Healthcare Coverage Struggles to Keep Up With Modern Work

The latest earnings from Oscar Health and GoodRx show both companies dealing with a changing customer base.

The former company reported half-year earnings Thursday (Aug. 6) showing record profitability for the first six months of 2026, with revenues surging 70% to $4.9 billion.

Speaking during an earnings call, Oscar Health Chief Executive Officer Mark Bertolini attributed much of this success to the company’s proprietary technology stack, which he said allows Oscar to deploy artificial intelligence (AI) more efficiently than its legacy rivals.

“We have one platform, we have one data set,” Bertolini told analysts. “As a result, we start with a huge advantage in being able to use AI at scale without having to make the investments in platform integration and data rationalization that a lot of our competitors do.”

Among the company’s AI tools is “Oswal,” an AI agent designed to guide members through the healthcare system by analyzing clinical history and claims data to recommend high-quality, lower-cost providers.

“We will expand this capability to additional procedures using care standards from leading centers of excellence. AI is powering operations across benefits, billing claims, clinical care and member support,” Bertolini said.

Beyond technology, Oscar is banking on a fundamental shift in consumer behavior. Bertolini added that the individual insurance market is expanding to accommodate a labor force increasingly defined by “entrepreneurs, gig workers, part-time employees and early retirees.”

He suggested that “AI will accelerate that shift” as workers move between full-time jobs, contract roles and retirement at twice the rate of previous generations.

Also Thursday, GoodRx reported second-quarter revenue of $200.4 million, a 1% dip, with management raising its full-year outlook based in part on a projected 70% jump in revenue from the company’s Pharma Direct business.

While its traditional monthly active consumer base declined 12% to 5 million, executives characterized this as a strategic transition toward deeper, recurring customer relationships as healthcare consumers face intensifying affordability pressures.

“Consumers are bearing more cost, facing less predictable coverage and increasingly need to know what a medication will cost before they reach the pharmacy counter,” CEO Wendy Barnes said during the earnings call.

“Employers are under the same pressure, and as costs rise, many are covering less or shifting more of the expense to employees across the board, coverage is becoming harder to maintain and more expensive to use.”

To address this, GoodRx in May introduced “GoodRx Companion,” a subscription service designed to provide predictable pricing for chronic conditions, taking multiple medications, or dealing with coverage limitations, or out-of-pocket costs.