UHG Still Made The Most
Despite major financial challenges, UnitedHealth Group still made the most of the major national health plan vertically integrated behemoths in 2025. UHG brought in just over $12 billion in earnings for 2025. That was followed by Cigna at about $6 billion, with Elevance Health at almost $5.7 billion. CVS Health was at about $1.8 billion and Humana at about $1.2 billion. Centene lost $6.7 billion. Most of the plans see 2026 as yet another transition year with improving results.
#healthplans #margins
Rural Providers Criticize End To Reform Pilot
A program to enhance primary care, especially in rural areas, is being shuttered just a year into its launch due to early savings efforts by the Trump efficiency program DOGE. The model, Making Care Primary (MCP), was supposed to improve primary care at nearly 700 practices in eight states by providing flexible and quality bonus payments for physicians to address patient needs. Organizations were to use the dollars for staff, to integrate with specialists, and more.
The Centers for Medicare and Medicaid Services (CMS) said elimination of four models (including MCP) will save $750 million and the pilots were not expected to reach savings targets. It will instead launch a new 10-year program to boost primary care called the Long-term Enhanced ACO Design or LEAD. Critics say new dollars will not go to providers directly but through other organizations.
In 2023, more than 100 million people in the U.S. had no access to a primary care doctor in their area.
There also is a new 10-year $50 billion rural health initiative that was included in the One Big Beautiful Bill Act (OBBBA) that is meant to ameliorate the impact of Medicaid and Exchange reductions on rural providers.
#primarycare #cms #vbc
AmeriHealth Caritas To Shutter PerformRx
AmeriHealth Caritas will close its pharmacy benefits manager, PerformRx, at the end of 2026. Most of Perform’s business is with its corporate parent’s health plans. AmeriHealth will transition to OptumRx as of 2027.
#pbms #margins
Wakely Analyzes C-SNP Surge
Actuarial and consulting firm Wakely issued a white paper on the surge of Medicare Advantage (MA) Chronic Care Special Needs Plans (C-SNPs). I noted in my blog Monday the following on SNPs in general and C-SNPs specifically:
- From February 2025 to February 2026, SNPs grew an additional 647K, with 259K coming from December 2025 to February 2026.
- SNP growth was 74% of the 874K enrollment growth in MA from February 2025 to February 2026.
- SNPs grew 259K from December to February, while non-SNP plans contracted 144K — for a net of 115K overall in MA enrollment in the timeframe.
- The vast majority of enrollees are in dual eligible SNPs (D-SNPs) – 6.425M or 78.4% as of February 2026. D-SNPs grew from 6.324M in February 2025, or 101K (16%).
- Chronic Care SNPs had healthy growth in 2025 and now in 2026. C-SNPs now have 1.646M or 20%. C-SNPs grew from 1.108, or 538K (49%).
- CMS has indicated it wants to rein in the growth of C-SNPs, worried that more and more dual eligibles are enrolling in them without the regulatory and clinical safeguards that exist with D-SNPs.
#medicareadvantage #snps
https://www.wakely.com/blog/the-value-shift-inside-the-c-snp-surge/
— Marc S. Ryan
