The Ledger

Oscar Health swung from a $137.5 million loss to a $167.3 million profit in a year, and now expects as much as $950 million in operating earnings for 2026. Oscar, which sells individual-market and small-group plans, said in its third quarter 2026 results release that revenue was $5.14 billion against $2.99 billion a year ago, on 2.69 million members against 2.12 million. The medical loss ratio, the share of premium spent on care, fell to 84.0% from 88.5%, and the selling, general and administrative ratio fell to 14.0% from 17.5%. The company raised its earnings-from-operations outlook for a third time, to $850 million to $950 million from $600 million to $800 million, and cut its full-year medical loss ratio range to 80.5% to 81.5%. Who it hits: every individual-market competitor, and every operator pricing 2027 plans against a rival that is both growing and widening margin. So what: the quarter included a $250 million benefit from updated risk adjustment estimates, the federal system that moves money between plans based on member health, and Oscar’s net risk adjustment payable stood at $2.99 billion at September 30. Part of the profit therefore rests on estimates that can still move. The release gives no numeric 2027 guidance and lists the expiration of enhanced premium tax credits as a risk. Confidence: High on reported figures; Med on how durable the margin is.

agilon health reported $35 million in net income and raised guidance, but its own numbers imply a loss in the fourth quarter. The physician-enablement company, which runs risk contracts for independent primary care groups, reported in its Form 8-K earnings release that third quarter revenue rose 6% to $1.52 billion, and the medical services expense ratio fell to 88.5% from 104.0%. Adjusted EBITDA (earnings before interest, taxes, depreciation and amortization) was $64 million against negative $91 million. Full-year adjusted EBITDA guidance moved to $145 million to $155 million from $75 million to $95 million. Who it hits: independent practices weighing risk partners, and Medicare Advantage plans that contract with enablers. So what: nine-month adjusted EBITDA is already $187.1 million, so the guidance implies a fourth quarter loss of roughly $32 million to $42 million. The release says the quarter benefited from favorable claims development in the first half of 2026, and Medicare Advantage membership fell 10% to 454,000 on a “disciplined approach to contracting.” Confidence: High on reported figures; Med on the fourth quarter inference, which is our arithmetic, not company guidance.

Clover Health raised the floor on every 2026 guidance range, and its guidance also implies a weak fourth quarter. In its Form 8-K earnings release dated November 4, the Medicare Advantage insurer reported revenue of $759.3 million, up 52.9%, net income of $6.4 million against a $24.4 million loss, and a benefit expense ratio of 91.1% against 93.5%. Medicare Advantage membership reached 158,907, up 45%. Revenue guidance moved to $2.97 billion to $3.00 billion from $2.92 billion to $3.00 billion, and adjusted EBITDA to $75 million to $85 million from $70 million to $85 million. Who it hits: Medicare Advantage rivals competing for 2027 enrollment, which the company says is tracking well. So what: the top of each range did not move, and nine-month adjusted EBITDA is already $97.2 million, above the $85 million ceiling. That implies fourth quarter adjusted EBITDA of negative $12 million to negative $22 million. The release does not explain the gap. Confidence: High on reported figures; Med on the implied quarter, our arithmetic.

Privia Health bought a 36,000-life Medicare accountable care organization from Cano Health for about $36 million and raised guidance above its high end. Privia, a physician-enablement platform, said in its Form 8-K earnings release that third quarter revenue rose 13.2% to $657.0 million, net income was $13.5 million, and adjusted EBITDA was $40.6 million. Value-based care attributed lives reached 1.676 million, up 19.2%. The acquired American Choice Healthcare Medicare Shared Savings Program entity starts contributing January 1, 2027, with minimal 2026 impact. Full-year adjusted EBITDA guidance rose to $154 million to $157 million from $145 million to $155 million. Who it hits: distressed risk-bearing groups that may be shopping contracts, and ACO operators competing for attribution. So what: Privia also said it will end its Montana partnership with Surgery Partners in January 2027, covering 69 providers and about $23 million in annual practice collections, with no material 2027 adjusted EBITDA impact. Surgery Partners agreed in October to a take-private at $23.50 per share, per its Form 8-K. The release does not link the two events. Confidence: High on figures; Low on any connection between the Montana exit and the pending sale.

THE DEAL SHEET

No other new transactions confirmed to a primary source in the last 24 hours. Pending deals such as Option Care Health and Surgery Partners are not new.