Of the 24 start-up companies selling insurance when the ACA market first opened, Oscar Health is the last one standing.
Alessa Quane, chief insurance officer at Oscar Health, told Becker's the individual insurance market has matured and stabilized in the 14 years since the law was passed. What sets Oscar apart from other players in the space, she said, is a customer-focused approach the individual market needs.
"We've learned a ton over the time period. We've matured as an organization, even the way in which we approach a market, the way we play in a market, price products, design our products, I think is helpful," Ms. Quane said. "We treat the market as very consumerized. I think it will become the example for how other markets should be."
The New York City-based startup brought on former Aetna CEO Mark Bertolini in 2023. Though Oscar is yet to turn a profit, the company increased its revenue by 49% year-over-year and cut its losses by 56%.
At the end of 2023, Oscar had 967,000 individual marketplace members, up from 598,169 at the end of 2021.
The company is focused primarily on the ACA market. It ended almost all of its Medicare Advantage offerings at the end of 2022, though executives have said they hope to eventually re-enter the market.
"That's a challenging market to be successful in. Some of the changes in the regulation or reimbursement is going to make it challenging for people to make the kind of money they were making in the MA space. It's highly saturated, much more so than the ACA," Ms. Quane said.
Oscar's enrollment is growing alongside the ACA marketplace overall. The marketplace reached its highest-ever enrollment numbers in 2024, at 21.4 million, according to KFF. The increase was driven by enhanced subsidies from the federal government, which are set to expire at the end of 2025.
Ms. Quane said she's optimistic no matter which party holds the majority in 2025, a deal can be struck to extend the subsidies.
"I'm hopeful that the two sides will come together and realize that this is really important for the American population, more generally. Regardless of that, hope is not a strategy, so we are planning for both outcomes. For Oscar, our footprint does not span the entire U.S. right now. We still have room for growth, just by expanding our footprint into other markets. So, we have that going for us."
ICHRA, or individual coverage health reimbursement arrangements, is another growth opportunity for Oscar, Ms. Quane said.
In January, Mr. Bertolini told investors the company believes ICHRA's time has come. The model was implemented in 2019 and allows employers to offer their employees contributions toward premiums for marketplace coverage.
HHS predicts that eventually more than 800,000 employers will offer ICHRA to 11 million employees.
Ms. Quane said the space is still small but growing rapidly, and more education is required to make employers aware of the option.
"I do think there are a lot more people now actively in this space. A lot of them are tech-enabled to make that process easier for these employers, and the employees themselves, to go on the exchange, to understand what's available and to choose it," Ms. Quane said. "I think the more and more investment there is in the space, the easier it will be to convert employers over to this option."