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UnitedHealth to Curtail Medicare Advantage Costs: Margin Boost Ahead?
ZACKSยท 2025-06-03 15:31
Core Insights - UnitedHealth Group's new CEO, Steve Hemsley, issued an apology to investors after the company reported its first earnings miss in nearly 20 years, primarily due to high medical costs in the Medicare Advantage segment, leading to the suspension of full-year guidance [1][8] - The medical care ratio increased to 84.8% in Q1 2025 from 84.3% the previous year, with expectations for it to rise to 87.8% for the full year [2] - The Department of Justice is investigating billing practices at UnitedHealth's Optum related to Medicare Advantage, prompting Hemsley to commit to higher care-cost assumptions in future pricing [3] Financial Performance - Medical costs surged by 11.7% in Q1 2025, following a 9.2% increase in 2024, with projections indicating a growth of over 16% in 2025 [2] - UnitedHealth's shares have declined by 39.8% year-to-date, compared to a 29.1% drop in the industry [7][8] - The Zacks Consensus Estimate for UnitedHealth's 2025 earnings suggests a 17.3% decline from the previous year [11] Operational Changes - Hemsley has initiated a comprehensive review of the company's operations, focusing on Medicare Advantage risk adjustment and pharmacy benefit management, with the involvement of external experts [4] - Despite challenges, Medicare Advantage membership grew by 6.3% in Q1 2025, with expectations for a 9.2% increase for the full year [4] Industry Context - Competitors like Humana and Elevance Health are also facing rising benefit expenses, with Humana's expenses increasing by 13.9% in 2024 and 5.6% in Q1 2025, while Elevance's expenses rose by 2.6% in 2024 and 15.6% in Q1 2025 [5] - Humana's Medicare Advantage memberships declined by 6% in Q1, while Elevance's memberships increased by 11.8% in the same period [6] Valuation Metrics - UnitedHealth trades at a forward price-to-earnings ratio of 12.42, above the industry average but below its five-year median of 19.20 [10] - The stock currently holds a Zacks Rank of 5 (Strong Sell) [13]