ZACKS·2025-12-30 18:15Core Insights - U.S. managed healthcare insurers are undergoing significant transformation due to rising medical costs, increased regulatory scrutiny, and a surge in investments in data and value-based care [1] - Scale, diversification, and disciplined capital allocation are crucial for payers to protect margins and sustain long-term growth [1] - UnitedHealth Group (UNH) and Elevance Health, Inc. (ELV) are two major players in the health insurance and managed care sector [1] UnitedHealth Group (UNH) - UNH, with a market cap of nearly $298 billion, is the largest health insurer in the U.S. and operates beyond traditional insurance through its Optum healthcare services unit [4] - The company serves 50.1 million people as of September 30, 2025, reflecting a 1.6% year-over-year growth [5] - Total revenues increased by 11.6% year-over-year in the first nine months of 2025, with UnitedHealthcare growing by 15% and Optum by 6.6% [6] - UNH is divesting assets, including a $1 billion sale of its South American operation, Banmedica, to streamline operations and address regulatory challenges [7] - The company ended Q3 2025 with $30.6 billion in cash and short-term investments, with a total debt-to-capital ratio of 41.6% [8] - Rising medical costs have pressured profit margins, with the medical care ratio increasing to 88.1% in Q3 2025 from 84.9% the previous year [10] Elevance Health, Inc. (ELV) - ELV, with a market cap of $77.4 billion, is a diversified managed care organization focusing on growth and operational efficiency [11] - The Carelon division, which integrates care delivery and data analytics, saw operating revenues rise by 35.4% year-over-year [12] - Total revenues for ELV increased by 13.9% year-over-year in the first nine months of 2025, supported by strong growth in premiums and product revenues [13] - Strategic acquisitions have strengthened ELV's portfolio, while divesting underperforming segments allows for resource reallocation [14] - Total expenses rose by 15% year-over-year in the first nine months of 2025, with the benefit expense ratio deteriorating to 88.9% [15] Comparative Analysis - Both UNH and ELV face unfavorable earnings estimates for 2025 due to rising costs, with UNH expected to see a 41.1% decline in EPS while ELV anticipates a 9.2% decline [16] - Valuation analysis shows ELV is more attractive, trading at a forward P/E of 12.68X compared to UNH's 18.69X [17] - In the past three months, UNH shares declined by 4.8% due to concerns over medical costs and investigations, while ELV shares increased by 7.8% [19] Conclusion - Both companies are navigating a challenging managed care environment with rising medical costs and regulatory pressures [22] - UNH has significant scale and the Optum platform but faces short-term margin pressures [22] - ELV appears to be in a stronger position with strategic market exits and a growing Carelon platform, offering a better near-term risk-reward profile [23]