Summary of Conference Call for Oscar Health Company Overview - **Company**: Oscar Health - **Industry**: Health Insurance Key Points and Arguments Third-Quarter Results - The third-quarter results were impacted by weekly data fluctuations, with expectations for stability moving forward [1][2] - Full-year guidance assumes no further decay in market morbidity for 2025, based on recent data [2] Market Morbidity and Risk Scores - Members who lost subsidies and left Oscar had higher risk scores, but this group represents less than 2% of the total membership [3] - Increased utilization pressure was noted in the industry, but Oscar's utilization has stabilized and is trending down [4][5] Utilization Management - Oscar has implemented measures to ensure members receive care at appropriate sites, contributing to improved utilization metrics [5][7] - The company has seen a positive shift in care categories due to proactive engagement with providers and members [7] Pricing Strategy - Oscar's premium increase of 28% year-over-year is competitive, with the company positioned as the lowest cost in 30% of its markets [8][9] - The pricing strategy involved extensive modeling, considering market morbidity, potential market contraction, and program integrity measures [10][11] Market Dynamics and Enrollment - The company anticipates a 20-30% contraction in the marketplace due to the expiration of enhanced subsidies, affecting affordability for many members [12][24] - Oscar has expanded into approximately 70 new counties, leveraging existing network relationships to enhance visibility and performance [13][14] Open Enrollment Performance - Early indicators of open enrollment are positive, with strong engagement from brokers and creative plan designs aimed at affordability [15][16] - Retention rates are expected to be lower than previous years due to subsidy losses, but initial retention stats are promising [16][25] Enhanced Subsidies and Future Outlook - Oscar has planned for 2026 without enhanced subsidies, indicating readiness for market changes [21] - The company remains optimistic about potential bipartisan solutions to support families in affording healthcare [19][20] Capital Management - Oscar has over $1 billion in excess capital, positioning the company well for growth and potential market changes [34][36] - The recent convertible debt reduction was a strategic move to improve liquidity and financial performance [31][33] Risks and Opportunities - The primary risk for 2026 is accurately pricing market morbidity, as mispricing could impact profitability [40][41] - Despite risks, Oscar is excited about opportunities for market share growth and profitability improvements in 2026 [41][42] Additional Important Insights - The company is focusing on Individual Coverage Health Reimbursement Arrangements (ICRAs) as a growth opportunity, despite skepticism in the market [38][39] - Oscar emphasizes the importance of maintaining access to affordable healthcare for essential workers and the gig economy [27][28]