Health Insurer Q3 Financial News
Oscar Health reported slipping financials and at least part of its long-term success is dependent on the continuation of enhanced premium subsidies in the Exchanges. After two quarters of net profit, Oscar posted a $54 million loss in Q3. But total revenue was $2.4 billion, a 68% year-over-year increase. Its medical loss ratio (MLR) climbed to 84.6%. It did raise revenue guidance and said EBITDA will be at the higher end of its earlier reported range.
Exchange-focused Oscar has 1.65 million members in total. The company added 73,000 members in the quarter. Its growth has been explosive during the Biden administration. It expects more big growth in 2025 as the premium enhancements are still in place.
Oscar Health CEO Mark Bertolini’s had a rather stern message and challenge for what is expected to be a totally GOP controlled Washington. Bertolini says the GOP would allow the enhanced premium subsidies to expire at great risk. Almost two-thirds of Exchange enrollees live in GOP-led states and enrollment in those states grew 76% from 2023 to 2024. That Exchange enrollment is slanted toward GOP states is because ten of them did not expand Medicaid.
Oscar stock dropped over 15% following Trump’s electoral win — a seven-month low.
Medicare Advantage-focused Clover Health also reported Q3 news. After its first quarterly net profit in Q2, Clover posted a net loss of $8.8 million from Q3. But that still is a 74% improvement from Q3 2023. Clover is bullish on the 2025 enrollment season and has been less impacted by the fallout seen by larger plans. It achieved a 4 Star rating in 2025.
Other news:
- The Q3 MLRs reported so far.
- A Kaiser family Foundation overview of the 2025 Exchange enrollment season.
Additional articles: https://www.fiercehealthcare.com/payers/clover-health-pushing-growth-shows-74-net-income-boost and https://www.kff.org/policy-watch/ten-things-to-watch-for-2025-aca-open-enrollment/ and https://www.beckerspayer.com/payer/payers-ranked-by-q3-mlr-ratios.html
#exchanges #aca #obamacare #medicareadvantage #coverage #trump
https://www.fiercehealthcare.com/payers/oscar-health-racks-55m-net-loss-aca-uncertainty-returns
More Major Healthcare News Post Election Outcome
Some prognostications on what will happen with the Affordable Care Act (ACA) and Medicaid, arguing Donald Trump will follow some of the same policies from his previous administration. These would reshape the ACA if not repeal it and reduce Medicaid outlays. Enhanced premium subsidies in the Exchange would likely expire.
Predictions are that he will be friendly to Medicare Advantage (MA) and that the Federal Trade Commission’s crackdown on pharmacy benefit managers (PBMs) will continue. Prior authorization reform could continue to dog insurers, but site neutral payments could gain traction and mean ire from hospitals.
With the GOP takeover of the Senate, Bill Cassidy is slated to be Chairman of HELP and Mike Crapo will lead Finance. These are the two committees of cognizance over health matters in the upper chamber.
(Some articles may require a subscription.)
Additional articles: https://www.beckerspayer.com/payer/what-trumps-2nd-term-could-mean-for-medicare-advantage.html and https://insidehealthpolicy.com/inside-drug-pricing-daily-news/trump-admin-expected-back-existing-ftc-crackdown-pbm-tactics and https://insidehealthpolicy.com/daily-news/gop-senate-takeover-sets-stage-health-care-policy-shifts-trump-s-second-term
#healthcare #healthcarereform #coverage #medicaid #aca #obamacare #exchanges #election2024 #trump
— Marc S. Ryan
