Insurer Woes Dominate Headlines
Clover reported meeting guidance to The Street, but saw its stock drop due to reports of higher expenses, especially related to Part D drug costs from the Inflation Reduction Act (IRA). Clover’s medical expenses were 88.4% of revenue and could climb in 2025 to just 89.5%.
After decreasing full-year guidance by about half a billion dollars recently, Oscar Health missed earnings projections for Q2. Oscar had a net loss of $228 million, after reporting a net profit of $275 million in Q1. Its medical expense climbed to 91.1%.
Oscar says sicker individuals are entering the Exchanges from Medicaid and healthier enrollees are leaving. The company is trimming its workforce to help save on administrative expense. It continues to maintain its financial targets, in part through its investments in the “ICHRA” program, created by Trump 45 to allow employers to seed premiums to employees who enroll in individual coverage.
In other news, Healthcare Dive discusses the fact that CVS Health and Humana reported relatively positive results after realigning their busineses in 2024, while others (including UnitedHealth Group) reduced or pulled guidance just recently as their balance sheets and outlooks eroded. Humana and CVS’ Aetna contracted products, geography, and benefits for 2025 in Medicare Advantage (MA) and others will have to do so going into 2026. All major health insurer stocks are down on the negative financial results in 2025, with prospects looking bad for many plans due to the passage of the budget reconciliation bill.
Additional articles: https://www.fiercehealthcare.com/payers/clover-health-stock-sinks-following-elevated-part-d-utilization and https://www.fiercehealthcare.com/payers/oscar-health-misses-estimates-q2-plans-rif-and-announces-hyvee-ichra-partnership and https://www.healthcaredive.com/news/medicare-advantage-contraction-health-insurer-q2-2025/756807/
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#healthplans #medicareadvantage #oscar #clover #margins
https://www.modernhealthcare.com/insurance/mh-unitedhealth-humana-elevance-cigna-stock-q2
Fitch Report Calls Out Uncertainty For Hospitals
After a few years of financial recovery, rating company Fitch says the greatest threat to nonprofit hospitals’ operations and cash flow isn’t cost pressures, but policy uncertainty related to the budget reconciliation act and other trends. Fitch sees continued improvements in 2025, but then uncertainty as major policy changes take effect.
#hospitals #healthcare #margins
Exchange Premiums To Soar in 2026
Healthcare policy group KFF updated its analysis of rates filed regarding Exchange premiums for 2026. The analysis now includes submissions by 312 insurers in all 50 states and the District of Columbia. It finds that the median proposed increase for 2026 is 18%, more than double last year’s 7% median proposed increase. The increase is tied to the expiration of premium subsidies at the end of the year, budget reconciliation changes, and a new rule that tightens enrollment.
#exchanges #coverage
— Marc S. Ryan
