United Reports Financial News; Big Plans Tighten Belts
Investors cheered news from UnitedHealth Group that its efforts to get back to margins are working. United raised its full-year guidance Tuesday when announcing its Q3 results. United reported that net earnings fell 59.4% to $2.54 billion and earnings from operations dropped 50.4% to $4.31 billion. Revenue grew 12.2% to $113.16 billion. But these figures beat Wall Street expectations.
United’s strategy has been to massively retrench in both Medicare Advantage (MA) and standalone Part D (PDP). United expects all its government lines of business to contract – MA, PDP, Medicaid, and the Exchanges. It expects to shed 600,000 in MA and has expanded some markets in the Exchanges but exited less profitable ones. Utilization and medical expense continues to be a challenge as its medical loss ratio was just short of 90% across all business lines. However, revenues from services entity Optum grew 8.3% to $69.2 billion. Earlier, the services entity was reporting struggles. United says it will have solid earnings growth in 2026.
In other news, struggling Aetna is looking for ways to tighten networks to ensure all providers in the continuum of care, from primary care to specialty to hospitals, are aligned around value-based models. The insurer is building a team around provider experience and improving satisfaction.
Elevance Health’s new out-of-network care policy may reduce healthcare costs but also rankle providers. Elevance will penalize in-network facilities that use out-of-network providers.
Additional articles: https://www.fiercehealthcare.com/payers/why-aetna-putting-focus-provider-experience-it-navigates-medicare-advantage-headwinds and https://www.modernhealthcare.com/insurance/mh-unitedhealth-group-guidance-aca-enrollment/ and https://www.modernhealthcare.com/providers/mh-elevance-health-out-of-network-charge-explained/ and https://www.healthcaredive.com/news/unitedhealth-2025-guidance-raise-q3-beat-ma-aca/803856/ and https://www.beckerspayer.com/financial/unitedhealth-posts-2-3b-profit-for-q3-raises-outlook/
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#healthplans #margins #medicareadvantage #medicaid #managedcare #exchanges #unitedhealthcare #cvsaetna #elevancehealth
https://www.fiercehealthcare.com/payers/unitedhealth-boosts-2025-outlook-back-q3-earnings-beat
Exchange Saga Continues
More than two dozen Republican lawmakers have expressed support for some form of extension of the enhanced premium subsidies. They largely hail from swing districts and are moderates. While many conservatives in each chamber are staunchly opposed to an extension, GOP leaders may be forced to allow a vote where moderates in each chamber could team up with unified Democrats to extend the subsidies in some form. One rightist supporting an extension, Marjorie Taylor Greene, R-GA, attacked House Speaker Mike Johnson, R-LA, today for refusing to disclose any plans on a replacement for the Affordable Care Act (ACA) and a subsidy extension plan.
The Centers for Medicare and Medicaid Services (CMS) published a press release today fawning about the Exchanges’ stability and access. A few of the advertised facts:
- Similar to 2025, on average, tax credits are projected to cover 91% of the lowest cost plan premium in 2026 for eligible enrollees. This compares to 85% in the 2020 coverage year, which was the last coverage year not impacted by temporary COVID-19 pandemic policies.
- The average Marketplace premium after tax credits is projected to be $50 per month for the lowest cost plan in 2026 for eligible enrollees. While this represents a $13 increase from 2025, it remains $20 less expensive than the monthly premium after tax credits in 2020.
- In 2026, nearly 60% of eligible re-enrollees will have access to a plan in their chosen health plan category at or below $50 after tax credits. This compares to 83% of eligible enrollees in 2025 and 56% in 2020 with equivalent access.
The reality, though, is less rosy. Healthcare policy group KFF says premiums for subsidized enrollees will leap 114% on average. Enrollment only surged (doubled) since 2020 due to the enhancements to the premium subsidies.
There is press coming out of various states on premium hikes being faced by those who now get subsidies. New Jerseyans will see an average increase of nearly 175%. Illinois residents will pay an average of 78% more.
I have taken the position that some sort of extension should occur for the stability of the program, with some anti-fraud and improper enrollment efforts.
KFF also has just published eight things to know about the Exchange open enrollment period, which starts November 1.
Additional articles: https://www.politico.com/news/2025/10/27/new-jerseyans-expected-to-pay-174-percent-more-for-health-insurance-on-exchange-00623995 and https://www.chicagotribune.com/2025/10/27/illinois-affordable-care-act-plans/ and https://thehill.com/policy/healthcare/5577748-republicans-obamacare-repeal-defense/ and https://thehill.com/homenews/house/5577071-greene-johnson-health-care-plans-shutdown/ and https://www.cms.gov/newsroom/fact-sheets/plan-year-2026-marketplace-plans-prices-fact-sheet and https://www.kff.org/affordable-care-act/8-things-to-watch-for-the-2026-aca-open-enrollment-period/
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#exchanges #healthcare #coverage
— Marc S. Ryan
