OSCR · Oscar Health

The thesis

Oscar Health is modestly more likely than not to beat the S&P 500 over the next three months. On 5 November 2026, Oscar raised its 2026 earnings-from-operations guidance for the third time, to $850–950 million. It is also growing its 2027 footprint while rivals pull back. The 2027 enrollment and pricing season decides the call, and the fourth-quarter report gives the first formal 2027 targets.

The rating is Medium because the profit recovery is filed and the guidance is raised. Part of the third-quarter beat came from a $250 million risk-adjustment estimate, and individual-market enrollment is shrinking, so the edge over the index is modest. The 10-Q filed on 5 November 2026 shows third-quarter revenue of $5.14 billion, against $2.99 billion in the same quarter a year earlier.

The market has already priced the raise and then marked it down. The shares closed at $32.11 on 11 November 2026, 16.6% below the $38.50 intraday high set on 5 November, the day of the report.

Bullish and bearish views on Oscar Health, Inc.

The bull case on Oscar Health, Inc. (OSCR), in brief: guidance has been raised three times. The bear case: part of the beat will not repeat.

Bull case

• Guidance has been raised three times. The 5 November 2026 results release raised 2026 earnings from operations to $850–950 million from $600–800 million. It raised revenue guidance to $19.0–19.3 billion from $18.7–19.0 billion, per 247WallSt.
• Margins widened in the third quarter. The medical loss ratio (MLR, medical costs as a share of premiums) was 84.0% against 88.5% a year earlier. The selling, general and administrative (SG&A) expense ratio fell to 14.0% from 17.5%, per 247WallSt. Becker's Payer reported net income of about $167 million for the quarter.
• The footprint is growing for 2027. Healthcare Dive reported on 21 October 2026 that Oscar is adding 140 counties and entering South Carolina for 2027. That is part of a plan for 400 to 600 new counties by 2029. Company news on 10 November 2026 announced coverage across nearly all of Ohio.
• Long-term target restated. On 5 November 2026, Oscar said it is on track for EPS of at least $4.00 by 2029. Management also said it targets share gains and margin expansion in 2027.
• Post-report targets sit above the price. Piper Sandler kept Overweight with a $45 target on 6 November 2026, down from $48. UBS raised its target to $38 from $36 the same day.

Bear case

• Part of the beat will not repeat. The third quarter included a $250 million benefit from updated risk-adjustment estimates and $42 million of favorable prior-period development, per 247WallSt. Both flatter the raised 2026 range.
• The market is shrinking. A KFF analysis released 14 October 2026 estimated that individual-market enrollment fell 18%, from 25.2 million in June 2025 to 20.5 million in June 2026, as cited by Healthcare Finance News. Press coverage of the third-quarter call says Oscar expects to end 2026 near 2.5 million members after disenrollments from a second federal review.
• 2027 pricing is the next test. The Commonwealth Fund, as cited by Health Care Dive on 21 October 2026, put the median proposed 2027 rate increase at 15%, the highest back-to-back rise since 2018. Piper Sandler cited 2027 ACA pricing risk when it cut its target on 6 November 2026.
• Exits and legal headlines are open. Oscar announced on 29 October 2026 that it will leave the New York State of Health marketplace for 2027. A Senate inquiry into ACA coverage terminations named Oscar on 27 October 2026.
• Insiders sold into the September rally. SEC Form 4 filings show the chief financial officer, the chief legal officer, the president of Oscar Insurance and a director selling at $31.45 on 3 September 2026, all under Rule 10b5-1 plans. Another director sold 25,000 shares at $32.24 on 18 September 2026.

Price setup

The shares closed at $35.19 on 4 November 2026, the day before the report. They traded up to the $38.50 intraday 52-week high on 5 November but closed that day at $33.18. They then fell to $30.65 on 6 November and closed at $32.11 on 11 November. The selling on the report day shows the market discounting the risk-adjustment part of the raise.

On adjusted daily closes, the last close sits just above the 50-day moving average of $31.99 and well above the 200-day moving average of $24.27, both as of 11 November 2026. The three-month price change is 4.3%. The 52-week closing low was $10.85 on 30 March 2026, so most of the year's recovery is intact.

The nearest reference point below is the weekly close of 25 September 2026, the week Thrive Partners II GP and co-founder Joshua Kushner reported a non-open-market transaction covering 19,030,851 shares (SEC Form 4, 18 September 2026). A weekly close below that week's close would erase the post-September gains and the rise that followed the November report.

Catalysts ahead

• ~15 December 2026 (est.): HealthCare.gov sign-up deadline for coverage starting 1 January 2027. Sign-ups through this date are the first public read on whether rate increases and subsidy loss shrink the pool Oscar prices against for 2027.
• ~January 2027 (est.): Federal open-enrollment snapshot reports for plan year 2027. Federal sign-up counts by state show whether Oscar's new counties offset the 18% market contraction KFF measured through June 2026.
• ~February 2027 (est.): Fourth-quarter 2026 report and first 2027 guidance. This report gives the first formal 2027 profit and loss-ratio targets, and shows whether the fourth-quarter loss ratio held inside the 80.5–81.5% full-year range.

What would change the view

A weekly close below $29.60, the 25 September 2026 weekly close after the Thrive share distribution. A cut that puts the 2026 earnings-from-operations floor below $850 million or the medical loss ratio ceiling above 81.5% also ends the case.

The risks this note tracks, each with what would confirm it:

• The risk-adjustment benefit and reserve releases flatter the raised guide, so underlying 2026 earnings are lower than the headline range. Confirmed by: a fourth-quarter medical loss ratio above the 80.5–81.5% full-year range, or further negative revisions to risk-adjustment estimates.
• 2027 membership falls more than pricing offsets because of subsidy loss, rate increases and market exits such as New York. Confirmed by: open-enrollment data or management commentary showing year-over-year membership declines in Oscar's main states.
• A smaller, sicker pool raises 2027 claims costs faster than the roughly 15% median rate increases cover. Confirmed by: 2027 medical loss ratio guidance above the 2026 range, or morbidity commentary on the fourth-quarter call.
• New counties in Ohio, South Carolina and elsewhere carry higher start-up loss ratios and SG&A costs. Confirmed by: management commentary that 2027 expansion markets run above company-average loss ratios, or an SG&A ratio rising back above the 14.0% third-quarter level.
• Regulatory and legal headlines weigh on the shares independently of earnings. Confirmed by: escalation of the Senate inquiry into ACA coverage terminations, or an adverse ruling in the cancer-medication coverage case.

What it trades with

Oscar earns its premiums almost entirely from the ACA individual market, so it trades with exchange-heavy carriers such as Centene rather than with diversified insurers that have Medicare Advantage and employer books. Federal subsidy, enrollment-integrity and state rate-approval headlines move the shares in the same direction as other marketplace carriers, regardless of company results. Footprint decisions by competitors matter directly: Healthcare Dive reported on 21 October 2026 that Centene and UnitedHealthcare are also adding counties for 2027, so Oscar's new counties will face competition.