Oscar Health is doubling its “market footprint” over the next three years to grow its business selling individual health insurance known as Obamacare under the Affordable Care Act as well as a new form of coverage for workers and employers.
In a disclosure Friday during its 2024 investor day, Oscar executives outlined a plan to expand to more than 150 metropolitan statistical areas, which essentially doubles the company’s footprint, the company said.
Oscar, which shook up its management ranks and hired the former Aetna chief executive Mark Bertolini last year, reported a first quarter profit of $177.4 million. Founded in 2012, Oscar had yet to turn a profit, but Bertolini and his new team have said that will change this year as they remain bullish on the individual health insurance market.
Oscar, which has about 1.5 million health plan members and is best known for sales of individual Obamacare plans, is looking to build on its current ACA market share in 18 states. Oscar plans to grow market share from 13% in its 2024 footprint to about 18% by 2027 through a mix of new health insurance products for individuals, workers and their employers, the company said.
Oscar wouldn’t disclose what new states or metropolitan statistical areas it might enter in the next three years but said it has ample opportunity to grow from a current “in market opportunity” of 10 million potential customers to an “in market opportunity” of 20 million potential customers in 2027. One large market Oscar executives say they are targeting is the large U.S. gig economy of about 58 million independent workers.
In addition, Oscar executives will stop selling small group policies after December 2024 in favor of a new plan known as an “individual coverage health reimbursement arrangement” that will be available during this fall’s ACA open enrollment period. According to the federal government’s healthcare.gov website, such ICHRAs are “an alternative to offering a traditional group health plan to employees.”
“It’s a specific account-based health plan that allows employers to provide defined non-taxed reimbursements to employees for qualified medical expenses, including monthly premiums and out-of-pocket costs, like copayments and deductibles,” the healthcare.gov website says. “Employees must be enrolled in individual health insurance coverage (like a plan they bought through the Marketplace) to use the funds.”
Oscar executives say such ICHRAs are attractive to small and mid-sized businesses typically with less than 50 employees and up to 1,000 employees. Oscar executives say some of the larger employers they work with are adopting individual coverage health reimbursement arrangements, “particularly in industries that have high utilization and benefits costs like manufacturing and hospitality,” a company spokeswoman said.
“Our model is uniquely positioned to address these trends and reorient healthcare around individuals and families,” Oscar said in its investor day presentation unveiled Friday. “The U.S. healthcare system is failing individuals and families accelerating trends that are shaping the future of the market.”