Oscar Health Expands ACA Plans as Rivals Exit
Operators buying individual coverage should check carrier availability as Cigna and Aetna withdraw from the market.
Updated on Nov. 5, 2026 in Healthcare
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Oscar Health reported $167.3 million in third-quarter 2026 net income, or 49 cents per share, on $5.1 billion in revenue, and is expanding its Affordable Care Act plans into South Carolina for 2027, creating a 21-state footprint.
Why it matters
Oscar's results reflect a shift in the individual health insurance market, where Cigna and CVS Health's Aetna are exiting, leaving members to find new coverage and leaving room for carriers that remain. For operators who buy health coverage for staff or sell into the sector, the period shows how carrier financial health and footprint changes can affect plan availability.
Oscar's third-quarter net income reached $167.3 million, compared with a $137.4 million loss a year earlier, while revenue grew 70% to $5.1 billion. The company's medical loss ratio fell to 84% from 88.5%, and its membership rose to 2.7 million from 2.1 million.
The players
Oscar Health
A health insurance company focused on individual and family Affordable Care Act plans, with operations expanding to 21 states.
Cigna
A large national health services company that disclosed plans to exit the individual health insurance business, affecting about 369,000 members in 11 states.
CVS Health
A large national health company whose Aetna unit announced plans to exit the individual health insurance business, affecting about 1 million members in 17 states.
The details
Oscar's medical loss ratio measures how much premium revenue goes to medical claims, so a lower ratio means more of each premium dollar is retained by the insurer. Its improvement came alongside membership growth, which added premium revenue while the company managed medical expenses more tightly. The company also raised its 2026 earnings from operations guidance for the third time this year, to a range of $850 million to $950 million.
Timeline
March 2023: Mark Bertolini was named Oscar's top executive.
2024: Oscar turned a full-year profit for the first time.
Third quarter 2025: Oscar reported a net loss of $137.4 million.
Third quarter 2026: Oscar reported $167.3 million in net income, with results released November 5, 2026.
2027: Oscar expands its Affordable Care Act offerings into South Carolina.
Market Landscape
Cigna and CVS Health's Aetna have announced exits from the individual health insurance business, affecting roughly 1.37 million combined members across 11 and 17 states. Oscar's growth and expansion into South Carolina for 2027 places it against that retreat, as it grows its footprint while larger competitors pull back.
Operators who buy individual coverage should check whether their current carriers remain in their state for 2027, given the Cigna and Aetna exits. Carrier consolidation can shift premiums and network options, so reviewing plan availability with a benefits broker or qualified advisor is a sensible near-term step.
The takeaway
Carrier exits in the individual market can reduce plan options in affected states, so operators should watch which insurers stay in their markets for 2027. Calendar open enrollment dates and ask a benefits advisor to confirm coverage availability before renewal.
Further reading
For broader context on carrier economics and coverage markets, see more Healthcare coverage coverage reporting in the Healthcare section.
Source note: This article includes information reported by Forbes.
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