Oscar, the health insurance startup that just raised $375 million in new funding from Google parent Alphabet, on Wednesday disclosed that it generated a $5 million profit on $363 million in net revenue during the first half of 2018.
Bottom line: The revenue figure is around 3 times what Oscar generated for the first half of 2017, although the profit is expected to disappear later this year as patients spend through their deductibles.
The company, which is required to file financial data with state health regulators, also reported that it had 231,000 members at the end of June, compared to just 85,000 one year earlier.
It still believes it will generate over $1 billion in gross premium revenue for 2018 ($630 million in the first half) and have a medical loss ratio in the mid-80s (it’s currently at 74%, which is a 17 point year-over-year improvement).
Per a company spokesman: “This year, Oscar’s focus has been to scale our consumer-focused, technology-driven approach to cover more members, in more markets. After doubling our market footprint, our financial results for the first half of 2018 prove that our business is trending in-line with expectations.”
• Note: In California Oscar offers coverage in Los Angeles, Orange County, and San Francisco County.
In announcing a new $165 million cash injection, the co-founders of Oscar Health Insurance said the startup had made an “underwriting profit” in 2017.
Reality check: There’s a lot of wiggle room in “underwriting profit,” based on Oscar’s own financial data. Oscar’s core insurance functions are still in the red — which will have to turn around if the company also continues to spend more money on its health technology.
Behind the numbers: We looked at Oscar’s 2017 financial documents in March; they showed a net loss of $127 million on $229 million of revenue in 2017. That includes overhead and administrative costs, like salaries, advertising, technology and keeping the office lights on.
Oscar calculating its underwriting profit by subtracting medical costs from premium revenues and adding in reinsurance money for high-cost claims, according to company spokesman Khan Shoieb. Using that measure, Oscar’s gross margin was roughly break-even.
Before adding in reinsurance, though, the company lost more than $50 million last year.
Despite a few rocky years, many of Oscar’s competitors in the Affordable Care Act’s exchanges are turning a profit even without reinsurance — just from the balance between premium revenues and expenses. Other experts I contacted agreed that Oscar’s situation is far from rosy.
The big picture: Many startups are unprofitable as they make investments in technology and elsewhere, but Oscar has to find a path to profitability somewhat soon.
State insurance departments require insurers to have enough money to cover their operations (so they don’t go under and leave people uninsured). It’s not feasible to rely on large funding rounds by outside investors who will eventually want their money back — and then some.
*Modified from an Axios.com online articles by Dan Primack (August 15), and Bob Herman (March 29).