Insurtech Oscar Health expects a $228 mn net loss for the second quarter 2025. The revised projection follows a deeper review of claims data showing rising morbidity levels among marketplace enrollees.
According to Oscar, paid claims submitted through April 30 indicate that marketplace policyholders are presenting with more severe health needs than previously estimated.
The company’s updated analysis includes risk adjustment reports that now cover nearly all of its operating regions.
Medical costs remained elevated in Q2, though the increase was more subdued compared to Q1 trends. Oscar now projects a full-year 2025 medical loss ratio of 86–87, a sharp rise reflecting ongoing pressure in the individual market.
The insurtech plans to resubmit 2026 rate filings in jurisdictions covering around 98% of its membership to reflect higher risk scores.
According to Beinsure’s data, insurtech Oscar raised capital across a dozen funding rounds totaling about $1.63 bn, culminating in its public offering in March 2021. That IPO brought in roughly $1.44 bn and marked its latest equity infusion.
Prior private funding rounds included: early‑stage support from Founders Fund and others in 2014 and 2015 (series A and B rounds). Those were followed by a Fidelity‑led series C in 2016 that raised $400 m, and two major 2018 rounds—$165 m, then $375 m led by Alphabet/Google Capital—bringing its valuation to around $3 bn at that time.
A later round in December 2020 generated $140 m, backed by Tiger Global, Baillie Gifford, Coatue and other earlier investors.
Oscar’s total equity raised, including its IPO, stands at approximately $1.63 bn over twelve rounds.
Oscar revised its 2025 outlook, projecting total revenue between $12 bn and $12.2 bn. It now anticipates an operational loss of $200 mn to $300 mn for the year.
Oscar CEO Mark Bertolini said the company is implementing pricing changes for next year that account for the higher acuity profile of its enrollees.
We are taking appropriate pricing actions for 2026 that reflect higher acuity in the individual market, and we will continue to take steps to deliver for our members, partners and shareholders
Mark Bertolini, Oscar chief executive officer
The Q2 2025 update follows a strong start to the year. Oscar reported $275.3 mn in net income for Q1, up from $177.4 mn a year earlier. However, its medical loss ratio worsened to 75.4, compared to 74.2 in the same period last year.
Oscar’s announcement aligns with Molina Healthcare’s recent disclosure. Molina is also bracing for a Q2 net loss of $259 mn due to continued pressure on medical costs. Molina is scheduled to report on July 24.
