Elevance Reports Q3 Financials
Elevance Health is boosting its outlook for the year as it beat The Street for Q3 2026. Elevance earned $1.4 billion in profit for the quarter, up slightly from $1.2 billion a year ago. Profits through the first nine months of the year were $4.6 billion, down year-over-year from $5.1 billion.
Revenues were $50.4 billion in Q3, about the $50.1 billion from the prior year quarter. Revenues through three quarters were $149.8 billion, up from $148.3 billion a year ago.
Elevance says 2026 is a “trough year” for the company’s Medicaid business and that there are positive signs in 2027. Medicaid is now ahead of outlook. But Medicaid is facing looming turbulence from the massive budget cuts that have passed impacting the next ten years.
The overall medical loss ratio for the quarter was 90.6%, compared to 91.7% a year ago. The insurance unit was slightly ahead on revenue, with services unit Carleon having strong growth.
In related news, Elevance wisely is requiring hospitals to identify the physical location where care was provided on billing forms and adjust reimbursement for certain off-campus services. This will apply to commercial, Medicare Advantage and Medicaid and will be rolled out through 2027. Providers complain of the administrative costs, but it is all about maintaining preferred rates and battling the overturn of site neutrality nationally.
Additional articles: https://www.fiercehealthcare.com/payers/elevance-health-posts-14b-profit-q3-earnings-beat and https://www.beckershospitalreview.com/finance/elevances-site-of-care-rules-put-revenue-cycles-on-alert/
#elevancehealth #healthplans #margins
https://www.healthcaredive.com/news/elevance-medicaid-momentum-q3-2026-elv/833559
States Force Charity Care
A Kaiser Health News article tackles the issue of charity care and states forcing hospitals to ramp up assistance. Frustrated with low levels of assistance for the medically needy, states are enacting far-reaching laws.
In Oregon, a law requires hospitals to proactively screen patients and give financial aid to those who qualify for it. Oregon’s new rules, which took effect in July 2024, require hospitals to skip applications for nearly all patients. In their first full fiscal year under the law, spending by Oregon hospitals on financial assistance more than doubled, on average.
North Carolina expanded its screening requirements to include patients with income up to triple the poverty line. California and Delaware are requiring hospitals to automatically grant financial aid by July 2027.
#charitycare #hospitals #uncompensatedcare
More Exchange Landscape Announcements
Yesterday we reported on Centene’s and Oscar’s plans for the Exchange in 2027, a mix of expansion and exit. Now we have more announcements. UnitedHealthcare is shutting down its Exchange plans in Georgia. Its footprint of about 1,300 counties is unchanged, suggesting it is expanding in its remaining 29 states.
Health Care Service Corporation and FL’s GuideWell made no changes to their footprints for 2027. Molina Healthcare is cutting more than half of its Exchange states.
Additional article: https://www.beckerspayer.com/payer/aca/how-insurers-aca-footprints-are-changing-in-2027/
#exchanges #enrollment #coverage
https://www.healthcaredive.com/news/centene-oscar-unitedhealthcare-new-counties-aca-2027/833442
Trump Admin Announces PA Expansion to Employer Coverage
The Centers for Medicare and Medicaid Services (CMS) and the Department of Labor (DOL) are working together to expand the benefits of prior authorization reform to the self-funded market. Health plans usually serve as third-party administrators for self-funded employers. Up to 180 million people — more than half — receive their health coverage through employers that sponsor self-funded health plans at some time in a given year.
#employercoverage #priorauthorization
— Marc S. Ryan
