The rise in Medicare premiums and deductibles will be offset by a cap on drug prices. The Inflation Reduction Act of 2022, championed by then-President Joe Biden, places a $2,000 annual cap on overall prescription drug costs, representing potentially huge savings for retirees.If you have a high-deductible health plan, you likely have access to a health savings account. Take full advantage of it. In 2026, HSA contribution limits are $4,400 for individuals and $8,750 for family coverage, with an extra $1,000 ...

North America Equity Research December 2025 Healthcare Services 2026 Outlook: It's Different This Time: Potential for Margin Improvement and Policy Clarity Create a Positive Backdrop Conference Call Details Tuesday, December 17 @ 10:00am ET / 15:00 UK Dial-in Info: Please contact us or your JPM salesperson for details Replay Info: Available approximately 2-3 hours after the call ends Healthcare Services Lisa C. Gill AC (212) 622-6466 lisa.c.gill@jpmorgan.com Bloomberg JPMA GILL J.P. Morgan Securities LLC Ma ...

Key Takeaways Managed care stocks were pressured by high utilization, but pricing and cost trends are now stabilizing.UNH benefits from scale and Optum integration as margins normalize after earlier medical cost pressure.CVS and CNC show improving execution as pricing discipline and enrollment trends support 2026 earnings.The overall healthcare sector entered 2025 on shaky ground. Managed care stocks, especially HMOs, were weighed down by stubbornly high medical utilization, tighter reimbursement assumption ...

Core Viewpoint - The U.S. health insurance industry, particularly Health Maintenance Organizations (HMOs), is leveraging strategic mergers and acquisitions along with technological innovations to enhance market presence and competitiveness despite rising medical costs and regulatory pressures [1][3]. Industry Overview - The HMO industry includes entities that provide basic and supplemental health services, assuming risks and assigning premiums to health insurance policies [4]. - Services are typically offered through a network of approved care providers, with exceptions for emergencies [5]. Current Trends - Rising medical expenses are driven by deferred care, chronic disease management, and increasing costs of specialty drugs, leading to higher healthcare utilization and insurance claims [6][7]. - Demographic trends, such as an aging population and increased chronic illnesses, are intensifying long-term cost pressures, straining the Health Benefit Ratio and compressing profit margins [7]. - Regulatory challenges are significant, with proposals potentially reducing federal Medicaid funding and altering Medicare Advantage payment rates, creating uncertainty for health insurers [8][9]. - The ongoing shortage of healthcare professionals, particularly nurses, is impacting hospital operations and the quality of care provided by HMOs [11][12]. Strategic Focus - HMOs are increasingly engaging in mergers and acquisitions to enhance capabilities and market reach, supported by favorable interest rates from the Federal Reserve [13][14]. - The anticipated Medicare Advantage rate increases in 2026 may provide some margin support for insurers [10]. Industry Performance - The Zacks Medical-HMO industry has underperformed, declining 25.8% over the past year compared to the S&P 500's growth of 2.4% [18]. - The industry is currently trading at a forward 12-month price-to-earnings (P/E) ratio of 16.04X, lower than the S&P 500's 23.35X and the sector's 20.92X [19]. Company Highlights - **UnitedHealth Group**: Driven by strong performances in its UnitedHealthcare and Optum segments, with a consensus estimate for 2025 earnings at $16.29 per share, indicating an 11.9% revenue growth [21][22]. - **Humana**: Steady growth supported by rising premiums and an expanding membership base, with a 2025 earnings estimate of $17.08 per share, reflecting a 5.4% increase from 2024 [23][24]. - **Centene**: Revenue growth fueled by its Medicare and Medicaid businesses, with a 2025 earnings estimate of $2.00 per share, indicating an 18.5% growth from 2024 [25][26].

Company Overview - Molina Healthcare, Inc. (MOH) has a market cap of $8.7 billion and provides managed healthcare services to low-income individuals and families through Medicaid, Medicare, and state insurance marketplace programs [1] - The company operates in four key segments: Medicaid, Medicare, Marketplace, and Other [1] Stock Performance - MOH shares have dropped 55.4% from their 52-week high of $359.97 and decreased 10.4% over the past three months, underperforming the Dow Jones Industrials Average, which rose by 5.6% during the same period [2] - Year-to-date, MOH stock is down 44.9%, lagging behind the Dow's nearly 13% gain, and has dipped 46.2% over the past 52 weeks compared to the Dow's 8.6% increase [3] Recent Financial Results - Following the Q3 2025 results on October 22, MOH shares tumbled 17.5% as adjusted EPS fell to $1.84 from $6.01 due to elevated medical costs, with about half of the underperformance attributed to the Marketplace segment [4] - The company has revised its full-year 2025 adjusted profit forecast to approximately $14 per share, citing ongoing pressure from higher-than-expected healthcare utilization, particularly in Medicare and Marketplace plans [4] Competitive Landscape - In comparison, rival CVS Health Corporation (CVS) has significantly outperformed MOH, with CVS stock surging 75.9% year-to-date and 43.2% over the past 52 weeks [5] - Analysts remain cautious about MOH's prospects, with a consensus rating of "Hold" from 18 analysts and a mean price target of $170, representing a 5.9% premium to current levels [5]

Molina Healthcare is trading near multi-year lows, yet Cobalt Capital moved in with a position large enough to make MOH a top-four holding. For shareholders trying to understand whether this downturn represents structural erosion or cyclical noise, this move offers a revealing clue.COBALT Capital Management disclosed a new position in Molina Healthcare (MOH +2.13%) on November 13, 2025, acquiring 115,000 shares valued at $22,006,400. Its net position change estimated at $22,006,400. The position accounts fo ...

Core Insights - Medicaid and CHIP are essential federal programs aimed at providing healthcare coverage for children in low-income families, with distinct structures and coverage options [2][3][9]. Medicaid Overview - Medicaid was established in 1965 to provide health coverage for families with dependent children living below the federal poverty line (FPL), initially covering children up to 133% of FPL, later expanded to 138% under the Affordable Care Act (ACA) [5][8]. - Medicaid mandates coverage for a wide range of services, including check-ups, hospital visits, and dental care, and also covers adults [6][13]. CHIP Overview - CHIP was created in 1997 to extend Medicaid coverage to low-income children who do not qualify for Medicaid but cannot afford private insurance [9][11]. - The program simplifies the enrollment process and covers more children, although its coverage options are more limited compared to Medicaid [10][11]. Key Differences - Medicaid has over 76 million enrollees, while CHIP has around 6 million, indicating Medicaid's larger scope [13]. - Medicaid provides coverage for adults, while CHIP is exclusively for children [13]. - The federal matching funds for CHIP are higher (71%) compared to Medicaid (56%), but CHIP has capped matching funds, unlike Medicaid [15]. Coverage Requirements - Medicaid has comprehensive coverage requirements, including Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) services, while CHIP has more flexibility in its coverage design [16]. - States can impose premiums and cost-sharing under CHIP, but Medicaid does not allow this for mandatory coverage [17]. Application Process - Eligibility for Medicaid and CHIP can be determined using an income calculator on healthcare.gov, and applications can be submitted through the Health Insurance Marketplace or state Medicaid agencies [19][20][21]. - Teenagers up to age 19 are eligible for coverage, but application is still required regardless of age [22]. Coverage Details - Both programs provide comprehensive coverage for children, including routine check-ups, prescriptions, and emergency services, though specific benefits may vary by state [24].

Core Insights - Ariel Global Fund's third-quarter 2025 performance was influenced by global equity rallies, AI enthusiasm, resilient corporate earnings, and the first U.S. rate cut of the year, with the fund returning +4.99% compared to +7.62% for the MSCI ACWI Index [1] Group 1: Fund Performance - The Ariel Global Fund traded +4.99% higher in Q3 2025, underperforming the MSCI ACWI Index which returned +7.62% and the MSCI ACWI Value Index which returned +6.13% [1] - The fund's performance was driven by factors such as AI enthusiasm and targeted policy easing across key regions [1] Group 2: Humana Inc. (NYSE:HUM) Overview - Humana Inc. offers medical and specialty insurance products, with a one-month return of -18.64% and a 52-week loss of 20.37%, closing at $234.10 per share with a market capitalization of $28.156 billion on November 18, 2025 [2] - The fund initiated a position in Humana, focusing on its Medicare Advantage, Medicaid, and specialty healthcare services [3] Group 3: Humana Inc. Performance and Outlook - Humana's largest Medicare Advantage plan, H5216, was downgraded from 4.5 to 3.5 Stars in 2025, affecting eligibility for federal bonus payments in 2026 [3] - There is optimism regarding Humana's potential to regain a higher Star rating in 2027, which could restore access to quality-based federal bonuses [3] Group 4: Hedge Fund Interest - Humana Inc. was held by 69 hedge fund portfolios at the end of Q2 2025, a decrease from 73 in the previous quarter [4] - While Humana is recognized for its investment potential, certain AI stocks are viewed as having greater upside potential and less downside risk [4]

Centene Corporation Conference Call Summary Company Overview - **Company**: Centene Corporation (NYSE:CNC) - **Date of Conference**: November 11, 2025 - **Speakers**: Sarah London (CEO), Drew Asher (CFO) Key Points Industry Context - Centene operates primarily in the healthcare services sector, focusing on government-sponsored programs such as Medicaid and Medicare. Financial Performance - Q3 results exceeded expectations, leading to an upward revision of the full-year outlook to at least $2 per share [4][7] - The company reported a revenue stream of approximately $5 billion from the Florida Medicaid contract, which is expected to decrease to between $4.5 billion and $9.3 billion next year due to contract changes [8][9] Medicaid Updates - Centene was not awarded the CMS Florida contract after six years, impacting their revenue but allowing for a focus on sustainable margins [5][8] - The company is prioritizing a seamless transition for affected members and is not planning to protest the contract decision [5] - Medicaid margins are expected to remain consistent next year, contrasting with some peers who anticipate declines [15][36] Medicare and Marketplace Insights - Open enrollment for Medicare is ongoing, with a focus on margin improvement rather than membership growth [49][54] - The company is optimistic about its position in the Medicare Advantage market, aiming for break-even by 2027 [49] - There is an uptick in call volume related to Marketplace inquiries, indicating member confusion over premium changes [20][22] Legislative and Subsidy Discussions - Ongoing discussions in Congress regarding enhanced subsidies could significantly impact members and the overall market [24][25] - Centene has prepared for various scenarios regarding subsidy extensions and has built pricing for 2026 accordingly [26][30] Operational Strategies - The company is focused on improving margins through various levers, including rate negotiations and utilization management [15][17] - Centene is actively engaged with state governments to optimize Medicaid programs and address issues like fraud and waste [41][42] Future Outlook - The company sees potential for growth in Medicaid and is exploring disruptive opportunities in employer-sponsored insurance [59] - Centene aims to maintain a flexible capital structure, targeting a debt-to-capital ratio below 40% to seize future opportunities [58] Behavioral Health and Cost Management - Behavioral health accounts for approximately 20% of Medicaid spending, and states are increasingly focused on managing these costs [42][43] - Centene is working with states to implement effective policy changes to control costs while maintaining care quality [41] Conclusion - Centene is navigating a complex healthcare landscape with a focus on sustainable growth, margin improvement, and proactive engagement with legislative changes and state partnerships [59][60]

Core Insights - Long-term care costs, particularly for nursing homes, can significantly deplete retirement savings, with the national average cost for a semi-private room exceeding $94,000 per year [3] - Medicare offers limited coverage for nursing home stays, primarily for short-term rehabilitation, while Medicaid serves as a primary payer for long-term care, subject to strict financial eligibility criteria [4][3] - Medicaid eligibility is determined by income and asset limits, with individuals typically allowed no more than $2,000 in countable assets, and married couples having different asset retention rules [4][6] Medicaid Eligibility and Planning - Medicaid is a means-tested program, requiring individuals to meet specific income and asset thresholds to qualify for nursing home coverage [4][6] - Asset transfers to trusts or other entities can be strategies to qualify for Medicaid, but a five-year lookback period applies, scrutinizing any transfers made within that timeframe [7][8] - Proper planning, including the use of special trusts, home equity transfers, and annuities, can help protect assets from Medicaid spend-down requirements [8][9] Financial Advisory Role - Engaging a financial advisor is recommended for individuals planning for long-term care expenses, as they can provide guidance on eligibility strategies and asset protection [2][4][9]