Humana Reports Q3 Financial News
Medicare Advantage (MA)-dominant Humana reported Q3 financial news today. Humana, the second biggest MA player, slashed its earnings guidance as enrollment ticks above initial expectations during open enrollment. It now projects to have about 425,000 fewer Medicare MA enrollees next year, not 500,000 fewer as previously anticipated. Investors worry that these additional members, driven by generous benefits, will increase medical expense more than projected. Humana says it is confident in projections despite higher enrollment numbers but says it can throttle back enrollment with several levers if needed.
Operating expenses surged to $32.25 billion, up 11.75% year over year. Humana is spending more (hundreds of millions more) to better operations and increase Star ratings. Its Star Year 2026 rating actually dropped from a very low 25% of enrollment in 4 Star or greater plans to an even lower 20%.
Third-quarter net income declined 59.6% to $194 million. Revenue rose 11.1% to $32.6 billion. The medical loss ratio (MLR) rose to 91.1% from 89.1% a year ago. This was consistent with projections.
One analyst asked the burning question on Stars — why Humana didn’t crosswalk MA members out of one major contract suffering from low ratings to other contracts. Humana says that would be a short-term financial gain that could have negatives, including member attrition and hurt future Star performance. Humana says it will break up the master contract over time.
Additional articles: https://www.fiercehealthcare.com/payers/humana-slims-expectations-membership-losses-2025-425k and https://www.healthcaredive.com/news/humana-medicare-advantage-growth-confident-q3-2025/804661/ and https://www.beckerspayer.com/financial/humana-posts-195m-q3-profit/
(Some articles may require a subscription.)
#medicareadvantage #humana #margins #stars #quality
https://www.modernhealthcare.com/insurance/mh-humana-medicare-advantage-centerwell/
Exchanges Lose Plan Participation
Six health plans fully pulled out of the Exchanges for 2026, including big plan Aetna. And leading insurers such as Centene, UnitedHealthcare and Molina exited some counties but added others. It also means 1.1 million enrollees in 17 states, 4.5% of national enrollment in 2025, will need to find new coverage.
Across the board, insurers had major premium hikes for many reasons, including utilization and the expected enhanced premium subsidy expiration.
(Article may require a subscription.)
#exchanges #healthcare #coverage
https://www.modernhealthcare.com/insurance/mh-aetna-carle-health-aultcare-aca-markets-2026
Mass Blue Loses Star Lawsuit
Blue Cross and Blue Shield of Massachusetts (BCBSMA) has lost its legal challenge over its 2025 Medicare Advantage Star ratings. A federal judge sided with the Centers for Medicare and Medicaid Services (CMS), saying what CMS did is consistent with agency rules. BCBSMA said CMS used an unlawful methodology that caused contracts to drop from 4 Stars to 3.5 Stars in Star Year 2025. It said CMS’ use of “case-mix adjustments” to account for demographic factors for customer surveys are outside a plan’s control and that reliance on a weighted national average when comparing plan scores violated federal rules.
#medicareadvantage #stars #quality
Democrats Percolating On Funding Compromise
A group of centrist Senate Democrats are working toward a government funding solution and are sounding out Democratic colleagues on a potential deal. The deal would include a plan to pass regular appropriations bills and a promised vote on extending expiring health insurance subsidies.
If an agreement is reached, a deal could be voted on this week or next. Some more liberal Senate Democrats and some moderates want to hold the line if Exchange premium subsidies are not protected. But moderates have become anxious about the impact of the shutdown.
The Democratic centrists include retiring Sens. Jeanne Shaheen, D-NH, and Gary Peters, D-MI. These senators are trying to get the eight Democrats needed to hit 60 votes (Republican Rand Paul will not vote for the measure). Three Democrats or independents have voted with Democrats already. With Shaheen and Peters, that is five. Three more Democrats would be needed. Sen. Maggie Hassan, D-NH, likely would vote yes. Sens. Jacky Rosen, D-NV, Jon Ossoff, D-GA, Mark Kelly, D-AZ, Peter Welch, D-VT, Tammy Baldwin, D-WI, and Elissa Slotkin, D-MI, are possible yes votes.
There is a brewing debate over whether government would be funded to mid-December or the end of January.
Additional article: https://thehill.com/homenews/senate/5589424-gop-divisions-end-date-funding-bill-shutdown/
#governmentshutdown #congress #trump #exchanges #healthcare #coverage
https://thehill.com/homenews/senate/5589686-senate-democrats-shutdown-fight
— Marc S. Ryan
