America's largest insurer is making sweeping changes to its Medicare Advantage plans to improve profit margins. ...

Investor Presentation November 2025 LGTMs: Date: Peter K. LGTM 11.10.25 Legal (Karen / Peter R.) LGTM Disclaimer This presentation and the accompanying oral presentation include forward-looking statements, including, without limitation, statements regarding future events and Clover Health Investments, Corp.'s ("Clover Health," "we," "our," or "us") expectations regarding Adjusted EBITDA, Adjusted Net income from continuing operations, Adjusted SG&A, Adjusted SG&A as a percentage of revenue, Insurance BER, N ...

By Sriparna Roy and Sneha S K (Reuters) -Health insurer Humana's shares fell more than 7% after it did not provide performance commentary for 2026, disappointing investors even as it reported better-than-expected quarterly profit on higher revenues and in-line medical costs. The company did not provide membership or profit forecasts for 2026 in its quarterly results on Wednesday and at least two analysts said the lack of clarity on next year's performance could be weighing on sentiment. Lower quality ra ...

Core Insights - Humana reported a net income of $195 million for the third quarter, with medical cost trends aligning with previous forecasts [2][5] - The company is reaffirming its full year 2025 adjusted earnings per share outlook of approximately $17.00, supported by solid execution and results [6] Financial Performance - Humana's net income decreased to $195 million, or $1.62 per share, compared to $480 million, or $3.98 per share in the same quarter last year [5] - Revenue increased to $32.6 billion, up from $29.4 billion in the year-ago period [5] - The insurance segment benefit ratio was reported at 91.1%, consistent with guidance of just above 91% and an increase from 89.9% in the previous year [4] Medicare Advantage Plans - The company has been experiencing higher costs in its Medicare Advantage plans, which are a significant part of its business [3] - Humana's Medicare Advantage enrollment reached over 5.2 million individuals, with a projected decline of approximately 425,000 members for FY 2025, an improvement from earlier expectations [7] Growth in Healthcare Services - Humana's CenterWell healthcare services business reported growth of 56,600 patients, or nearly 15% [8] - CenterWell Pharmacy is driving strong growth across payor agnostic offerings, with increased specialty volumes and strong direct-to-consumer growth [8] Strategic Outlook - The company is confident in its strategy of prioritizing consumer needs, with solid year-to-date performance and strong momentum heading into the Annual Election Period [9][10]

Core Insights - Humana reported third-quarter profit exceeding Wall Street estimates, driven by higher premiums and medical costs aligned with expectations [1][4] - The health insurance industry has faced high costs due to increased healthcare service usage in government-backed plans [2] Company Performance - Humana anticipates a decline of approximately 425,000 members in its individual Medicare Advantage plans, an improvement from the previously expected loss of up to 500,000 members, attributed to stronger member retention and better sales [3] - The company expects most new members to enroll in higher-rated plans for 2026 [4] - Humana's quarterly medical cost ratio was 91.1%, consistent with its expectations of "just above 91%" and slightly above analysts' expectations of 90.90% [4] - The company reaffirmed its annual adjusted profit forecast of about $17 per share [4] - Adjusted quarterly profit was reported at $3.24 per share, surpassing estimates of $2.82 per share [5]

(Reuters) -Humana reported third-quarter profit that beat Wall Street estimates on Wednesday, on higher premiums. The company also reaffirmed its annual profit forecast of about $17 per share. "We feel positive about the direction we're headed and the value we are creating for our members, patients and investors," CEO Jim Rechtin said. Humana is one of the largest providers of Medicare Advantage plans, under which the U.S. government pays private insurers a set rate to manage healthcare for people 65 an ...

Financial Performance - 3Q25 Medicare Advantage membership increased by 35% year-over-year[8] - 3Q25 Insurance revenue increased by 49% year-over-year[8] - 3Q25 Adjusted EBITDA and Adjusted Net income were $2 million[8] - 3Q YTD Adjusted EBITDA was $45 million and Adjusted Net income was $44 million[8] - 3Q25 Adjusted SG&A as a % of Total revenues improved by 370 bps year-over-year[8] - Updated FY25 Guidance: Insurance Revenue is expected to be $1.85 billion - $1.88 billion[36], Adjusted SG&A is expected to be $325 million - $335 million[36], Adjusted EBITDA is expected to be $15 million - $30 million[36], and Average Medicare Advantage Membership is expected to be 106,000 - 108,000[36] Clinical Model and Technology - Clover Health's Medicare Advantage PPO plans received a score of 4.72 / 5 Stars on HEDIS Measures for Star Rating Year 2026[33] - Clover Assistant enables better care for patients from socioeconomically disadvantaged neighborhoods, with higher diagnosis rates of diabetes (75% higher), CKD (89% higher), CHF (89% higher) and COPD (70% higher)[29] Future Outlook - Clover Health expects to achieve FY26 GAAP Net income[8] - Clover Health is well-positioned for above-market growth & profitability expansion in 2026 & beyond[9]

DC_Studio/Envato Moneywise and Yahoo Finance LLC may earn commission or revenue through links in the content below. Turning 65 in the U.S. means finally being able to rely on Medicare covering most of your health expenses. But before you join the 67 million Americans enrolled in this program, it’s important to understand what’s covered and what’s not. If you have already been receiving Social Security benefits for at least four months when you turn 65, you’ll automatically be enrolled for Medicare Part ...

Financial Data and Key Metrics Changes - Health plan membership reached 229,600 members, reflecting a growth of approximately 26% year over year [4][12] - Total revenue for Q3 2025 was $994 million, an increase of approximately 44% year over year [4][12] - Adjusted gross profit was $127 million, up 58% year over year, resulting in a consolidated Medical Benefit Ratio (MBR) of 87.2%, an improvement of 120 basis points [4][12] - Adjusted SG&A ratio improved to 9.6%, also an improvement of 120 basis points year over year [4][12] - Adjusted EBITDA was $32 million, representing a margin of 3.3% and a 240 basis points expansion compared to Q3 2024 [14] Business Line Data and Key Metrics Changes - Inpatient admissions per thousand were in the low 140s, indicating effective risk management in Medicare Advantage [5][12] - Part D performance modestly outperformed expectations, with growth in utilization trends moderating sequentially [12] Market Data and Key Metrics Changes - 100% of health plan members are in plans rated four stars or above for rating year 2026, compared to a national average of approximately 63% [6][8] - The California HMO contract achieved a four-star rating for the ninth consecutive year, while competitors in the state have about 70% of members in plans rated four stars or higher [6][8] Company Strategy and Development Direction - The company is focused on investments in back office automation, clinical engagement, AVA AI clinical stratification, and STARS durability to differentiate from competitors [5][10] - The strategy for 2026 includes a balanced approach to membership growth and profitability, with expectations of at least 20% year-over-year growth [10][18] Management's Comments on Operating Environment and Future Outlook - Management expressed confidence in the ability to manage care effectively, which is crucial in a tightening reimbursement environment [76] - The company is well-positioned for growth despite industry disruptions and anticipates continued strong performance in 2026 [10][76] Other Important Information - The company raised its full-year guidance for adjusted EBITDA to $94 million at the midpoint, up from an initial guidance of $47.5 million [6][15] - Cash and cash equivalents at the end of Q3 were $644 million, positively impacted by the timing of medical expense payments [14] Q&A Session Summary Question: Insights on growth for 2026 and market share opportunities - Management is pleased with growth across California and other states, emphasizing strong provider networks and product mix [20][21] Question: Considerations for M&A or partnerships - The company is discerning in evaluating tuck-in opportunities for supplemental benefits, focusing on margin improvement with minimal execution risk [23][25] Question: Status of risk sharing with physicians in California - Approximately 65% to 70% of the business is in shared risk arrangements, with expectations for more shared risk in the future [28][29] Question: SG&A reinvestment details - SG&A was favorable in Q3, with investments aimed at automation and efficiency improvements across the organization [32][33] Question: Clarification on star ratings and underlying performance - The overall raw star rating score improved significantly, with management confident in the quality of care provided [36][38] Question: Brand investment strategy - The company is establishing a brand to reflect its commitment to quality Medicare Advantage services, aiming to change perceptions of MA [40][42] Question: Retention versus new member acquisition for 2026 - Both gross ads and retention rates are strong, with investments in member experience yielding positive results [45][46] Question: Management of Part D redesign - The company has maintained stability in benefits and is well-prepared for the competitive landscape in Part D [48][49] Question: Future competitive environment and market expansion - The company plans to explore new markets while ensuring that care management capabilities remain strong [80]

Alignment Healthcare Thursday reported its second consecutive profitable quarter as a publicly-traded company in part by managing medical expenses better than many of its rivals who sell Medicare Advantage coverage to older adults.Alignment HealthcareAlignment Healthcare reported its second consecutive profitable quarter as a publicly trade company in part by managing medical expenses better than many of its rivals who sell Medicare Advantage coverage to older adults. Alignment, which reported third quarter ...