Oscar Health Inc (OSCR) 2025 Q3 法說會逐字稿

Good morning. My name is Dustin, and I will be your conference operator today. At this time, I would like to welcome everyone to Oscar Health's 3rd Quarter 2025 Earnings Conference Call.

早安.我叫達斯汀，今天我將擔任你們的會議接線生。在此，我謹代表 Oscar Health 歡迎各位參加 2025 年第三季財報電話會議。

(Operator Instructions)

（操作說明）

I will now turn the conference over to Chris Potochar, Vice President of Treasury and Investor Relations. Please go ahead, sir.

現在我將把會議交給財務和投資者關係副總裁克里斯·波托查爾。請繼續，先生。

Good morning, everyone.

各位早安。

Thank you for joining us for our 3rd Quarter 2025 Earnings Call. Mark Bertolini, Oscar Health's Chief Executive Officer, and Scott Blackley, Oscar's Chief Financial Officer, will host this morning's call.

感謝您參加我們2025年第三季財報電話會議。Oscar Health 的執行長 Mark Bertolini 和 Oscar 的財務長 Scott Blackley 將主持今天上午的電話會議。

This call can also be accessed through our investor relations website at ir.hioscar.com.

您也可以透過我們的投資者關係網站 ir.hioscar.com 收聽本次電話會議。

Full details of our results and additional management commentary are available in our earnings release, which can be found on our investor relations website at ir.hioscar.com.

有關我們業績的完整詳情和管理層補充評論，請參閱我們的盈利報告，該報告可在我們的投資者關係網站 ir.hioscar.com 上找到。

Any remarks that Oscar makes about the future constitute forward-looking statements within the meaning of the safe harbor provisions under the Private Securities Litigation Reform Act of 1995. Actual results may differ materially from those indicated by those forward-looking statements as a result of various important factors, including those discussed in our annual report on Form 10-K for the period ended December 30th, 2024.

Oscar 對未來發表的任何言論均構成 1995 年《私人證券訴訟改革法案》安全港條款意義上的前瞻性陳述。由於各種重要因素的影響，實際結果可能與這些前瞻性聲明所指出的結果有重大差異，這些因素包括我們在截至 2024 年 12 月 30 日的 10-K 表格年度報告中討論的因素。

And the quarterly report on Form 10-Q for the period ended June 30th, 2025. Each is filed with the SEC and other filings with the SEC, including our quarterly report on Form 10q for the quarterly period ended September 30th, 2025, to be filed with the SEC.

以及截至 2025 年 6 月 30 日的季度報告（10-Q 表格）。每份文件均已提交給美國證券交易委員會 (SEC)，其他文件也已提交給美國證券交易委員會，包括我們截至 2025 年 9 月 30 日的季度報告（10-q 表格），該報告將提交給美國證券交易委員會。

Such forward-looking statements are based on current expectations as of today. Oscar anticipates that subsequent events and developments may cause estimates to change. While the company may elect to update these forward-looking statements at some point in the future, we specifically disclaim any obligation to do so. The call will also refer to certain non-GAAP measures. A reconciliation of these measures to the most directly comparable GAAP measures can be found in the 3rd quarter earnings press release available on the company's investor relations website. At ir.hioscar.com, we have not provided a quantitative reconciliation of estimated full year 2025 adjusted EBITTA as described on this call to GAAP net income because Oscar is unable without making unreasonable efforts to calculate certain reconciling items with confidence. With that, I will turn the call over to our CEO, Mark Bertolini.

此類前瞻性陳述是基於截至目前為止的預期。奧斯卡預計，後續事件和發展可能會導致估算結果改變。雖然公司未來可能會選擇更新這些前瞻性聲明，但我們特此聲明不承擔任何更新義務。本次電話會議也將提及某些非GAAP指標。這些指標與最直接可比較的 GAAP 指標的比較情況，可以在公司投資者關係網站上發布的第三季財報新聞稿中找到。在 ir.hioscar.com 上，我們沒有提供本次電話會議中所述的 2025 年全年調整後 EBITTA 估計值與 GAAP 淨收入的定量調節表，因為 Oscar 無法在不付出不合理努力的情況下有把握地計算某些調節項目。接下來，我將把電話交給我們的執行長馬克貝爾托利尼。

Good morning.

早安.

Thank you, Chris, and thank you all for joining us.

謝謝你，克里斯，也謝謝各位的參與。

Today, Oscar announced 3rd quarter results and reaffirmed updated 2025 guidance. We reported total revenue of approximately 3 billion, a 23% increase year over year.

今天，Oscar公佈了第三季業績，並重申了更新後的2025年業績指引。我們公佈的總收入約為30億美元，較去年同期成長23%。

MLR increased approximately 380 basis points to 88.5% due to higher market morbidity, partially offset by favorable prior period development.

由於市場波動加劇，MLR 上升約 380 個基點至 88.5%，但前期發展有利，部分抵消了這種影響。

Her SG&A expense ratio of 17.5%, meaningfully improved by approximately 150 basis points year over year.

她的銷售、一般及行政費用率為 17.5%，較上年同期顯著改善了約 150 個基點。

Overall, Oscar reported a $129 million loss from operations and an adjusted EBITDA loss of $101 million. Net loss for the third quarter was $137 million.

總體而言，Oscar 報告營運虧損 1.29 億美元，調整後 EBITDA 虧損 1.01 億美元。第三季淨虧損為1.37億美元。

We remain confident in our ability to expand margins and return to profitability in 2026. Scott will walk through our financials and details in a few moments.

我們仍然有信心在 2026 年擴大利潤率並恢復盈利。Scott 稍後會詳細介紹我們的財務狀況和細節。

Before I get into our results, I want to underscore the long-term importance of the individual market.

在介紹我們的結果之前，我想先強調個人市場的長期重要性。

The individual market is the only source of affordable health coverage to 22 million Americans who power our economy.

對於支撐我們經濟的 2,200 萬美國人來說，個人市場是他們獲得負擔得起的醫療保險的唯一途徑。

The majority of members are from the small businesses, service, and farming sectors which together generate nearly 50% of US GDP.

大多數成員來自小型企業、服務業和農業部門，這些部門加起來創造了美國近 50% 的 GDP。

These hardworking people do not have access to employer coverage and rely on enhanced premium tax credits to fill the GAAP.

這些辛勤工作的人無法獲得雇主提供的醫療保險，只能依靠提高保費稅收抵免來滿足公認會計原則 (GAAP) 的要求。

For example, the average farmer making $60,000 a year now pays $75 a month for health insurance compared to $300 a month before the enhanced premium tax credits. That $225 is the difference between paying for healthcare or paying the bills.

例如，年收入 6 萬美元的普通農民現在每月支付 75 美元的健康保險費，而在此之前，他們每月需要支付 300 美元的保費稅收抵免。這225美元的差別，決定了你是能支付醫療費用還是能支付帳單。

Limiting access to affordable coverage in the individual market undermines Main Street and rural America. This market is critical regardless of policy changes, and we are engaged with policymakers on both sides of the aisle to ensure Americans have access to the coverage they need. Now I will update you on current market dynamics. As we said last quarter, 2025 is a reset moment for the individual market.

限制個人市場獲得價格合理的醫療保險會損害美國一般民眾和農村地區的利益。無論政策如何變化，這個市場都至關重要，我們正在與兩黨的政策制定者合作，以確保美國人能夠獲得所需的保險。現在我將向大家介紹目前的市場動態。正如我們上個季度所說，2025 年是個人市場的重置時刻。

Overall risk adjustment data from Wakely in the 3rd quarter showed continued higher market morbidity, which we attribute to Medicaid Lives entering the market and the initial impacts of program integrity efforts.

Wakely 第三季的整體風險調整數據顯示，市場發生率持續偏高，我們認為這是由於 Medicaid Lives 進入市場以及專案完整性工作的初步影響所致。

Looking ahead, we see rational pricing in the 2026 open enrollment period. We also the overall market to contract due to the expiration of enhanced premium tax credits and program integrity efforts. However, we remain optimistic Congress will reach a compromise on tax credits to address affordability issues many Americans will face without them.

展望未來，我們預期 2026 年開放註冊期間的定價將較為合理。我們也預計，由於保費稅收抵免政策的到期以及專案完整性努力，整體市場將會萎縮。然而，我們仍然樂觀地認為，國會將就稅收抵免問題達成妥協，以解決許多美國人如果沒有稅收抵免將面臨的負擔能力問題。

The Oscar team is well positioned to profitably grow share and improve margins. Our 2026 pricing strategy remained disciplined, balancing membership and profitability. For 2026, we resubmitted rate filings in states covering close to 99% of current membership.

Oscar團隊已做好充分準備，能夠實現市場份額的獲利成長並提高利潤率。我們2026年的定價策略依然嚴謹，在會員數和獲利能力之間取得平衡。2026 年，我們重新提交了覆蓋近 99% 當前會員所在州的費率申請。

And our weighted average rate increase is approximately 28%.

我們的加權平均利率漲幅約為 28%。

Our rate filings reflect elevated trend, significantly higher market morbidity in 2025, the expiration of enhanced premium tax credits, and program integrity initiatives.

我們的費率申報反映了上漲趨勢、2025 年市場波動性顯著增加、增強型保費稅收抵免到期以及專案完整性舉措。

Our teams are actively directing members to plans at affordable price points to ease this transition.

我們的團隊正積極引導會員選擇價格合理的方案，以減輕過渡壓力。

We have a strong opportunity to capture share profitably as other carriers retreat or price themselves out of the market.

隨著其他業者撤出市場或因定價過高而退出市場，我們有很好的機會以盈利的方式搶佔市場份額。

Oscar ended the 1st 9 months of 2025 with more than 2 million members, a 28% increase over last year.

Oscar 在 2025 年前 9 個月結束時擁有超過 200 萬會員，比去年增長了 28%。

We are now in the first week of the 2026 enrollment period. The Oscar Experience will be available in 20 states, including two new states, Alabama and Mississippi.

我們現在正處於2026年招生期的第一週。奧斯卡體驗活動將在 20 個州推出，其中包括阿拉巴馬州和密西西比州這兩個新州。

We are also entering new markets and expect to grow share in existing markets in core states next year. Our total addressable market for plan year 2026 is approximately $12 million, up $500,000 year over year.

我們也在進軍新市場，並預計明年將在核心州的現有市場份額中擴大份額。我們 2026 年計畫年度的潛在市場總額約為 1,200 萬美元，比上一年增長 50 萬美元。

Oscar offers consumers more choice in the individual market. We continue to diversify our product mix, evolving from condition and specific plans to plans tailored to meet different phases of life.

Oscar 為個人市場的消費者提供了更多選擇。我們不斷豐富產品組合，從針對特定病症和特定計畫發展為滿足不同人生階段需求的客製化計畫。

Our longstanding clinical plans for members with diabetes, asthma, COPD, and multiple chronic conditions remain strong performers in the book.

我們為患有糖尿病、氣喘、慢性阻塞性肺病和多種慢性疾病的會員制定的長期臨床計劃，在業績方面仍然表現出色。

Now our new product, Hello Meno, helps women take control of the menopause experience.

現在，我們的新產品 Hello Meno 可以幫助女性掌控更年期體驗。

Today, nearly 5.4 million women over the age of 45 are enrolled in the ACA.

如今，近 540 萬名 45 歲以上的女性參加了《平價醫療法案》。

A rapidly growing demographic with limited support.

人口快速成長，但支持有限。

Oscar is the first individual market carrier to offer this type of product in partnership with leading women's health clinics and menopause certified clinicians across the US. We help members save up to $900 per year by getting them into the right plans with $0 benefits, early intervention programs, and high value treatments that improve outcomes at lower costs.

Oscar 是第一家與美國領先的女性健康診所和更年期認證臨床醫生合作，提供此類產品的個人市場營運商。我們幫助會員每年節省高達 900 美元，方法是讓他們加入合適的計劃，享受 0 美元福利、早期幹預計劃和高價值治療，從而以更低的成本改善治療效果。

Oscar also continues to shape the future of employer coverage through ICHRA. Our pricing is competitive across our major markets compared to group plans. We expect to see continued conversion from small and mid-size employers who are suffering from double-digit group rate increases. Our Hy-Vee Health with Oscar product is now live in Des Moines, Iowa for plan year 2026.

Oscar 也透過 ICHRA 繼續塑造雇主保險的未來。與團體套餐相比，我們在主要市場上的定價具有競爭力。我們預計，那些正遭受兩位數團體費率成長之苦的中小型企業將會繼續轉變經營模式。我們的 Hy-Vee Health with Oscar 產品現已在愛荷華州得梅因市上線，計畫年度為 2026 年。

This innovative plan is the first of its kind. The plan offers $0 concierge type care at an affordable fixed price and in-store rewards for buying healthy food.

這項創新計劃是史無前例的。該計劃以實惠的固定價格提供 0 美元的管家式護理服務，並在店內購買健康食品時提供獎勵。

We plan to expand this partnership in additional markets. Our momentum in ICHRA reflects the growing demand among employers for a wider range of affordable and innovative benefits.

我們計劃將這種合作關係擴展到更多市場。我們在 ICHRA 領域的進展反映了雇主對更廣泛、更經濟實惠且更具創新性的福利日益增長的需求。

Finally, Oscar is infusing an industry first health AI agent, Oswell, into our entire product portfolio.

最後，Oscar 將業內首個健康 AI 代理商 Oswell 融入我們的整個產品組合中。

Oswald is powered by OpenAI and helps members manage their health on demand.

Oswald 由 OpenAI 提供技術支持，可協助使用者按需管理自身健康狀況。

Unlike other AI tools, Oswell is connected to Oscar's cloud native tech platform. It draws from claims, medical records, care guide notes, and other member data for a personal experience.

與其他人工智慧工具不同，Oswell 與 Oscar 的雲端原生技術平台相連。它利用理賠記錄、醫療記錄、護理指南筆記和其他會員數據，提供個人化的體驗。

Members can better understand symptoms, common test results, medications, and pre-approvals tied to plan benefits. Oswell also provides doctors with data to improve care paths and members with questions to ask their doctors, so they are informed on their care. This is just the beginning of what we will do with leading AI models to redefine the healthcare experience.

會員可以更好地了解症狀、常見測試結果、藥物以及與計劃福利相關的預先批准。Oswell 也向醫生提供數據以改善治療方案，並向會員提供可以向醫生提出的問題，以便他們了解自己的治療情況。這只是我們利用領先的人工智慧模型重新定義醫療保健體驗的開始。

In summary, Oscar's highly innovative products, superior member experience, and disciplined pricing set us up to grow market share.

總而言之，Oscar 極具創新性的產品、卓越的會員體驗和嚴謹的定價策略，為我們擴大市場份額奠定了基礎。

We remain front footed and know how to run a successful company in dynamic markets.

我們始終保持積極主動，並且知道如何在瞬息萬變的市場中成功經營一家公司。

Oscar will continue to lead the individual market regardless of the outcome on enhanced premium tax credits. All of our attention and resources are focused on executing against our strategic plan.

無論提高保費稅收抵免政策的結果如何，Oscar 仍將繼續引領個人保險市場。我們所有的精力和資源都集中在執行我們的策略計劃上。

We are well positioned to expand margins and return to profitability in 2026.

我們已做好充分準備，在 2026 年擴大利潤率並恢復盈利。

The ACA and ICHRA have the potential to meet the healthcare needs of approximately 120 million working people. The individual market aligns with major macroeconomic, workforce, and consumer trends. More Americans work in the service economy than ever before. More businesses want affordable benefit options. More people want greater choice.

《平價醫療法案》(ACA) 和《綜合醫療保健改革法案》(ICHRA) 有可能滿足約 1.2 億勞動人口的醫療保健需求。個人市場與宏觀經濟、勞動力和消費趨勢密切相關。從事服務業的美國人比以往任何時候都多。越來越多的企業希望選擇價格合理的福利方案。越來越多的人希望有更多選擇。

Oscar is ahead of the demand, and we are creating the future of individual healthcare for all Americans. I want to thank the entire Oscar team for their hard work during our busiest time of the year. I am proud of how we consistently show up for our members, partners, and the business community. I will now turn the call over to Scott. Scott.

Oscar 領先於市場需求，我們正在為所有美國人創造個人醫療保健的未來。我要感謝奧斯卡團隊全體成員在一年中最繁忙的時期所付出的辛勤努力。我為我們始終如一地為會員、合作夥伴和商業界提供支持而感到自豪。現在我將把通話轉給史考特。斯科特。

Thank you, Mark, and good morning, everyone. This morning, we reported our 3rd quarter financial results and reaffirmed our full year guidance.

謝謝你，馬克，大家早安。今天上午，我們公佈了第三季財務業績，並重申了全年業績預期。

2025 has been a dynamic year for the ACA marketplace.

2025年對於ACA市場來說是充滿活力的一年。

We've observed higher average market morbidity attributable to strong ACA growth from Medicaid redeterminations and ACA program integrity efforts that were implemented after the completion of 2025 pricing.

我們觀察到，由於 2025 年定價完成後實施的 Medicaid 重新評估和 ACA 專案完整性努力，ACA 的強勁成長導致平均市場發病率上升。

We've taken disciplined actions to manage costs this year and position us to ensure we return to profitability next year.

今年我們採取了嚴格的成本控制措施，為明年恢復獲利做好了準備。

Turning now to third quarter results, total revenue increased 23% year over year to approximately $3 billion driven by higher membership. We ended the quarter with 2.1 million members, an increase of 28% year over year. Membership growth was driven by solid retention, above market growth during open enrollment, and SEP member additions.

現在來看第三季業績，總營收年增 23%，達到約 30 億美元，主要得益於會員人數的成長。本季末，我們的會員人數達到 210 萬，年增 28%。會員成長主要得益於穩定的會員留存率、開放註冊期間高於市場平均的成長以及SEP會員的增加。

The third quarter medical loss ratio was 88.5%, an increase of approximately 380 basis points year over year.

第三季醫療損失率為 88.5%，較去年同期上升約 380 個基點。

We received a risk adjustment report in the 3rd quarter for claims through July which showed a further increase in market morbidity across several states.

我們在第三季收到了一份截至 7 月的索賠風險調整報告，該報告顯示多個州的市場疾病發生率進一步上升。

The 3rd quarter MLR was impacted by a $130 million increase to our risk adjustment payable for 2025, partially offset by $84 million of favorable prior period development, primarily related to claims run out from the prior year.

第三季醫療損失率受到 2025 年應付風險調整增加 1.3 億美元的影響，部分被前期有利發展 8,400 萬美元所抵消，主要與上一年結清的索賠有關。

As discussed during our second quarter earnings call, we observed a sequential decrease in utilization each month throughout the second quarter.

正如我們在第二季財報電話會議上所討論的那樣，我們觀察到第二季每個月的使用率都在逐月下降。

This trend persisted into early 3Q before stabilizing to be more in line with our expectations.

這趨勢持續到第三季初，之後趨於穩定，更符合我們的預期。

Overall year-to-date utilization is modestly above our expectations.

今年迄今為止的整體利用率略高於我們的預期。

By category, inpatient utilization remained elevated but moderated meaningfully throughout the 1st 9 months of the year.

按類別劃分，住院使用率仍然較高，但在今年前 9 個月中有所顯著下降。

Outpatient and professional were slightly elevated, while pharmacy remained favorable.

門診和專業服務略有提升，而藥局服務仍保持良好狀態。

Switching to administrative costs, we continued to deliver strong improvements in the SG&A expense ratio. The third quarter SG&A expense ratio improved by approximately 150 basis points year over year to 17.5%. The year over year improvement was driven by fixed cost leverage, lower exchange fee rates, and discipline cost management.

轉而關注管理費用，我們在銷售、一般及行政費用率方面繼續取得了顯著改善。第三季銷售、一般及行政費用率較去年同期下降約 150 個基點至 17.5%。年比改善主要得益於固定成本槓桿作用、較低的匯率以及嚴格的成本管理。

Partially offset by the impact of higher risk adjustment payable as a percentage of premium.

部分被保費百分比支付的較高風險調整金的影響所抵銷。

In the third quarter, the loss from operations was $129 million a change of $81 million year over year, and the net loss was $137 million and $0.83 million dollars change year over year.

第三季度，營業虧損為 1.29 億美元，年減 8,100 萬美元；淨虧損為 1.37 億美元，年減 83 萬美元。

The adjusted EBITDA loss was $101 million in the quarter, a change of $90 million year over year.

本季調整後的 EBITDA 虧損為 1.01 億美元，年減 9,000 萬美元。

Shifting to the balance sheet, we have taken opportunistic steps to strengthen our capital position and optimize our capital structure.

從資產負債表來看，我們採取了機會主義措施來加強我們的資本狀況並優化我們的資本結構。

During the 3rd quarter we completed a $410 million convertible notes offering due 2030. Net proceeds were $360 million inclusive of the costs of a cap call transaction which increased the effective conversion price to $37.46.

第三季度，我們完成了 4.1 億美元的 2030 年到期可轉換債券發行。淨收益為 3.6 億美元，其中包括資本收購交易的成本，該交易將實際轉換價格提高到 37.46 美元。

In addition, subsequent to quarter end, we entered into an agreement to redeem the vast majority of our outstanding $305 million convertible senior notes for shares.

此外，季末之後，我們達成協議，將我們未償還的 3.05 億美元可轉換優先票據中的絕大部分兌換成股票。

We ended the third quarter with approximately $4.8 billion of cash and investments, including $541 million of cash and investments at the parent. As of September 30th, 2025, our insurance subsidiaries had approximately $1.2 billion of capital and surplus, including $564 million of excess capital.

第三季末，我們擁有約 48 億美元的現金和投資，其中包括母公司 5.41 億美元的現金和投資。截至 2025 年 9 月 30 日，我們的保險子公司擁有約 12 億美元的資本和盈餘，其中包括 5.64 億美元的超額資本。

Turning now to 2025 for year guidance, based on our results through the first nine months of the year, we are reaffirming all of our guidance metrics.

現在展望 2025 年，根據我們今年前九個月的業績，我們重申所有業績指標。

For total revenue, we now expect to be towards the low end of our guidance range of $12 billion to $12.2 billion, driven by the third quarter ACA marketplace morbidity that increased by more than our prior estimates. Membership growth has been strong through the first nine months of 2026.

就總收入而言，我們現在預計會接近我們先前預測的 120 億美元至 122 億美元範圍的下限，這主要是由於第三季 ACA 市場疾病發病率的增長超過了我們先前的預期。2026 年前九個月，會員人數成長強勁。

For the fourth quarter, our outlook contemplates a sequential decline in membership driven by more historical churn patterns as the continuous monthly SEP for those at or below 150% of federal poverty level ended in the beginning of September.

對於第四季度，我們的展望是，由於9月初面向收入低於聯邦貧困線150%的人群的連續每月SEP計劃結束，會員人數將出現更多歷史性的流失模式，從而導致會員人數環比下降。

Our outlook also assumes risk adjustment as a percentage of direct and assumed policy premiums is in the high mid-teens range.

我們的展望也假設風險調整佔直接和假定保單保費的百分比在十幾個百分點左右。

Shifting to the medical loss ratio, we continue to expect a full year MLR in the range of 86.0% to 87.0%. The full year MLR guidance reflects higher average market morbidity, year-to-date utilization patterns, and continues to assume a modest increase in utilization in the 4th quarter as members may seek additional care ahead of anticipated coverage changes next year.

就醫療損失率而言，我們繼續預計全年醫療損失率將在 86.0% 至 87.0% 之間。全年醫療損失率指引反映了較高的平均市場發病率、年初至今的使用模式，並繼續假設第四季度使用量將小幅增長，因為會員可能會在明年預期的承保範圍變化之前尋求額外的護理。

On administrative expenses, we continue to expect an SG&A expense ratio in the range of 17.1% to 17.6% driven by greater operating leverage and variable cost efficiencies.

在行政費用方面，我們繼續預期銷售、一般及行政費用率將在 17.1% 至 17.6% 之間，這主要得益於更高的經營槓桿和變動成本效率。

We expect a loss from operations in the range of $200 million to $300 million and an adjusted EBITDA loss of approximately $120 million less than the loss from operations.

我們預計營運虧損將在 2 億美元至 3 億美元之間，調整後的 EBITDA 虧損將比營運虧損少約 1.2 億美元。

While the 3rd quarter risk adjustment true up is expected to drive total revenues towards the low end of our full year guidance range, favorable prior period and in-year claims development and administrative expense efficiencies substantially offset the impact, so net net, our outlook for the loss from operations, remains unchanged.

雖然預計第三季風險調整將使總收入接近我們全年指導範圍的下限，但有利的前期和年內索賠發展和管理費用效率大幅抵消了這一影響，因此，淨額而言，我們對營運虧損的預期保持不變。

Now I'll spend a moment on our planning assumptions for 2026.

現在我將花一點時間談談我們對 2026 年的規劃假設。

While it is too early to provide formal guidance, we have taken appropriate actions to ensure we can deliver meaningful margin expansion and return to profitability next year.

雖然現在提供正式的業績指引還為時過早，但我們已經採取了適當的措施，以確保明年能夠實現利潤率的顯著增長並恢復盈利。

Our 2026 pricing strategy balanced growing market share and improving profitability. As Mark mentioned, our weighted average rate increase is approximately 28% for 2026.

我們的 2026 年定價策略旨在平衡不斷增長的市場份額和不斷提高的獲利能力。正如馬克所提到的，我們 2026 年的加權平均利率漲幅約為 28%。

This increase anticipates above average trend and a significantly higher market morbidity driven by increased market morbidity in 2025, the expiration of enhanced premium tax credits, and the current ACA program integrity initiatives.

這一增長預示著高於平均水平的趨勢，以及由於 2025 年市場疾病增加、增強型保費稅收抵免到期以及當前的 ACA 計劃完整性舉措而導致的市場疾病顯著增加。

We believe our discipline pricing strategy captures the changing market conditions we've observed this year and the expected changes next year.

我們相信，我們穩健的定價策略能夠反映今年我們觀察到的市場變化以及明年預期的變化。

Based on a review of final rates, our competitive positioning is in line with our expectations, and we are confident in our ability to profitably grow market share next year.

根據對最終價格的評估，我們的競爭地位符合預期，我們有信心明年能夠獲利地擴大市場份額。

As previously mentioned, we also took actions to eliminate approximately $60 million in administrative costs for 2026.

如前所述，我們也採取措施，在 2026 年削減約 6,000 萬美元的行政成本。

In closing, we remain committed to bringing consumers affordable, innovative products and building an even larger ACA market over the long-term.

最後，我們將繼續致力於為消費者帶來價格合理、創新的產品，並在長期內打造一個更大的ACA市場。

2025 is a reset for the ACA marketplace. We've taken necessary pricing and cost actions and are confident in our ability to meaningfully expand margins and return to profitability in 2026.

2025 年是 ACA 市場重置之年。我們已經採取了必要的定價和成本措施，並有信心在 2026 年大幅提高利潤率並恢復獲利能力。

With that, I'll turn the call over to the operator for the Q&A portion of the call.

接下來，我將把電話轉交給接線生進行問答環節。

Thank you.

謝謝。

(Operator Instructions)

（操作說明）

And we will take our first question from Michael Ha from Baird.

接下來，我們將回答來自 Baird 公司的 Michael Ha 提出的第一個問題。

Please go ahead.

請繼續。

All right. Thank you.

好的。謝謝。

Hi, thank you. Regarding the September weekly report, I understand there's worsening market morbidity shifts, but curious, is there any indication in that report how much of that might have been from things like FTR checks and removal of duplicated members heading into 4th quarter?

您好，謝謝。關於九月份的周報，我了解到市場狀況正在惡化，但我很好奇，這份報告是否有任何跡象表明，其中有多少是由於 FTR 檢查和在進入第四季度之前刪除重複成員等原因造成的？

I'm curious to hear how you view the potential risk of there being maybe more market morbidity shifts in the December weekly report. So, thoughts there would be great.

我很想知道您如何看待 12 月週報中可能出現更多市場波動帶來的潛在風險。所以，大家有什麼想法嗎？

Thank you.

謝謝。

Hey Michael, good morning. Thanks for the question. So, the weekly report that we received, had market morbidity increases by about 1.5 points to 2 points across several of our markets. We think that the drivers of that increase are the same types of things that we discussed last quarter, obviously to a lesser magnitude.

嗨，邁克爾，早安。謝謝你的提問。因此，我們收到的每週報告顯示，我們幾個市場的市場發病率上升了約 1.5 到 2 個百分點。我們認為，導致這一成長的因素與我們上個季度討論的因素類似，只是規模要小一些。

As you think about that report captures claims through July and so it wouldn't capture the impacts of FTR or dual enrollment churn that really happened in the 3rd quarter.

仔細想想，這份報告只統計了截至 7 月的索賠情況，因此它無法反映出第三季 FTR 或雙重註冊流失的影響。

On those two topics I would say that you know we've seen about 45% of the people who were part of CMS's list to us on FTR or dual enrollments, with 45% of that list has churned when we look at the nature of those members they actually have higher risk than our average book so if we, the whole industry had similar types of characteristics in their populations that actually would be a tailwind to market morbidity.

關於這兩個主題，我想說的是，我們已經看到，在 CMS 的 FTR 或雙重註冊名單中，大約有 45% 的人流失了。當我們觀察這些成員的性質時，他們的風險實際上高於我們平均值。因此，如果我們整個行業的客戶群具有類似的特徵，那麼實際上將有利於市場發病率的下降。

So, we don't see any reason to change our expectations that market morbidity will stay consistent through the end of the year.

因此，我們認為沒有理由改變我們對市場低迷狀況將持續到年底的預期。

Great, thank you. And just one more question.

太好了，謝謝。最後一個問題。

So, G&A, if I take a step back, has been such a bright spot in your fundamental story. I think it's shined a really powerful light on Plus Oscar as well. So, in thinking ahead regarding your longer-term G&A target for '27, 16%, just wanted to ask if you still feel confident on achieving this target even with, the magnitude of expected member attrition over the next couple of years.

所以，從整體來看，G&A（一般及行政費用）一直是你們公司發展歷程中的一大亮點。我認為這也讓Plus Oscar這個獎項得到了更廣泛的關注。所以，在考慮您 2027 年的長期 G&A 目標（16%）時，我想問一下，即使考慮到未來幾年預計會員流失的規模，您是否仍然有信心實現這一目標。

So, I'm curious on the target. And I guess more broadly as well, how to think about decremental margins. Thank you.

所以，我對目標很有興趣。更廣泛地說，還有如何看待遞減利潤率的問題。謝謝。

Thanks Michael. Mark, here, we actually believe we have more room in our SG&A as we go forward. The a a models we're creating, the, we got well over 2 dozen models on the back end. We've just launched our first agentic. We have another one.

謝謝你，麥可。馬克，我們認為，隨著業務發展，我們在銷售、一般及行政費用方面還有更大的發展空間。我們正在創建的模型，後端已經有超過二十幾個模型了。我們剛剛推出了我們的第一個代理商。我們還有一個。

Coming out of the lab we have a lot of really good opportunity with AI to streamline our operating costs and of course the discipline we have on making sure that our variable costs first and foremost are fit to the size of our business. So, if there is market shrinkage, then we believe that we have plenty of time to be able to adapt our variable cost to fit our cost structure going forward.

從實驗室出來後，我們利用人工智慧有很多非常好的機會來簡化我們的營運成本，當然，我們也有嚴格的紀律，確保我們的可變成本首先與我們業務的規模相匹配。因此，如果市場萎縮，我們相信我們有足夠的時間調整變動成本，以適應我們未來的成本結構。

Other questions.

其他問題。

Thank you.

謝謝。

Our next question comes from the land of Joshua Raskin from Nephron Research.

我們的下一個問題來自 Nephron Research 的 Joshua Raskin。

Please go ahead.

請繼續。

Hi, thanks. Good morning. I was wondering, Scott, if you could just elaborate a little bit more on the underlying cost trends in the quarter and maybe any changes you saw from the first half and within that what areas drove that favorable development and seemed like a pretty sizable number for the prior year and then I guess I know it's super early, but any sense of, that expected increase in utilization that you mentioned as we're entering 4th quarter, are you seeing any of that as members get their new rates?

您好，謝謝。早安.史考特，我想請你詳細說說本季的基本成本趨勢，以及你觀察到的與上半年相比的任何變化，並分析哪些方面推動了這種有利的發展，以及與去年同期相比這個數字似乎相當可觀。我知道現在問這個問題還為時過早，但你提到我們即將進入第四季度，預計使用率會上升，隨著會員獲得新的費率，你是否看到了任何這種增長？

Josh, let me go through, those questions. So, I'll start with the PPD, which was $84 million, excuse me, in the quarter, and that was.

喬希，讓我來回答這些問題。那麼，我先從PPD說起，這個季度是8400萬美元，抱歉，是8400萬美元。

About half of that was related actually to a risk adjustment where we had some favorable development around some of our estimates for rebates. I know you wouldn't expect that we have rebates because we're a large payer, but we do have some markets where we do pay rebates, and we got some clarity on a few topics that allowed us to true that up.

其中大約一半實際上與風險調整有關，因為我們的一些退款估算出現了一些有利的進展。我知道你們不會指望我們有回扣，因為我們是支付大額款項的機構，但我們確實在某些市場提供回扣，而且我們對一些問題有了更清晰的認識，這使我們能夠糾正這種情況。

So that was about half of it. The remainder was favorable development from claims, and you know that just is, I think, encouraging for us that we continue to see both, prior year development that's favorable and, in your development.

所以大概只剩下一半了。其餘部分來自索賠的有利發展，而且我認為，這對我們來說是令人鼓舞的，因為我們繼續看到上一年有利的發展，以及你們的發展。

So, we feel like those are, positives in terms of, that we're appropriately reserving for the rest that we're seeing. And if I shift them to what's going on in utilization and trend.

所以，我們覺得這些都是正面的方面，我們應該把這些留給接下來我們所看到的情況。如果我把它們轉移到利用率和趨勢方面。

I would say that utilization continues to moderate year over year. It's still modestly elevated versus our pricing expectations. Inpatient, remains elevated, continued to moderate into the 3rd quarter, outpatient, professional, slightly elevated.

我認為，利用率逐年保持穩定。與我們的定價預期相比，這個價格仍然略高一些。住院患者，病情持續高位，第三季病情持續轉為中度；門診患者、專業人員，病情略為升高。

I would say that we believe that some of the changes we're seeing in terms of, shifts between categories as a result of some of the total cost of care initiatives that we're running. You know where we're really focused on driving appropriate side of care transitions, so not much there that that we're seeing that gives us pause and generally speaking, I think that, we look at utilization softening throughout the year and and approaching kind of where we we expected in pricing to be a good thing.

我認為，我們看到的一些變化，例如類別之間的轉變，是由於我們正在推行的一些降低醫療總成本的措施所致。你知道，我們真正關注的是推動適當的照護過渡，所以我們並沒有看到任何讓我們猶豫的事情。總的來說，我認為，全年使用率的下降以及價格接近我們預期水平，都是一件好事。

Perfect, that's helpful. And then is there some, if there is some sort of compromise that extends the enhanced subsidies, what should we be looking for that would create a more stable re-enrollment process, what mechanisms do you think would be helpful for consumers in getting their insurance for 2026?

太好了，這很有幫助。那麼，如果存在某種妥協方案來延長增強補貼，我們應該尋找什麼來創建一個更穩定的重新註冊流程？您認為哪些機制有助於消費者獲得 2026 年的保險？

Josh, I think a couple of points I would make. First, we have been very careful with our plan design and their strategies to create $0 gold plans, $0 bronze plans, and have spent a lot of time with the broker community helping educate them on the types of products that they can move people to, and we're seeing good activity on that. In in the early innings of the open enrollment period.

喬希，我想提幾點。首先，我們非常謹慎地設計了我們的計劃及其策略，以創建 0 美元黃金計劃、0 美元青銅計劃，並花了大量時間與經紀人社區合作，幫助他們了解可以引導人們使用的產品類型，我們看到這方面取得了良好的效果。在公開報名期間的早期階段。

Secondly, if enhanced tax credits are extended, we don't think there'll be any real meaningful way to change prices, the longer it goes, and I think we're probably beyond that now, but we shall see. But I think there are a couple of things that could happen.

其次，如果延長稅收抵免政策，我們認為隨著時間的推移，將不會有任何真正有意義的方法來改變價格，而且我認為我們可能已經錯過了最佳時機，但我們拭目以待。但我認為有幾件事可能會發生。

One is that, we have this minimum MLR in the ACA market and then a minimum MLR would require us to rebate if the plan's made quote unquote too much money, based on having a lower MLRs and we would see that as a positive thing for the community and for our members to get a rebate back from their plan as a result of having these enhanced tax credits continue.

一方面，我們在 ACA 市場中設有最低醫療損失率 (MLR)，如果計劃因 MLR 較低而“賺了太多錢”，則需要我們退還部分款項。我們認為這對社區和我們的會員來說是一件好事，因為他們可以因這些增強的稅收抵免政策的持續實施而從計劃中獲得退款。

We don't know what the price effect is until we know what the plan is and quite frankly how it's going to fit but that's how we think about enhanced premium tax credits.

在了解計劃內容以及坦白說，了解它將如何實施之前，我們無法知道價格影響是什麼，但這就是我們對增強保費稅收抵免的看法。

Okay, thanks.

好的，謝謝。

Thank you.

謝謝。

Our next question comes from the line of Jessica Tassan from Piper Sandler. Please go ahead.

我們的下一個問題來自 Piper Sandler 的 Jessica Tassan。請繼續。

Hi guys, thanks for taking the question. I was wondering maybe if you could talk about, the enrollment in 2025 in diabetes, asthma, COPD-specific plans, maybe just remind us of the, increased risk adjustment visibility and favorability of MLR in these plans, if any, and then the extent to which these plans were expanded for 2026, and whether they've got better retention or different metal mix. Thanks.

大家好，感謝你們回答這個問題。我想請您談談 2025 年糖尿病、氣喘、慢性阻塞性肺病專案計畫的投保情況，提醒我們這些計畫中風險調整可見性和醫療損失率 (MLR) 的有利程度（如果有的話），以及這些計畫在 2026 年的擴展程度，以及它們的續保率是否更高或金屬組合是否不同。謝謝。

Hey, Jess, thanks for the question. So you know the thing about these plans is that we create them to draw into the plans people who are interested in managing their conditions and it allows us to have, really, better than average engagement with those members which helps us to manage costs for them and for us so that's why we really.

嗨，傑西，謝謝你的提問。所以你知道，這些計劃的意義在於，我們制定這些計劃是為了吸引那些有興趣管理自身健康狀況的人加入，這使我們能夠與這些成員建立遠高於平均水平的互動，從而幫助我們控制他們和我們自身的成本，這就是我們制定這些計劃的原因。

Think that these are are both creative to help people manage their specific conditions we continue to roll out new ones because you know we do see success with retention when we have people with these conditions they have a, high, NPS on these plans so you know it's still not a large portion of our membership, but it's an important part of our membership in terms of our ability to attract and retain members.

我們認為這些方案都具有創造性，可以幫助人們管理他們的特定疾病。我們會繼續推出新的方案，因為我們發現，當有這些疾病的人使用這些方案時，他們的淨推薦值 (NPS) 很高，這確實有助於提高會員留存率。雖然這部分會員在我們會員中所佔比例仍然不大，但就我們吸引和留住會員的能力而言，這部分會員非常重要。

Got it.

知道了。

And then just maybe do you have any early thoughts on how Oscar's morbidity in 2020, I know it's five days in, but how Oscar's morbidity in 2026 might evolve relative to the market or maybe just anything in your pricing or product design or commercial strategy that you'd call out that would give you maybe more control over your morbidity relative to the market. Thanks.

那麼，您能否就 Oscar 在 2020 年的市場表現（我知道現在才過了五天）以及 2026 年的市場表現（相對於市場而言）有什麼初步想法？或者，您在定價、產品設計或商業策略方面有什麼建議，可以幫助您更好地控制相對於市場的市場表現？謝謝。

Well, on the first point, we have priced.

嗯，關於第一點，我們已經定價了。

As if premium tax credits are gone, 25 impact of morbidity, 26 potential impacts on morbidity given the shrinkage of the market, which we think is anywhere between 20% and 30%, 20% is the lower end without a number of these things, 30% being the highest, but that has an impact on a morbidity and program integrity efforts as if they were implemented and we stacked those in our pricing.

彷彿保費稅收抵免政策消失了，25 發病率的影響，26 考慮到市場萎縮，發病率可能受到 20% 到 30% 的影響，20% 是較低的幅度，30% 是最高的幅度，但這會對發病率和項目完整性工作產生影響，就好像這些措施已經實施，並且我們把這些因素都考慮在內了。

We did not look for any duplication and so we believe we're well covered depending on whatever happens next year relative to the morbidity in the market.

我們沒有尋找任何重複投資，因此我們相信，無論明年市場狀況如何，我們都能得到充分的保障。

Anything to add on that, Scott?

史考特，還有什麼要補充的嗎？

No, and I think it's, too early to say much about 2026 morbidity. I think that when I look at the core performance of the company this year and I strip out kind of what happened, with the impacts of market morbidity shifting higher this year.

不，我認為現在談論 2026 年的發病率還為時過早。我認為，當我審視公司今年的核心業績，並剔除市場波動的影響（今年市場波動加劇）等因素後，就會發現公司整體表現良好。

We're really pleased with the underlying trends, right? We're seeing an MLR when I strip out kind of the impact of what was happening, with market morbidity. The MLR underlying MLR is pretty consistent with the guidance that we gave at the beginning of the year in the low, 81% range. And so, when I step back from that, look at the dynamics in the company, our ability to.

我們對目前的趨勢非常滿意，對吧？當我們剔除市場波動等因素的影響後，我們看到的是一個 MLR。MLR 的基礎 MLR 與我們年初給出的較低 81% 的指導意見相當一致。所以，當我從那個角度跳出來，審視公司的動態，以及我們的能力時，我意識到…

To influence, what's going on with our medical expenses, we feel like we're really well positioned to continue to navigate this marketplace and as Mark talked about we feel like our pricing captures the risk we feel like the company is, getting ever better at delivering our services so you know we feel really well positioned for 2026.

為了影響我們的醫療費用，我們感覺我們已經做好了充分的準備，可以繼續在這個市場中游刃有餘。正如馬克所說，我們感覺到我們的定價反映了我們認為公司正在不斷改進服務所帶來的風險，因此我們感覺我們已經為 2026 年做好了充分的準備。

Great, thank you.

太好了，謝謝。

Thank you.

謝謝。

Our next question comes from the lion of Scott Fidel from Goldman Sachs. Please go ahead.

我們的下一個問題來自高盛的史考特‧菲德爾，他可是個很有魄力的人。請繼續。

Hi, thanks, good morning. First question, and I understand it's still very early into the OEP here, but could you maybe just sort of walk us through the initial intelligence and feedback that you're getting from all your channels, what they, how that may inform, the, you know. How sort of enrollment may be or sign up maybe tracking relative to the industry expectations and then the expectations, mark that you just, mentioned, around that down 20% to 30%, obviously very early here but just curious on sort of the initial indicators that you're getting from the OP.

您好，謝謝，早安。第一個問題，我知道現在 OEP 還處於非常早期的階段，但您能否帶我們了解您從所有管道獲得的初步情報和回饋，以及它們如何影響…招生或註冊情況與業界預期相比如何？正如你剛才提到的，預期可能會下降 20% 到 30%。當然，現在討論這個還為時過早，但我只是好奇你從樓主那裡得到的初步指標。

Thanks Scott. We have seen a lot of activity, more than we thought we would see at this point in time. However, you have to look at the structure of bonus programs and the broker network and all the education we did, and we are not banking on anything based on what we've seen in the 1st 5 days, quite frankly, that we'll be willing to leverage off of and say we expect our enrollment to be X for 2026, and so, we're.

謝謝你，斯科特。我們看到了很多活動，比我們預想的在這個時間點會看到的要多得多。但是，你必須看看獎金計劃的結構、經紀人網絡以及我們所做的所有教育工作，坦白說，我們不會根據前 5 天所看到的情況就做出任何預測，也不會據此說我們預計 2026 年的註冊人數會達到 X，所以，我們是。

Pleased with the progress so far but we're not banking any of it as a future.

對目前的進展感到滿意，但我們並不把這些成果當作未來的保障。

Perspective on what our enrollment will be by in the in the beginning of the year.

年初時我們對招生人數的展望。

And Scott, I'd just add, Mark talked about this, but I think it's an important thing. We did a significant amount of preparation with our brokers training.

史考特，我還要補充一點，馬克也談到了這一點，但我認為這是一件很重要的事。我們對經紀人的培訓做了大量的準備工作。

Mapping members, so we went into open enrollment with a pretty sophisticated game plan about where do members who are going to lose subsidies map to. We've got, brokers have all of the information about people who may lose subsidies. So, should the.

為了繪製會員分佈圖，我們在開放註冊期間制定了一個相當複雜的計劃，以確定哪些會員將失去補貼。我們已經掌握了所有關於可能失去補貼的人的信息，經紀人也掌握了這些信息。所以，應該是如此。

Enhanced premium tax credits get extended. We know who the members, today are who would be impacted by that. The brokers know who they are. We would certainly be able to, quickly outreach to them and TRY to bring them also into the marketplace. So the early days are certainly showing that the preparation and the work we did, is proving successful.

提高保費稅收抵免政策將延長。我們知道今天哪些成員會受到影響。經紀人們知道他們是誰。我們當然可以迅速與他們取得聯繫，並嘗試將他們也引入市場。所以，目前的情況表明，我們所做的準備和工作確實取得了成功。

And also I would add that we had in November, early or late October was auto mapping on the plans that are leaving the market. And we received the share that we thought we would receive.

另外，我還想補充一點，我們在 11 月份，或者 10 月初或下旬，對即將退出市場的計劃進行了自動映射。我們收到了我們預期會收到的份額。

Okay, got it, thank you. And then, for my follow-up question, curious to what extent just as you've gotten the latest, weekly data and has shown, variation and, morbidity and sort of your positioning around risk adjustment in different states, how much were you able to, I guess sort of, factor or inform your pricing and your positioning strategy for 2026 just curious around you know how much that may have sort of fed into your your go to market strategy for 26 to try to you know sort of operate against some of those changing morbidity dynamics thanks.

好的，明白了，謝謝。然後，我的後續問題是，您已經獲得了最新的每週數據，這些數據顯示了不同州的疫情變化和發病率，以及您在風險調整方面的定位。我想知道，您在多大程度上能夠將這些因素納入或影響您2026年的定價和市場定位策略？我只是好奇，這些因素在多大程度上影響了您2026年的市場進入策略，以應對這些不斷變化的疫情動態。謝謝。

Yeah, well, as Mark said, we're expecting the market is going to contract, by 20%-30%, we actually, our best estimate is towards the lower end of that range in terms of impact, but we price towards the high end of that range, so we think we've got some, the potential for some buffer, already in there based on the way that we built the pricing for 2026. Mark went through that we.

是的，正如馬克所說，我們預計市場將萎縮 20%-30%，實際上，就影響而言，我們最好的估計是接近該範圍的下限，但我們的定價接近該範圍的上限，因此我們認為，根據我們為 2026 年制定的定價方式，我們已經留出了一些緩衝空間。馬克也經歷過我們經歷過的事。

We didn't attempt to look for for overlaps in the way we measured. We think that creates some natural, cushion in terms of the ability to absorb the change that we've seen. So, net, I think that we continue to believe that our 26 pricing is resilient against what we've seen so far and that it positions as well to return to profitability and see margin expansion next year.

我們沒有嘗試尋找測量方法上的重疊之處。我們認為這在吸收我們所看到的變化方面創造了一些自然的緩衝空間。綜上所述，我認為我們仍然相信，我們 26 的定價策略能夠抵禦目前所看到的各種因素，也為明年恢復盈利和利潤率擴張奠定了基礎。

Thank you.

謝謝。

Our next question comes from the line of Stephen Baxter from Wells Fargo.

我們的下一個問題來自富國銀行的史蒂芬‧巴克斯特。

Please go ahead.

請繼續。

Hi, thanks for the question. I guess the first question would just be trying to, dive into the competitive dynamics a little bit more for next year. It seems like maybe some of your large peers have rate increases that are at or maybe above your 28%, but then maybe some of the not for profits could be a little bit.

您好，感謝您的提問。我想第一個問題就是，能否更深入了解明年的競爭動態。看起來你們的一些大型同行的利率漲幅可能達到或超過你們的 28%，但一些非營利組織的利率漲幅可能會略低一些。

Lower just to kind of boil it down like is there any kind of metric you have where you kind of have an analysis of what percentage of your markets you're going to be in a low cost position either, just in the silver market or maybe across all your markets and how that compares to 2025 and then have a follow-up thank you.

更確切地說，你們是否有某種指標來分析你們的市場中，無論是白銀市場還是所有市場，你們在多大程度上處於低成本地位，以及與 2025 年相比情況如何？之後請跟進，謝謝。

Steve, so you know when we think about competitive position relative to last year, first of all these, increases in prices, you've got to start with last year's, price position where last year we were only, I think in 15% of our markets we were the lowest or second lowest silver price plan. This year that's moving up to 30%. We still think that that's less than some of the other, large competitors that we see in the marketplace. So while we're competitive, we're not, as competitive as some others.

史蒂夫，你知道，當我們考慮相對於去年的競爭地位時，首先要考慮的是價格上漲，你必須從去年的價格地位說起，去年我們只有，我認為在15%的市場中，我們的白銀價格方案是最低或第二低的。今年這一比例將提高到 30%。我們仍然認為這比我們在市場上看到的一些其他大型競爭對手要少。所以，雖然我們具有競爭力，但我們的競爭力不如其他一些公司。

When I think about that relative price position, we think we can grab share, in several of these markets. We think that the average price increase nationally is around 26%, based on, research by the Kaiser Family Foundation. So, we think that we've done, a nice job of putting our pricing into the market in a way which is competitive, allows us to grow margin. But also is disciplined, and allows us to protect ourselves as well.

考慮到這種相對價格地位，我們認為我們可以在其中幾個市場搶佔份額。根據凱撒家庭基金會的研究，我們認為全國平均物價上漲幅度約為 26%。所以，我們認為我們在定價方面做得很好，我們的定價具有競爭力，這使我們能夠提高利潤率。但它也具有紀律性，並能讓我們保護自己。

And one more point, Steve, because we believe the enhanced tax we price without the enhanced tax credits being in place, our metal strategy is fundamentally different than where we were.

還有一點，史蒂夫，因為我們認為，在沒有加強稅收抵免的情況下，我們定價的金屬策略與之前截然不同。

Last year, but we still think we'll have a lot more we'll still have the majority of our people in silver plans we have priced gold and bronze plans that fit certain profiles in certain markets based on our underlying provider networks that allow us to have differential pricing from our competitors that are hard to compare by looking at average rate increases.

去年，我們仍然認為我們會有更多的人加入，我們的大部分人仍然會選擇銀級計劃。我們已經根據我們的基礎供應商網絡，針對特定市場的特定人群制定了金級和銅級計劃，這使我們能夠與競爭對手進行差異化定價，而這種差異化定價很難通過查看平均費率增長來比較。

Got it, thanks. That's very helpful. And then just to, quick numbers of follow-ups, I guess first, the risk adjustment as you spoke to is now, 17% of direct premiums year-to-date is just making sure that's the right way to think about the full year at this point. And then, what is cost trend running at this year and what are you assuming cost trend is next year?

明白了，謝謝。那很有幫助。然後，為了快速跟進一些數據，我想首先，正如您所說，風險調整目前佔今年迄今為止直接保費的 17%，我只是想確保這是目前考慮全年情況的正確方法。那麼，今年的成本趨勢如何？您預計明年的成本趨勢又會如何？

Thank you.

謝謝。

Yeah, so Steve, I think that the 17%, risk adjustment year-to-date is probably a reasonable estimate for the full year, plus or minus, and with respect to cost trend, I won't go further than to than I did in terms of my discussion of utilization and what we're seeing in that and, kind of.

是的，史蒂夫，我認為年初至今 17% 的風險調整率可能是對全年情況的合理估計，上下浮動一些。至於成本趨勢，我不會再深入討論，就像我之前討論利用率以及我們在這方面看到的情況一樣。

It's slightly above our pricing expectations for last year. We have for 2026 assumed, a trend increase that is higher than what we've seen historically, and so we are expecting, at least in our pricing to see, trend, and this is excluding the impacts of all the market morbidity shifts, but just core cost trend that would be higher than what we've seen in the past.

這比我們去年的定價預期略高。我們假設 2026 年的成長趨勢將高於歷史上的水平，因此我們預計，至少在我們的定價中，將會出現高於過去水平的趨勢，這還不包括所有市場疾病變化的影響，僅僅是核心成本趨勢。

I think that last point is an important one because we stack these things and our morbidity includes a lot of these program efforts and the impact on the population as a result of how risk adjustment came out. So that's separate than the pure underlying trend of our relationships with providers.

我認為最後一點很重要，因為我們把這些因素疊加起來，我們的發病率包含了這些計畫努力以及風險調整結果對人口的影響。所以這與我們和供應商關係的純粹潛在趨勢是分開的。

Thank you.

謝謝。

Our next question comes from the line of Jonathan Yong from UBS.

我們的下一個問題來自瑞銀集團的 Jonathan Yong。

Please go ahead.

請繼續。

Hey, thanks for taking the question. I guess under the premise of a possible extension of the enhance subsidies and whatever it may or may not include, how are you thinking about operationalizing this and, what may or may not be included in G&A at this moment, if anything, and what kind of step up would you need if it were to occur?

嘿，謝謝你回答這個問題。我想，在可能延長增強補貼的前提下，無論補貼內容可能包含或不包含什麼，您認為應該如何實施這項補貼？目前一般及行政費用可能包含哪些內容（如果有的話）？如果補貼真的實施，您需要採取哪些措施？

I think the SG&A piece is not relevant to the to the enhanced premium tax credit. It's really around growth, so we look at both our fixed cost leverage and our and our variable cost leverage. We manage a variable cost leverage very close to membership and then we impact fixed cost leverage we actually already have going into 26 and expectations for 27, and that's part of what we're doing with our AI capabilities.

我認為銷售、管理及行政費用與提高保費稅收抵免無關。關鍵在於成長，所以我們既要專注於固定成本槓桿，也要關注變動成本槓桿。我們透過非常接近會員資格的可變成本槓桿來管理成本，然後影響我們實際上已經擁有的固定成本槓桿，以及對 2026 年和 2027 年的預期，這是我們利用人工智慧能力所做的一部分工作。

In the end result, how we're going to operationalize it, we're, we think we're in a good place. I mean, we look at this every day. We were actually met on it yesterday to go over how do we have to think about growth up or down, based on our projections, and I think we have the right tools in place with BPOs, for example, and other capabilities that we can use to meet up, meet the needs of the people we have on board or to pull back if we need to.

最終，關於如何實施它，我們認為我們目前處境良好。我的意思是，我們每天都會看到這種情況。實際上，我們昨天開會討論瞭如何根據我們的預測來考慮增長或下降，我認為我們已經擁有合適的工具，例如業務流程外包 (BPO) 和其他能力，可以用來滿足我們團隊成員的需求，或者在需要時進行調整。

Okay, great. And then I know again it's early on the enrollment period, but in terms of the members that are kind of showing up, are these kind of the typical members that would naturally have a zero, effectively not be paying anything and kind of for the members that are losing their enhanced subsidies, are they trying to downgrade, or are they just kind of leaving the market altogether? What are you kind of seeing and hearing with respect to that.

好的，太好了。我知道現在還是報名期的早期階段，但就目前到場的會員而言，這些會員是典型的會員（自然會員費為零，實際上無需支付任何費用）嗎？而那些失去額外補貼的會員，他們是試圖降級會員，還是乾脆徹底退出市場？你對此有何看法和聽聞？

Way too early to tell. We don't have that level of detail yet.

現在下結論還為時過早。我們目前還沒有掌握那麼詳細的資訊。

Got you. Okay, thank you. We will get it, but it's going to be a while.

抓到你了。好的，謝謝。我們會收到的，但還需要一段時間。

Thank you.

謝謝。

Our next question comes from the line of Andrew Mok from Barclays. Please go ahead.

下一個問題來自巴克萊銀行的 Andrew Mok。請繼續。

Hi, good morning. You mentioned that your competitive pricing was in line with expectations and that you expect to take market share next year. Can you help us understand that strategy a bit more? Why is taking market share the right strategy in 2026? And do you think that is more likely or less likely to hurt from an adverse selection standpoint? Thanks.

您好，早安。您提到您的定價策略符合預期，並預計明年將獲得市場份額。您能幫我們更詳細地了解這個策略嗎？為什麼在 2026 年，爭奪市佔率才是正確的策略？從逆向選擇的角度來看，你認為這種情況更有可能還是不太可能造成損害？謝謝。

Taking market share really means, taking advantage of people who priced way out of the market. And I think there's a subtle difference here between the group market that I hope you all understand.

搶佔市場份額的真正意義是，利用那些定價過高而無法參與市場競爭的人。我認為團體市場和團體市場之間存在著微妙的差別，希望大家都能理解。

Given the risk adjustment mechanism and the way it works, it's almost impossible or just not, it's not worth underwriting the members in the network. It's about the network itself and underwriting that provider network and so some of our competitors who have priced way out of the market or left the market we're using commercial networks at commercial prices where we've been using narrow networks in every market and in the individual purchasing decision.

鑑於風險調整機制及其運作方式，幾乎不可能或根本不可能，為網路中的成員提供保險是不值得的。關鍵在於網路本身以及為該提供者網路提供承保，因此，我們的一些競爭對手要么定價過高而退出市場，要么選擇退出市場，而我們則以商業價格使用商業網絡，而我們之前在每個市場和個人購買決策中都使用窄網絡。

People at the local market have the opportunity to buy their network. And the plan design that works for them versus having an employer offer them a broad area network which costs more and a benefit plan that doesn't meet anyone's needs specifically.

當地市場的人們有機會購買他們的網路。而且，與其讓雇主提供覆蓋範圍廣、成本更高但福利計劃卻無法滿足任何人的特定需求，不如選擇適合他們的計劃設計。

And so for that reason we believe that looking at taking a share from people that are pricing at 30%-40% higher, we have an opportunity to take that share, put them into our networks and our underwriting, and make it work better and effectively for us, and that's how we price. We're pricing off of the underlying cost of the network because we get covered on the risk adjustment side.

因此，我們認為，如果能從定價高出 30%-40% 的公司手中奪取市場份額，我們就有機會將這些市場份額納入我們的網絡和承保範圍，從而更好地、更有效地為我們服務，這就是我們的定價方式。我們根據網路的底層成本進行定價，因為風險調整方面我們已經得到了保障。

And I just reiterate something that we that Mark said earlier we think this is, what we see is evidence of a very rational marketplace, right? So it's, we don't think that there's been, anyone who's tried to do a land grab and price, dramatically lower. We feel like we're right in the pack, so, from an adverse selection perspective, that's not something that is at the top of our list worries.

我只想重申一下馬克之前說過的話，我們認為我們看到的正是市場非常理性的證據，對吧？所以，我們認為還沒有人試圖透過掠奪土地和大幅壓低價格來達到目的。我們覺得自己處於領先地位，所以從逆向選擇的角度來看，這並不是我們最擔心的事情。

Great. And if I could just follow-up on membership, I think last quarter you, said that you expected membership to trend down in the back half of the year. It looks like 3 membership was up about 90,000 members or 4.5%, sequentially. So I just wanted to get more color on what's driving that change versus your expectation and the implications of that higher membership on 4Q MLR. Thanks.

偉大的。如果我能跟進一下會員人數的問題，我想上個季度您說過，您預計下半年會員人數將呈下降趨勢。看起來會員人數比上一季增加了約 9 萬，增幅達 4.5%。所以我想更詳細地了解是什麼因素導致了這種變化，與你的預期相比有何不同，以及更高的會員人數對第四季度MLR的影響。謝謝。

Yeah, I appreciate that question. So membership was, stronger than what we had expected in the 3rd quarter. A good portion of that was driven just by lower churn, and so, that is a positive that helps obviously with the MLR, dynamics.

是的，我很感謝你的提問。因此，第三季的會員人數比我們預期的要多。其中很大一部分原因是客戶流失率降低，因此，這對 MLR 動態顯然是一個正面因素。

We did have SEP member additions as well, but that ended, as of September in terms of the continuous SEP, as I said in my comments, so. Overall we continue to expect MLR to drift up in the 4th quarter. You can obviously do the math. We give you the full year guidance of MLR so you can figure out what the point estimate is there. But, we build up when we reviewed our guidance for the year, we looked at all of the.

我們也確實增加了 SEP 成員，但就持續 SEP 而言，這種情況已於 9 月結束，正如我在評論中所說。總體而言，我們仍然預計 MLR 在第四季度會上升。你當然可以自己算出來。我們會提供全年的 MLR 指導，以便您計算出點估計值是多少。但是，當我們回顧年度業績指引時，我們考慮了所有因素。

Trends that we're seeing, we're looking at the details of, is there anything that caused us to believe that we needed to increase, the full year guidance of MLR, including the SEP performance, and, we just haven't seen anything in the details that makes us concerned, and we're able to reaffirm our guidance.

我們看到的趨勢，我們正在研究細節，看看是否有任何因素導致我們認為需要提高 MLR 的全年業績預期，包括 SEP 的業績，但我們沒有看到任何細節讓我們感到擔憂，因此我們能夠重申我們的預期。

And one more thing I'll add is that, we are very supportive of the program integrity efforts. And the things that happened this year in program integrity had less and less impact on us as an organization than others because we spend a lot of time validating as much as we can the membership that comes into our plan and if we see what we see as potential fraud, we sideline those brokers and those members and evaluate whether or not it's appropriate to bring them on board.

我還要補充一點，我們非常支持維護專案完整性的努力。今年在專案誠信方面發生的事情對我們這個組織的影響越來越小，因為我們花了很多時間盡可能地驗證加入我們計劃的成員資格，如果我們發現任何潛在的欺詐行為，我們會將這些經紀人和成員排除在外，並評估是否適合讓他們加入。

So given that when we received our dual eligible information, it was low double-digit thousands, very low double-digit thousands, versus the headline report put out by certain people in the press of 2.4 million people. And so the obvious impact to us was a lot less than we thought it was going to be because we had done the homework up front.

因此，當我們收到符合雙重資格的人數資訊時，人數只有幾萬，非常少，而某些媒體人士發布的頭條報道稱有 240 萬人。因此，對我們來說，實際的影響比我們預想的要小得多，因為我們事先做了充分的準備。

We think this is a key part of making sure risk adjustment works well is that everybody uses the same tools to make sure that the people we're bringing on board belong on board, not because somebody else was able to get commission.

我們認為，確保風險調整有效運作的關鍵在於，每個人都使用相同的工具，以確保我們引進的人員是真正適合加入的，而不是因為其他人能夠獲得佣金。

Great, thank you.

太好了，謝謝。

Thank you.

謝謝。

Our next question comes from the line of Craig Jones from Bank of America.

我們的下一個問題來自美國銀行的克雷格瓊斯。

Please go ahead.

請繼續。

Great, thanks for the question. So, to follow-up on the fraud comments there, there's been a lot of that talk about the, about, out of the current administration around the various ways to root it out. So if you were advising Congress on maybe what they could do as a negotiated deal on the enhanced subsidy extension, what would be some of the most effective tools that could be implemented for 2026, maybe during a special enrollment period, alongside enhanced subsidy extension to help root out some of that fraud? Thanks.

太好了，謝謝你的提問。所以，關於詐欺的評論，目前有很多關於如何根除詐欺行為的討論，包括現任政府的各種措施。因此，如果您要就加強補貼延期事宜向國會提供建議，那麼在 2026 年，或許可以在一個特殊的註冊期內，除了加強補貼延期之外，實施哪些最有效的工具來幫助根除一些欺詐行為？謝謝。

Again, we support all the program integrity efforts that were put forward this year. We were prepared and we have priced as if those were in place. We have kept that pricing in place because we expect some of them may come along through regulatory action by CMS throughout the year.

我們再次支持今年提出的所有維護項目誠信的努力。我們已做好準備，並按照這些條件都已到位的情況進行定價。我們維持了目前的定價，因為我們預計其中一些可能會在年內透過 CMS 的監管行動而出現。

We want to be prepared to handle that. Of course, we would prefer that the industry get the opportunity to work with CMS to do this within the pricing cycle so that we're having all of these impacts fit.

我們希望做好應對準備。當然，我們希望業界有機會與 CMS 合作，在定價週期內完成這項工作，以便我們能夠將所有這些影響納入考慮。

And that we aren't disadvantaging our members as a result, this advantaging working Americans as a result of having to have these huge morbidity jumps because we did it in the middle of pricing. So if we could do it before we price and work together on it, we're more than happy to support the program integrity efforts put forward by CMS.

而且，我們這樣做並沒有使我們的成員處於不利地位，反而使美國勞動者受益，因為我們在定價過程中不得不承受如此巨大的發病率增長。因此，如果我們能在定價和合作之前做到這一點，我們非常樂意支持 CMS 提出的專案完整性工作。

Okay great thank you.

好的，非常感謝。

Thank you.

謝謝。

Our next question comes from the line of Stephen Kouch from Jefferies.

我們的下一個問題來自傑富瑞集團的史蒂芬·庫奇。

Please go ahead.

請繼續。

Hi, thanks for taking the question. I, is there any way you can quantify what you believe your cost advantages from your narrow network of strategy versus peers?

您好，感謝您回答這個問題。請問您能否量化一下，您認為您憑藉自身狹窄的策略網絡所獲得的成本優勢相對於同行有哪些？

Yes, Look, I think obviously we're not going to get into the details of our competitive positioning on that, and we think that many of the, of our competitors do have, particularly the more successful, competitors have similar, strategies around narrow networks.

是的，你看，顯然我們不會深入探討我們在這方面的競爭定位細節，而且我們認為，我們的許多競爭對手，特別是那些更成功的競爭對手，都圍繞著窄網絡採取了類似的策略。

What's most important is really making sure that you have the right network, you have the right providers, you have the right systems in the markets where you're trying to grow, and we think that's one of the important reasons why we can have, similar costs, but, grow above, the market average because we do, spend a ton of time in making sure that we curate our markets and that we have, the right set of doctors, the right set of hospital systems that are attractive in those markets.

最重要的是確保你在想要發展的市場中擁有合適的網路、合適的供應商和合適的系統。我們認為，這是我們能夠以類似的成本實現高於市場平均水平的增長的重要原因之一，因為我們投入了大量時間來精心打造我們的市場，確保我們擁有合適的醫生團隊和在這些市場中具有吸引力的醫院系統。

Great and then is there any way you can help us or you know share what your assumptions were for the impact of the program integrity measures because we've seen estimates anywhere from sort of a de minimis impact to something quite meaningful and then are there specific program integrity measures that you think, we're going to have the most impact?

好的，那麼您能否幫助我們，或分享您對專案誠信措施影響的假設？因為我們看到的估計各不相同，從影響微乎其微到影響相當顯著都有。您認為有哪些具體的專案誠信措施會產生最大的影響？

Well, look, I don't think that we'll get into the specifics of that, we do think that the state program integrity, provisions, would have been in place, had a, an adverse market or an adverse impact on the total size of the market, so, we built that into our expectations as Mark talked about for pricing. But, we'll have to see how those things play out, but we are prepared in terms of the pricing and, for 26 that that they may come back into practice at some point during the year.

嗯，你看，我覺得我們不會深入討論具體細節，但我們確實認為，州政府項目的完整性、條款，如果到位，會對市場產生不利影響，或者對市場總規模產生不利影響，所以，正如馬克在定價方面所說的那樣，我們把這一點納入了我們的預期。但是，我們也要看看這些事情會如何發展，但我們在定價方面已經做好了準備，而且對於 26 號條款，它們可能會在今年的某個時候重新實施。

Got it.

知道了。

Thank you.

謝謝。

Thank you. There are no further questions. That concludes our question-and-answer session. That also concludes this call for today.

謝謝。沒有其他問題了。我們的問答環節到此結束。今天的通話到此結束。

Thank you all for joining. You may now disconnect.

感謝各位的參與。您現在可以斷開連線了。