UnitedHealth Group Reports Strong Financials
UnitedHealth Group, the nation’s largest insurer, reported $4.1 billion in profit for Q3 2026, up from $2.3 billion in Q3 2025. And YTD 2026 profit is now $15.9 billion vs. $12 billion through Q3 2025. Revenues dipped slightly year over year in Q3 to $112.7B, in part due to lower Medicare Advantage (MA) enrollment. Revenue is up through three quarters.
United saw improvement in its medical loss ratio (MLR) in Q3, reporting 88.4%, driven by medical cost management, benefit design changes, pricing discipline, and care delivery enhancements such as integrated value-based care. Services subsidiary Optum’s earnings increased 48% to $3.7 billion.
Executives said they are confident heading into MA’s open enrollment and see opportunities for growth in lucrative markets, including Special Needs Plans (SNPs). United sees great pressures from the No Surprises Act arbitration process.
In other news, Humana will enter into a joint venture with investment firm BlackRock to manage and operate its roughly 150 CenterWell primary care clinics for seniors. This replaces a deal with Welsh, Carson, Anderson & Stowe (WCAS).
And Centene is launching a new program aimed at streamlining the prior authorization process for some providers by introducing so-called gold carding.
Additional articles: https://www.fiercehealthcare.com/payers/unitedhealth-group-beats-street-41b-profit-q3 and https://www.fiercehealthcare.com/payers/humana-blackrock-strike-28b-deal-manage-centerwell-clinics and https://www.modernhealthcare.com/insurance/mh-centene-gold-card-program-prior-authorizations/ and https://www.modernhealthcare.com/insurance/mh-humana-blackrock-centerwell-clinic-private-equity/ and https://www.healthcaredive.com/news/humana-enters-28b-primary-care-joint-venture-with-blackrock/832872/ and https://www.healthcaredive.com/news/unitedhealth-q3-2026-profits-soar-medicare-advantage-strategy/832827/
#healthplans #margins
https://www.modernhealthcare.com/insurance/mh-unitedhealth-q3-earnings-optum-health
Plans Launch Provider Data Collaborative
Six major health insurers launched the Provider Data Collective to standardize how provider directory accuracy is measured. The Centers for Medicare and Medicaid Services (CMS) has asked for major reforms here. And a number of states have set up their own standardized processes. Plans are seeking to respond to the trends. There is some push for a national standardized directory. The shared framework targets inconsistencies across plan directories.
In other news, a pricing transparency reform rule was finalized. Plans worry about the swift timeframe and costs of nearly $400 million. Ghost network rates are eliminated. Some disclosure requirements were relaxed from an earlier rule.
Additional article: https://www.modernhealthcare.com/insurance/mh-cms-insurer-price-transparency-rule-ghost/
#healthplans #providers #pricetransparency
https://www.modernhealthcare.com/insurance/mh-unitedhealth-cigna-aetna-provider-data-standard
KFF Explores Medigap Limitations
Healthcare policy group KFF has looked at Medigap rules in various states and found that underwriting rules limit the ability of Medicare members obtaining Medigap if they return to the traditional program from Medicare Advantage. KFF finds that guaranteed issue outside initial enrollment periods and some other circumstances are limited in many states. There is a required 12-month trial period for MA. Medigap can deny coverage, apply higher premiums, or establish pre-existing conditions outside the guaranteed issue periods. Some states have far more liberal conditions for acceptance.
KFF finds that nearly 75% of MA enrollees or almost 21 million people in 2023 had a pre-existing medical condition identified from KFF’s review of Medigap applications that could result in a denial for a Medigap policy.
#medicare #medicareadvantage #medigap
— Marc S. Ryan
