Don't assume that all will go smoothly.At this point, there are only a couple more weeks left in Medicare's fall open enrollment period. So if you're looking to make changes to your coverage, now's the time to get moving.One thing you may be considering is moving off of original Medicare, dumping your Part D drug plan, and signing up for an all-in-one Medicare Advantage plan. And there are certain perks you might enjoy if you sign up for Medicare Advantage. Not only do Medicare Advantage plans limit your an ...

Key Takeaways CVS Aetna is rolling out a generative AI assistant to streamline benefits navigation for members.CVS Aetna's tool embeds AI across digital channels to deliver fast, personalized and easy-to-digest answers.CVS Aetna's beta launch expands through 2026, adding proactive insights and multimodal interaction support.CVS Health (CVS) Aetna’s latest offering aligns with its strategic efforts to move away from the transactional approach to health care to a consumer health experience. The company is rol ...

CANADA - 2025/10/01: In this photo illustration, the UnitedHealth Group (United Health) logo is seen displayed on a smartphone screen. (Photo Illustration by Thomas Fuller/SOPA Images/LightRocket via Getty Images)SOPA Images/LightRocket via Getty ImagesUnitedHealth stock (NYSE: UNH) has faced significant pressure this year, creating a potential setup for a major rally.Currently, UNH stock is down 36% year-to-date, driven by several challenges, including margin compression. However, this weakness should be v ...

Stonegate Capital Partners Updates Coverage on GoHealth Inc. (GOCO) 2025 Q3November 17, 2025 9:52 AM EST | Source: Reportable, Inc. Dallas, Texas--(Newsfile Corp. - November 17, 2025) - GoHealth Inc. (NASDAQ: GOCO): Stonegate Capital Partners updates their coverage on GoHealth Inc. (NASDAQ: GOCO). GoHealth, Inc. reported a difficult 3Q25 as the Company continued to navigate a materially different Medicare Advantage environment. Net revenues declined to $34.2M from $118.3M a year ago, reflectin ...

Your plan may deny you some care that original Medicare might have covered. (About 6.4% of prior authorization requests in 2022 were denied, though many decisions were reversed on appeal, per a Kaiser Family Foundation report.)Medicare Advantage plans are rated for quality, so you can shop for the best plans near you.Your out-of-pocket spending will be capped. The 2026 limit is $9,250 for in-network expenses (excluding drugs) or $14,750 if your plan allows you to see some out-of-network providers. Some plan ...

Financial Data and Key Metrics Changes - GoHealth reported a cash balance of approximately $32 million at the end of Q3 2025, with access to an additional $40 million from a new super-priority term loan facility [44][47]. - The company emphasized cash management and maintaining liquidity to support operations and strategic opportunities [45][48]. Business Line Data and Key Metrics Changes - The company shifted focus from Medicare Advantage (MA) to GoHealth Protect, prioritizing retention and stable member profiles over volume growth due to tightening health plan economics [5][9]. - GoHealth Protect has been instrumental in retaining business, with a strategy to enhance consumer peace of mind through complementary product offerings [19][20]. Market Data and Key Metrics Changes - The Medicare Advantage market is experiencing strong demand, but health plans are prioritizing retention and stable member profiles rather than broad expansion [5][9]. - The total available non-special needs plan products are declining for 2026, while special needs plan options are increasing, indicating a shift in industry priorities [9]. Company Strategy and Development Direction - The company is focusing on quality over quantity, retention over short-term submissions, and cash preservation to maintain strategic flexibility [7][8]. - GoHealth aims to lead consolidation in a fragmented broker landscape, leveraging its strong balance sheet and governance structure to create long-term value [10][11]. Management's Comments on Operating Environment and Future Outlook - Management believes that the current actions taken by health plans are justified and prudent, reflecting a focus on retention and quality [6][9]. - The company expects the Medicare Advantage market to stabilize over the next 12-24 months, allowing for potential revenue growth with improved margins and cash profiles [12][17]. Other Important Information - GoHealth has retained its highest-quality agents and adjusted compensation structures to reinforce retention strategies [8][53]. - The company has invested in AI and automation to improve agent effectiveness and consumer experience [8][58]. Q&A Session Summary Question: What is the growth trajectory for Medicare Advantage over the next 12 to 24 months? - Management indicated that growth will depend on health plans stabilizing their cost structures and focusing on retention, with expectations for a return to growth as the market rationalizes [15][17]. Question: Can you discuss the key drivers of growth for GoHealth Protect? - The growth of GoHealth Protect is driven by enhancing consumer peace of mind and serving both existing and new customers effectively [19][20]. Question: Why did the company decide to pull back on Medicare Advantage? - The decision was based on feedback from health plans prioritizing retention and stability over new enrollments, as well as the need to focus on existing members [25][26]. Question: What are the implications of the company's current strategy if the market conditions change? - If the assessment proves correct, the company retains its capabilities and cash position, but if wrong, it may need to ramp up operations quickly [28][30]. Question: Why should the industry consolidate, and how is GoHealth positioned to lead? - The company believes that consolidation can reduce duplicative costs and enhance efficiency, positioning GoHealth as a leader due to its strong consumer base and technology investments [31][32].

Core Insights - Humana Inc. is a health and well-being company with a market cap of $29.3 billion, providing various insurance services and clinical-care operations [1] Performance Overview - Humana's stock has underperformed the broader market, declining 13.1% over the past 52 weeks, while the S&P 500 Index gained 14.1%. Year-to-date, the stock is down 4.1%, compared to the S&P 500's 16.4% return [2] - The company has also lagged behind the iShares U.S. Healthcare ETF, which saw an 8.8% rise year-to-date [3] Earnings Report - On November 5, shares of Humana fell 6% following its Q3 earnings release, despite better-than-expected results. Adjusted revenue was $32.6 billion, and adjusted EPS was $3.24, both surpassing consensus estimates. The top line increased by 11.4% year-over-year, but the bottom line decreased by 22.1%, raising concerns about profitability [4] Analyst Expectations - For the current fiscal year ending in December, analysts project Humana's EPS to grow by 5.4% year-over-year to $17.08. The company's earnings surprise history is mixed, with three out of the last four quarters exceeding estimates [5] - Among 27 analysts covering the stock, the consensus rating is a "Moderate Buy," with seven "Strong Buy," two "Moderate Buy," 17 "Hold," and one "Strong Sell" rating [5] Price Target Adjustments - Truist Financial Corporation maintained a "Hold" rating on Humana but lowered its price target to $285, indicating a potential upside of 16.3% from current levels [6]

Financial Data and Key Metrics Changes - Total revenue for Q3 2025 was approximately $53.9 million, down 8% year-over-year [14] - GAAP net loss improved to $31.7 million from $42.5 million, and adjusted EBITDA loss was $34 million, an improvement from a loss of $34.8 million last year [15] - Positive net adjustment revenue (TEL revenue) for Q3 was $12.1 million, compared to $1.1 million last year, contributing to improved profitability [15][17] Business Line Data and Key Metrics Changes - Medicare segment revenue was $49.9 million, down from $53.2 million, reflecting lower enrollment volume but partially offset by TEL revenue [15] - Total Medicare applications declined by 26%, attributed to the impact of new dual-eligible enrollment rules [15] - Employer and individual segment revenue was $3.9 million, down from $5.2 million, due to shifts in market dynamics and reduced marketing spend [17] Market Data and Key Metrics Changes - The company noted a solid year-over-year increase in commission rates, indicating strong relationships with carriers [7] - The overall Medicare Advantage membership is expected to decline by about 3%, but long-term growth is anticipated as Medicare Advantage is projected to represent a larger percentage of total Medicare by 2030 [38] Company Strategy and Development Direction - The company is focused on executing the Annual Enrollment Period (AEP) effectively and is well-prepared compared to competitors [5] - Plans to refresh three-year financial targets and enhance capital structure were mentioned, including extending the maturity of a term loan [5][19] - The company aims to leverage its technology and AI capabilities to improve operational efficiencies and consumer experience [10][12] Management's Comments on Operating Environment and Future Outlook - Management expressed confidence in the strategic decisions made to prepare for elevated consumer activity during AEP [14] - The company raised its 2025 GAAP net income and adjusted EBITDA guidance ranges, reflecting strong performance through Q3 [12][21] - Management emphasized the importance of member retention and the effectiveness of new initiatives aimed at improving engagement [16][31] Other Important Information - The company ended Q3 with $75.3 million in cash and equivalents, down from $105.2 million last year [18] - Operating cash flow was negative $25.3 million, an improvement from negative $29.3 million last year [18] Q&A Session Summary Question: Can you discuss the disruption relative to AEP and its implications? - Management noted that similar levels of demand year-over-year are tied to carrier disruption, with results aligning with expectations so far [24][25] Question: What does being opportunistic during AEP look like? - The company is focusing on investing in marketing channels with better economics and higher LTV to CAC ratios [26][28] Question: How is retention being improved? - Management highlighted increased outbound calls and investments in brand and retention initiatives, leading to improved retention metrics [30][31] Question: Are the current enrollments commissionable? - Management confirmed that the enrollments are in commissionable plans, expecting to receive commissions on the production [41] Question: What are the expectations for tail revenue and adjusted EBITDA? - Management explained the increase in tail revenue guidance and its relationship to overall revenue expectations, indicating potential upside in Q4 [45]

Financial Performance - Q3 2025 total revenue was $53.9 million, a decrease of 8% year-over-year (YoY)[7] - Q3 2025 GAAP net loss improved to $31.7 million, compared to a $42.5 million loss a year ago[7] - Q3 2025 adjusted EBITDA was $(34.0) million, compared to $(34.8) million a year ago[7] - Q3 2025 operating cash flow was $(25.3) million, compared to $(29.3) million a year ago[7] - As of September 30, 2025, cash, cash equivalents, and marketable securities totaled $75.3 million, and commissions receivable balance was $907.7 million[7] Medicare Segment - Medicare segment revenue declined 6% YoY to $49.9 million, primarily due to lower enrollments[14, 16] - Medicare submissions decreased by 36% YoY, from 55,518 to 40,921[16] - Total acquisition cost per MA-equivalent approved member increased 19% YoY, from $1,256 to $1,489[15, 16] - Medicare segment gross loss improved from $(5.6) million to $(1.2) million[16] Guidance - The company updated its FY 2025 adjusted EBITDA guidance range to $60 million - $80 million and GAAP Net Income to $9 million - $30 million[21] - The updated guidance includes an estimate for positive net adjustment revenue in the range of $40 million to $43 million, compared to the prior range of $29 million to $32 million[20]

Core Insights - Humana Inc. expects a smaller decline in full-year individual Medicare Advantage membership than previously projected, but has reduced its unadjusted profit forecast due to high medical costs [1][2] Membership Projections - The company projects a decline of approximately 425,000 members in its Medicare Advantage business for the fiscal year, an improvement from the prior estimate of up to 500,000, attributed to stronger retention and robust sales [2] Quality Ratings and Financial Impact - About 20% of Humana's members, or roughly 1.2 million, are enrolled in Medicare Advantage plans rated four stars or higher for 2026, with 14% in 4.5-star plans, a significant increase from 3% the previous year [3] - A U.S. court ruling rejected Humana's challenge to 2025 plan ratings from the Centers for Medicare & Medicaid Services (CMS), which may negatively impact future government bonus payments [4] - The company anticipates a "significant decline" in higher-rated plans in 2025, warning that failure to overturn the ruling could reduce its 2026 CMS quality bonus payments, affecting revenue, operating results, and cash flow [5] Financial Performance - Humana reported a third-quarter medical cost ratio of 91.1%, an increase from 89.9% a year ago, but within expectations, facing ongoing cost pressures from higher utilization in government-backed programs [5] - Adjusted earnings were $3.24 per share, exceeding estimates, while revenue reached $32.65 billion. The company now expects unadjusted earnings of about $12.26 per share, down from $13.77 previously, while reaffirming adjusted EPS guidance of around $17.00 [6]