- For the quarter ended September 30, 2024:
- Total Revenue of $2.4 billion, a 68% increase
year-over-year
- Medical Loss Ratio of 84.6%, an 80 bps increase
year-over-year
- SG&A Expense Ratio of 19.0%, a 360 bps improvement
year-over-year
- Net loss attributable to Oscar of $54.6 million, or
$(0.22) of earnings per share, a $10.8 million improvement
year-over-year
- Adjusted EBITDA loss of $11.6 million, an $8.7 million
improvement year-over-year
Oscar Health, Inc. (“Oscar” or the “Company”) (NYSE: OSCR), a
leading healthcare technology company, today announced its
financial results for the third quarter ended September 30,
2024.
“Oscar reported positive third quarter results with strong
revenue growth and improved financial performance," said Mark
Bertolini, CEO of Oscar Health. “Our technology continues to
enhance our growth and positions us to efficiently scale the
business. We expect to deliver positive Adjusted EBITDA and net
income profitability this year, setting a solid foundation to
achieve our long-term targets.”
Total Revenue of $2.4 billion in the quarter increased 68%
year-over-year, driven primarily by higher membership and rate
increases.
The Medical Loss Ratio increased 80 bps year-over-year to 84.6%,
due to modestly higher medical costs, primarily driven by higher
Special Enrollment Period membership resulting in higher risk
adjustment transfers as well as higher COVID-related costs,
partially offset by favorable prior period development. The
SG&A Expense Ratio improved 360 bps year-over-year to 19.0%,
driven by improved fixed cost leverage and variable cost
efficiencies.
Adjusted EBITDA loss of $11.6 million improved by $8.7 million
year-over-year, and Net loss attributable to Oscar of $54.6 million
also improved by $10.8 million year-over-year.
Oscar is updating its full year 2024 outlook to reflect
year-to-date performance. The Company projects Revenue to be in the
$9.2 billion to $9.3 billion range, $200 million above the prior
range of $9.0 billion to $9.1 billion, and a lower SG&A Expense
Ratio in the range of 19.4% to 19.6%. Additionally, the Company now
projects Medical Loss Ratio to be towards the high-end of the prior
range of 80.5% to 81.5%, and Adjusted EBITDA to be towards the
high-end of the prior range of $160 million to $210 million. The
Company also expects to achieve net income profitability this
year.
Key Metrics and Non-GAAP
Financial Metrics
Three Months Ended September
30,
Nine Months Ended September
30,
(in thousands, except percentages)
2024
2023
2024
2023
Total revenue
$
2,423,482
$
1,439,991
$
6,785,128
$
4,431,211
Medical Loss Ratio (MLR)
84.6
%
83.8
%
79.5
%
80.0
%
SG&A Expense Ratio
19.0
%
22.6
%
19.0
%
24.0
%
Adjusted EBITDA(1)
$
(11,563
)
$
(20,285
)
$
311,877
$
66,355
(1)
Adjusted EBITDA is a non-GAAP measure. See
“Key Operating and Non-GAAP Financial Metrics - Adjusted EBITDA” in
this release for a reconciliation to net loss, the most directly
comparable GAAP measure, and for information regarding Oscar’s use
of Adjusted EBITDA.
As of September 30,
Membership by Offering
2024
2023
Individual and Small Group
1,602,993
912,761
Medicare Advantage
—
1,840
Cigna+Oscar (1)
51,291
68,559
Total Members (2)
1,654,284
983,160
(1)
Represents total membership for Oscar’s co-branded partnership with
Cigna.
(2)
A member covered under more than one of our health plans counts as
a single member for the purposes of this metric.
Quarterly Conference Call Details Oscar will host a
conference call to discuss the financial results today, November 7,
2024, at 8:00 a.m. (ET). A live audio webcast will be available via
the Investor Relations page of Oscar’s website at ir.hioscar.com. A
replay of the webcast will be available for on-demand listening
shortly after the completion of the call, at the same web link, and
will remain available for approximately 90 days.
Non-GAAP Financial Information This release presents
Adjusted EBITDA, a non-GAAP financial metric, which is provided as
a complement to the results provided in accordance with accounting
principles generally accepted in the United States of America
(“GAAP”). A reconciliation of historical non-GAAP financial
information to the most directly comparable GAAP financial measure
is provided in the accompanying tables found at the end of this
release. For more information regarding Adjusted EBITDA, please see
“Key Operating and Non-GAAP Financial Metrics” below.
Oscar has not provided a quantitative reconciliation of
forecasted Adjusted EBITDA to forecasted GAAP net income (loss)
within this press release because Oscar is unable, without making
unreasonable efforts, to calculate certain reconciling items with
confidence. These items include, but are not limited to,
stock-based compensation expense. These items, which could
materially affect the computation of forecasted GAAP net income
(loss), are inherently uncertain and depend on various factors,
some of which are outside of Oscar’s control. As such, any
associated estimate and its impact on GAAP net income (loss) could
vary materially.
Cautionary Note Regarding Forward-Looking Statements This
press release contains forward-looking statements within the
meaning of the Private Securities Litigation Reform Act of 1995.
All statements other than statements of historical fact contained
herein are forward-looking statements. These statements include,
but are not limited to, statements about our financial outlook and
estimates, including Total revenue, Medical Loss Ratio, SG&A
Expense Ratio and Adjusted EBITDA and other financial performance
metrics, and the related underlying assumptions, our profitability
goals, our business and financial prospects, including potential
future growth, and our management’s plans and objectives for future
operations, expectations and business strategy. In some cases, you
can identify forward-looking statements by terms such as “may,”
“will,” “should,” “expects,” “plans,” “anticipates,” “could,”
“intends,” “targets,” “projects,” “contemplates,” “believes,”
“estimates,” “predicts,” “potential,” or “continue” or the negative
of these terms or other similar expressions. Accordingly, we
caution you that any such forward-looking statements are not
guarantees of future performance and are subject to risks,
assumptions, and uncertainties that are difficult to predict and
generally beyond our control.
Although we believe that the expectations reflected in these
forward-looking statements are reasonable as of the date made,
there are or will be important factors that could cause our actual
results to differ materially from those indicated in these
forward-looking statements, including, but not limited to, the
following: our ability to execute our strategy and manage our
growth effectively; our ability to retain and expand our member
base; heightened competition in the markets in which we
participate; our ability to accurately estimate our incurred
medical expenses or effectively manage our medical costs or related
administrative costs; our ability to achieve or maintain
profitability in the future; changes in federal or state laws or
regulations, including changes with respect to the Patient
Protection and Affordable Care Act and the Health Care and
Education Reconciliation Act of 2010, as amended (collectively, the
“ACA”), and any regulations enacted thereunder; our ability to
comply with ongoing regulatory requirements, including capital
reserve and surplus requirements and applicable performance
standards; changes or developments in the health insurance markets
in the United States, including passage and implementation of a law
to create a single-payer or government-run health insurance
program; our, or any of our vendors’, ability to comply with laws,
regulations, and standards related to the handling of information
about individuals or applicable consumer protection laws; our
ability to arrange for the delivery of quality care and maintain
good relations with the physicians, hospitals, and other providers
within and outside our provider networks; unanticipated results of,
or changes to, risk adjustment programs; our ability to utilize
quota share reinsurance to meet our capital and surplus
requirements and protect against downside risk on medical claims;
unfavorable or otherwise costly outcomes of lawsuits, audits,
investigations, and claims that arise from the extensive laws and
regulations to which we are subject; incurrence of data security
breaches of our and our partners’ information and technology
systems; our ability to attract and retain qualified personnel; our
ability to detect and prevent material weaknesses or significant
control deficiencies in our internal controls over financial
reporting or other failure to maintain an effective system of
internal controls; adverse publicity or other adverse consequences
related to our dual class structure or “controlled company” status;
and the other factors set forth under the caption “Risk Factors” in
our Annual Report on Form 10-K for the year ended December 31,
2023, filed with the Securities and Exchange Commission (“SEC”),
and our other filings with the SEC, including our Quarterly Report
on Form 10-Q for the quarterly period ended September 30, 2024, to
be filed with the SEC.
You are cautioned not to place undue reliance on any
forward-looking statements made in this press release. Any
forward-looking statement speaks only as of the date as of which it
is made, and, except as otherwise required by law, we do not
undertake any obligation to publicly update or review any
forward-looking statement, whether as a result of new information,
future developments or otherwise. New factors emerge from time to
time, and it is not possible for us to predict which will
arise.
About Oscar Health Oscar Health, Inc. (“Oscar”) is a
leading healthcare technology company built around a full stack
technology platform and a relentless focus on serving our members.
We have been challenging the status quo in the healthcare system
since our founding in 2012, and are dedicated to making a healthier
life accessible and affordable for all. Oscar offers Individual
& Family plans and health technology solutions that power the
healthcare industry through +Oscar. Our technology drives superior
experiences, deep engagement, and high-value clinical care, earning
us the trust of approximately 1.65 million members, as of September
30, 2024.
Oscar Health, Inc.
Condensed Consolidated Statements of Operations
(unaudited)
Three Months Ended September
30,
Nine Months Ended September
30,
(in thousands, except per share
amounts)
2024
2023
2024
2023
Revenue
Premium
$
2,368,257
$
1,392,082
$
6,626,055
$
4,295,674
Investment income
50,326
42,368
143,309
119,908
Services and other
4,899
5,541
15,764
15,629
Total revenue
2,423,482
1,439,991
6,785,128
4,431,211
Operating Expenses
Medical
2,003,979
1,163,194
5,267,475
3,436,785
Selling, general, and administrative
460,377
325,850
1,289,745
1,061,612
Depreciation and amortization
7,500
9,191
22,912
22,952
Total operating expenses
2,471,856
1,498,235
6,580,132
4,521,349
Earnings (loss) from operations
(48,374
)
(58,244
)
204,996
(90,138
)
Interest expense
5,815
6,130
17,708
18,386
Other expenses (income)
(1,877
)
414
173
8,132
Earnings (loss) before income
taxes
(52,312
)
(64,788
)
187,115
(116,656
)
Income tax expense
2,076
915
7,709
4,100
Net income (loss)
(54,388
)
(65,703
)
179,406
(120,756
)
Less: Net income (loss) attributable to
noncontrolling interests
208
(305
)
427
(58
)
Net income (loss) attributable to Oscar
Health, Inc.
$
(54,596
)
$
(65,398
)
$
178,979
$
(120,698
)
Earnings (Loss) per Share
Basic
$
(0.22
)
$
(0.29
)
$
0.75
$
(0.55
)
Diluted
$
(0.22
)
$
(0.29
)
$
0.65
$
(0.55
)
Weighted Average Common Shares
Outstanding
Basic
243,106
223,099
237,759
219,827
Diluted
243,106
223,099
301,459
219,827
Oscar Health, Inc.
Condensed Consolidated Balance Sheets (unaudited)
(in thousands)
September 30, 2024
December 31, 2023
Assets
Current
Assets:
Cash and cash equivalents
$
1,206,145
$
1,870,315
Short-term investments
503,784
689,833
Premiums and accounts receivable (net of
allowance for credit losses of $30,100 and $31,600)
300,635
201,269
Risk adjustment transfer receivable
63,512
51,925
Reinsurance recoverable
273,317
241,194
Other current assets
20,661
6,564
Total current assets
2,368,054
3,061,100
Property, equipment, and capitalized
software, net
66,631
61,930
Long-term investments
1,933,892
365,309
Restricted deposits
30,069
29,870
Other assets
84,369
83,271
Total assets
$
4,483,015
$
3,601,480
Liabilities and Stockholders'
Equity
Current
Liabilities:
Benefits payable
$
1,356,726
$
965,986
Risk adjustment transfer payable
1,083,880
1,056,941
Premium deficiency reserve
1,444
5,776
Unearned premiums
66,129
65,918
Accounts payable and other liabilities
395,481
273,367
Reinsurance payable
51,117
61,024
Total current liabilities
2,954,777
2,429,012
Long-term debt
299,361
298,777
Other liabilities
63,537
67,574
Total liabilities
3,317,675
2,795,363
Commitments and contingencies
Stockholders' Equity
Class A common stock ($0.00001 par value;
825,000 thousand shares authorized, 211,702 thousand and 193,875
thousand shares outstanding as of September 30, 2024 and December
31, 2023, respectively)
2
2
Class B common stock ($0.00001 par value;
82,500 thousand shares authorized, 35,514 thousand shares
outstanding as of September 30, 2024 and December 31, 2023,
respectively)
—
—
Treasury stock (315 thousand shares as of
September 30, 2024 and December 31, 2023)
(2,923
)
(2,923
)
Additional paid-in capital
3,837,369
3,682,294
Accumulated deficit
(2,697,736
)
(2,876,715
)
Accumulated other comprehensive income
26,051
1,309
Total Oscar Health, Inc. stockholders'
equity
1,162,763
803,967
Noncontrolling interests
2,577
2,150
Total stockholders' equity
1,165,340
806,117
Total liabilities and stockholders'
equity
$
4,483,015
$
3,601,480
Oscar Health, Inc.
Condensed Consolidated Statements of Cash Flows
(unaudited)
Nine Months Ended September
30,
(in thousands)
2024
2023
Cash Flows from Operating
Activities:
Net income (loss)
$
179,406
$
(120,756
)
Adjustments to reconcile net income (loss)
to net cash provided by operating activities:
Deferred taxes
(68
)
95
Net realized loss on sale of financial
instruments
2
70
Depreciation and amortization expense
22,912
22,952
Amortization of debt issuance costs
583
583
Stock-based compensation expense
83,969
133,541
Net accretion of investments
(18,956
)
(22,856
)
Change in provision for credit losses
(1,500
)
12,000
Changes in assets and liabilities:
(Increase) / decrease in:
Premiums and accounts receivable
(97,867
)
(2,622
)
Risk adjustment transfer receivable
(11,587
)
(4,265
)
Reinsurance recoverable
(32,123
)
615,084
Other assets
(15,127
)
3,854
Increase / (decrease) in:
Benefits payable
390,740
(27,278
)
Unearned premiums
211
(7,396
)
Premium deficiency reserve
(4,332
)
(4,035
)
Accounts payable and other liabilities
118,079
(41,366
)
Reinsurance payable
(9,907
)
(360,335
)
Risk adjustment transfer payable
26,938
(766,297
)
Net cash provided by (used in)
operating activities
631,373
(569,027
)
Cash Flows from Investing
Activities:
Purchase of investments
(2,023,049
)
(622,183
)
Sale of investments
21,188
26,656
Maturity of investments
663,011
1,019,612
Purchase of property, equipment and
capitalized software
(21,078
)
(19,475
)
Change in restricted deposits
3,942
100
Net cash (used in) provided by
investing activities
(1,355,986
)
404,710
Cash Flows from Financing
Activities:
Proceeds from joint venture
contribution
—
2,491
Proceeds from exercise of stock
options
64,571
2,886
Net cash provided by financing
activities
64,571
5,377
Decrease in cash, cash equivalents and
restricted cash equivalents
(660,042
)
(158,940
)
Cash, cash equivalents, restricted cash
and cash equivalents—beginning of period
1,891,971
1,580,497
Cash, cash equivalents, restricted cash
and cash equivalents—end of period
1,231,929
1,421,557
Cash and cash equivalents
1,206,145
1,399,791
Restricted cash and cash equivalents
included in restricted deposits
25,784
21,766
Total cash, cash equivalents and
restricted cash and cash equivalents
$
1,231,929
$
1,421,557
Supplemental Disclosures:
Interest payments
$
22,480
$
22,893
Income tax payments
$
636
$
1,000
Key Operating and Non-GAAP Financial Metrics We regularly
review the following key operating and Non-GAAP financial metrics
to evaluate our business, measure our performance, identify trends
in our business, prepare financial projections, and make strategic
decisions. We believe these operational and financial measures are
useful in evaluating our performance, in addition to our financial
results prepared in accordance with GAAP.
Members Members are defined as any individual covered by
a health plan that we offer directly or through a co-branded
arrangement. We view the number of members enrolled in our health
plans as an important metric to help evaluate and estimate revenue
and market share. Additionally, the more members we enroll, the
more data we have, which allows us to improve the functionality of
our platform.
Total Revenue Total revenue includes Premium revenue,
Investment income, and Services and other revenue. We believe Total
revenue is an important metric to assess the growth of our
business, as well as the earnings potential of our investment
portfolio.
Medical Loss Ratio Medical Loss Ratio is a metric used to
calculate medical expenses as a percentage of net premiums before
ceded quota share reinsurance. Medical expenses are the total
expenses incurred by members in order to utilize health care
services less any member cost sharing. These services include
inpatient, outpatient, pharmacy, and physician costs. Medical
claims also include fee-for-service claims, pharmacy benefits,
capitation payments to providers, provider disputed claims, risk
sharing arrangements with certain of our providers, and various
other medical-related costs. The impact of the federal risk
adjustment program is included in the denominator of our MLR. We
believe MLR is an important metric to demonstrate the ratio of our
costs to pay for healthcare of our members to the net premium
before ceded reinsurance. MLR in our existing products are subject
to various federal and state minimum requirements.
Three Months Ended September
30,
Nine Months Ended September
30,
(in thousands, except percentages)
2024
2023
2024
2023
Medical
$
2,003,979
$
1,163,194
$
5,267,475
$
3,436,785
Less: Ceded quota share reinsurance claims
(1)
2,036
(4,870
)
(2,879
)
(1,221
)
Net claims before ceded quota share
reinsurance (A)
$
2,001,942
$
1,168,064
$
5,270,353
$
3,438,006
Premium
$
2,368,257
$
1,392,082
$
6,626,055
$
4,295,674
Less: Ceded quota share reinsurance
premiums (2)
2,971
(1,448
)
(1,865
)
(2,131
)
Net premiums before ceded quota share
reinsurance (B)
$
2,365,286
$
1,393,530
$
6,627,920
$
4,297,805
Medical Loss Ratio (A divided by
B)
84.6
%
83.8
%
79.5
%
80.0
%
(1)
Represents prior period development for claims ceded to
reinsurers pursuant to quota share treaties accounted for under
reinsurance accounting, which are in runoff.
(2)
Represents prior period development for premiums ceded to
reinsurers pursuant to quota share treaties accounted for under
reinsurance accounting, which are in runoff.
SG&A Expense Ratio The SG&A Expense Ratio
reflects the Company’s selling, general and administrative
("SG&A") expenses, as a percentage of Total revenue. Selling,
general and administrative expenses primarily include distribution
expenses, wages, benefits, costs of software and hardware, the
impact of quota share reinsurance, stock-based compensation, and
other administrative costs. We believe the SG&A Expense Ratio
is useful to evaluate our ability to manage our overall selling,
general, and administrative cost base.
Adjusted EBITDA Adjusted EBITDA is defined as Net income
(loss) for the Company and its consolidated subsidiaries before
interest expense, income tax expense (benefit), and depreciation
and amortization, as further adjusted for stock-based compensation
and other items that are considered unusual or not representative
of underlying trends of our business, where applicable for the
period presented. We present Adjusted EBITDA because we consider it
to be an important supplemental measure of our performance and
believe it is frequently used by securities analysts, investors,
and other interested parties in the evaluation of companies in our
industry. Adjusted EBITDA is a non-GAAP measure. Management
believes that investors’ understanding of our performance is
enhanced by including this non-GAAP financial measure as a
reasonable basis for comparing our ongoing results of
operations.
We caution investors that amounts presented in accordance with
our definition of Adjusted EBITDA may not be comparable to similar
measures disclosed by our competitors, because not all companies
and analysts calculate Adjusted EBITDA in the same manner.
By providing this non-GAAP financial measure, together with a
reconciliation to the most comparable U.S. GAAP measure, Net income
(loss), we believe we are enhancing investors’ understanding of our
business and our results of operations, as well as assisting
investors in evaluating how well we are executing our strategic
initiatives. Adjusted EBITDA has limitations as an analytical tool,
and should not be considered in isolation, or as an alternative to,
or a substitute for Net income (loss) or other financial statement
data presented in our Condensed Consolidated Financial Statements
as indicators of financial performance.
Three Months Ended September
30,
Nine Months Ended September
30,
(in thousands)
2024
2023
2024
2023
Net income (loss)
$
(54,388
)
$
(65,703
)
$
179,406
$
(120,756
)
Interest expense
5,815
6,130
17,708
18,386
Other expenses
(1,877
)
414
173
8,132
Income tax expense
2,076
915
7,709
4,100
Depreciation and amortization
7,500
9,191
22,912
22,952
Stock-based compensation(1)
29,311
28,768
83,969
133,541
Adjusted EBITDA
$
(11,563
)
$
(20,285
)
$
311,877
$
66,355
(1)
Represents non-cash expenses related to equity-based
compensation programs, which vary from period to period depending
on various factors including the timing, number, and the valuation
of awards. The nine months ended September 30, 2023 includes a
non-recurring charge of $46.3 million related to accelerated
stock-based compensation expense recognized as a result of the
cancellation of the Founders Awards previously granted to Mario
Schlosser and Joshua Kushner.
Appendix
Reinsurance Impact
Three Months Ended September
30,
Nine Months Ended September
30,
(in thousands)
2024
2023
2024
2023
Quota share ceded premiums
$
1,300
$
284
$
(3,120
)
$
7,107
Quota share ceded claims
(2,036
)
4,869
2,879
1,221
Ceding commission, net of deposit
accounting impact (1)
(13,747
)
(7,169
)
(39,273
)
(23,431
)
Experience refund
1,671
(1,732
)
1,255
(9,238
)
Net quota share impact
$
(12,812
)
$
(3,748
)
$
(38,259
)
$
(24,341
)
(1)
Includes ceding commissions received from reinsurers, net of the
impact of deposit accounting of $(13,658) and $(7,139) for the
three months ended September 30, 2024 and 2023, respectively, and
$(39,656) and $(22,455) for the nine months ended September 30,
2024 and 2023, respectively.
The Company records Premium revenue net of reinsurance. The
following table reconciles total reinsurance premiums ceded and
reinsurance premiums assumed, which are included as components of
total Premium revenue in the Condensed Consolidated Statements of
Operations:
Three Months Ended September
30,
Nine Months Ended September
30,
(in thousands)
2024
2023
2024
2023
Direct policy premiums
$
2,687,883
$
1,548,571
$
7,542,098
$
4,796,819
Assumed premiums
55,062
57,836
173,134
174,166
Risk adjustment transfers
(374,828
)
(211,422
)
(1,077,121
)
(665,200
)
Reinsurance premiums ceded
140
(2,903
)
(12,056
)
(10,111
)
Premium
$
2,368,257
$
1,392,082
$
6,626,055
$
4,295,674
The Company records Medical expenses net of reinsurance
recoveries. The following table reconciles total Medical expenses
to the amount presented in the Condensed Consolidated Statements of
Operations:
Three Months Ended September
30,
Nine Months Ended September
30,
(in thousands)
2024
2023
2024
2023
Direct claims incurred
$
1,986,189
$
1,116,679
$
5,189,901
$
3,301,424
Ceded reinsurance claims
(41,171
)
(15,266
)
(90,823
)
(33,833
)
Assumed reinsurance claims
58,961
61,781
168,397
169,194
Medical expenses
$
2,003,979
$
1,163,194
$
5,267,475
$
3,436,785
The Company records Selling, general and administrative
("SG&A") expenses net of reinsurance ceding commissions and
assumed SG&A expenses. The following table reconciles total
Selling, general and administrative expenses to the amount
presented in the Condensed Consolidated Statements of
Operations:
Three Months Ended September
30,
Nine Months Ended September
30,
(in thousands)
2024
2023
2024
2023
Selling, general and administrative
expenses, gross
$
459,522
$
325,820
$
1,289,362
$
1,060,636
Reinsurance ceding commissions
855
30
383
976
Selling, general and administrative
expenses
$
460,377
$
325,850
$
1,289,745
$
1,061,612
The Company classifies Reinsurance recoverable within current
assets on its Condensed Consolidated Balance Sheets. The
composition of the Reinsurance recoverable balance is as
follows:
(in thousands)
September 30, 2024
December 31, 2023
Reinsurance premium and claim
recoverables
$
272,478
$
224,837
Reinsurance ceding commissions
6,915
7,054
Experience refunds on reinsurance
agreements
(6,076
)
9,303
Reinsurance recoverable
$
273,317
$
241,194
View source
version on businesswire.com: https://www.businesswire.com/news/home/20241107962943/en/
Investor Contact: Chris Potochar VP of Investor
Relations ir@hioscar.com
Media Contact: Kristen Prestano VP of Communications
press@hioscar.com Source: Oscar Health, Inc.
Oscar Health (NYSE:OSCR)
Graphique Historique de l'Action
De Nov 2024 à Déc 2024
Oscar Health (NYSE:OSCR)
Graphique Historique de l'Action
De Déc 2023 à Déc 2024