UnitedHealth Raises Guidance As Profits Spike
UnitedHealth reported a profit spike to $5.5 billion in Q2 2026, driven by the recovery in its insurance unit, UnitedHealthcare. As well, United’s Optum services business had a nice recovery. UnitedHealthcare posted an 86.7% medical loss ratio (MLR) in Q2, improving year over year.
Medicare Advantage (MA) turned around as well. Costs are running high but below the 10% it projected. The company expects its Medicare plans to generate a 3% operating margin this year. United lost a planned 965,000 members in a retrenchment, but was somewhat lower than the 1.1 million expected.
United urged Congress and the administration to reform what it says is a broken No Surprises Act (NSA) arbitration process that is driving prices higher.
Additional articles: https://www.healthcaredive.com/news/unitedhealth-q2-results-beat-2026-guidance-raise/825385/ and https://www.beckerspayer.com/payer/unitedhealthcare-no-surprises-arbitration-system-needs-to-be-reformed/ and https://www.beckerspayer.com/financial/unitedhealth-posts-5-5b-profit-in-q2/ and https://www.modernhealthcare.com/insurance/mh-unitedhealth-earnings-guidance/
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#healthplans #margins #unitedhealthcare
https://www.modernhealthcare.com/insurance/mh-unitedhealth-earnings-unitedhealthcare-medicare-optum/
Judge Blocks Certain ACA Marketplace Rule Provisions
A federal judge temporarily blocked eight provisions of the Centers for Medicare and Medicaid Services’ (CMS) Affordable Care Act (ACA) Exchange marketplace rule from taking effect. The court said the plaintiffs would likely succeed at trail. The plaintiffs argued certain provisions are arbitrary or violate the ACA. The blocked provisions are:
- Expanded hardship exemption, which effectively broadens catastrophic coverage eligibility.
- Revised network adequacy standards allowing states to oversee reviews. This also seems to impact a proposal to allow non-network plans as qualified plans in the Exchanges.
- Two provisions requiring stricter income verification.
- CMS’ reinstatement of a policy regarding failure to reconcile tax data.
- New verification requirements for special enrollment periods.
- CMS’ updated cost-sharing methodology for bronze plans.
- The elimination of standardized plans.
(Article may require a subscription.)
#exchanges #aca #healthcare #coverage
https://www.modernhealthcare.com/politics-regulation/mh-aca-exchange-rule-blocked-federal-judge
Some Health Systems Exit Insurance Market
Over 800 hospitals owned a health plan as of 2023, but in some cases regional health systems are exiting the insurance business. They blame rising costs and competition from big health plans. More often than not, they are exiting just select lines of business.
(Article may require a subscription.)
#hospitals #healthplans
https://www.modernhealthcare.com/providers/mh-health-systems-provider-health-plans-insurance
MFN Will Save In Medicaid
A research letter publish in JAMA finds that basing Medicaid drug prices on the most-favored-nation (MFN) pricing system would save $8.6 billion or 34.7% of net spending. When the Trump administration announced deals with brand drug makers, many dismissed the savings given aggressive federal and state rebates. MFN is being rolled out in Medicaid through Trump’s Generating Cost Reductions for U.S. Medicaid (GENEROUS) model.
A new program to base Medicaid drug prices on the lowest drug prices in other countries — known as “most favored nation” (MFN) pricing — could result in substantial savings, researchers found.
#drugpricing #MFN #irp
https://www.medpagetoday.com/publichealthpolicy/medicaid/122229
— Marc S. Ryan
