Oscar Health Cuts 2025 Guidance, Cites ACA Pressures

Oscar Health has significantly changed its 2025 outlook, now projecting an operating loss of $200 million to $300 million, reversing earlier expectations of up to $275 million in operating income. This revision is due to higher-than-expected utilization and rising Affordable Care Act (ACA) risk scores, based on analysis from actuarial firm Wakely. The company expects a second-quarter net loss of $228 million and a medical loss ratio of 86%-87%. Despite these setbacks, Oscar has raised its 2025 revenue guidance to $12 billion to $12.2 billion. Similar adverse trends have led other insurers, including Centene, Elevance Health, and UnitedHealth Group, to lower guidance and anticipate premium hikes in the ACA market. CEO Mark Bertolini stated that Oscar will adjust 2026 pricing to address increased member acuity and maintain its strategic direction.