Payers, Policy

Insurtech company Oscar Health chooses MA launch markets

Oscar, which was initially founded in 2012 to serve the emerging Obamacare insurance exchanges, decided to enter into Medicare Advantage after a $375 million funding round from Alphabet last year.

Oscar Health’s long awaited entry into the Medicare Advantage market will initially start in its hometown of New York and its growth market of Houston, the company announced Wednesday.

Oscar, which was initially founded in 2012 to serve the emerging Obamacare insurance exchanges, decided to enter the Medicare Advantage after a $375 million funding round from Alphabet last year.

The company has been steadily increasing its revenue and geographic footprint over that time. Last year, the company made more than $1 billion in gross premium revenues and has grown its membership base to around 257,000 people, according to insurance commission filings.

In New York City, the company is partnering with Montefiore Health System to launch a co-branded MA plan in the market. Currently the company offers individual plans and small group plans in New York.

“Oscar has built an experience that meets our members where they are, no matter their age or health history, and Montefiore, with its academic expertise, extensive physician network and longstanding success providing comprehensive care to Medicare beneficiaries has done the same,” Oscar CEO Mario Schlosser said in a statement.

“We are confident that our proven track record of providing health insurance with a superior member experience makes us an ideal match for Medicare Advantage’s consumer-driven model.”

In Houston, the company is partnering with a number of local providers including Houston Methodist, HCA Houston Healthcare, VillageMD, St. Joseph Medical Center, IntegraNet and Privia Medical Group. The decision to launch in Houston was built upon the company’s previous success in the ACA exchanges in nearby markets like San Antonio, Austin, El Paso, and Dallas.

According to data provided by Brandon Gee, a senior analyst at Decision Resources Group, Medicare Advantage enrollment in Houston grew at an average annual rate of 10 percent between 2015 and 2019, compared to 7 percent for all urban US counties and 5 percent for New York City specifically.

Between 2019 and 2021, Gee projects that Houston and New York will add 79,000 and 68,000 Medicare-eligible seniors, respectively. While New York will still have a greater number of MA-enrolled seniors in 2021, enrollment growth in Houston is expected to outstrip New York.

Medicare Advantage poses an enormous growth opportunity for both traditional insurers and the host of new health plan providers looking to shake up the industry.

Medicare Advantage startups like Devoted Health, Clover Health and Bright Health have raised mega nine-figure fundraising rounds with a focus on branching out into new geographies.

The new entrants are looking to compete with blue chip insurers like UnitedHealthcare, Humana, Aetna and Anthem, which all have more than 1 million Medicare Advantage members, vastly outstripping the membership of any of the MA startups.

In a blog post, Schlosser highlighted the company’s success in the individual markets of getting people more engaged with their healthcare using technology.

The company boasts of its ability to efficiently link members to higher quality and less expensive providers and modes of care like its free round-the-clock telemedicine services.

According to Schlosser, 76 percent of the company’s members who are 63 and over have digital accounts with Oscar and 83 percent of them have connected with the company’s concierge care navigators.

Picture: designer491, Getty Images

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