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CVS Health and Centene Report Q3 Financial News

CVS Health, hit by a literal financial meltdown, reported relatively good recovery news for Q3 2025. Its troubled Aetna insurance business and pharmacy benefit management Caremark are recovering. Because of this, CVS Health is forecasting double-digit earnings growth in 2026.

CVS Health had $103 billion in revenue for Q3. Revenue was up 7.8% year over year. The company recorded a Q3 net loss of $3.99 billion, compared with net income of $71 million, or 7 cents per share, in the same period for 2024. The decline was due to a $5.7 billion goodwill impairment charge from the healthcare delivery unit. Aetna had $36 billion in revenue in the third quarter, up 9% year over year. The medical cost ratio dropped from 95.2% to 92.8%. 

Centene raised its yearly profit guidance despite ongoing struggles with health insurance Exchange spending and huge cuts to the federal health programs that are the foundation of its business. Centene posted a $6.6 billion loss in Q3 after incurring a one-time impairment charge related to ongoing market headwinds. The goodwill impairment charge was $6.7 billion and tied in part to the changes in the One Big Beautiful Bill Act. But Centene is making good progress on its turnaround. The company’s medical loss ratio was 92.7% in the third quarter, up from 89.2% at the same time last year but down sequentially.

Revenues were $49.7 billion in the quarter, which also beat Wall Street forecasts. By comparison, Centene reported $42 billion in revenue and $713 million in profit in the prior year quarter. Through the first nine months of 2026, the company posted $145.1 billion in revenue and $5.6 billion in losses. It brought in $122.3 billion in revenue and $3 billion in profit through the first three quarters of 2024.

Centene also emphasized its commitment to the Exchange line of business, saying even a smaller population after a subsidy expiration will still make coverage more affordable for many.

In other news, UnitedHealth Group is projecting its Medicare Advantage (MA) enrollment will decrease by 1 million people in 2026. That is up from a 600,000-member decrease it projected in July.

Additional articles: https://www.fiercehealthcare.com/payers/centene-posts-66b-loss-writedown-cost-pressures-continue and https://www.modernhealthcare.com/insurance/mh-centene-marketplace-congress-medicare-medicaid/ and https://www.healthcaredive.com/news/centene-value-writedown-q3-2025-medicaid-centene/804074/ and https://www.beckerspayer.com/financial/centene-ceo-prescription-drug-plans-steering-medicare-revenue/ and https://www.beckerspayer.com/financial/cvs-health-reports-4b-q3-loss-but-raises-earnings-outlook/ and https://www.beckerspayer.com/financial/centene-posts-6-6b-loss-but-steep-revenue-increase-for-q3/ and https://www.modernhealthcare.com/insurance/mh-cvs-health-earnings-oak-street-health/ and https://www.beckerspayer.com/payer/medicare-advantage/unitedhealth-projects-1-million-member-drop-in-medicare-advantage-enrollment/

(Some articles may require a subscription.)

#healthplans #centene #cvshealth #margins

https://www.fiercehealthcare.com/payers/cvs-health-hikes-earnings-forecast-despite-57b-impairment-charge-q3

United Reports Financial News; Big Plans Tighten Belts

Investors cheered news from UnitedHealth Group that its efforts to get back to margins are working. United raised its full-year guidance Tuesday when announcing its Q3 results. United reported that net earnings fell 59.4% to $2.54 billion and earnings from operations dropped 50.4% to $4.31 billion. Revenue grew 12.2% to $113.16 billion. But these figures beat Wall Street expectations.

United’s strategy has been to massively retrench in both Medicare Advantage (MA) and standalone Part D (PDP). United expects all its government lines of business to contract – MA, PDP, Medicaid, and the Exchanges. It expects to shed 600,000 in MA and has expanded some markets in the Exchanges but exited less profitable ones. Utilization and medical expense continues to be a challenge as its medical loss ratio was just short of 90% across all business lines. However, revenues from services entity Optum grew 8.3% to $69.2 billion. Earlier, the services entity was reporting struggles. United says it will have solid earnings growth in 2026.

In other news, struggling Aetna is looking for ways to tighten networks to ensure all providers in the continuum of care, from primary care to specialty to hospitals, are aligned around value-based models. The insurer is building a team around provider experience and improving satisfaction.

Elevance Health’s new out-of-network care policy may reduce healthcare costs but also rankle providers. Elevance will penalize in-network facilities that use out-of-network providers.

Additional articles: https://www.fiercehealthcare.com/payers/why-aetna-putting-focus-provider-experience-it-navigates-medicare-advantage-headwinds and https://www.modernhealthcare.com/insurance/mh-unitedhealth-group-guidance-aca-enrollment/ and https://www.modernhealthcare.com/providers/mh-elevance-health-out-of-network-charge-explained/ and https://www.healthcaredive.com/news/unitedhealth-2025-guidance-raise-q3-beat-ma-aca/803856/ and https://www.beckerspayer.com/financial/unitedhealth-posts-2-3b-profit-for-q3-raises-outlook/

(Some articles may require a subscription.)

#healthplans #margins #medicareadvantage #medicaid #managedcare #exchanges #unitedhealthcare #cvsaetna #elevancehealth

https://www.fiercehealthcare.com/payers/unitedhealth-boosts-2025-outlook-back-q3-earnings-beat

Cigna’s Express Scripts Is Eliminating Rebates

Spurred on by demands from the Trump administration to reform, Cigna’s Express Scripts pharmacy benefits manager (PBM) is phasing out prescription drug rebates for brand drugs. Rebates are issued by brand drug makers and usually do not go to consumers at the point of sale, causing brand drugs to have a high cost at the pharmacy. The rebates are issued by Big Pharma to gain preferred placement on drug formularies.

Cigna will eliminate rebates in many of its commercial health plans in 2027. The phaseout will expand to Express Scripts clients starting in 2028 as the default option. The PBM’s phaseout program could mean a major transformation of the PBM industry, moving billions of dollars to offset consumer costs at the expense of rebates to insurers and employers as well as some amounts retained by PBMs.

The new model will save members an average of 30% each month on brand-name medications. Patients will pay the lowest available cost — whether the PBM’s negotiated rate, the consumer’s benefit copay, the cash price, or a direct-to-consumer price.

In addition, Express Scripts will adopt a cost-plus reimbursement model for pharmacies, paying them based on their cost for medications with a dispensing fee added in.

Additional articles: https://www.fiercehealthcare.com/payers/cignas-express-scripts-set-shift-away-pbm-rebates and https://www.modernhealthcare.com/insurance/mh-cigna-drug-rebates-health-plans-2027/ and https://www.beckerspayer.com/payer/cignas-evernorth-unveils-rebate-free-pharmacy-model/

(Some articles may require a subscription.)

#pbms #branddrugmakers #rebates #cigna #expressscripts

https://www.healthcaredive.com/news/evernorth-express-scripts-new-pbm-model-cost-plus/803864/

Bipartisan Support For 340B Reform

Senators on both sides of the political aisle expressed support for reforming the 340B drug discount program at a Senate HELP committee hearing today. While some expressed urgency for reform, others said that more caution needs to occur with reform to ensure rural facilities are not hurt.

While hospitals have defended their use of the discounts over the years, independent studies question whether discounts are used to benefit the needy and that pricing at 340B-eligible hospitals can be more than at those ineligible for the program. In addition, many say that non-profit hospitals get far more benefit in tax exemptions than given back to poor Americans and charity care.

Senators championed transparency around how revenue is generated in the program and how it is spent as well as more audit dollars. As well, senators want hospitals’ and other facilities’ aggressive debt collection practices curbed and more resources used for uncompensated and discounted care.

The Trump administration is pursuing some reform, including a voluntary pilot to convert the upfront discount to a retrospective rebate. Brand drug makers are endorsing and opting in to the pilot. Bloated hospitals of course hate the change and scrutiny. They are simply protecting their inefficiency and unaccountable empires.

#340b #drugpricing #branddrugmakers #hospitals

https://www.healthcaredive.com/news/help-senate-hearing-340b-reform/803630

Molina Reels From Medical Expense

Molina Healthcare reported Q3 financials and cut its 2025 earnings guidance for the third time this year. It is citing high medical costs particularly in its Exchange line of business. Molina is not the first to report the Exchange medical trend concern. The impacts will only be worse in 2026 if Exchange credits expire, risk increases, and enrollment drops.

While Molina revenues beat analyst expectations, the plan missed on earnings. Molina is a Medicaid- and Exchange- dominant health plan with some Medicare Advantage (MA) lives. Molina posted a very-high medical loss ratio (MLR) of 92.6% in the quarter, up from 89.2% at the same time last year. Exchange plans hit a 95.6% MLR, up from 73% same time last year. Medicaid margins were strong but pressured from continued utilization. MA sees high utilization as well.

In other news, a mix of Exchange pullouts and some expansions (surprisingly). Aetna is fully exiting the Exchanges in 2026. Molina is pulling out of one-fifth of the counties where it sells health insurance exchange plans and also will not pay commissions in several states. Centene is contracting in some states but expanding counties in others. UnitedHealthcare, Cigna, Oscar, and Elevance Health are expanding in some existing states. Oscar is adding a few states. Other regional players are pulling out.

Additional articles: https://www.healthcaredive.com/news/molina-2025-guidance-cut-aca-woes-q3/803580/ and https://www.beckerspayer.com/financial/molina-cuts-earnings-outlook-a-third-time-amid-aca-challenges/ and https://www.modernhealthcare.com/insurance/mh-aca-plans-centene-cigna-oscar-2026/ and https://acasignups.net/25/10/20/which-carriers-are-bailing-aca-exchanges-altogether-2026 and https://www.modernhealthcare.com/insurance/mh-molina-healthcare-aca-markets-2026/

(Some articles may require a subscription.)

#molina #exchanges #margins #coverage #healthcare

https://www.fiercehealthcare.com/payers/molina-healthcares-shares-tumble-marketplace-costs-drag-q3-results

Employer Family Coverage Hits $27,000 A Year

Healthcare policy group KFF finds from its annual employer survey that family premiums for employer-sponsored health insurance reached an average of $26,993 this year. On average, workers contribute $6,850 annually to the cost of family coverage. Family premiums increased 6%, or $1,408, from last year. KFF says the cumulative increase in family premiums is 26% over the past five years.

KFF finds that more workers are in HSA-Qualified Plans as average deductibles have reached $1,886 per year.

Additional articles: https://thehill.com/policy/healthcare/5567473-health-insurance-costs-rise-2025/?tbref=hp and https://www.healthaffairs.org/content/forefront/annual-family-premiums-employer-coverage-rise-6-2025-nearing-27-000-workers-paying-6 and https://www.kff.org/health-costs/perspectives-from-employers-on-the-costs-and-issues-associated-with-covering-glp-1-agonists-for-weight-loss/ and https://www.kff.org/affordable-care-act/annual-family-premiums-for-employer-coverage-rise-6-in-2025-nearing-27000-with-workers-paying-6850-toward-premiums-out-of-their-paychecks/ and https://www.kff.org/health-costs/2025-employer-health-benefits-survey/

(Some articles may require a subscription.)

#employercoverage #healthcare #coverage

https://www.fiercehealthcare.com/payers/new-care-vs-health-insurance-average-family-job-based-coverage-hits-27k

Elevance Reports Good News But Cautions On Medicaid

Elevance Health reported relatively good financial news for Q3 but warned investors about challenges in the Medicaid market. Ongoing eligibility determinations as well as changes to state programs are increasing the acuity of its membership. The company said its Medicaid margins will drop 125 basis points year over year in 2026 due to the eligibility changes and high utilization. This is before widescale reductions take place under the One Big Beautiful Bill Act (OBBBA). Insurers have complained that state Medicaid rates have not recognized actual costs after post-pandemic policy shifts in enrollment.

The other major moving part is the expiration of the enhanced Exchange subsidies, which could leave a sicker cohort and increased risk and costs in that line as well. Elevance also trimmed its Medicare Advantage (MA) footprint to stabilize that line. Its Carelon services entity did not meet investor expectations.

Elevance posted a medical loss ratio, a marker of spending on patient care, of 91.3% — up compared to 89.5% same time last year. Elevance did post double-digit year-over-year growth for both revenue and profits. It had $1.2 billion in profit for the third quarter, up 17% from the $1 billion for the third quarter of 2024. Revenues for the quarter were $50.7 billion, an increase of 12.4% from the $45.1 billion reported in the prior-year quarter. Elevance had $5.1 billion in profit for the first nine months of 2025, down 8% compared to the $5.7 billion in earnings reported through the first three quarters of 2024. Revenues across the first three quarters of 2025 were $149.4 billion, an increase of 13.5% year over year.

In other news, Point32Health has cut an additional 254 jobs to reduce its costs.

Additional articles: https://www.fiercehealthcare.com/payers/elevance-health-shares-rise-premarket-q3-earnings-revenue-beat and https://www.healthcaredive.com/news/elevance-outperforms-q3-2025-warns-medicaid-challenges/803326/ and https://www.beckerspayer.com/financial/elevance-q3-income-up-over-17/ and https://www.beckerspayer.com/workforce/point32health-to-cut-254-jobs/

(Some articles may require a subscription.)

#elevancehealth #exchanges #medicareadvantage #medicaid #managedcare #margins

https://www.modernhealthcare.com/insurance/mh-elevance-health-medicaid-2026/

11^th Vote To Reopen Government Voted Down By Democrats

Senate Democrats voted against reopening the federal government for the 11th time Monday, making the government shutdown continue. The chamber voted 50-43 on the House-passed continuing resolution, which needed 60 votes to pass. The same three Democratic caucusing senators voted with Republicans and one debt-and-deficit-hawk Republican voting with Democrats.

At the same time, Senate Majority Leader John Thune, R-SD, said the government shutdown has dragged on for so long that the GOP-controlled House may need to come back to Washington to pass a new stopgap funding bill. There are just 4 weeks left on the measure passed by the House and failing in the Senate.

And Rep. Chip Roy, R-TX, floated the use of the “nuclear option” to end the shutdown and get around Senate filibuster rules that require a 60-vote majority to pass a bill. Thune opposes the idea. Thune is right on this.

Meanwhile, the Trump administration asserted it could lay off about 1,000 employees despite a judge’s ruling, but the judge weighed back in and barred it.

 Additional articles: https://thehill.com/homenews/senate/5563802-thune-house-dc-government-funding-shutdown/ and https://www.fiercehealthcare.com/regulatory/shutdown-tracker-cms-issues-billing-guidance-hhs-furloughs-32000-employees and https://thehill.com/homenews/5563484-senate-filibuster-republican-debate/

#governmentshutdown #congress #trump #healthcare #coverage

https://thehill.com/homenews/senate/5564176-government-shutdown-vote-senate

Medicare Advantage Plans Want Fewer Members

Modern Healthcare covers a real oddity – Medicare Advantage (MA) plans want fewer members. Given upside down financials right now and the need to get back to investor margins, MA plans are trying all things to ensure they do not get members into plans that are underwater or even less profitable. The past few years and into 2026, the plans are eliminating commissions on a number of their plans and products. In addition, marketing budgets overall appear to be being reduced dramatically.

The lack of commissions, reduced marketing, and overall contraction of offerings has led the Centers for Medicare and Medicaid Services (CMS) to predict an actual contraction of 900,000 enrollees in 2026 compared with 2025. I see why they see a sea change, but I still have my doubts that we will see an actual contraction. Clearly growth will come down from a reduced rate in 2025. It might even be flat perhaps. But contract? Wow that we are even talking about it. How times change.

(Article may require a subscription.)

#medicareadvantage #enrollment #marketing

https://www.modernhealthcare.com/insurance/mh-medicare-advantage-marketing-unitedhealthcare-aetna-centene

Hospitals Hate Price Reform: CHA Sues State Over Price Caps

The oblivious-to-the-true-healthcare-crisis hospitals are once again trying to cripple reforms to price in the system. The California Hospital Association (CHA) has filed a lawsuit against the state’s Office of Health Care Affordability, arguing the agency’s price caps on hospitals are unlawful and will threaten critical access to patients in need. Chicken Little is back!

The arguments are old news from the hospital lobby playbook. The main goal is to continue to safeguard bloated price masters and bureaucracies at the expense of the American people.

The state agency is imposing a 3.5% statewide spending growth target for 2025, declining to 3% by 2029, as well as lower targets for existing price outlier hospitals. The CHA hides behind the fact that premiums are increasing by 10%, arguing the efforts have not worked. Yet, much of that is utilization increases as well as price hikes at hospitals and for drugs – the two big areas increasing in healthcare.

Of course, America as a whole should push for such reforms as price, driven in large measure by hospital care, is a huge outlier in America compared with other developed countries. Because federal officials refuse to take the healthcare crisis seriously, more and more states are pushing reform by establishing various caps on hospital and other costs.

As a recent Health Affairs Forefront blog argues, hospitals are about a third of all healthcare and are highly concentrated. This in and of itself leads to high price and ongoing inflation. Hospitals are increasingly buying physicians to drive practice patterns to expensive hospital or hospital-owned settings.

States are using various price caps on hospitals, including for state insurance plans, caps in the commercial market, rate-setting for various lines of business, and even global all-payer rate-setting. As the authors note, these changes have the potential to save big dollars and right-size spending. This is what the hospitals really fear.

Another Health Affairs study finds that commercial insurance prices were 78% higher in hospital outpatient settings compared with ambulatory surgical centers in 2024. This is what hospitals are protecting.

In related news, another Health Affairs Forefront article finds that four years’ worth of federal price transparency rule filings have revealed costly inefficiencies, obfuscation, and an immensely complex system of payer-provider contracts and payments. Transparency has given us at least a glimpse at how broken price is.

Additional articles: https://www.healthaffairs.org/content/forefront/states-using-hospital-price-caps-save-money and https://www.healthaffairs.org/content/forefront/transparency-reveals-health-care-prices-and-billing-and-payments-system-need-overhaul and https://www.beckerspayer.com/research-analysis/commercial-insurance-prices-78-higher-in-hopds-vs-ascs-study/

(Some articles may require a subscription)

#hospitals #rates #margins #employercoverage #transparency #pricetransparency #healthplans 

https://www.beckershospitalreview.com/finance/california-hospital-association-sues-state-over-unattainably-low-spending-caps/