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Something that seems to have not been spotted by FinX yet in the $OSCR bull case, 2 days ago Dr Oz at the CMS announced fees for carriers in the ACA market were reducing from 2.5% to 1.9% for Federal Marketplaces (FFE) and from 2.0% to 1.5% for State marketplaces (SBEs) for 2027?
Why does this matter you might say, it's tiny!
Here is why it does:
1) This is effectively a reversal back to 2025 pricing, CMS put the fees up for 2026 because they expected 30% reduction in market place size and needed to maintain income. So evidently, this bear case is now gone i.e. ACA shrinkage is minimal and we're hearing it indirectly from the horse's mouth
2) The fee is based on the gross premiums, that's before risk adjustment so disproportionally benefits Oscar who have a high risk adjustment of 20%. As an example a person paying $8.0k a year for coverage would appear on the revenue line for Oscar as $6.4k then incur a FFE CMS market place fee of $200 which is 3.125% and makes up that amount in the SG&A costs. This effect is now $152 so 2.375% falling into SG&A, this a 75 bps improvement on SG&A from the stroke of a pen or roughly one $ in twenty lower SG&A costs
3) "That's still immaterial" some will say, however a gold standard for ACA insurers is 5% margins, that means 15% more profit going from 5% margins to 5.75% margins and even more at the lower end when profits are only 2% or so of revenue
4) Oscar predominantly operate in the FFE markets, the SBEs are rates are down as well albeit marginally less, it will effectively have the same impact on the sub 10% of members Oscar hold in SBEs
Mark B said this in the latest earnings call
"taxes and fees are pretty much fixed for us based on the level of membership. It's 9%-10%. We're looking at the variable piece that we can manage versus that fixed piece, which we literally is sort of a tax for being in the game."
so that 9% to 10% range, just dropped to 8% to 9%
announcement in the link for the detail orientated folks
cms.gov/newsroom/press…
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For the second year, Oscar is proud to sponsor SureCo’s 2026 The State of ICHRA report.
SureCo partnered with a third party to survey 1,500 finance leaders, employees, and benefits consultants at companies with 150-2,500 employees and pulled the clearest read we’ve seen on how fast the market is changing.
And the headline is simple: when budgets are predictable and people can choose coverage that fits, everyone wins. That’s why more companies are taking a hard look at defined contribution.
🔗 See the full report: sureco.com/hubfs/SureCo%2…

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For decades, employer-sponsored group plans have been the default for American workers.
But the default isn’t always the best fit. Rising renewals, limited options, and burdensome admin put employers in the impossible position of choosing “one-size-fits-all” coverage for their employees.
Now, a new model is gaining momentum: ICHRA (Individual Coverage Health Reimbursement Arrangement.) Employers set a predictable monthly budget, and employees use that buying power to shop the individual marketplace for plans that match their doctors and health needs.
The data shift is promising: 60% of employees want to make the shift from group plans to ICHRA, and 94% of employers agree that switching was the right move.


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$OSCR
Oscar Health is SOARING!! Let's circle back to earnings... | Invest with AC
youtu.be/B8zaknjkX5E

YouTube
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@investingwithac @Lexx510916 it's you - you're making the news! - thanks for all the posts - i got some crazy numbers running pre 2024 sector multiples - have you run that model? - rn $OSCR at what $UNH historically gets for growing...in the single digits...think about that - this could get bonkers real fast
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$OSCR
I don’t even understand how profitability guidance wasn’t raised with increased RA accrual, which increase both MLR and SG&A ratio…
Are they really expecting utilization to kick that much higher?!
(This is max bull case, IMO, I felt insane running the numbers)

Invest with AC@investingwithac
$OSCR Run a 2024 seasonality-based MLR trend analysis onto 2026. I dare you. You’ll get shocking results. 2024 was the “gold standard trend” for steady MLR increase…
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@Thetreatment2 @investingwithac Thanks for sharing this chart, it paints a very compelling picture.
I’m happy to continue holding $OSCR,
currently selling covered calls on less than half of my shares since the premiums are way more worth it now.
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$oscr I see people saying overbought, it’s up 100%, needs to cool off, wave 1 is done and needs to pullback.
Look at rerates of companies whose story finally comes to fruition. This is a level of resistance but is being tested for the 5th time. What is the bear case after q1 earnings? The company had the best MLR out of any insurer in q1 with over 2 in eps. Double any analyst rating. The best ceo in the business is at Oscar. Why should it pullback to let people in? Nothing is guaranteed but overbought can become more overbought, just like oversold can become more oversold.

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@thomasthedeal @investingwithac @degeninvestor7 Wakely Report coming in cooler than projected - July
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@investingwithac @degeninvestor7 what else could they possibly announce that could also be jet fuel , $OSCR
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@investingwithac Would much prefer ICHRA (CHOICE) legislation
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@pdicarlotrader @X1Failure How to incorporate insight into institutional buying before the move? A bunch of 13Fs recently filled showed Vanguard, Fidelity, Google, Microsoft and a handful of smaller hedge funds purchased $OSCR
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@X1Failure Hey! Because there was no buying pressure.
Looks now like $10 buying was the move but imagine that liq support breaks and it died to $5
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@investingwithac Our man John Ransom - top 10% wall st analyst, like they say follow the smart money
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@theaiportfolios join us on the $OSCR thesis - AI healthcare insurer disruptor
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@jerseyman2222 @mariots @degeninvestor7 No third party platforms. The rents are not worth it. Our tech is cloud native, single platform with a data set that has one version of the truth.
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