The 2026 ACA Marketplace lost roughly 4.8 million people. Oscar Health gained nearly a million. That single contrast is the reason Oscar is worth understanding, and it is also the reason to be a little skeptical, because a carrier growing fast in a shrinking market is either pricing very well or pricing very aggressively.
Oscar does not publish a premium anywhere on its consumer site without a ZIP code, so the numbers below come from CMS’s 2026 Marketplace rate and plan files. Those list every exchange plan’s premium, deductible and out-of-pocket cap, and were last imported to CMS systems by August 4, 2026.
What Is Oscar Health
Oscar Health, Inc. is a publicly traded insurer (NYSE: OSCR) that sells only individual and family health plans. It has no employer group business left: its 10-K notes it stopped offering small group plans effective December 15, 2024 and did not renew the Cigna+Oscar partnership after 2024. Everything it does now runs through the individual market.
Its 2025 Form 10-K states that Oscar “offered coverage for individuals and families in 18 states” for the 2025 policy year and “expanded our offerings to 20 states for 2026.” KFF’s 2026 participation analysis independently counts Oscar in 20 states, third behind UnitedHealth at 30 and Centene at 29.
The growth number is the headline. Oscar’s second-quarter 2026 release, dated August 6, 2026, reports 2,963,002 effectuated members as of June 30, 2026, against 2,027,148 a year earlier. Total revenue was $4.88 billion for the quarter, up from $2.86 billion, with net income of $361.8 million against a $228.4 million loss the year before. The medical loss ratio fell from 91.1% to 79.2%, which Oscar attributes to “disciplined pricing” and $164 million of favorable prior period reserve development.
That happened in the same year the enhanced premium tax credits lapsed. The Congressional Research Service is precise about what did and did not expire: “The PTC will continue after 2025. There is no sunset provision applicable to authorization for the credit itself.” What ended was the 2021 enhancement, so the 400% federal poverty level income cap came back and subsidies got smaller. Our ACA subsidy expiration guide and the ACA subsidy income limits page cover who that hits.
How Oscar Health Plans Work
Oscar sells across all five ACA metal tiers, including catastrophic, which most carriers skip. Among its 321 on-exchange individual plans in CMS’s 2026 file, the mix is 154 silver, 93 expanded bronze, 72 gold and 2 catastrophic.
The network design deserves attention. Oscar’s 10-K says the company “has exclusive provider organization plans in most of our markets, and also offers HMO plans in select markets.” In the 2026 federal-platform data, HMOs are actually the most common design by plan count: 200 HMO, 107 EPO, 14 PPO. Either way, both HMO and EPO plans generally pay nothing out of network outside emergencies, so the in-network vs out-of-network rules are the ones that bite. If you want out-of-network coverage, the 14 PPOs are the only Oscar plans that offer it, and they may not exist in your county. Our HMO vs PPO explainer covers the trade.
Referrals split roughly three to one: 233 of 321 plans do not require a specialist referral, 88 do. Ninety-five of the 321 are HSA-eligible.
One geographic caveat. CMS’s Exchange public use files cover only states on the federal HealthCare.gov platform, 30 states in the 2026 file, and Oscar appears in 14 of them. The other six states in its 20-state footprint run their own exchanges and are not in this dataset. The ranges below therefore describe Oscar’s federal-platform business, not every plan it sells.
What Oscar Health Insurance Costs in 2026
All figures are the 2026 plan year, for a 40-year-old non-smoker, before any premium tax credit, from 1,601 age-40 rate rows across Oscar’s 321 plans.
| 2026 Oscar figure | Low | Median | High |
|---|---|---|---|
| Monthly premium, age 40, all tiers | $300 | $606 | $959 |
| Monthly premium, catastrophic | $300 | $353 | $414 |
| Monthly premium, expanded bronze | $338 | $521 | $774 |
| Monthly premium, silver | $452 | $691 | $941 |
| Monthly premium, gold | $435 | $635 | $959 |
| Individual deductible, standard on-exchange plans | $0 | $5,750 | $10,600 |
| Individual out-of-pocket maximum | $6,000 | $9,950 | $10,600 |
| Silver deductible (standard variant) | $0 | $6,000 | $6,500 |
| Gold deductible | $0 | $2,000 | $3,500 |
Across all 4,044 individual plans in the same CMS file, the national median age-40 premium is $691.56, with a floor of $277.59 and a ceiling of $3,051.03. Oscar’s $606.17 median is meaningfully below that, and it is the lowest median of the three big Marketplace-focused carriers.
Two things to read carefully.
Oscar buys its low premium partly with high out-of-pocket exposure. Its median individual out-of-pocket maximum of $9,950 is close to the legal ceiling and higher than Ambetter’s $8,525 median. The premium is lower; the worst case is worse. That is a legitimate trade if you are healthy and have savings, and a bad one if you are not.
Gold undercuts silver on Oscar. Median gold ($635) comes in below median silver ($691), while the median gold deductible is $2,000 against $6,000 on silver. Unless you qualify for cost-sharing reductions, which only attach to silver plans and only below roughly 250% of the federal poverty level, gold is often the better buy on Oscar in 2026. Run both in your own county.
For context on what people actually pay after subsidies, KFF found the average net Marketplace premium rose 58% from $113 to $178 a month between 2025 and 2026, and average deductibles rose 37% to a record $3,786. CRS’s 2026 benchmark examples show how much geography matters: for a 50-year-old, the benchmark silver premium was $541 a month in Anoka County, Minnesota, $1,053 in Smith County, Kansas and $1,785 in Monroe County, Florida.
Is Oscar Health Insurance Good?
CMS runs a Quality Rating System for Marketplace plans, a 1-to-5 star scale that is the exchange equivalent of Medicare Advantage star ratings. Almost no Oscar review cites it, which is a shame, because it is the only independent quality measure these plans have.
In the plan year 2026 nationwide file, Oscar has nine rated products (a product is one issuer in one state with one plan type, not one plan). Five sit at 2 stars, three at 3 stars, and one at 5 stars, for an average of about 2.7. The national average across 298 rated products is about 3.4.
That is a wide spread and a below-average middle. It means the answer to “is Oscar good insurance” is genuinely state-dependent: there is at least one excellent Oscar product in the file and several weak ones. Before you enroll, look up the star rating attached to the specific plan on HealthCare.gov rather than judging the brand.
The honest summary: Oscar is cheaper than average on premium and rated below average on quality. Those two facts are probably related, and the page you are reading is not going to pretend otherwise.
Who Oscar Is Good For and Who Should Skip It
A good fit if you are young, healthy and price-sensitive. Oscar is the only one of the three big Marketplace carriers selling catastrophic plans in these states, at $300 to $414 a month at age 40, and its bronze floor of $338 is the lowest of the three.
A good fit if you want gold-level coverage without a gold-level premium. The gold-under-silver inversion is real on Oscar in 2026.
A good fit if your employer offers an ICHRA. Oscar has built its strategy around individual coverage health reimbursement arrangements and acquired Lucie, IHC Specialty Benefits and Healthinsurance.org to support it.
Think twice if you expect a heavy medical year. A median out-of-pocket maximum near $9,950 is a lot of exposure. Model your worst case, not your average one.
Think twice if you need out-of-network coverage. Only 14 of Oscar’s 321 on-exchange plans are PPOs.
Think twice if quality ratings matter to you. At about 2.7 stars, Oscar is below the market. Check the specific product’s rating in your state.
Oscar vs. Ambetter vs. Molina
| 2026 plan year | Oscar | Ambetter | Molina |
|---|---|---|---|
| Marketplace states | 20 | 29 | 14 |
| Median age-40 premium, federal platform | $606 | $659 | $616 |
| Premium floor | $300 (catastrophic) | $357 | $428 |
| Median individual out-of-pocket max | $9,950 | $8,525 | $8,945 |
| CMS quality rating, average | about 2.7 stars | about 3.0 stars | about 2.5 stars |
| Membership, Q2 2025 to Q2 2026 | 2.03M to 2.96M | 5.86M to 3.49M | 690K to 283K |
| Catastrophic plans offered | Yes | No | No |
Oscar is the price leader and the growth story. Ambetter is the widest footprint and the best ratings of the three. Molina is the smallest and the lowest rated. All three sit below the national quality average.
The Bottom Line
Oscar’s pitch in 2026 is a low premium and a modern app, paid for with a narrow network and a high out-of-pocket ceiling. The CMS data supports that read: median premium about $85 a month below the national median at age 40, and a median out-of-pocket maximum near the legal cap.
Do three things before enrolling. Compare gold against silver in your county, because gold is often cheaper on Oscar this year. Look up the star rating for the exact product, since Oscar’s ratings run from 2 to 5. And check your doctors against that specific plan’s network, because with an HMO or EPO there is no out-of-network fallback and your only recourse would be an insurance denial appeal.
One timing note. Everything here is 2026 plan year data. HealthCare.gov lists Open Enrollment for 2027 coverage as starting November 1, 2026, with December 15 the cutoff for January 1 coverage and January 15, 2027 the final deadline. If you are between jobs, see health insurance for the unemployed; if you work for yourself, compare against self-employed health insurance costs and check when open enrollment runs.