While on its first-quarter earnings call with newly appointed CEO, Mark Bertolini, Oscar Health announced its plans to exit the California marketplace by the end of this year 2023. This strategic decision is the result of a thorough evaluation of performance metrics in the state.
Moreover, according to their executives, after repeatedly posting medical loss ratios above 100%, the insurer wants to leave the state despite expecting to have at least 35,000 members by the end of this year.
Furthermore, Bertolini said on the call that Oscar would “pause” implementation in California. The goal is to reenter the state in the future after reshaping its product offerings and strategy. They will focus on advancing the capabilities and technology to best serve their members. And they have been able to shift our attention to implementing a series of initiatives aimed at improving the efficiency of our operations
After last year’s announcement that it was withdrawing from several markets. Among these are markets in Arkansas and Colorado and Medicare Advantage plans in New York and Texas. Executives address the Arkansas and Colorado exits as “relatively small” and foresee the company reaching profitability goals this year.
There will be roughly 1 million members in the first quarter of 2023. In which membership in Oscar’s individual and Medicare Advantage markets declined by 8% and 61%, respectively. An increase of 85% in Cigna + Oscar growth (the co-branding venture with Cigna) compensates for the losses.
To make this transition as seamless as possible, Oscar will continue to provide coverage for services through the end of the current calendar year 2023. Throughout this summer, members will get more information about this transition. During Open Enrollment, from November 1st, 2023, to January 31, 2024, members will have the chance to explore alternative coverage.
This decision only impacts the Individual and Family Plans, not the Cigna + Oscar Small Group business.
We, at Solid Health Insurance Services have contacted our clients about the market interruption of Oscar leaving the individual marketplace in California. We expect this Fall in the Open Enrollment Period to be able to offer good alternative plans so that you can continue to find a medical plan which fits your budget and medical needs.