Oscar’s Culturally Competent Care Program

What Oscar’s Culturally Competent Care Program does

Oscar Health is a technology-enabled health insurance company that offers individual and family ACA plans, employer-sponsored coverage through the Individual Coverage Health Reimbursement Arrangement (ICHRA) model, and Medicare Advantage plans across 20+ U.S. states. The company serves approximately 3.2 million members as of early 2026, with the membership base having roughly doubled from approximately 1.6 million in August 2024. Oscar distributes through brokers, direct-to-consumer digital channels, the +Oscar platform, and the Cigna+Oscar small-group joint venture, and is publicly traded on the NYSE under ticker OSH.

Oscar's core technology stack is built around a mobile-first member experience that integrates $0 virtual urgent care, $3 prescription pricing, the Oscar Primary Care virtual primary care practice, dedicated human Care Teams, and a personalization layer called Care Router that is used by approximately 76% of members. The company has layered AI capabilities on top of this stack, including Oswell (an OpenAI-powered concierge assistant), Superagent (a proprietary internal AI tool), Live Chat, and condition-specific programs such as HelloMeno (menopause), Breathe Easy (asthma), and WellDia (diabetes). Provider data integration is handled through partnerships such as Availity, and the network spans more than 550,000 providers.

The business model is premised on per-member-per-month premium revenue across three segments: individual ACA plans sold on and off public exchanges, small group plans distributed via the Cigna+Oscar JV and ICHRA-enabled employer relationships, and Medicare Advantage plans sold to seniors. Oscar monetizes its tech platform externally through +Oscar, which licenses the underlying infrastructure to other payers and brokers. Member retention and brand loyalty are central to unit economics, with NPS reported at approximately 69 — roughly 21x the health insurance industry average — and 4 of 5 brokers recommending Oscar.

Name

Oscar’s Culturally Competent Care Program

Legal name

Oscar Health, Inc.

Website

https://hioscar.com

Company type

Public

Founded year

2012

Operating status

Operating

Short description

Oscar Health is a tech-enabled health insurer offering individual ACA, employer ICHRA, and Medicare Advantage plans across 20+ U.S. states, serving approximately 3.2 million members with AI-powered tools, $0 virtual care, and dedicated Care Teams.

Ownership category

akta.pro rank

Product category

Health Insurance

NAICS

Direct Health and Medical Insurance Carriers (524114)

SIC

Insurance Agents, Brokers & Service (6411)

akta.pro primary industry

ACA Marketplace (On-Exchange) Individual Plans (FSAIAEAA)

akta.pro secondary industries

Off-Exchange Individual Major Medical Plans (FSAIAEAB), Catastrophic Plans (Under-30/Hardship) (HLAEABAC), MA-PD Plans (Medicare Advantage with Prescription Drug Coverage) (FSAIAGAG)

Keywords

• Health insurance plans
• Virtual primary care
• Medicare Advantage
• Individual coverage HRA
• Chronic condition management

Headquarters

HQ city

New York

HQ country

United States

HQ region

North America

Offices2 records

Markets served

GTM type

B2C

Offering type

Services

Cost components

Personnel, Operations, Technology or R&D, Marketing or Sales, Infrastructure

Revenue model

1. Individual & Family Plan Premiums: Monthly premium payments from individuals and families purchasing health insurance on the individual market. Plans offered in 20 states across Bronze, Silver, and Gold tiers with varying cost-sharing structures.
2. Small Group/Employer ICHRA Premiums: Premium revenue from employers providing Individual Coverage Health Reimbursement Arrangements (ICHRA) to employees who then select Oscar plans. Includes partnerships like Hy-Vee Health.
3. Medicare Advantage Premiums: Monthly premium revenue from Medicare Advantage plans launched in 2020 as Oscar's third business line.

Pricing tiers

Go-to-market motion4 records

Distribution channels5 records

Marketing channels6 records

Core offering

Oscar Health offers Individual & Family health insurance plans (Bronze, Silver, and Gold metal tiers) across 20 U.S. states, serving approximately 3.2 million members. The plans bundle integrated care delivery including $0 Virtual Urgent Care, $0 Oscar Primary Care in select markets, $3 prescription drugs, dedicated Care Teams, and an AI-powered member engagement platform built on a full-stack proprietary technology stack. The company also distributes health benefits to employers via ICHRA and serves seniors through Medicare Advantage plans.

Product overview

Oscar Health is a healthcare technology company offering a suite of health insurance and care delivery products built around a full-stack technology platform. The core product is Individual & Family health insurance plans (Bronze, Silver, Gold tiers) providing coverage across 20 states with approximately 3.2M members. Key care delivery modules include Oscar Primary Care ($0 virtual primary care), Virtual Urgent Care (24/7, $0), and the Oscar Care Team (dedicated support). Additional offerings include the Oscar App (mobile), WellDia (diabetes management), HelloMeno (menopause program), and Oswell (AI agent). For employers, Oscar offers ICHRA products. The technology stack includes AI-powered member engagement tools (Superagent, Live Chat, Care Router) and a Provider Portal. Pharmacy benefits feature $3 prescriptions with home delivery via CVS and Capsule.

Differentiator

Problem solved

Functional benefit

Brands

• Oscar Primary Care: Virtual primary care service offering $0 visits for long-term medical care from high-quality providers.
• Virtual Urgent Care
• WellDia
• HelloMeno
• Oswell
• +Oscar
• Superagent

Products and services

• Oscar Health Insurance (Individual & Family Plans) Oscar's primary health insurance product offering Individual and Family plans across multiple states with Bronze, Silver, and Gold tiers; includes $3 prescriptions, $0 Virtual Urgent Care, Oscar Primary Care, and dedicated Care Teams.
• Oscar Primary Care $0 virtual primary care service available in select markets (TX, NY, FL, AZ, GA, OK for 2025); delivers long-term medical care including wellness visits, chronic disease management, and preventive care from Oscar Medical Group providers.
• Virtual Urgent Care 24/7 virtual urgent care available for $0 with most Oscar plans; members can talk to or message a provider in as little as 15 minutes for common issues including skin conditions, allergies, sore throat, nausea, sinus infections, and UTIs.
• Oscar Care Team Dedicated member support team whose role is to help members navigate their plan, answer questions, find in-network doctors, explain costs, and provide troubleshooting support via call, text, or message.
• Oscar Mobile App Member-facing mobile application that enables virtual care access, prescription management, claims viewing, ID card access, deductible tracking, Care Team messaging, autopay setup, and care tracking; available on iOS and Android.
• ICHRA (Individual Coverage Health Reimbursement Arrangement) Health benefits offering that allows employers of any size to provide fixed monthly tax-free allowances for employees to shop individual marketplace plans; employers set budgets with no contribution limitations.
• WellDia Diabetes Management Program Diabetes management program for Oscar members enrolled in the Diabetes Care Plan, Chronic Care Plan, or Buena Salud; members can earn $50 for healthy groceries by completing annual wellness exams.
• HelloMeno Menopause Program The first menopause program in the individual health insurance market, offering benefits for the whole family as part of Oscar's innovative product portfolio.
• Oswell AI Agent OpenAI-powered AI agent providing a personalized frontdoor to healthcare for Oscar members; offers on-demand support and supplies doctors with data to perfect care paths.
• Oscar Provider Portal Provider-facing platform that is 6x faster than traditional methods for viewing claims, checking member eligibility, uploading forms, and submitting prior authorizations; claims paid in as little as 5 days.
• Oscar Prescriptions & Pharmacy Pharmacy benefit offering many commonly prescribed drugs for $3; includes prescription refills through the app, home delivery via CVS Mail Order or Capsule (same-day delivery), and specialty pharmacy coordination.
• Medicare Advantage Plans Medicare Advantage health insurance plans for seniors and eligible individuals, providing comprehensive senior healthcare coverage as Oscar's third business line.
• Breathe Easy Plan Pulmonary care plan for Oscar members; members can earn $10 by completing a pulmonary function test, and $25 for getting flu and pneumonia vaccines in the same calendar year.

Quantifiable outcome

• 97% member satisfaction with virtual care delivery
• +6 more outcomes

Named customers4 records

Segments4 records

Ideal customer profiles5 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration3 records

AI capability7 records

Feature8 records

Partnerships

Nine partnerships are on record, tiered core and minor.

• Hy-Vee HealthcoreStrategic or Co-development Partner · 1 January 2025Partnership to redefine healthcare by delivering no-cost care, local access, and everyday wellness perks. Combines Hy-Vee's grocery and retail presence with Oscar's insurance coverage.
• Stride HealthcoreGTM or Marketing PartnerPartnership to provide best-in-class enrollment experience for members and brokers. Stride Health provides the plan shopping and enrollment platform integrated with Oscar's offerings.
• Optum Behavioral HealthcoreTechnology or IntegrationProvides in-network mental health services including talk therapy, substance abuse services, psychiatry, and autism care for Oscar members.
• CapsulecoreTechnology or IntegrationPrescription delivery partner offering free same-day delivery to Oscar members. Available within Capsule service areas.
• CVS Mail OrdercoreTechnology or Integration90-day prescription refill delivery service available to Oscar members for ongoing medication needs.
• Availity EssentialscoreTechnology or IntegrationProvider portal integration enabling providers to access Oscar services, submit prior authorizations, and access help & training through Availity platform.
• Elektra HealthminorStrategic or Co-development PartnerPartnership to advance menopause care through collaboration on content and care approaches for HelloMeno program.
• ThatchminorGTM or Marketing PartnerSmall business benefits partnership helping small businesses provide modern health benefits through Oscar plans.
• CignacoreStrategic or Co-development PartnerCigna+Oscar joint venture expanding virtual primary care access in certain markets (Tennessee, Georgia). Co-branded plan offerings in select states.

Scale indicators10 records

Recent moves7 records

Expansion highlights6 records

Broad incumbents

• Centene Corporation: Centene is the largest ACA Marketplace insurer by enrollment and a major Medicaid managed-care player. It directly competes with Oscar on individual marketplace plans in many of the same states, often with heavier concentration in lower-income and subsidy-eligible populations similar to Oscar's target segments.
• Kaiser Permanente: Kaiser Permanente combines an integrated insurer-provider model with strong digital care capabilities in select states where it competes with Oscar on individual marketplace plans and virtual primary care. Its closed-loop model represents the deepest version of the tech-enabled, vertically integrated insurer that Oscar is building toward.
• UnitedHealthcare (UnitedHealth Group): UnitedHealthcare is the largest U.S. health insurer, competing with Oscar across the individual ACA Marketplace and Medicare Advantage markets with national scale, far deeper provider networks, and significantly more capital. It is the dominant incumbent Oscar must compete against for members and provider contracts.
• Elevance Health (Anthem / Blue Cross Blue Shield plans): Elevance operates Anthem and the Blue Cross Blue Shield licensees that compete head-to-head with Oscar in the individual marketplace and increasingly in Medicare Advantage. Like Oscar, it sells ACA Marketplace plans across multiple states but with vastly greater scale and brand recognition.
• CVS Health / Aetna: Aetna (owned by CVS Health) is a national carrier offering individual ACA, Medicare Advantage, and employer-sponsored plans. CVS's retail health and pharmacy footprint (including the partnership that runs Oscar's pharmacy delivery) makes it both a supplier and a direct competitor across Oscar's three lines of business.

Others

• eHealth: eHealth is a leading online health insurance marketplace and broker, effectively a distribution competitor to Oscar's direct-to-consumer digital channel. While not an underwriter, it competes for the same individual consumer shopping and enrollment moments that drive Oscar's member acquisition.

Direct peers

• Cigna Group: Cigna is both an Oscar partner (Cigna+Oscar joint venture in TN and GA) and a competitor selling individual and Medicare Advantage plans in overlapping geographies. The partnership structure makes Cigna the most commercially intertwined peer in Oscar's set.
• Molina Healthcare: Molina is a government-program-focused insurer that aggressively competes in the ACA Marketplace, especially in lower-income and subsidy-heavy segments where Oscar also concentrates growth. Their market overlap on marketplace plan pricing and provider access is high.
• Humana: Humana is a leading Medicare Advantage carrier and also sells individual health plans, making it a direct competitor in two of Oscar's three business lines. Its senior-focused model and dense MA footprint overlap meaningfully with Oscar's third business line launched in 2020.

Emerging players

• Clover Health: Clover Health is a tech-forward Medicare Advantage insurer using its Clover Assistant software to drive value-based care, much like Oscar uses its Member Engagement Engine and Care Router. It is the closest analogue to Oscar as a smaller, technology-led challenger to incumbent insurers.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat7 records

Key risks5 records

Key highlights8 records

Customer concentration

• Xtwitter.com/OscarHealth
• YouTubeyoutube.com/user/OscarHealthInsurance
• Facebookfacebook.com/OscarHealth
• Instagraminstagram.com/oscarhealth

Compliance2 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles6 records

Subsidiaries13 records

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments1 record

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Oscar’s Culturally Competent Care Program