Another open enrollment period is set to begin on the Affordable Care Act's exchanges, and the team at Oscar Health is putting a focus on the unique ways it can innovate in the turbulent market.
Oscar is growing the number of counties in its geographic footprint by 24% in 2027, offering plans across 713 counties in 21 states. It is also investing in new specialized plans, such as its RetireEase offering, and in expanding coverage options designed for individuals with certain conditions.
Janet Liang, president of Oscar Insurance, told Fierce Healthcare that it's critical for plans to learn as much as they can about the individual consumer, so that they can shape benefits that effectively meet the needs of the people who are coming to the marketplaces for coverage.
"We are completely dialed in to the individual consumer," she said. "We know the people who are in the ACA, and it's a broad, broad range of of people. It's not one size fits all, and what we do is we spend the time to understand who comes into the ACA and what are the services and needs that individuals have."
That includes putting a focus on collecting plenty of feedback from existing members, and what they're searching for as existing enrollees, as well as collecting data on broader consumer behaviors on the exchanges.
The RetireEase plan, for example, was born from this thinking, Liang said. The offering, which is launching in five states for next year, aims to support members in the transition to Medicare coverage, targeted to people aged 55 to 64.
Benefits include set prices for key services in this age range, from preventive care to physical therapy to cardiology. Members that enroll in RetireEase can also access specific supports designed for the handoff to Medicare, for caregivers and transportation if needed.
Liang said this population tends to have unique concerns about affordability as employers shift their approaches in a way that is leading more people to retire early, leaving them on a fixed income. It's also an age range where people begin to develop challenging chronic conditions that would need to be managed in the future.
The team took that feedback and those particular needs it heart when building out RetireEase, Liang said.
Oscar's suite of specialized offerings includes some of its most popular plans, she said. In addition to the new launch, Oscar is expanding the reach of its existing specialized plans. HelloMeno, its plan designed for women navigating menopause, will grow to 15 states for 2027, for example.
Liang said that these plans have higher Net Promoter Scores than its traditional plans, and they also tend to have higher retention rates than the broader offerings.
"Based on the retention rate and the high NPS scores, we know that we're meeting an unmet need," she said.
And the Oscar team is already planning for the future around these specialized plans, and has determined where to go next for 2028. Expanding this slate is a central part of Oscar's broader strategy around the ACA, which also includes enhancements to bronze, silver and gold plans as well as a focus on individual coverage health reimbursement arrangements, or ICHRA.
ICHRA plans have rebranded as Custom Health Option and Individual Care Expense, or CHOICE. But in these models, an employer offers workers a stipend to purchase an exchange plan, rather than offering coverage directly.
Liang said Oscar believes this is an area that will continue to grow. She said that they're seeing higher numbers of employers requesting quotes for potential CHOICE arrangements, and Oscar has doubled its membership between 2025 and 2026.
She added that Oscar expects to triple its CHOICE membership by 2029.
"So there's an obvious interest by employers to reduce their costs," Liang said. "And we also look at markets where there's just a lot of interest by both small employers, regional employers, to just start off. What you see is new employers and new companies that are forming will go straight to CHOICE instead of starting on the traditional insurance path."