Financial Data and Key Metrics Changes - Total revenue for Q2 2025 was reported at $2,900,000,000, representing a 29% increase year over year [7][18] - The medical loss ratio (MLR) increased by 12 points year over year to 91.1%, primarily due to an overall increase in average market morbidity [7][19] - The SG&A ratio improved by 90 basis points year over year to 18.7% [8][21] - The loss from operations was $230,000,000, a decrease of $298,000,000 year over year, while the adjusted EBITDA loss was $199,000,000 [8][22] - The company reaffirmed its 2025 guidance, projecting total revenue between $12,000,000,000 and $12,200,000,000 [8][24] Business Line Data and Key Metrics Changes - Membership grew to over 2,000,000, an increase of 28% year over year, driven by solid retention and above-market growth during open enrollment [19] - The second quarter MLR was impacted by a $316,000,000 increase in risk adjustment payable for 2025 due to higher ACA marketplace morbidity [19] Market Data and Key Metrics Changes - The latest risk adjustment data indicates a meaningful market-wide increase in morbidity in 2025, affecting all carriers with increases in mid to high single digits [9] - The company anticipates double-digit rate increases in the market for 2026 to address current morbidity pressures [10] Company Strategy and Development Direction - The company is focused on the individual market, believing it will stabilize in 2026 and is taking actions to mitigate current industry headwinds [8][12] - Oscar Health is acquiring early-stage assets to build a consumer marketplace, including a brokerage and a direct enrollment technology platform [13][14] - The company is launching a new ICRA product in partnership with Hy Vee Inc., targeting employers and employees in Des Moines, Iowa [15] Management's Comments on Operating Environment and Future Outlook - Management believes the individual market has significant long-term growth potential and is taking corrective actions to return to profitability in 2026 [16][27] - The company is confident in its capital position and expects to absorb the majority of forecasted losses through its excess capital [32][90] Other Important Information - The company is reducing its workforce in the second half of 2025, expecting to save approximately $60,000,000 in administrative costs for 2026 [12][27] - The company has a strong capital position with approximately $5,400,000,000 in cash and investments [22][90] Q&A Session Summary Question: Guidance on 2025 free cash flow and risk adjustment payable - Management confirmed a strong capital position and indicated that the majority of expected losses would be absorbed by excess capital [31] Question: Long-term targets for 2027 - Management reaffirmed the 5% margin target and stated that no changes to long-term forecasts are being made at this time [34] Question: Multiyear earnings levers - Management indicated that there are still opportunities to improve medical costs and administrative efficiencies [41] Question: Potential risk pool deterioration - Management expressed confidence that the risk pool would not deteriorate further and that they have factored risks into their pricing for 2026 [48] Question: Market stabilization assumptions for 2026 - Management stated that conservative assumptions have been built into the 2026 guidance, considering market morbidity shifts and program integrity impacts [52] Question: Membership shifts and retention - Management noted that improved membership retention and lower lapse rates contributed to membership growth, with no adverse selection observed [105]

Core Insights - Centene Corporation (CNC) unexpectedly withdrew its earnings guidance for 2025 due to changes in the health insurance marketplace dynamics, which are anticipated to have a more significant impact on earnings than previously forecasted [1][7] Financial Impact - The company is expecting a shortfall of approximately $1.8 billion in net risk adjustment revenues, which translates to an estimated $2.75 reduction in adjusted diluted EPS for 2025 [3][7] - Wall Street analysts have significantly reduced their EPS projections for 2025, cutting the Zacks profit consensus from $7.29 to $3.55, reflecting a more cautious outlook [3][7] Market Conditions - The decision to withdraw guidance was influenced by industry risk adjustment data from Wakely, which indicated higher-than-expected overall market morbidity and a slower growth rate in the marketplace [2] - Despite challenges, the final 2024 risk-adjusted results from the Centers for Medicare and Medicaid Services met the company's expectations, and segments like Medicare Advantage are performing better than anticipated [4] Strategic Adjustments - Centene is proactively adjusting its rates to account for a higher morbidity baseline, which is seen as essential for mitigating potential losses [5] - The company plans to implement these pricing changes in states where it has significant marketplace operations, indicating a more defensive pricing strategy moving forward [5] Analyst Reactions - Wells Fargo downgraded CNC shares to Equal-Weight and reduced their price target from $72 to $30, reflecting the need for a closer examination of the second-quarter earnings and data analysis [6]

Financial Data and Key Metrics Changes - Oscar Health reported total revenue of $3 billion in Q1 2025, a 42% increase year over year [5] - Net income was approximately $275 million, a significant improvement of $98 million over the prior year period [6][20] - Earnings from operations grew by $112 million to $297 million, with an operating margin of 9.8%, an increase of 110 basis points year over year [6][18] - The medical loss ratio (MLR) increased by 120 basis points year over year to 75.4% [6][15] - The SG&A ratio improved to 15.8%, a 260 basis point improvement year over year, marking the lowest in the company's history [6][17] Business Line Data and Key Metrics Changes - The company closed the quarter with approximately 2 million effectuated members, a 41% increase year over year [7][14] - Membership growth was driven by strong retention and above-market growth during open enrollment [14] Market Data and Key Metrics Changes - Oscar Health is deepening its market presence with new partnerships, including the launch of Oscar Community Resources with Find Help, connecting members to local services [8] - The company is experiencing high levels of digital engagement across its IFP and ICRA membership [7] Company Strategy and Development Direction - Oscar Health's strategic plan focuses on top-line growth, bottom-line performance, and margin expansion [6][12] - The company is advocating for constructive solutions to strengthen the individual market and is engaged with policymakers [10][11] - Oscar aims to create a marketplace that meets consumer and employer expectations for choice, quality, and affordability [12] Management's Comments on Operating Environment and Future Outlook - Management expressed confidence in achieving 2025 targets, citing disciplined execution and strong growth [12][22] - The current policy environment, including proposed CMS initiatives, is viewed as positive for long-term market sustainability, despite potential enrollment constraints [10][11] - Management anticipates membership trends to increase in the first half of the year but expects a decline in the latter half due to policy changes [29] Other Important Information - The company reaffirmed its full-year guidance metrics, expecting total revenue in the range of $11.2 billion to $11.3 billion for 2025 [21] - Oscar Health's capital position remains strong, with approximately $4.9 billion in cash and investments [20] Q&A Session Summary Question: Membership expectations for the second quarter and the rest of the year - Management expects membership to trend up in the first half of the year but anticipates a decline in the latter half due to policy changes [28][30] Question: Context around grace period membership and its impact - Management indicated that the gap between effectuated and paid membership is expected to normalize, with a portion of members ending their grace period [34] Question: Utilization patterns between new and retired members - Management noted higher inpatient utilization with favorable pharmacy trends, but no specific condition was driving the inpatient increase [39] Question: Opportunities and risks around competitor exits - Management views competitor exits as an opportunity to attract members and maintain disciplined pricing in the market [42][58] Question: Regulatory environment and enrollment changes - Management supports CMS efforts to strengthen the ACA but expressed concerns about the shortened enrollment period affecting consumer shopping [48] Question: Risk adjustment expectations for 2025 - Management indicated no significant adjustments to risk adjustment payables at this time, but elevated claims could impact future percentages [60] Question: Drivers of SG&A performance - Management attributed SG&A improvements to fixed cost leverage, variable cost efficiencies, and lower exchange fee rates [70][71] Question: Valuation concerns and fraudulent member estimates - Management is conducting its own analysis regarding fraudulent members and remains committed to long-term targets despite market challenges [75] Question: CSR refund proposal and its implications - Management expressed concerns about the practical implementation of CSR refunds and recommended against moving forward with the proposal for 2026 [80]

Financial Data and Key Metrics Changes - For Q1 2025, total revenue was $1.53 billion, down from $1.6 billion in Q1 2024, primarily due to market and partnership exits, partially offset by premium growth [21] - Membership at the end of Q1 2025 was 491,000, a decrease from 523,000 in Q1 2024, reflecting a cautious approach to growth and partner exits [19] - Medical margin for Q1 2025 was $128 million, down from $157 million in Q1 2024, driven by elevated utilization and costs [21][22] - Adjusted EBITDA for Q1 2025 was $21 million, compared to $29 million in Q1 2024, reflecting ongoing elevated cost trends [23] Business Line Data and Key Metrics Changes - ACO REACH membership decreased to 114,000 in Q1 2025 from 131,000 in Q1 2024, primarily due to exiting an underperforming partnership [20] - Medical costs for Q1 2025 were in line with expectations, driven by elevated utilization and flu-related costs [22] - The medical cost trend for year two plus markets was 5.5% in Q1 2025, down from 6.7% in Q1 2024 [24] Market Data and Key Metrics Changes - The Medicare Advantage market continues to expand, with CMS data showing a year-over-year growth trend of 3.9% [10] - Overall market trends in 2025 remain consistent with the prior year, with an expected full-year trend of 5.3% [9] Company Strategy and Development Direction - The company is focused on disciplined growth, reducing exposure to costs outside of its control, and enhancing clinical and operational capabilities [6][12] - Investments in technology and clinical programs are expected to drive competitive advantages and improve quality outcomes [13][14] - The company anticipates a more favorable environment in 2026, supported by improved payer bids and final rate notices from CMS [11][18] Management's Comments on Operating Environment and Future Outlook - Management expressed optimism about the final rate notice from CMS for 2026, which is expected to address high cost and utilization trends [6][18] - The company is taking a cautious approach to membership growth, with expectations for retroactive membership assignments in Q2 [5][19] - Management highlighted the importance of early identification and management of chronic diseases as a key focus of their model [7][10] Other Important Information - The company ended Q1 2025 with $369 million in cash and marketable securities, expecting to use approximately $110 million of cash in 2025 [27] - The company is maintaining a disciplined approach to capital allocation to support business objectives while aiming for cash flow breakeven in 2027 [27] Q&A Session Summary Question: Impact of V-28 risk model transition on value-based care companies - Management indicated that the risk adjustment perspective for 2025 is in line with expectations, with a 2% net increase year over year, despite a 3% headwind from V-28 [33][34] Question: Contribution from previously exited areas - Management noted that unfavorable development from exited markets would not impact 2025 significantly, with minimal remaining IBNR [37][38] Question: 2026 MA final rate notice and its flow-through - Management confirmed that 40% of membership was repriced for January 2025, with expected benefits from the average 9% increase across the network [41][42] Question: Risk scores and patient movement - Management clarified that the 2% increase in risk adjustment is on a same member basis, with some movement between payers noted but not significantly affecting care models [49][52] Question: Expectations for 2026 MA bit cycle - Management expressed optimism about the 2026 environment, with a focus on quality incentives and clinical cost-saving initiatives tracking well [58][61] Question: Medical cost trends and visibility on completed claims - Management stated that medical cost trends were in line with expectations, with improved visibility from the new financial data pipeline [65][66] Question: Potential membership reduction due to Part D - Management indicated that they are making progress in reducing Part D exposure and do not anticipate a reduction in membership for 2026 [75][76] Question: Clinical programs and their impact - Management confirmed that while 2025 is an investment year for new clinical programs, benefits are expected to materialize in 2026 and beyond [104][106]

Financial Data and Key Metrics Changes - The company reaffirmed its full-year guidance, indicating a strong start to 2025 with Q1 results ahead of expectations [7][14] - Adjusted EPS guidance for the year is approximately $16.25, with an expected insurance segment benefit ratio of 90.1% to 90.5% [15][14] - G&A costs for the quarter were slightly better than expectations, attributed to the timing of costs expected to be incurred in the second and third quarters [11][14] Business Line Data and Key Metrics Changes - No changes to membership guidance for 2025, with strong performance in the Open Enrollment Period (OEP) and a positive outlook for the rest of the year [9] - Significant progress in closing care gaps, with expectations to reduce gaps in care by 25% year over year and medication adherence campaigns showing a 30% to 50% reduction in members with weight refills [10][11] - CenterWell and Medicaid businesses are experiencing robust patient and membership growth, with 30 new centers added through acquisition and partnership [12][14] Market Data and Key Metrics Changes - The company is seeing strong year-to-date performance in markets with high concentrations of members, particularly in Florida, Illinois, and Texas [41] - Medicaid is performing in line with expectations, with approximately 100,000 growth year-to-date, aligning with the anticipated growth of 175,000 to 250,000 for the year [74][75] Company Strategy and Development Direction - The company is focused on operational efficiencies, increasing flexibility, and improving member outcomes while positioning for long-term success [14] - Emphasis on capital allocation and growth in CenterWell and Medicaid, with a focus on unlocking substantial value over the mid to long term [16][12] - The integration between the insurance segment and CenterWell is aimed at delivering better health outcomes and improving STARS performance [59][60] Management's Comments on Operating Environment and Future Outlook - Management noted that while challenges remain, there are no surprises in the external environment, and they are executing against controllable factors [7][8] - The company is optimistic about the underlying progress of the business, despite external regulatory headwinds [49][51] - Management expressed confidence in the ability to manage medical costs and G&A effectively while focusing on STARS outcomes [51][92] Other Important Information - The company is actively monitoring changes in consumer behavior due to the Inflation Reduction Act (IRA) [7] - Management highlighted the importance of the upcoming investor conference to provide clarity on earnings power and progress tracking [8][16] Q&A Session Summary Question: How much of your investments moved out of Q1? - Management indicated that most of the impact of incremental investments flowed through the MLR in Q1, with expectations for higher levels in the second through fourth quarters [19][20] Question: Update on the path to the 3% MA margin target? - Management reiterated focus on achieving a 3% margin, with timing tied to STARS outcomes, but no significant changes from previous communications [22][23] Question: Update on STARS initiatives and bids? - Management expressed confidence in progress made on STARS initiatives and ongoing bid processes, emphasizing a balanced approach to membership and margins [25][30] Question: Experience in Part D relative to expectations? - Trends in Part D are consistent with expectations, with mid-single-digit growth on the medical side and low double-digit growth on the pharmacy side [34][35] Question: Visibility on risk adjustment and Group MA? - Management reported strong membership changes and performance in Group MA, with no significant changes in behavior due to recent repricing activity [40][42] Question: Comments on Medicaid visibility and utilization? - Medicaid is performing in line with expectations, with strong growth and modest margin improvements anticipated [72][75] Question: Clarification on GAAP EPS and valuation adjustments? - Management clarified that the adjustment in GAAP EPS guidance is unrelated to structural impairment and is a complex calculation [88][94]

Financial Data and Key Metrics Changes - The company reported first quarter adjusted diluted EPS of $2.90, consistent with previous expectations, with full-year 2025 adjusted EPS expectations remaining unchanged at greater than $7.25 [5][24][37] - Premium and service revenue for Q1 was $42.5 billion, with an increase in full-year revenue guidance to a midpoint of $165 billion, up from $159 billion [26][38] - The adjusted SG&A expense ratio decreased to 7.9% from 8.7% year-over-year, driven by revenue growth and expense discipline [35] Business Line Data and Key Metrics Changes - Medicaid membership was stable at approximately 12.9 to 13 million members, with a Medicaid HBR of approximately 93%, showing slight improvement from 93.4% in Q4 2024 [27][28] - The Medicare segment performed in line with expectations, with Medicare Advantage membership contributing an additional $1 billion to the 2025 revenue outlook due to better-than-expected retention [16][31] - The commercial segment saw strong growth, with a Q1 HBR of 75.0%, up from 73.3% the previous year, driven by new marketplace members [34] Market Data and Key Metrics Changes - The company noted an increase in bipartisan support for extending health care premium tax credits, with 78% of swing voters supporting the extension [9] - The expiration of enhanced premium tax credits is anticipated to be addressed by Congress, with significant implications for the marketplace [10][23] - The company is preparing for potential impacts from proposed marketplace integrity and affordability rules, which could influence market dynamics starting in 2026 [22][42] Company Strategy and Development Direction - The company is focused on margin recovery and aligning rates with member acuity, with expectations that Medicaid will return to pre-pandemic margin levels [11][13] - Strategic initiatives include expanding Medicaid managed care into rural areas and enhancing the Medicare Advantage value proposition [14][16] - The company is committed to navigating the evolving policy landscape while advocating for sound health care policy [7][11] Management's Comments on Operating Environment and Future Outlook - Management expressed confidence in the ability to manage through a dynamic policy landscape, noting that broad support for Medicaid benefit cuts is lacking [7][8] - The company anticipates continued momentum in discussions with state partners regarding rate negotiations and acuity data [75] - Management remains optimistic about long-term growth prospects, emphasizing the attractiveness of end markets and the potential for market share capture [24][25] Other Important Information - The company experienced $130 million in incremental medical expenses due to an active flu season, which offset underlying improvements in medical loss ratio [12][28] - The company is actively engaging with CMS on proposed rules that could impact the marketplace and is preparing for various potential outcomes [22][23] Q&A Session Summary Question: Details on flu-related costs - Management clarified that the $130 million in flu-related costs was tracked using a consistent definition and was isolated to Medicaid, with some flu impact seen in Medicare but not at the same level [49][51] Question: Long-term earnings outlook - Management confirmed that the long-term earnings potential remains optimistic, with opportunities for margin expansion in Medicaid and Medicare segments [54][56] Question: Impact of public exchange subsidies - Management indicated that the estimate of a $1 impact per share from the potential loss of enhanced APTCs remains valid, with ongoing discussions about the implications of work requirements [57][61] Question: Risk adjustment and membership growth - Management noted that risk adjustment numbers are consistent with expectations, and the majority of new membership remains subsidized, aligning with the company's focus on low-income populations [99][96] Question: Specialty drug trends - Management highlighted that specialty drug utilization trends are being closely monitored, particularly in Medicaid, with high-cost drugs impacting overall costs [118][120]