Group 1 - The final rules and rates set by CMS will enhance access to quality coverage and additional benefits for Medicare Advantage beneficiaries, including hearing, dental, and vision services [1][3] - Over 70 million people are eligible for Medicare, with nearly 36 million enrolled in Medicare Advantage plans, indicating a significant market size for health insurance providers [2] - The new rules are expected to lead to increased investment in Medicare offerings by health plans, reflecting the importance of the Medicare Advantage program and the role of licensed insurance agents [3] Group 2 - eHealth, Inc. has been a key player in the health insurance marketplace for over 25 years, helping millions of Americans find suitable healthcare coverage [4] - The company supports the final rules and rates from CMS, believing they will positively impact the Medicare Advantage program and the services provided to seniors [3][4] - eHealth offers access to over 180 health insurers, positioning itself as a leading independent licensed insurance agency [4]

Core Viewpoint - CVS Health has emerged as a top performer in the S&P 500, with a year-to-date return exceeding 41% in 2025, significantly outperforming its competitors and the broader market [1][2]. Business Performance - CVS Health's diversified business model spans healthcare and retail, providing a range of health insurance products and pharmacy benefit management solutions [5]. - The company has shown strong cash generation capabilities, which have helped it navigate market sell-offs and inflationary pressures [6]. - CVS Health's recent biosimilar launch with Cordavis has successfully converted over 90% of eligible Humira patients to a biosimilar, generating nearly $1 billion in client savings [8]. Strategic Initiatives - The company is optimistic about its 2025 roadmap, focusing on strengthening its position in Medicare Advantage and expecting a margin recovery of 100 to 200 basis points [9]. - Improved Star Ratings in 2025 could provide a $700 million boost, with additional gains driven by pricing initiatives [10]. - CVS Health is advancing its innovative pharmacy models and integrating healthcare delivery assets to achieve profitable growth [11]. Valuation - CVS Health's forward 12-month price-to-earnings (P/E) ratio is 10.35X, which is a discount compared to the S&P 500's 18.56X [12]. - However, it trades at a premium to competitors like Walgreens Boots Alliance and Herbalife, indicating a higher price relative to expected earnings growth [13]. Challenges - The Aetna unit faces challenges from elevated service utilization and reimbursement pressures, leading to a high medical-benefit ratio [16][22]. - Concerns exist regarding the proposed 2026 Medicare Advantage advanced rate notice, which may not adequately address industry-wide cost trends [18]. - The current stock price is close to the average target price, suggesting limited upside potential for investors [19][22]. Market Sentiment - Investor confidence remains strong, supported by CVS Health's strategic initiatives and performance in the Pharmacy and Consumer Wellness segment [21].

Financial Data and Key Metrics Changes - Health plan membership reached 189,100, growing approximately 59% year-over-year, exceeding initial guidance by over 25,000 members [5][21] - Total revenue for Q4 2024 was $701 million, a 51% year-over-year increase, and $2.7 billion for the full year, representing a 48% growth [6][21] - Adjusted gross profit for Q4 was $88 million, with a consolidated Medical Benefit Ratio (MBR) of 87.5%, improving by 200 basis points year-over-year [6][22] - Adjusted EBITDA was positive $1 million for Q4, marking the first year of adjusted EBITDA profitability as a public company [8][26] Business Line Data and Key Metrics Changes - The company reported a significant improvement in margin ratios across all key metrics, with adjusted gross profit for the full year at $303 million and an MBR of 88.8% [7][21] - Inpatient admissions per 1,000 for at-risk members improved to 149 in 2024, down from 156 in 2023 [22][23] Market Data and Key Metrics Changes - Membership in California grew by 28%, while ex-California markets saw over 100% growth, indicating strong performance outside California [11][12] - The company achieved a 5-star rating in Nevada and North Carolina, enhancing reimbursement from CMS and lowering costs [13] Company Strategy and Development Direction - The company focuses on Medicare Advantage as a care management business, emphasizing quality care over actuarial underwriting [9][10] - Future growth is expected to be driven by strong Stars ratings and the final phase-in of the V28 risk adjustment model, with a target of maintaining at least 4 stars for California members [14][15] Management's Comments on Operating Environment and Future Outlook - Management expressed confidence in achieving membership growth of 20% or more in the coming years while balancing margin expansion objectives [18] - The company anticipates a favorable operating environment due to its differentiated care management approach and strong Stars performance [19][20] Other Important Information - The company ended 2024 with $471 million in cash and investments, significantly lowering its cost of capital [27] - For 2025, the company expects health plan membership to be between 227,000 and 233,000 members, with revenue guidance of $3.72 billion to $3.78 billion [28][30] Q&A Session Summary Question: Can you unpack the guidance for 2025 for adjusted EBITDA? - Management noted that the guidance reflects a prudent approach to the new aspects of the Part D program under the Inflation Reduction Act, with a conservative outlook on MLR [39][40] Question: What is the expected split of membership growth between California and non-California? - Management expects ex-California to grow materially faster than California, but California will still drive over 50% of total net member growth [45] Question: How do you see the MLR guidance for 2025 compared to peers? - Management highlighted that their MLR is expected to decrease slightly, contrasting with peers who may see larger increases due to various challenges [50][51] Question: What is the current raw star rating score for the California HMO contract? - Management confirmed that maintaining a 4-star rating is a priority, with potential to improve to 4.5 or 5 stars based on competitive positioning [63][66] Question: How is the cohort maturation tracking? - Management expressed confidence in the maturation of the 2024 cohort into 2025, with strong engagement metrics supporting this trend [72][75] Question: What are the expectations for cash flow and CapEx? - Management indicated expectations for approximately $30 million to $35 million in CapEx for 2025, with a strong cash position to support growth [80][82]

Financial Data and Key Metrics Changes - Q4 2024 revenue increased to $389 million, a 41% improvement compared to $277 million in Q4 2023 [18][39] - Adjusted EBITDA for Q4 2024 grew to $118 million, representing a 107% year-over-year improvement from $57 million in Q4 2023 [18][39] - Full year 2024 revenue was $798.9 million, reflecting a 9% year-over-year increase compared to $734.7 million in 2023 [39] - Full year adjusted EBITDA increased to $120.3 million, a 60% increase from $75.1 million in 2023 [39][40] - Direct operating cost per submission decreased by 27% year-over-year in Q4 to $501 [17][41] Business Line Data and Key Metrics Changes - Captive Medicare team submissions increased by approximately 82% year-over-year, driven by improved conversion rates and call efficiency [16][17] - External agents (GoPartner Solutions) saw a 25% year-over-year increase in submissions due to effective onboarding of new agency partners [17] - PlanFit CheckUp grew 72% in Q4 2024 compared to the same period in 2023, reflecting strong consumer engagement [23] Market Data and Key Metrics Changes - Nearly 3 million consumers were supported in assessing their benefit options in 2024, with over 481,000 submissions in Q4, a 67% improvement year-over-year [15] - The U.S. has over 67 million Medicare-eligible consumers, with over half enrolled in Medicare Advantage [10] Company Strategy and Development Direction - The company aims to transform from a traditional Medicare enrollment company to a Medicare engagement company, focusing on long-term relationships with consumers [14] - The integration of e-TeleQuote is seen as a strategic move to enhance operational efficiency and drive growth [26] - The company plans to capitalize on favorable market conditions and expects meaningful revenue growth and profit expansion in the first three quarters of 2025 [30][31] Management's Comments on Operating Environment and Future Outlook - Management expressed cautious optimism for the first three quarters of 2025, anticipating favorable market dynamics [30][34] - The CMS final rate notice is a key determinant for health plan funding and revenue assumptions, projecting a 4.3% average revenue increase for Medicare Advantage health plans in 2026 [34] - Management highlighted the importance of adapting to regulatory changes and maintaining engagement efficiency [35][36] Other Important Information - The company successfully refinanced its term loan credit facility, extending the maturity through 2029 and improving financial terms [42][43] - Commissions receivable totaled approximately $1.1 billion at December 31, 2024 [45] Q&A Session Summary Question: Discussion on revenue per submission and margin expansion - Management discussed the balance between agency and non-agency products affecting revenue per submission and emphasized ongoing efficiency improvements [55][56][60] Question: Expectations for AEP and market dynamics - Management noted that fewer plan exits are expected in 2025, which may lead to different types of disruption compared to 2024 [65][66][68] Question: Impact of PlanFit Save on revenue - Management indicated that PlanFit Save had a small impact on Q4 performance due to fewer scenarios where it was applicable [70][74] Question: Balance sheet and potential securitization of commission receivables - Management stated that all options are being considered to optimize the balance sheet and reduce the cost of capital [77][81] Question: Customer acquisition cost (CAC) expectations - Management refrained from providing specific multi-year guidance on CAC but emphasized ongoing efficiency improvements [83][85][88] Question: Differentiation against competitors in a stable market - Management highlighted targeted marketing and the ability to provide peace of mind to consumers as key differentiators [97][102][104] Question: Success of e-TeleQuote and its application to core business - Management explained that learnings from the core business were applied to enhance e-TeleQuote's performance [106][108] Question: Changes in LTV model assumptions - Management clarified that LTV assumptions are based on historical data and not overly reactive to current market conditions [112][115] Question: Opportunities to expand beyond Medicare Advantage - Management expressed openness to exploring new populations or products if they align with the company's capabilities and consumer needs [120][123]

Financial Data and Key Metrics Changes - For Q4 2024, Medicare Advantage (MA) membership increased by 36% year-over-year to 527,000 members, driven by the expansion of the '24 partner class and 4.1% same geography growth [10][30] - Total revenue grew by 44% to $1.52 billion for the quarter and $6.06 billion for the year, primarily driven by the class of '24 and organic growth in existing classes [11][31] - Adjusted EBITDA was negative $84 million for the quarter and negative $154 million for the year, reflecting elevated medical cost trends and unfavorable prior year development [12][37] Business Line Data and Key Metrics Changes - ACO model membership reached 132,000 members, representing a 48% year-over-year growth [30] - Medical margin for Q4 2024 was $1 million, compared to a negative margin of $102 million in Q4 2023, while the full year 2024 medical margin was $205 million compared to $299 million in 2023 [34] - Medical expenses for Q4 2024 increased by 31% to $1.52 billion, driven by the expansion of the 2024 class and elevated cost trends [32] Market Data and Key Metrics Changes - The company anticipates a full-year MA membership decline of approximately 4% or 22,000 members for 2025, projecting a range of 490,000 to 520,000 members [14] - Revenue for 2025 is forecasted to decline by 2% to $5.925 billion, driven by the anticipated membership decline [15] Company Strategy and Development Direction - The company aims to be cash flow breakeven by 2027, focusing on reducing underwriting exposure to costs outside its control and pursuing profitable growth [7][8] - Strategic decisions include constraining 2025 MA membership to balance near-term risks and opportunities, while enhancing clinical and operational capabilities [13][21] - The company is investing in clinical programs to improve quality outcomes and reduce medical costs, leveraging technology and data analytics [22][23] Management's Comments on Operating Environment and Future Outlook - Management acknowledges a challenging macro environment for 2025 but expresses optimism for a more favorable overall environment in 2026 and beyond [9][24] - The recent favorable trends in payor bids and the 2026 advanced notice from CMS are seen as positive signals for future performance [25][28] Other Important Information - The company has exited two unprofitable partnerships and improved back-end processes to enhance visibility and reduce volatility around risk adjustment and medical costs [27] - Cash and marketable securities at the end of Q4 2024 were $406 million, with an expected cash use of approximately $110 million for 2025 [39][50] Q&A Session Summary Question: Changes to Part D and its impact on P&L - Management explained that they have reduced Part D risk to less than 30% of membership, which reflects a successful strategy to manage costs [56][57] - Part D continues to be a loss, and the company has doubled the PMPM loss for 2025 based on anticipated increases from the Inflation Reduction Act [59][60] Question: Year 1 performance expectations - The class of '24 performed strongly, while the class of '25 is smaller with a focus on measured growth and a care management fee structure [63][64] Question: Medical cost trend guidance - Management confirmed that the 50 basis point estimate for the 2 Midnight rule is incorporated into the 2025 guidance, and supplemental benefits are expected to decrease due to payor adjustments [72][73] Question: ACO REACH impact - The company is exiting an underperforming MSSP contract, which had a significant negative impact on profitability [79] Question: Working capital improvements - Management highlighted disciplined cash management and successful partnership exits as key factors improving cash flow [85][88] Question: Visibility on initiatives to improve medical margin - Management expressed confidence in initiatives aimed at improving quality performance and clinical management, which are expected to offset revenue and cost challenges [92][96] Question: 2026 MA advance notice - Management is encouraged by the advance notice but emphasizes the need for rates to catch up with increased costs in Medicare Advantage [101][102]

agilon health, inc. (NYSE:AGL) Q4 2024 Earnings Conference Call February 25, 2025 4:30 PM ET Company Participants Evan Smith - Senior Vice President of Investor Relations Steven Sell - Chief Executive Officer Jeffrey Schwaneke - Chief Financial Officer Conference Call Participants Stephen Baxter - Wells Fargo Justin Lake - Wolfe Research Jack Slevin - Jefferies Ryan Langston - TD Cowen Amir Farahani - Bernstein Jailendra Singh - Truist Securities Michael Ha - Baird Elizabeth Anderson - Evercore Adam Ron - B ...

Core Points - Medicare open enrollment occurs from October 15 to December 7, allowing over 66 million Americans to make changes to their coverage for the upcoming year [1][2] - This period is crucial as it is the only time beneficiaries can alter their coverage unless they qualify for a special enrollment period [2][18] Enrollment Details - During the open enrollment, beneficiaries should review materials regarding eligibility and plan changes, typically titled "Evidence of Coverage" (EOC) or "Annual Notice of Change" (ANOC) [3] - Beneficiaries can switch between traditional Medicare and Medicare Advantage plans, enroll in a Medicare Part D plan, or change their existing Part D plan [7] Medicare Plan Types - Traditional Medicare covers hospital stays (Part A) and doctor visits (Part B), with most beneficiaries not paying premiums for Part A but incurring costs for Part B and other services [4][5] - Medicare Advantage plans, offered by private insurers, bundle various Medicare parts and often include additional benefits like dental and vision coverage, but may limit provider choices [6] Future Changes - Starting in 2026, out-of-pocket costs for prescriptions under Medicare's drug plan will be capped at $2,100, with the maximum Part D deductible increasing from $590 to $615 [9] Coverage Components - Medicare consists of several parts: Part A covers inpatient care, Part B covers medically necessary services, Part C is Medicare Advantage, and Part D covers prescription drugs [10][11][12][13][14] - Standard Medicare does not cover certain services such as routine eye exams, dental care, and cosmetic surgery [15] Special Enrollment and Initial Enrollment - Special enrollment periods may apply for beneficiaries who experience specific life changes, such as moving or losing employer-sponsored coverage [18] - New Medicare enrollees have an initial enrollment period that spans three months before and after their 65th birthday [19] Government Shutdown Impact - Medicare open enrollment for 2026 will proceed as scheduled despite a federal government shutdown, with benefits and coverage remaining unaffected [20][21]