healthier life accessible and affordable for all. Headquartered in
.
Oscar Health, Inc.
|
|||||||||||||
|
Three Months Ended June 30, |
|
Six Months Ended June 30, |
||||||||||
(in thousands, except per share amounts) |
2024 |
|
2023 |
|
2024 |
|
2023 |
||||||
Revenue |
|
|
|
|
|
|
|
||||||
Premium |
|
2,164,116 |
|
|
1,474,966 |
|
|
$ |
4,257,798 |
|
$ |
2,903,592 |
|
Investment income |
|
49,994 |
|
|
41,484 |
|
|
|
92,983 |
|
|
77,540 |
|
Services and other |
|
5,231 |
|
|
5,085 |
|
|
|
10,865 |
|
|
10,088 |
|
Total revenue |
|
2,219,341 |
|
|
1,521,535 |
|
|
|
4,361,646 |
|
|
2,991,220 |
|
|
|
|
|
|
|
|
|
||||||
Operating Expenses |
|
|
|
|
|
|
|
||||||
Medical |
|
1,708,722 |
|
|
1,181,999 |
|
|
|
3,263,496 |
|
|
2,273,591 |
|
Selling, general, and administrative |
|
435,206 |
|
|
337,244 |
|
|
|
829,368 |
|
|
735,763 |
|
Depreciation and amortization |
|
7,601 |
|
|
8,821 |
|
|
|
15,412 |
|
|
13,760 |
|
Total operating expenses |
|
2,151,529 |
|
|
1,528,064 |
|
|
|
4,108,276 |
|
|
3,023,114 |
|
Earnings (loss) from operations |
|
67,812 |
|
|
(6,529 |
) |
|
|
253,370 |
|
|
(31,894 |
) |
Interest expense |
|
5,991 |
|
|
6,120 |
|
|
|
11,893 |
|
|
12,256 |
|
Other expenses |
|
872 |
|
|
1,612 |
|
|
|
2,050 |
|
|
7,718 |
|
Earnings (loss) before income taxes |
|
60,949 |
|
|
(14,261 |
) |
|
|
239,427 |
|
|
(51,868 |
) |
Income tax expense |
|
4,637 |
|
|
1,164 |
|
|
|
5,633 |
|
|
3,185 |
|
Net income (loss) |
|
56,312 |
|
|
(15,425 |
) |
|
|
233,794 |
|
|
(55,053 |
) |
Less: Net income attributable to noncontrolling interests |
|
105 |
|
|
103 |
|
|
|
219 |
|
|
247 |
|
Net income (loss) attributable to Oscar Health, Inc. |
$ |
56,207 |
|
$ |
(15,528 |
) |
|
$ |
233,575 |
|
$ |
(55,300 |
) |
|
|
|
|
|
|
|
|
||||||
Earnings (Loss) per Share |
|
|
|
|
|
|
|
||||||
Basic |
$ |
0.24 |
|
$ |
(0.07 |
) |
|
$ |
0.99 |
|
$ |
(0.25 |
) |
Diluted |
|
0.20 |
|
|
(0.07 |
) |
|
$ |
0.82 |
|
$ |
(0.25 |
) |
Weighted Average Common Shares Outstanding |
|
|
|
|
|
|
|
||||||
Basic |
|
238,672 |
|
|
219,400 |
|
|
|
235,056 |
|
|
218,164 |
|
Diluted |
|
303,965 |
|
|
219,400 |
|
|
|
299,186 |
|
218,164 |
||
Oscar Health, Inc.
|
|||||||
(in thousands, except share amounts) |
June 30, 2024 |
|
December 31, 2023 |
||||
Assets |
|
|
|
||||
Current Assets: |
|
|
|
||||
Cash and cash equivalents |
$ |
2,268,154 |
|
|
$ |
1,870,315 |
|
Short-term investments |
|
363,639 |
|
|
|
689,833 |
|
Premiums and accounts receivable (net of allowance for credit losses of |
|
398,366 |
|
|
|
201,269 |
|
Risk adjustment transfer receivable |
|
72,136 |
|
|
|
51,925 |
|
Reinsurance recoverable |
|
241,284 |
|
|
|
241,194 |
|
Other current assets |
|
15,514 |
|
|
|
6,564 |
|
Total current assets |
|
3,359,093 |
|
|
|
3,061,100 |
|
Property, equipment, and capitalized software, net |
|
63,953 |
|
|
|
61,930 |
|
Long-term investments |
|
1,465,974 |
|
|
|
365,309 |
|
Restricted deposits |
|
29,856 |
|
|
|
29,870 |
|
Other assets |
|
87,273 |
|
|
|
83,271 |
|
Total assets |
$ |
5,006,149 |
|
|
$ |
3,601,480 |
|
|
|
|
|
||||
Liabilities and Stockholders' Equity |
|
|
|
||||
Current Liabilities: |
|
|
|
||||
Benefits payable |
$ |
1,252,228 |
|
|
$ |
965,986 |
|
Risk adjustment transfer payable |
|
1,779,039 |
|
|
|
1,056,941 |
|
Premium deficiency reserve |
|
2,887 |
|
|
|
5,776 |
|
Unearned premiums |
|
59,970 |
|
|
|
65,918 |
|
Accounts payable and other liabilities |
|
347,523 |
|
|
|
273,367 |
|
Reinsurance payable |
|
60,094 |
|
|
|
61,024 |
|
Total current liabilities |
|
3,501,741 |
|
|
|
2,429,012 |
|
Long-term debt |
|
299,166 |
|
|
|
298,777 |
|
Other liabilities |
|
64,674 |
|
|
|
67,574 |
|
Total liabilities |
|
3,865,581 |
|
|
|
2,795,363 |
|
Commitments and contingencies |
|
|
|
||||
Stockholders' Equity |
|
|
|
||||
Class A common stock ( |
|
2 |
|
|
|
2 |
|
Class B common stock ( |
|
— |
|
|
|
— |
|
Treasury stock (315 thousand shares as of June 30, 2024 and December 31, 2023) |
|
(2,923 |
) |
|
|
(2,923 |
) |
Additional paid-in capital |
|
3,786,885 |
|
|
|
3,682,294 |
|
Accumulated deficit |
|
(2,643,140 |
) |
|
|
(2,876,715 |
) |
Accumulated other comprehensive income (loss) |
|
(2,625 |
) |
|
|
1,309 |
|
Total Oscar Health, Inc. stockholders' equity |
|
1,138,199 |
|
|
|
803,967 |
|
Noncontrolling interests |
|
2,369 |
|
|
|
2,150 |
|
Total stockholders' equity |
|
1,140,568 |
|
|
|
806,117 |
|
Total liabilities and stockholders' equity |
$ |
5,006,149 |
|
|
$ |
3,601,480 |
|
Oscar Health, Inc.
|
|||||||
|
Six Months Ended June 30, |
||||||
(in thousands) |
|
2024 |
|
|
|
2023 |
|
Cash Flows from Operating Activities: |
|
|
|
||||
Net income (loss) |
$ |
233,794 |
|
|
$ |
(55,053 |
) |
Adjustments to reconcile net income (loss) to net cash provided by operating activities: |
|
|
|
||||
Deferred taxes |
|
51 |
|
|
|
26 |
|
Net realized loss on sale of financial instruments |
|
— |
|
|
|
9 |
|
Depreciation and amortization expense |
|
15,412 |
|
|
|
13,761 |
|
Amortization of debt issuance costs |
|
389 |
|
|
|
389 |
|
Stock-based compensation expense |
|
54,658 |
|
|
|
104,773 |
|
Net accretion of investments |
|
(12,219 |
) |
|
|
(15,275 |
) |
Change in provision for credit losses |
|
(1,200 |
) |
|
|
9,779 |
|
Changes in assets and liabilities: |
|
|
|
||||
(Increase) / decrease in: |
|
|
|
||||
Premiums and accounts receivable |
|
(195,898 |
) |
|
|
13,617 |
|
Risk adjustment transfer receivable |
|
(20,211 |
) |
|
|
(10,474 |
) |
Reinsurance recoverable |
|
(89 |
) |
|
|
539,004 |
|
Other assets |
|
(13,001 |
) |
|
|
1,294 |
|
Increase / (decrease) in: |
|
|
|
||||
Benefits payable |
|
286,242 |
|
|
|
(82,016 |
) |
Unearned premiums |
|
(5,947 |
) |
|
|
(5,925 |
) |
Premium deficiency reserve |
|
(2,888 |
) |
|
|
(832 |
) |
Accounts payable and other liabilities |
|
71,254 |
|
|
|
(38,330 |
) |
Reinsurance payable |
|
(930 |
) |
|
|
(360,015 |
) |
Risk adjustment transfer payable |
|
722,097 |
|
|
|
465,507 |
|
Net cash provided by operating activities |
|
1,131,514 |
|
|
|
580,239 |
|
Cash Flows from Investing Activities: |
|
|
|
||||
Purchase of investments |
|
(1,362,993 |
) |
|
|
(537,688 |
) |
Sale of investments |
|
— |
|
|
|
19,160 |
|
Maturity of investments |
|
596,838 |
|
|
|
711,453 |
|
Purchase of property, equipment and capitalized software |
|
(13,512 |
) |
|
|
(12,996 |
) |
Change in restricted deposits |
|
1,451 |
|
|
|
(522 |
) |
Net cash (used in) provided by investing activities |
|
(778,216 |
) |
|
|
179,407 |
|
Cash Flows from Financing Activities: |
|
|
|
||||
Proceeds from joint venture contribution |
|
— |
|
|
|
471 |
|
Proceeds from exercise of stock options |
|
46,011 |
|
|
|
2,586 |
|
Net cash provided by financing activities |
|
46,011 |
|
|
|
3,057 |
|
Increase in cash, cash equivalents and restricted cash equivalents |
|
399,309 |
|
|
|
762,703 |
|
Cash, cash equivalents, restricted cash and cash equivalents—beginning of period |
|
1,891,971 |
|
|
|
1,580,497 |
|
Cash, cash equivalents, restricted cash and cash equivalents—end of period |
|
2,291,280 |
|
|
|
2,343,200 |
|
Cash and cash equivalents |
|
2,268,154 |
|
|
|
2,322,069 |
|
Restricted cash and cash equivalents included in restricted deposits |
|
23,126 |
|
|
|
21,131 |
|
Total cash, cash equivalents and restricted cash and cash equivalents |
$ |
2,291,280 |
|
|
$ |
2,343,200 |
|
Supplemental Disclosures: |
|
|
|
||||
Interest payments |
$ |
11,269 |
|
|
$ |
22,636 |
|
Income tax payments |
$ |
84 |
|
|
$ |
400 |
|
Key Operating and Non-GAAP Financial Metrics
We regularly review the following key operating and Non-GAAP financial metrics to evaluate our business, measure our performance, identify trends in our business, prepare financial projections, and make strategic decisions. We believe these operational and financial measures are useful in evaluating our performance, in addition to our financial results prepared in accordance with GAAP.
Members
Members are defined as any individual covered by a health plan that we offer directly or through a co-branded arrangement. We view the number of members enrolled in our health plans as an important metric to help evaluate and estimate revenue and market share. Additionally, the more members we enroll, the more data we have, which allows us to improve the functionality of our platform.
Medical Loss Ratio
Medical Loss Ratio is a metric used to calculate medical expenses as a percentage of net premiums before ceded quota share reinsurance. Medical expenses are the total expenses incurred by members in order to utilize health care services less any member cost sharing. These services include inpatient, outpatient, pharmacy, and physician costs. Medical claims also include fee-for-service claims, pharmacy benefits, capitation payments to providers, provider disputed claims, risk sharing arrangements with certain of our providers, and various other medical-related costs. The impact of the federal risk adjustment program is included in the denominator of our MLR. We believe MLR is an important metric to demonstrate the ratio of our costs to pay for healthcare of our members to the net premium before ceded reinsurance. MLR in our existing products are subject to various federal and state minimum requirements.
|
Three Months Ended June 30, |
|
Six Months Ended June 30, |
||||||||||||
(in thousands, except percentages) |
|
2024 |
|
|
|
2023 |
|
|
|
2024 |
|
|
|
2023 |
|
Medical |
$ |
1,708,722 |
|
|
$ |
1,181,999 |
|
|
$ |
3,263,496 |
|
|
$ |
2,273,591 |
|
Less: Ceded quota share reinsurance claims (1) |
|
(3,860 |
) |
|
|
(2,786 |
) |
|
|
(4,915 |
) |
|
|
3,649 |
|
Net claims before ceded quota share reinsurance (A) |
$ |
1,712,582 |
|
|
$ |
1,184,785 |
|
|
$ |
3,268,411 |
|
|
$ |
2,269,942 |
|
|
|
|
|
|
|
|
|
||||||||
Premium |
$ |
2,164,116 |
|
|
$ |
1,474,966 |
|
|
$ |
4,257,798 |
|
|
$ |
2,903,592 |
|
Less: Ceded quota share reinsurance premiums (2) |
|
(2,820 |
) |
|
|
(7,338 |
) |
|
|
(4,836 |
) |
|
|
(683 |
) |
Net premiums before ceded quota share reinsurance (B) |
$ |
2,166,936 |
|
|
$ |
1,482,304 |
|
|
$ |
4,262,634 |
|
|
$ |
2,904,275 |
|
Medical Loss Ratio (A divided by B) |
|
79.0 |
% |
|
|
79.9 |
% |
|
|
76.7 |
% |
|
|
78.2 |
% |
(1) | Represents prior period development for claims ceded to reinsurers pursuant to quota share treaties accounted for under reinsurance accounting, which are in runoff. |
|
(2) | Represents prior period development for premiums ceded to reinsurers pursuant to quota share treaties accounted for under reinsurance accounting, which are in runoff. |
|
SG&A Expense Ratio
The SG&A Expense Ratio reflects the Company’s selling, general and administrative ("SG&A") expenses, as a percentage of Total revenue. Selling, general and administrative expenses primarily include wages, benefits, costs of software and hardware, and administrative costs for our corporate and technology functions, the impact of quota share reinsurance, and stock-based compensation. We believe the SG&A Expense Ratio is useful to evaluate our ability to manage our overall selling, general, and administrative cost base.
Adjusted EBITDA
Adjusted EBITDA is defined as Net income (loss) for the Company and its consolidated subsidiaries before interest expense, income tax expense (benefit), and depreciation and amortization, as further adjusted for stock-based compensation, and other items that are considered unusual or not representative of underlying trends of our business, where applicable for the period presented. We present Adjusted EBITDA because we consider it to be an important supplemental measure of our performance and believe it is frequently used by securities analysts, investors, and other interested parties in the evaluation of companies in our industry. Adjusted EBITDA is a non-GAAP measure. Management believes that investors’ understanding of our performance is enhanced by including this non-GAAP financial measure as a reasonable basis for comparing our ongoing results of operations.
We caution investors that amounts presented in accordance with our definition of Adjusted EBITDA may not be comparable to similar measures disclosed by our competitors, because not all companies and analysts calculate Adjusted EBITDA in the same manner.
By providing this non-GAAP financial measure, together with a reconciliation to the most comparable
should not be considered in isolation, or as an alternative to, or a substitute for Net income (loss) or other financial statement data presented in our Condensed Consolidated Financial Statements as indicators of financial performance.
|
Three Months Ended June 30, |
|
Six Months Ended June 30, |
||||||||||
(in thousands) |
2024 |
|
|
2023 |
|
|
2024 |
|
|
2023 |
|
||
Net income (loss) |
$ |
56,312 |
|
$ |
(15,425 |
) |
|
$ |
233,794 |
|
$ |
(55,053 |
) |
Interest expense |
|
5,991 |
|
|
6,120 |
|
|
|
11,893 |
|
|
12,256 |
|
Other expenses |
|
872 |
|
|
1,612 |
|
|
|
2,050 |
|
|
7,718 |
|
Income tax expense |
|
4,637 |
|
|
1,164 |
|
|
|
5,633 |
|
|
3,185 |
|
Depreciation and amortization |
|
7,601 |
|
|
8,822 |
|
|
|
15,412 |
|
|
13,761 |
|
Stock-based compensation(1) |
|
28,713 |
|
|
33,279 |
|
|
|
54,658 |
|
|
104,773 |
|
Adjusted EBITDA |
$ |
104,126 |
|
$ |
35,572 |
|
|
$ |
323,440 |
|
$ |
86,640 |
|
(1) |
Represents non-cash expenses related to equity-based compensation programs, which vary from period to period depending on various factors including the timing, number, and the valuation of awards. The six months ended June 30, 2023 includes a non-recurring charge of |
|
Appendix
Reinsurance Impact |
|||||||||||||||
|
Three Months Ended June 30, |
|
Six Months Ended June 30, |
||||||||||||
(in thousands) |
|
2024 |
|
|
|
2023 |
|
|
|
2024 |
|
|
|
2023 |
|
Quota share ceded premiums |
$ |
574 |
|
|
$ |
(5,537 |
) |
|
$ |
(4,420 |
) |
|
$ |
6,823 |
|
Quota share ceded claims |
|
3,860 |
|
|
|
2,787 |
|
|
|
4,915 |
|
|
|
(3,648 |
) |
Ceding commission, net of deposit accounting impact (1) |
|
(13,354 |
) |
|
|
(6,967 |
) |
|
|
(25,526 |
) |
|
|
(16,262 |
) |
Experience refund |
|
(3,395 |
) |
|
|
(1,801 |
) |
|
|
(416 |
) |
|
|
(7,506 |
) |
Net quota share impact |
$ |
(12,315 |
) |
|
$ |
(11,518 |
) |
|
$ |
(25,447 |
) |
|
$ |
(20,593 |
) |
(1) |
Includes ceding commissions received from reinsurers, net of the impact of deposit accounting of |
The Company records Premium revenue net of reinsurance. The following table reconciles total reinsurance premiums ceded and reinsurance premiums assumed, which are included as components of total Premium revenue in the condensed consolidated statement of operations.
|
Three Months Ended June 30, |
|
Six Months Ended June 30, |
||||||||||||
(in thousands) |
|
2024 |
|
|
|
2023 |
|
|
|
2024 |
|
|
|
2023 |
|
Direct policy premiums |
$ |
2,544,115 |
|
|
$ |
1,584,774 |
|
|
$ |
4,854,215 |
|
|
$ |
3,248,248 |
|
Assumed premiums |
|
60,460 |
|
|
|
60,395 |
|
|
|
118,072 |
|
|
|
116,330 |
|
Risk adjustment transfers |
|
(432,895 |
) |
|
|
(160,631 |
) |
|
|
(702,293 |
) |
|
|
(453,778 |
) |
Reinsurance premiums ceded |
|
(7,564 |
) |
|
|
(9,572 |
) |
|
|
(12,196 |
) |
|
|
(7,208 |
) |
Premium |
$ |
2,164,116 |
|
|
$ |
1,474,966 |
|
|
$ |
4,257,798 |
|
|
$ |
2,903,592 |
|
The Company records Medical expenses net of reinsurance recoveries. The following table reconciles total Medical expenses to the amount presented in the condensed consolidated statement of operations:
|
Three Months Ended June 30, |
|
Six Months Ended June 30, |
||||||||||||
(in thousands) |
|
2024 |
|
|
|
2023 |
|
|
|
2024 |
|
|
|
2023 |
|
Direct claims incurred |
$ |
1,680,066 |
|
|
$ |
1,136,687 |
|
|
$ |
3,203,712 |
|
|
$ |
2,184,745 |
|
Ceded reinsurance claims |
|
(29,954 |
) |
|
|
(14,943 |
) |
|
|
(49,652 |
) |
|
|
(18,567 |
) |
Assumed reinsurance claims |
|
58,610 |
|
|
|
60,255 |
|
|
|
109,436 |
|
|
|
107,413 |
|
Medical expenses |
$ |
1,708,722 |
|
|
$ |
1,181,999 |
|
|
$ |
3,263,496 |
|
|
$ |
2,273,591 |
|
The Company records Selling, general and administrative ("SG&A") expenses net of reinsurance ceding commissions and assumed SG&A expenses. The following table reconciles total Selling, general and administrative expenses to the amount presented in the condensed consolidated statement of operations:
|
Three Months Ended June 30, |
|
Six Months Ended June 30, |
||||||||||
(in thousands) |
2024 |
|
|
2023 |
|
|
|
2024 |
|
|
2023 |
||
Selling, general and administrative expenses, gross |
$ |
435,144 |
|
$ |
337,833 |
|
|
$ |
829,840 |
|
|
$ |
734,817 |
Reinsurance ceding commissions |
|
62 |
|
|
(589 |
) |
|
|
(472 |
) |
|
|
946 |
Selling, general and administrative expenses |
$ |
435,206 |
|
$ |
337,244 |
|
|
$ |
829,368 |
|
|
$ |
735,763 |
The Company classifies Reinsurance recoverable within current assets on its condensed consolidated balance sheets. The composition of the Reinsurance recoverable balance is as follows:
(in thousands) |
June 30, 2024 |
|
December 31, 2023 |
|||
Reinsurance premium and claim recoverables |
$ |
242,639 |
|
|
$ |
224,837 |
Reinsurance ceding commissions |
|
7,017 |
|
|
|
7,054 |
Experience refunds on reinsurance agreements |
|
(8,372 |
) |
|
|
9,303 |
Reinsurance recoverable |
$ |
241,284 |
|
|
$ |
241,194 |
View source version on businesswire.com: https://www.businesswire.com/news/home/20240807220528/en/
Investor Contact:
Chris Potochar
VP of Investor Relations
ir@hioscar.com
Media Contact:
Kristen Prestano
VP of Communications
press@hioscar.com
Source: Oscar Health, Inc.
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