Oscar Health’s CEO Says 2026 Is the Year It Finally Turns a Profit — Here’s What He’s Betting On

William TempleSat, March 7, 2026 at 3:05 PM UTC

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Oscar Health (OSCR) rose 9.6% despite -$1.24 EPS miss, guiding $750M earnings improvement in 2026 with medical loss ratio dropping to 82.4%-83.4% from Q4’s 95.4%. Membership hit 3.4M. CVS Health (CVS) exited the ACA exchange market.

Oscar Health targets 2026 profitability through AI-driven efficiency, 28% rate increases, and market share gains as CVS cedes ground in the individual ACA exchange.

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Oscar Health (NYSE:OSCR) CEO Mark Bertolini has been making the same promise for four consecutive quarters: 2026 is the year the company turns profitable. Now, with the Q4 2025 results in hand, we can see exactly what he's betting on to make that happen.

The headline numbers from Q4 were rough. EPS came in at -$1.24, missing the estimate of -$0.92 by nearly 35%. More alarming, the medical loss ratio hit 95.4% in Q4, up from 88.1% the prior year — meaning Oscar spent 95 cents in medical costs for every dollar of premium it collected. That's not a business. That's a charity with extra steps.

But the stock still jumped roughly 9.6% following the Q4 announcement, because investors focused on what Bertolini said about 2026, not what happened in 2025.

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Here's the core quote from the earnings call:

"Oscar is on track to return to profitability this year. We expect a significant year-over-year improvement of nearly $750 million in earnings from operations in 2026, representing the midpoint of our guidance."

That $750 million swing is the whole story. Oscar's 2026 guidance targets earnings from operations of $250 million to $450 million, against a 2025 loss from operations of $396 million.

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The math only works if the medical loss ratio comes down dramatically. Oscar is guiding for an MLR of 82.4% to 83.4% in 2026 — a massive improvement from Q4's 95.4%. To get there, Bertolini is pulling three levers.

Lever one: AI-driven efficiency. Bertolini was unusually specific here. "Our Agentic AI bot for care guides reduced response times by 67% during peak open enrollment periods," he said. More tellingly: "Oswell, our industry-first health agent, now completes 86% of questions received from members with high accuracy and quality." That's not a pilot program. That's operational infrastructure.

Lever two: pricing discipline. Oscar took a weighted average rate increase of approximately 28% for 2026 and explicitly priced in the expiration of enhanced premium tax credits that inflated enrollment with higher-risk members in 2025.

Lever three: record membership. Oscar enrolled 3.4 million members as of February 1, 2026, up sharply from prior years. More members spread fixed costs thinner. Oscar's market share across its footprint expanded from 17% in 2025 to 30% in 2026.

The competitive backdrop helps too. CVS Health (NYSE:CVS) exited the individual ACA exchange market for 2026, ceding ground that Oscar is actively taking.

The risk is real. Bertolini made this same profitability promise in Q2, Q3, and Q4 of 2025, while the MLR deteriorated each quarter. EPS came in at -$1.24, missing the estimate of -$0.92. The 2026 guidance requires execution on pricing, underwriting, and AI efficiency simultaneously. But with $2.77 billion in cash and a new $475 million revolving credit facility, Oscar has the runway to find out if Bertolini's bet finally pays off.

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Source: “AOL Money”