Medical Cost Trends

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UnitedHealth's Misdiagnosis: Can Berkshire's Bet Spark a Recovery?
ZACKS· 2025-08-26 16:06
Core Insights - UnitedHealth Group Incorporated (UNH) is facing significant pressure due to underestimating medical cost trends, leading to eroded margins and investor concerns [1][2] - Medical costs increased nearly 16% in the first half of 2025, following a 9.2% rise in 2024, with the cost ratio climbing from 83.2% in 2023 to an expected 89.4% by year-end 2025 [1][7] - The company has revised its EPS outlook down to at least $16, with earnings growth not anticipated until 2026 [2][7] Financial Performance - UNH missed earnings estimates in both quarters of 2025 and has seen a significant drop in its EPS outlook from $26–$26.50 to at least $16 [2][7] - The Zacks Consensus Estimate for 2025 earnings is projected at $16.21 per share, indicating a 41.4% decline from the previous year [10] Market Reaction - Despite the turmoil, Warren Buffett's Berkshire Hathaway purchased over 5 million shares of UNH, valued at approximately $1.57 billion, which spurred additional buying from other investors [3] - UNH shares are down 39.7% year-to-date, which is a steeper decline compared to the industry average of 30.8% [6][7] Industry Context - Peers such as Centene Corporation (CNC) and Elevance Health, Inc. (ELV) are also experiencing challenges due to rising medical costs, leading to significant cuts in their earnings guidance for 2025 [5] - Centene has reduced its adjusted EPS outlook to $1.75 from $7.25, while Elevance has lowered its forecast to $30 from a previous range of $34.15–$34.85 [5] Valuation Metrics - UNH currently trades at a forward price-to-earnings ratio of 17.87, above the industry average of 14.96 [9] - The stock carries a Zacks Rank 5 (Strong Sell), reflecting the current market sentiment [13]
When 90% Isn't an A+: Elevance's Cost Crunch and Carelon's Cushion
ZACKS· 2025-08-13 15:06
Core Insights - Elevance Health, Inc. is facing challenges from rising medical costs, slower Medicaid recovery, and increased utilization, leading to a reduced outlook for 2025 [1][5] - The company reported a significant increase in benefits expenses and cost of products sold in the first half of the year [1] Financial Performance - Benefits expense surged nearly 18% to over $72 billion, while cost of products sold increased almost 19% to $10.3 billion [1] - The second-quarter benefit expense ratio reached 88.9%, up 260 basis points year over year, with a projected full-year ratio of about 90% compared to 88.5% in 2024 [2][9] Membership and Growth - Commercial individual memberships rose 9.7% in the first half of 2025, following a 25.6% increase in 2024, indicating strong growth in the commercial segment [3][9] - Carelon's revenue is expected to grow nearly 30% in 2025, driven by a 60% surge in Carelon Services [4][9] Competitive Landscape - Other companies in the health benefits space, such as UnitedHealth Group and Centene Corporation, are also experiencing pressure from rising medical costs [6] - UnitedHealth's medical care ratio deteriorated to 89.4%, while Centene's health benefits ratio reached 93%, indicating industry-wide challenges [7] Valuation and Estimates - Elevance's shares have declined 20.7% year-to-date, compared to a 3.9% decline in the industry [8] - The forward price-to-earnings ratio for Elevance is 9.19, significantly lower than the industry average of 14.57, with a Zacks Consensus Estimate for 2025 earnings at $30.59 per share, reflecting a 7.4% decline from the previous year [10][11]
CVS Health's MBR Improves: Can It Sustain Amid Elevated Cost Trends?
ZACKS· 2025-06-12 13:06
Core Insights - CVS Health's medical benefit ratio (MBR) improved to 87.3% in Q1 2025, a 310 basis point increase year over year, driven by favorable reserve development and stronger Medicare performance [1][9] - The company recorded a $431 million premium deficiency reserve (PDR) for expected losses in the individual exchange business, which will be exited in 2026, raising the MBR by approximately 130 basis points [1][9] - CVS anticipates a full-year MBR of approximately 91.3%, slightly better than its previous forecast of 91.5%, with expectations of stabilization in medical cost trends [4][9] Industry Trends - Elevated medical cost trends persisted across the industry, with major health insurers like UnitedHealth Group and Elevance Health experiencing similar dynamics [2][3] - UnitedHealth Group's medical care ratio rose by 50 basis points year over year to 84.8%, reflecting increased care activity in its Medicare Advantage business [2] - Elevance Health reported a benefit expense ratio of 86.4%, up 80 basis points year over year, primarily due to Medicaid rates not keeping pace with medical cost trends [3] Valuation and Performance - CVS Health shares have increased by 9.6% over the past year, contrasting with an 18.5% decline in the industry [7] - The company is trading at a forward 12-month price-to-earnings ratio of 10.12X, compared to the industry average of 14.60X, indicating a favorable valuation [8]