Elevance Reports Caution, But Better News Than United
Elevance Health reported 2025 financial news today and its status is better than imploding UnitedHealth Group. That led to a recovery to some degree in its stock price today.
Elevance beat The Street on profit in Q4 2025 but missed on revenue. The company reported $547 million in profit for Q4, up from $418 million in Q4 2024. However, its $49.3 billion in Q4 revenue fell short. It did have almost 10% growth year over year.
For the full year, Elevance Health brought in $197.6 billion in revenue, up 12.8% from 2024’s $175.2 billion. Profits were down by 5.3% compared to 2024, decreasing from $6 billion to $5.7 billion.
Elevance did report that it will see declining revenue in 2026, though. And profit could be constrained as well. This is tied to shedding of membership to right the financial ship as well as governmental impacts in Medicaid and the Exchanges. The insurer also had elevated utilization and medical costs, with a medical loss ratio of 93.5% in Q4.
Its small but growing Carelon services unit had a good year, with operating revenues of $18.7 billion in Q4 2025, up 27% year over year.
Elevance expects to make a return to 12% growth in earnings per share in 2027.
Elevance expects its Medicare Advantage (MA) membership to drop about 18% or about 400,000. Medicaid rolls will drop as well. Medicaid enrollees are also expected to be more adverse.
Additional articles: https://www.fiercehealthcare.com/payers/elevance-health-beats-profit-misses-revenue-mixed-q4 and https://www.healthcaredive.com/news/elevance-2025-results-2026-outlook-lower/810680/ and https://www.beckerspayer.com/financial/elevance-posts-5-7b-profit-in-2025/
(Some articles may require a subscription.)
#healthplans #margins #elevancehealth #medicareadvantage #medicaid
https://www.modernhealthcare.com/insurance/mh-mied-elevance-health-quarter-bolstered-carelon
Insurers’ Recovery Takes A Twist
What was supposed to be a year of returning to margins and investor expectations suddenly looks a bit cloudy. After disastrous 2024s and 2025s, health plans were expecting to stabilize their finances.
Analysts do expect margins to improve due to some better premiums and rates as well as contraction in business lines. And Medicare Advantage (MA) profits will likely tick up, which would help address ongoing woes in Medicaid (due to enrollment declines and rising adversity) and the Exchanges (same issues).
Analysts also says new sweeping impacts in 2026 on insurers are unlikely expect perhaps on MA overpayments and pharmacy benefits manager reform.
But the road to fiscal recovery was thrown for a loop this week with proposals to implement some risk adjustment reform in MA and to essentially have flat rates. Rates will likely rise some with the final announcement, but the impact was unexpected and creates some uncertainty in 2027.
The silver lining here is that the biggest health plans practicing aggressive risk adjustment optimization will be hurt the most. Smaller and regional plans do not have such aberrant practices and this could become the great equalizer over time. Still, the flat rates are not good for the industry or member benefits, costs, access, and coverage. Another year of MA realignment will indeed occur.
In other news, healthcare policy group published an analysis of prior authorization in MA. 99% of MA enrollees face prior authorization for some services, usually higher costs services and drugs. Nearly 53 million prior authorization requests were submitted to MA plans in 2024, an increase from 2023’s 49.8 million. Most of this is tied to increasing enrollment. In 2024, there were 1.7 prior authorization requests on average per MA enrollee, a slight decline from 1.8 in 2023.
In 2024, MA plans fully or partially denied 4.1 million prior authorization requests, which is a somewhat larger share (7.7%) of all requests than in 2023 (6.4%) and similar to 2022 (7.4%).
Just a small number of appeals are undertaken but when they are most are successful.
Additional articles: https://www.healthcaredive.com/news/health-insurance-industry-2026-predictions/808982/ and https://www.kff.org/medicare/medicare-advantage-insurers-made-nearly-53-million-prior-authorization-determinations-in-2024/
(Some articles may require a subscription.)
#healthplans #margins #medicareadvantage #medicaid #exchanges
https://www.modernhealthcare.com/insurance/mh-cms-medicare-advantage-unitedhealth-humana
Frosty Internecine Warfare: Grand Old Food Fight Over ICE
In an effort to keep the government from shutting down, some Senate Republicans have expressed openness to splitting out Department of Homeland Security (DHS) funding from the rest of agreed-upon appropriations to help address Democratic concerns about DHS’ conduct and the violence in Minnesota. Senate Majority Leader John Thune, R-SD, does not necessarily agree but did not rule it out.
However, House Republicans are warning the Senate against making any changes to a government funding package. House GOP leaders say the Democrats’ changes would not clear the House and would lead to a government shutdown. The problem: Democrats may not supply the 60 votes in the Senate needed to pass the bill without certain DHS changes.
Senate Minority Leader Chuck Schumer, D-NY, outlined his party’s demands for voting for Homeland Security funding:
- End roving patrols by Immigration and Customs Enforcement (ICE).
- Tighten rules governing use of warrants by officers targeting migrants.
- Establish a universal code of conduct governing federal law enforcement officers’ use of force.
- Prohibit federal officers from wearing masks.
- Require officers to wear body cameras and proper identification.
A frustrated Thune stated today: “I think right now the conversation should be between the White House and Democrats.
A government shutdown certainly looms.
Additional articles: https://thehill.com/homenews/house/5711687-house-republicans-senate-dhs-bill/ and https://thehill.com/homenews/senate/5711343-democrats-schumer-immigration-demands-dhs-funding/
#governmentshutdown #congress #trump
https://thehill.com/homenews/senate/5710655-thune-government-shutdown-white-house-democrats
OIG On DTC Drug Sales
A Health and Human Services Office of Inspector General bulletin seeks to quell fears about federal enforcement actions against drug manufacturers who could be selling direct to consumer on TrumpRx to government program enrollees. A series of fraud and anti-kickback rules govern the programs.
The bulletin explains the low risk and general ability to make such self-pay sales. It outlines parameters to ensure rules are not violated.
#fwa #drugpricing #medicare
— Marc S. Ryan
