US Market News
2月前
Elevance Health Reports First Quarter 2026 Results; Raises Full-Year GuidanceApril 22, 2026 6:00 AM
Business Wire
1Q 2026 operating revenue of $49.5 billion, up 1.5% from 1Q 2025
1Q 2026 diluted EPS1 of $8.00; adjusted diluted EPS2 of $12.58 driven by strong operating results and ~$1 per share of non-recurring investment income
FY 2026 diluted EPS1 guidance to be at least $19.85, including the Company's estimate of the financial impact for the CMS matter
FY 2026 adjusted diluted EPS2 guidance raised to at least $26.75, supported by underlying business strength, actions to reduce medical costs, and increased visibility
Reaffirm FY 2026 operating cash flow of at least $5.5 billion, inclusive of potential cash payments for the CMS matter
Returned $1.5 billion of capital to shareholders in 1Q 2026
Elevance Health, Inc. (NYSE: ELV) reported first quarter 2026 results ahead of expectations.
"Our first quarter results exceeded expectations, reflecting underlying business strength and improving claims experience. We are raising our full-year adjusted EPS guidance, supported by greater visibility into the balance of the year. Our actions are driving more consistent performance and position Elevance Health for continued improvement over time.”
Gail K. Boudreaux
President and Chief Executive Officer
1.
Earnings per diluted share ("EPS").
2.
Refer to GAAP reconciliation tables for reconciliation of GAAP to adjusted measures.
Elevance Health
Consolidated Enterprise Highlights
(Unaudited)
(In billions)
Three Months Ended
March 31, 2026
March 31, 2025
Operating Revenue1
$49.5
$48.8
Operating Gain1,2
$2.1
$3.2
Adjusted Operating Gain1,3
$3.2
$3.3
Operating Margin1
4.2 %
6.5 %
Adjusted Operating Margin1,3
6.5 %
6.7 %
1.
See “Basis of Presentation.”
2.
Operating Gain for the three months ended March 31, 2026, and March 31, 2025, include items that are excluded from adjusted shareholders' net income. See "GAAP Reconciliation."
3.
Adjusted Operating Gain for the three months ended March 31, 2026, and March 31, 2025, exclude items that are excluded from adjusted shareholders' net income. See "GAAP Reconciliation."
Operating revenue was $49.5 billion in the first quarter of 2026, an increase of $0.7 billion, or 1.5 percent compared to the prior year quarter. This was driven by higher premium yields in our Health Benefits segment and growth in CarelonRx product revenue, partially offset by anticipated declines in our Medicare Advantage, Medicaid, and Employer Group risk membership.
The benefit expense ratio was 86.8 percent, an increase of 40 basis points, reflecting expected elevated medical cost trend in our Medicaid business, partially offset by improved performance in Medicare. Days in Claims Payable stood at 46.6 days as of March 31, 2026, an increase of 5.3 days from December 31, 2025 and an increase of 3.8 days year over year.
The operating expense ratio of 12.8 percent included a $935 million accrual representing our current best estimate of the identified potential exposure related to the CMS notice. The Company also recorded a charge of $129 million related to business optimization as we simplify and enhance our organizational structure.
The adjusted operating expense ratio was 10.5 percent, a decrease of 20 basis points, driven by disciplined expense management. We are prioritizing targeted investments across clinical, operational, and administrative workflows to position the enterprise for long-term growth.
Cash Flow & Balance Sheet
Operating cash flow of $4.3 billion in the quarter increased $3.3 billion year over year, reflecting underlying business strength and favorable working capital dynamics. As of March 31, 2026, cash and investments at the parent company totaled approximately $2.2 billion.
During the first quarter of 2026, the Company repurchased 3.7 million shares of its common stock for $1.1 billion, at a weighted average price of $304.68, and paid a quarterly dividend of $1.72 per share, representing a distribution of cash totaling $376 million. As of March 31, 2026, the Company had approximately $5.6 billion of Board approved share repurchase authorization remaining.
Health Benefits is comprised of Individual, Employer Group risk-based, Employer Group fee-based, BlueCard®, Medicare, Medicaid, and Federal Employee Program businesses.
Health Benefits
Reportable Segment Highlights
(Unaudited)
(In billions)
Three Months Ended
March 31, 2026
March 31, 2025
Operating Revenue1
$42.5
$41.4
Operating Gain1
$2.2
$2.2
Operating Margin1
5.1 %
5.4 %
1.
See “Basis of Presentation.”
Health Benefits segment operating revenue was $42.5 billion in the first quarter of 2026, an increase of $1.1 billion, or 2.6 percent compared to the prior year quarter, driven primarily by higher premium yields, partially offset by anticipated declines in our Medicare Advantage, Medicaid, and Employer Group risk membership.
Operating gain totaled $2.2 billion, down 2.7 percent from the prior year. Growth in operating revenue was offset by anticipated higher medical costs, primarily in Medicaid.
Medical membership of approximately 45.4 million as of March 31, 2026 increased by 186 thousand from year-end 2025, driven by expansion of our commercial fee-based membership, partially offset by anticipated reductions in our Medicare Advantage and Employer Group risk membership as we took disciplined action to reposition these businesses for sustainable performance.
Carelon is comprised of CarelonRx and Carelon Services.
Carelon
Reportable Segment Highlights
(Unaudited)
(In billions)
Three Months Ended
March 31, 2026
March 31, 2025
Operating Revenue1
$18.0
$16.7
Operating Gain1
$1.1
$1.1
Operating Margin1
5.9 %
6.6 %
1.
See “Basis of Presentation.”
Operating revenue for Carelon was $18.0 billion in the first quarter of 2026, an increase of $1.3 billion, or 7.9 percent compared to the prior year quarter. Growth was driven by the scaling of Carelon Services risk-based solutions and CarelonRx product revenue.
Operating gain for Carelon totaled $1.1 billion, a decline of 3.8 percent year over year, reflecting the impact of lower health plan membership and continued investment in the expansion of risk-based capabilities in our Carelon Services business. These factors were partly offset by improved profitability in our specialty pharmacy and behavioral health businesses.
Quarterly Dividend
On April 21, 2026, the Audit Committee of the Company's Board of Directors declared a second quarter 2026 dividend to shareholders of $1.72 per share. The second quarter dividend is payable on June 25, 2026, to shareholders of record at the close of business on June 10, 2026.
About Elevance Health
Elevance Health is a lifetime, trusted health partner whose purpose is to improve the health of humanity. The company supports consumers, families, and communities across the entire healthcare journey – connecting them to the care, support, and resources they need to lead better lives. Elevance Health’s companies serve approximately 105 million consumers through a diverse portfolio of industry-leading medical, pharmacy, behavioral, clinical, home health, and complex care solutions. For more information, please visit www.elevancehealth.com or follow us @ElevanceHealth on X and Elevance Health on LinkedIn.
Conference Call and Webcast
Management will host a conference call and webcast today at 8:30 a.m. Eastern Daylight Time (“EDT”) to discuss the company’s first quarter results and outlook. The conference call should be accessed at least 15 minutes prior to the start of the call with the following numbers:
888-947-9963 (Domestic)
800-391-9853 (Domestic Replay)
312-470-0178 (International)
203-369-3269 (International Replay)
The access code for today's conference call is 3972058. There is no access code for the replay. The replay will be available from 11:30 a.m. EDT today, until the end of the day on May 22, 2026. The call will also be available through a live webcast at www.elevancehealth.com under the “Investors” link. A webcast replay will be available following the call.
Basis of Presentation
Operating revenue and operating gain/loss are the key measures used by management to evaluate performance in each of its reporting segments, allocate resources, set incentive compensation targets and to forecast future operating performance. Operating gain/loss is calculated as total operating revenue less benefit expense, cost of products sold and operating expense. It does not include net investment income, net gains/losses on financial instruments, interest expense, amortization of other intangible assets, gains/losses on extinguishment of debt or income taxes, as these items are managed in a corporate shared service environment and are not the responsibility of operating segment management. Refer to the GAAP reconciliation tables.
Operating margin is defined as operating gain divided by operating revenue.
Elevance Health
Earnings Release Financial Schedules and Supplementary Information
Quarter Ended March 31, 2026
Membership and Other Metrics
Quarterly Consolidated Statements of Income
Condensed Consolidated Balance Sheet
Condensed Consolidated Statement of Cash Flows
Supplemental Financial Information - Reportable Segments & Health Benefits Revenue Details
Supplemental Financial Information - Reconciliation of Medical Claims Payable
Reconciliation of Non-GAAP Financial Measures
Elevance Health
Membership and Other Metrics
(Unaudited)
Change from
Medical Membership (in thousands)
March 31,
2026
March 31,
2025
December 31,
2025
March 31,
2025
December 31,
2025
Individual
1,424
1,423
1,307
0.1
%
9.0
%
Employer Group Risk-Based
3,439
3,638
3,617
(5.5
)%
(4.9
)%
Commercial Risk-Based
4,863
5,061
4,924
(3.9
)%
(1.2
)%
BlueCard®
6,579
6,608
6,509
(0.4
)%
1.1
%
Employer Group Fee-Based
21,170
20,522
20,583
3.2
%
2.9
%
Commercial Fee-Based
27,749
27,130
27,092
2.3
%
2.4
%
Medicare Advantage
1,899
2,255
2,230
(15.8
)%
(14.8
)%
Medicare Supplement
888
876
882
1.4
%
0.7
%
Total Medicare
2,787
3,131
3,112
(11.0
)%
(10.4
)%
Medicaid
8,456
8,862
8,500
(4.6
)%
(0.5
)%
Federal Employee Program
1,563
1,649
1,604
(5.2
)%
(2.6
)%
Total Medical Membership
45,418
45,833
45,232
(0.9
)%
0.4
%
Other Metrics (in millions)
CarelonRx Quarterly Adjusted Scripts
80.3
83.9
88.5
(4.3
)%
(9.3
)%
Carelon Services Consumers Served
92.9
99.5
91.8
(6.6
)%
1.2
%
Elevance Health
Consolidated Statements of Income
(Unaudited)
(In millions, except per share data)
Three Months Ended
March 31
2026
2025
Change
Revenues
Premiums
$
41,024
$
40,887
0.3
%
Product revenue
6,225
5,809
7.2
%
Service fees
2,245
2,069
8.5
%
Total operating revenue
49,494
48,765
1.5
%
Net investment income
765
590
29.7
%
Net losses on financial instruments
(78
)
(464
)
NM
Total revenues
50,181
48,891
2.6
%
Expenses
Benefit expense
35,615
35,312
0.9
%
Cost of products sold
5,463
4,983
9.6
%
Operating expense
6,330
5,300
19.4
%
Interest expense
357
344
3.8
%
Amortization of other intangible assets
112
155
(27.7
)%
Total expenses
47,877
46,094
3.9
%
Income before income tax expense
2,304
2,797
(17.6
)%
Income tax expense
544
613
(11.3
)%
Net income
1,760
2,184
(19.4
)%
Net loss (gain) attributable to noncontrolling interests
4
(1
)
NM
Shareholders' net income
$
1,764
$
2,183
(19.2
)%
Shareholders' earnings per diluted share
$
8.00
$
9.61
(16.8
)%
Diluted shares
220.4
227.2
(3.0
)%
Benefit expense as a percentage of premiums
86.8
%
86.4
%
40 bp
Operating expense as a percentage of total operating revenue
12.8
%
10.9
%
190 bp
Income before income tax expense as a percentage of total revenue
4.6
%
5.7
%
(110) bp
"NM" = calculation not meaningful
Elevance Health
Condensed Consolidated Balance Sheet
(In millions)
March 31,
2026
December 31,
2025
Assets
(Unaudited)
Current assets:
Cash and cash equivalents
$9,657
$9,491
Fixed maturity and equity securities
27,416
26,624
Premium and other receivables
22,790
21,542
Other current assets
7,169
5,344
Total current assets
67,032
63,001
Long-term investments
12,123
11,960
Property and equipment, net
4,657
4,679
Goodwill and other intangible assets
39,433
39,544
Other noncurrent assets
2,582
2,310
Total assets
$125,827
$121,494
Liabilities and equity
Liabilities
Current liabilities:
Medical claims payable
$18,425
$17,084
Short-term borrowings
724
150
Current portion of long-term debt
350
1,099
Other current liabilities
25,810
22,702
Total current liabilities
45,309
41,035
Long-term debt, less current portion
30,768
30,797
Other noncurrent liabilities
5,708
5,636
Total liabilities
81,785
77,468
Total shareholders’ equity
43,902
43,882
Noncontrolling interests
140
144
Total equity
44,042
44,026
Total liabilities and equity
$125,827
$121,494
Elevance Health
Condensed Consolidated Statement of Cash Flows
(Unaudited)
(In millions)
Three Months Ended
March 31
2026
2025
Operating activities
Net income
$1,760
$2,184
Depreciation and amortization
354
373
Share-based compensation
55
81
Changes in operating assets and liabilities
2,660
(1,785
)
Other non-cash items
(497
)
164
Net cash provided by operating activities
4,332
1,017
Investing activities
Sales and maturities of investments, net of purchases (purchases of investments, net of sales and maturities)
(1,089
)
610
Purchases of subsidiaries, net of cash acquired
5
4
Purchases of property and equipment
(235
)
(196
)
Other, net
(323
)
(315
)
Net cash provided by (used in) investing activities
(1,642
)
103
Financing activities
Net change in short-term and long-term borrowings
(176
)
(1,365
)
Repurchase and retirement of common stock
(1,124
)
(880
)
Cash dividends
(376
)
(386
)
Other, net
(839
)
722
Net cash used in financing activities
(2,515
)
(1,909
)
Effect of foreign exchange rates on cash and cash equivalents
(9
)
1
Change in cash and cash equivalents
166
(788
)
Cash and cash equivalents at beginning of period
9,491
8,288
Cash and cash equivalents at end of period
$9,657
$7,500
REPORTABLE SEGMENTS
Elevance Health has four reportable segments: Health Benefits (comprised of Individual, Employer Group risk-based, Employer Group fee-based, BlueCard®, Medicare, Medicaid, and Federal Employee Program businesses); CarelonRx; Carelon Services; and Corporate & Other (comprised of businesses that do not individually meet the quantitative thresholds for an operating division as well as corporate expenses not allocated to our other reportable segments).
Elevance Health
Reportable Segment Details
(Unaudited)
(In millions)
Three Months Ended March 31
2026
2025
Change
Operating Revenue
Health Benefits
$42,490
$41,431
2.6 %
CarelonRx
10,600
10,116
4.8 %
Carelon Services
7,365
6,536
12.7 %
Corporate & Other
4
165
(97.6) %
Eliminations
(10,965)
(9,483)
NM6
Total Operating Revenue1
$49,494
$48,765
1.5 %
Operating Gain (Loss)
Health Benefits
$2,157
$2,217
(2.7) %
CarelonRx
582
602
(3.3) %
Carelon Services
470
491
(4.3) %
Corporate & Other2,3
(1,123)
(140)
NM6
Total Operating Gain1,4
$2,086
$3,170
(34.2) %
Operating Margin
Health Benefits
5.1 %
5.4 %
(30) bp
CarelonRx
5.5 %
6.0 %
(50) bp
Carelon Services
6.4 %
7.5 %
(110) bp
Total Operating Margin1
4.2 %
6.5 %
(230) bp
Health Benefits Revenue Details
(In millions)
Three Months Ended March 31
2026
2025
Change
Health Benefits Operating Revenue
Commercial
$13,238
$12,352
7.2 %
Individual5
2,540
2,361
7.6 %
Medicare
10,991
11,406
(3.6) %
Medicaid
14,280
14,043
1.7 %
Federal Employee Program
3,981
3,630
9.7 %
Total Health Benefits Operating Revenue1
$42,490
$41,431
2.6 %
1.
See “Basis of Presentation.”
2.
Operating Gain for the three months ended March 31, 2026 included $935 million for the Company's current best estimate of the identified potential exposure for certain historical Medicare Advantage risk adjustment data related to the CMS notice to the Company dated February 27, 2026, $129 million of business optimization program charges, $47 million of transaction and integration related costs, and $7 million of litigation and settlement expenses, which reside in the Corporate & Other reportable segment.
3.
Operating Gain for the three months ended March 31, 2025 included $80 million of transaction and integration related costs and $5 million of litigation and settlement expenses, which reside in the Corporate & Other reportable segment.
4.
Operating Gain for three months ended March 31, 2026, and March 31, 2025, included items excluded from adjusted shareholders' net income. See "GAAP Reconciliation."
5.
The Individual business, including ACA products, is reported as part of Commercial Operating Revenue.
6.
"NM" = calculation not meaningful.
Elevance Health
Reconciliation of Medical Claims Payable
Three Months Ended March 31
Years Ended December 31
2026
2025
2025
2024
2023
(In millions)
(Unaudited)
(Unaudited)
Gross medical claims payable, beginning of period
$
16,829
$
15,580
$
15,580
$
15,865
$
15,348
Ceded medical claims payable, beginning of period
(48
)
(13
)
(13
)
(7
)
(6
)
Net medical claims payable, beginning of period
16,781
15,567
15,567
15,858
15,342
Business combinations and purchase adjustments
—
(85
)
344
143
—
Net incurred medical claims:
Current year
35,677
35,313
145,566
125,370
121,798
Prior years redundancies1
(1,124
)
(1,025
)
(1,290
)
(1,731
)
(1,571
)
Total net incurred medical claims
34,553
34,288
144,276
123,639
120,227
Net payments attributable to:
Current year medical claims
23,010
23,392
130,265
110,930
107,146
Prior years medical claims
10,250
9,863
13,141
13,143
12,565
Total net payments
33,260
33,255
143,406
124,073
119,711
Net medical claims payable, end of period
18,074
16,515
16,781
15,567
15,858
Ceded medical claims payable, end of period
45
14
48
13
7
Gross medical claims payable, end of period2
$
18,119
$
16,529
$
16,829
$
15,580
$
15,865
Current year medical claims paid as a percentage of current year net incurred medical claims
64.5
%
66.2
%
89.5
%
88.5
%
88.0
%
Prior year redundancies in the current year as a percentage of prior year net medical claims payable less prior year redundancies in the current year
7.2
%
7.1
%
9.0
%
12.3
%
11.4
%
Prior year redundancies in the current year as a percentage of prior year net incurred medical claims
0.8
%
0.8
%
1.0
%
1.4
%
0.9
%
1.
Negative amounts reported for net incurred medical claims related to prior years result from claims being settled for amounts less than originally estimated.
2.
Excludes insurance lines other than short duration.
Elevance Health
GAAP Reconciliation
(Unaudited)
This document references non-GAAP measures, including “Adjusted Diluted EPS,” “Adjusted Operating Expense Ratio,” “Adjusted Operating Gain,” “Adjusted Operating Margin,” “Adjusted Shareholders’ Net Income,” and “Adjusted Operating Expense”. These non-GAAP measures are intended to aid investors when comparing Elevance Health’s financial results among periods and are not intended to be alternatives to any measure calculated in accordance with GAAP. Reconciliations of these non-GAAP measures to the most directly comparable measures calculated in accordance with GAAP are available below. In addition to these non-GAAP measures, references are made to the measures “Operating Revenue,” “Operating Gain/Loss,” and “Operating Margin”. Operating revenue and operating gain/loss are the key measures used by management to evaluate performance in each of its reportable segments, allocate resources, set incentive compensation targets and to forecast future operating performance. Operating gain/loss is calculated as total operating revenue less benefit expense, cost of products sold and operating expense. It does not include net investment income, net gains/losses on financial instruments, interest expense, amortization of other intangible assets and gains/losses on extinguishment of debt or income taxes, as these items are managed in a corporate shared service environment and are not the responsibility of operating segment management. Each of these measures is provided to further aid investors in understanding and analyzing Elevance Health’s operating and financial results. A reconciliation of Operating Revenue to Total Revenue is set forth in the Consolidated Statements of Income herein. A reconciliation of reportable segments operating gain to income before income tax expense is provided below. Prior amounts may be grouped differently to conform to the current presentation. Net adjustment items per share may not sum due to rounding.
Three Months Ended
March 31
(In millions, except per share data)
2026
2025
Change
Shareholders' net income
$
1,764
$
2,183
(19.2
)%
Add / (Subtract):
Accrual related to CMS notice1,2
935
—
Business optimization program charges1
129
—
Amortization of other intangible assets
112
155
Net losses on financial instruments
78
464
Transaction and integration related costs1
47
80
Litigation and settlement expenses1
7
5
Tax impact of non-GAAP adjustments
(300
)
(168
)
Net adjustment items
1,008
536
Adjusted shareholders' net income
$
2,772
$
2,719
1.9
%
Shareholders' earnings per diluted share
$
8.00
$
9.61
(16.8
)%
Add / (Subtract):
Accrual related to CMS notice1,2
4.24
—
Business optimization program charges1
0.59
—
Amortization of other intangible assets
0.51
0.68
Net losses on financial instruments
0.35
2.04
Transaction and integration related costs1
0.21
0.35
Litigation and settlement expenses1
0.03
0.02
Tax impact of non-GAAP adjustments
(1.36
)
(0.74
)
Net adjustment items
4.58
2.36
Adjusted shareholders' earnings per diluted share
$
12.58
$
11.97
5.1
%
Three Months Ended
March 31
(In millions)
2026
2025
Change
Income before income tax expense
$
2,304
$
2,797
(17.6
)%
Net investment income
(765
)
(590
)
Net losses on financial instruments
78
464
Interest expense
357
344
Amortization of other intangible assets
112
155
Reportable segments operating gain
$
2,086
$
3,170
(34.2
)%
1.
Adjustment item resides in the Corporate & Other reportable segment.
2.
Adjustment item represents the Company's current best estimate of the identified potential exposure for certain historical Medicare Advantage risk adjustment data related to the CMS notice to the Company dated February 27, 2026.
Elevance Health
GAAP Reconciliation
(Unaudited)
Three Months Ended
March 31
(In millions)
2026
2025
Change
Reportable segments operating gain
$
2,086
$
3,170
(34.2
)%
Add / (Subtract):
Accrual related to CMS notice1,2
935
—
Business optimization program charges1
129
—
Transaction and integration related costs1
47
80
Litigation and settlement expenses1
7
5
Net adjustment items
1,118
85
Reportable segments adjusted operating gain
$
3,204
$
3,255
(1.6
)%
Operating revenue
$
49,494
$
48,765
1.5
%
Operating margin
4.2
%
6.5
%
(230) bp
Adjusted operating margin
6.5
%
6.7
%
(20) bp
Three Months Ended
March 31
(In millions)
2026
2025
Change
Operating expense
$
6,330
$
5,300
19.4
%
Add / (Subtract):
Accrual related to CMS notice1,2
(935
)
—
Business optimization program charges1
(129
)
—
Transaction and integration related costs1
(47
)
(80
)
Litigation and settlement expenses1
(7
)
(5
)
Net adjustment items
(1,118
)
(85
)
Adjusted operating expense
$
5,212
$
5,215
(0.1
)%
Operating revenue
$
49,494
$
48,765
1.5
%
Operating expense ratio
12.8
%
10.9
%
190 bp
Adjusted operating expense ratio
10.5
%
10.7
%
(20) bp
Full Year
2026 Outlook
Shareholders' earnings per diluted share
At least $19.85
Add / (Subtract):
Accrual related to CMS notice1,2
$4.24
Amortization of other intangible assets3
$2.00
Net losses on financial instruments3
$1.15
Transaction and integration related costs1,3
$0.90
Business optimization program charges1
$0.59
Litigation and settlement expenses1,3
$0.10
Tax impact of non-GAAP adjustments3
Approximately ($2.08)
Net adjustment items
$6.90
Adjusted shareholders' earnings per diluted share
At least $26.75
1.
Adjustment item resides in the Corporate & Other reportable segment.
2.
Adjustment item represents the Company's current best estimate of the identified potential exposure for certain historical Medicare Advantage risk adjustment data related to the CMS notice to the Company dated February 27, 2026.
3.
Adjustment item represents the midpoint of a projected range and serves as the estimated full year adjustment amount.
Forward-Looking Statements
This document contains certain forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. Forward-looking statements reflect our views about future events and financial performance and are generally not historical facts. Words such as “expect,” “feel,” “believe,” “will,” “may,” “should,” “anticipate,” “intend,” “estimate,” “project,” “forecast,” “plan,” "potential," "predict" and similar expressions are intended to identify forward-looking statements. These statements include, but are not limited to: financial projections and estimates and their underlying assumptions; statements regarding plans, objectives and expectations with respect to future operations, products and services; and statements regarding future performance. Such statements are subject to certain risks and uncertainties, many of which are difficult to predict and generally beyond our control, that could cause actual results to differ materially from those expressed in, or implied or projected by, the forward-looking statements. You are cautioned not to place undue reliance on these forward-looking statements that speak only as of the date hereof. You are also urged to carefully review and consider the various risks and other disclosures discussed in our reports filed with the U.S. Securities and Exchange Commission from time to time, which attempt to advise interested parties of the factors that affect our business. Except to the extent required by law, we do not update or revise any forward-looking statements to reflect events or circumstances occurring after the date hereof. These risks and uncertainties include, but are not limited to: trends in healthcare costs and utilization rates; reduced enrollment; our ability to secure and implement sufficient premium rates; the impact of large scale medical emergencies, such as public health epidemics and pandemics, and other catastrophes; the impact of new or changes in existing federal, state and international laws or regulations, including laws and regulations impacting healthcare, insurance, pharmacy services and other diversified products and services, or their enforcement or application; the impact of cyber-attacks or other privacy or data security incidents or our failure to comply with any privacy, data or security laws or regulations, including any investigations, claims or litigation related thereto; failure to effectively maintain and modernize our information systems, or failure of our information systems or technology, including artificial intelligence, to operate as intended; failure to effectively maintain the availability and integrity of our data; changes in economic and market conditions, as well as regulations that may negatively affect our liquidity and investment portfolios; competitive pressures and our ability to adapt to changes in the industry and develop and implement strategic growth opportunities; risks and uncertainties regarding Medicare and Medicaid programs, including those related to non-compliance with the complex regulations imposed thereon; our ability to maintain and achieve improvement in Centers for Medicare and Medicaid Services Star Ratings and other quality scores and funding risks with respect to revenue received from participation therein; a negative change in our healthcare product mix; costs and other liabilities associated with litigation, government investigations, audits or reviews; our ability to contract with providers on cost-effective and competitive terms; risks associated with providing healthcare, pharmacy and other diversified products and services, including medical malpractice or professional liability claims and non-compliance by any party with the pharmacy services agreement between us and CaremarkPCS Health, L.L.C.; the effects of any negative publicity or sentiment related to the health benefits industry in general or us in particular; risks associated with mergers, acquisitions, joint ventures and strategic alliances; possible impairment of the value of our intangible assets if future results do not adequately support goodwill and other intangible assets; possible restrictions in the payment of dividends from our subsidiaries and increases in required minimum levels of capital; our ability to repurchase shares of our common stock and pay dividends on our common stock due to the adequacy of our cash flow and earnings and other considerations; the potential negative effect from our substantial amount of outstanding indebtedness and the risk that increased interest rates or market volatility could impact our access to or further increase the cost of financing; a downgrade in our financial strength ratings; events that may negatively affect our licenses with the Blue Cross and Blue Shield Association; intense competition to attract and retain employees; risks associated with our international operations; and various laws and provisions in our governing documents that may prevent or discourage takeovers and business combinations.
View source version on businesswire.com: https://www.businesswire.com/news/home/20260421687833/en/
Elevance Health Contacts:
Investor Relations
Nathan Rich
Investor.Relations@elevancehealth.com
Media
Leslie Porras
Leslie.Porras@elevancehealth.com
Original: Elevance Health Reports First Quarter 2026 Results; Raises Full-Year Guidance
US Market News
5月前
Elevance Health Reports Fourth Quarter and Full Year 2025 Results; Sets Full Year 2026 OutlookJanuary 28, 2026 11:00 AM
Business Wire
4Q 2025 operating revenue of $49.3 billion; FY 2025 of $197.6 billion
4Q 2025 diluted EPS1 of $2.47; adjusted diluted EPS2 of $3.33
FY 2025 diluted EPS1 of $25.21; adjusted diluted EPS2 of $30.29
Projected FY 2026 GAAP diluted EPS1 to be at least $22.30
Projected FY 2026 adjusted diluted EPS2 to be at least $25.50
Returned $4.1 billion of capital to shareholders in 2025
Reaffirming long-term earnings algorithm; recalibrating segment margin targets
Elevance Health, Inc. (NYSE: ELV) reported fourth quarter and full year 2025 results.
"Elevance Health delivered fourth quarter results in line with our outlook, reflecting disciplined execution in a dynamic environment. As we enter 2026, our focus is on advancing affordability and making healthcare easier to access and navigate for the members we serve. Through pricing discipline and targeted investments, we are strengthening the earnings power of our diversified platform and remain confident in our ability to return to at least 12% adjusted EPS growth in 2027."
Gail K. Boudreaux
President and Chief Executive Officer
1.
Earnings per diluted share ("EPS").
2.
Refer to GAAP reconciliation tables herein for reconciliation of GAAP to adjusted measures.
Elevance Health
Consolidated Enterprise Highlights
(Unaudited)
(In billions)
Three Months Ended
Twelve Months Ended
December 31,
2025
December 31,
2024
December 31,
2025
December 31,
2024
Operating Revenue1
$49.3
$45.0
$197.6
$175.2
Operating Gain1,2
$0.3
$0.7
$7.2
$7.9
Adjusted Operating Gain1,3
$0.4
$0.8
$7.5
$9.3
Operating Margin1
0.6%
1.5%
3.6%
4.5%
Adjusted Operating Margin1,3
0.8%
1.9%
3.8%
5.3%
1.
See “Basis of Presentation.”
2.
Operating Gain for the three and twelve months ended December 31, 2025, and December 31, 2024, includes items that are excluded from adjusted shareholders' net income. See "GAAP Reconciliation."
3.
Adjusted Operating Gain for the three and twelve months ended December 31, 2025, and December 31, 2024, excludes items that are excluded from adjusted shareholders' net income. See "GAAP Reconciliation."
Operating revenue was $49.3 billion in the fourth quarter of 2025, an increase of $4.3 billion, or 10 percent compared to the prior year quarter. Operating revenue was $197.6 billion in 2025, an increase of $22.4 billion, or 13 percent. The increase in revenue for the quarter and year was driven by higher premium yields in our Health Benefits segment, contributions from acquisitions, and growth in Medicare Advantage membership, partially offset by membership attrition in our Medicaid business.
The benefit expense ratio was 93.5 percent in the fourth quarter, an increase of 110 basis points compared to the prior year period, reflecting higher medical cost trend primarily in our Affordable Care Act health plans and heightened Medicare Part D seasonality driven by Inflation Reduction Act changes. For the year, our benefit expense ratio was 90.0 percent, an increase of 150 basis points year over year, driven by elevated medical cost trends.
Days in Claims Payable was 41.3 days as of December 31, 2025, a decrease of 0.1 days from September 30, 2025, and a decrease of 1.9 days compared to December 31, 2024.
The operating expense ratio was 11.0 percent in the fourth quarter and 10.6 percent for the full year. On an adjusted basis, the corresponding operating expense ratios were 10.8 percent and 10.5 percent. We maintained expense discipline while investing to support and strengthen our workforce, scale Carelon's capabilities, and accelerate technology adoption across the enterprise.
Cash Flow & Balance Sheet
Operating cash flow was $4.3 billion in 2025, approximately 0.8 times GAAP net income. As of December 31, 2025, cash and investments at the parent company totaled approximately $2.6 billion.
During the fourth quarter of 2025, the Company repurchased 1.4 million shares of its common stock for $471 million, at a weighted average price of $335.64, and paid a quarterly dividend of $1.71 per share, representing a distribution of cash totaling $377 million. As of December 31, 2025, the Company had approximately $6.7 billion of Board approved share repurchase authorization remaining.
Health Benefits is comprised of Individual, Employer Group risk-based, Employer Group fee-based, BlueCard®, Medicare, Medicaid, and Federal Employee Program businesses.
Health Benefits
Reportable Segment Highlights
(Unaudited)
(In billions)
Three Months Ended
Twelve Months Ended
December 31,
2025
December 31,
2024
December 31,
2025
December 31,
2024
Operating Revenue1
$41.8
$37.6
$167.1
$150.3
Operating Gain1,2
($0.2)
$0.2
$4.2
$6.2
Adjusted Operating Gain1,3
($0.2)
$0.2
$4.2
$6.3
Operating Margin1
(0.5%)
0.6%
2.5%
4.2%
Adjusted Operating Margin1
(0.5%)
0.6%
2.5%
4.2%
1.
See “Basis of Presentation.”
2.
Operating Gain for the three and twelve months ended December 31, 2024 includes items that are excluded from adjusted shareholders' net income. See "GAAP Reconciliation."
3.
Adjusted Operating Gain for three and twelve months ended December 31, 2024 excludes $16 and $66 million, respectively, of 2024 business dispositions and related items adjusted out of adjusted shareholders' net income for the Health Benefits segment.
Health Benefits segment operating revenue was $41.8 billion in the fourth quarter of 2025, an increase of $4.3 billion, or 11 percent compared to the fourth quarter of 2024. Operating revenue was $167.1 billion in 2025, an increase of $16.8 billion, or 11 percent. The increases for the quarter and year were driven primarily by higher premium yields, contributions from acquisitions, and growth in our Medicare Advantage membership, partially offset by membership attrition in our Medicaid business.
The Company reported an adjusted operating loss of $0.2 billion in the fourth quarter of 2025 and an adjusted operating gain of $4.2 billion for the full year. Adjusted operating results in both periods were impacted primarily by higher medical cost trend.
Medical membership totaled approximately 45.2 million as of December 31, 2025, a decrease of 0.5 million, or 1 percent, year over year, driven by attrition in our Medicaid business.
Carelon is comprised of CarelonRx and Carelon Services.
Carelon
Reportable Segment Highlights
(Unaudited)
(In billions)
Three Months Ended
Twelve Months Ended
December 31,
2025
December 31,
2024
December 31,
2025
December 31,
2024
Operating Revenue1,2
$18.7
$14.7
$71.7
$53.9
Operating Gain1,3
$0.6
$0.6
$3.4
$2.9
Adjusted Operating Gain1,4,5
$0.6
$0.6
$3.4
$3.1
Operating Margin1
3.1%
3.9%
4.7%
5.4%
Adjusted Operating Margin1
3.3%
4.4%
4.8%
5.8%
1.
See “Basis of Presentation.”
2.
Operating revenue for the three and twelve months ended December 31, 2024 includes $0.2 and $0.8 billion, respectively, of revenue related to 2024 business dispositions and related items that have been excluded from adjusted operating gain.
3.
Operating Gain for the three and twelve months ended December 31, 2025, and December 31, 2024, includes items that are excluded from adjusted shareholders' net income. See "GAAP Reconciliation."
4.
Adjusted Operating Gain for three and twelve months ended December 31, 2025 excludes $38 million of 2025 business dispositions and related items adjusted out of adjusted shareholders' net income for the Carelon segment.
5.
Adjusted Operating Gain for the three and twelve months ended December 31, 2024 excludes $74 and $215 million, respectively, of 2024 business dispositions and related items adjusted out of adjusted shareholders' net income for the Carelon segment.
Operating revenue for Carelon was $18.7 billion in the fourth quarter of 2025, an increase of $3.9 billion, or 27 percent compared to the prior year period, driven by growth in CarelonRx product revenue, the expansion of Carelon Services risk-based solutions, and the acquisition of CareBridge. Operating revenue was $71.7 billion in 2025, an increase of $17.8 billion, or 33 percent.
Adjusted operating gain for Carelon totaled $0.6 billion in the fourth quarter, approximately flat year over year. On a full year basis, adjusted operating gain was $3.4 billion in 2025, an increase of $0.3 billion, or 10 percent, driven by improved CarelonRx performance and growth in Carelon Services risk-based solutions.
Quarterly Dividend
On January 27, 2026, the Audit Committee of the Company's Board of Directors declared a first quarter 2026 dividend to shareholders of $1.72 per share. The first quarter dividend is payable on March 25, 2026 to shareholders of record at the close of business on March 10, 2026.
About Elevance Health
Elevance Health is a lifetime, trusted health partner whose purpose is to improve the health of humanity. The company supports consumers, families, and communities across the entire healthcare journey – connecting them to the care, support, and resources they need to lead better lives. Elevance Health’s companies serve approximately 104 million consumers through a diverse portfolio of industry-leading medical, pharmacy, behavioral, clinical, home health, and complex care solutions. For more information, please visit www.elevancehealth.com or follow us @ElevanceHealth on X and Elevance Health on LinkedIn.
Conference Call and Webcast
Management will host a conference call and webcast today at 8:30 a.m. Eastern Standard Time (“EST”) to discuss the company’s fourth quarter and full year 2025 results and 2026 outlook. The conference call should be accessed at least 15 minutes prior to the start of the call with the following numbers:
888-947-9963 (Domestic)
888-566-0046 (Domestic Replay)
312-470-0178 (International)
203-369-3677 (International Replay)
The access code for today's conference call is 3972058. There is no access code for the replay. The replay will be available from 11:30 a.m. EST today, until the end of the day on February 27, 2026. The call will also be available through a live webcast at www.elevancehealth.com under the “Investors” link. A webcast replay will be available following the call.
Basis of Presentation
Operating revenue and operating gain/loss are the key measures used by management to evaluate performance in each of its reporting segments, allocate resources, set incentive compensation targets and to forecast future operating performance. Operating gain/loss is calculated as total operating revenue less benefit expense, cost of products sold and operating expense. It does not include net investment income, net gains/losses on financial instruments, interest expense, amortization of other intangible assets, gains/losses on extinguishment of debt or income taxes, as these items are managed in a corporate shared service environment and are not the responsibility of operating segment management. Refer to the GAAP reconciliation tables.
Operating margin is defined as operating gain divided by operating revenue.
Elevance Health
Earnings Release Financial Schedules and Supplementary Information
Quarter & Year Ended December 31, 2025
Membership and Other Metrics
Quarterly & Full Year Consolidated Statements of Income
Condensed Consolidated Balance Sheet
Condensed Consolidated Statement of Cash Flows
Supplemental Financial Information - Reportable Segments
Supplemental Financial Information - Reconciliation of Medical Claims Payable
Reconciliation of Non-GAAP Financial Measures
Financial Guidance Summary
Membership Guidance Summary
Elevance Health
Membership and Other Metrics
(Unaudited)
Change from
Medical Membership (in thousands)
December 31,
2025
December 31,
2024
September 30,
2025
December 31,
2024
September 30,
2025
Individual
1,307
1,287
1,354
1.6%
(3.5%)
Employer Group Risk-Based
3,617
3,713
3,616
(2.6%)
—%
Commercial Risk-Based
4,924
5,000
4,970
(1.5%)
(0.9%)
BlueCard®
6,509
6,630
6,394
(1.8%)
1.8%
Employer Group Fee-Based
20,583
20,569
20,608
0.1%
(0.1%)
Commercial Fee-Based
27,092
27,199
27,002
(0.4%)
0.3%
Medicare Advantage
2,230
2,066
2,245
7.9%
(0.7%)
Medicare Supplement
882
891
877
(1.0%)
0.6%
Total Medicare
3,112
2,957
3,122
5.2%
(0.3%)
Medicaid
8,500
8,917
8,645
(4.7%)
(1.7%)
Federal Employee Program
1,604
1,661
1,630
(3.4%)
(1.6%)
Total Medical Membership
45,232
45,734
45,369
(1.1%)
(0.3%)
Other Metrics (in millions)
CarelonRx Quarterly Adjusted Scripts
88.5
82.9
85.0
6.8%
4.1%
Carelon Services Consumers Served
91.8
101.1
97.6
(9.2%)
(5.9%)
Elevance Health
Consolidated Statements of Income
(Unaudited)
(In millions, except per share data)
Three Months Ended
December 31
Twelve Months Ended
December 31
2025
2024
Change
2025
2024
Change
Revenues
Premiums
$
40,690
$
36,245
12.3%
$
164,639
$
144,166
14.2%
Product revenue
6,460
6,714
(3.8%)
24,470
22,630
8.1%
Service fees
2,161
2,030
6.5%
8,475
8,408
0.8%
Total operating revenue
49,311
44,989
9.6%
197,584
175,204
12.8%
Net investment income
493
527
(6.5%)
2,194
2,051
7.0%
Net losses on financial instruments
(57)
(74)
NM
(653)
(445)
NM
Gain on sale of business
—
—
NM
—
201
NM
Total revenues
49,747
45,442
9.5%
199,125
177,011
12.5%
Expenses
Benefit expense
38,065
33,500
13.6%
148,223
127,567
16.2%
Cost of products sold
5,522
6,012
(8.2%)
21,178
19,750
7.2%
Operating expense
5,415
4,804
12.7%
20,984
20,025
4.8%
Interest expense
366
340
7.6%
1,402
1,185
18.3%
Amortization of other intangible assets
164
180
(8.9%)
628
580
8.3%
Total expenses
49,532
44,836
10.5%
192,415
169,107
13.8%
Income before income tax expense
215
606
(64.5%)
6,710
7,904
(15.1%)
Income tax expense (benefit)
(331)
193
NM
1,049
1,933
(45.7%)
Net income
546
413
32.2%
5,661
5,971
(5.2%)
Net loss attributable to noncontrolling interests
1
5
NM
1
9
NM
Shareholders' net income
$
547
$
418
30.9%
$
5,662
$
5,980
(5.3%)
Shareholders' earnings per diluted share
$
2.47
$
1.81
36.5%
$
25.21
$
25.68
(1.8%)
Diluted shares
221.8
231.1
(4.0%)
224.6
232.9
(3.6%)
Benefit expense as a percentage of premiums
93.5%
92.4%
110 bp
90.0%
88.5%
150 bp
Operating expense as a percentage of total operating revenue
11.0%
10.7%
30 bp
10.6%
11.4%
(80) bp
Income before income tax expense as a percentage of total revenue
0.4%
1.3%
(90) bp
3.4%
4.5%
(110) bp
"NM" = calculation not meaningful
Elevance Health
Condensed Consolidated Balance Sheet
(In millions)
December 31,
2025
December 31,
2024
Assets
(Unaudited)
Current assets:
Cash and cash equivalents
$9,491
$8,288
Fixed maturity and equity securities
26,624
26,393
Premium and other receivables
21,542
19,071
Other current assets
5,344
4,700
Assets held for sale
—
490
Total current assets
63,001
58,942
Long-term investments
11,960
10,784
Property and equipment, net
4,679
4,652
Goodwill and other intangible assets
39,544
40,371
Other noncurrent assets
2,310
2,140
Total assets
$121,494
$116,889
Liabilities and equity
Liabilities
Current liabilities:
Medical claims payable
$17,084
$15,746
Short-term borrowings
150
365
Current portion of long-term debt
1,099
1,649
Other current liabilities
22,702
22,668
Liabilities held for sale
—
153
Total current liabilities
41,035
40,581
Long-term debt, less current portion
30,797
29,218
Other noncurrent liabilities
5,636
5,664
Total liabilities
77,468
75,463
Total shareholders’ equity
43,882
41,315
Noncontrolling interests
144
111
Total equity
44,026
41,426
Total liabilities and equity
$121,494
$116,889
Elevance Health
Condensed Consolidated Statement of Cash Flows
(Unaudited)
(In millions)
Twelve Months Ended
December 31
2025
2024
Operating activities
Net income
$
5,661
$
5,971
Depreciation and amortization
1,546
1,393
Share-based compensation
276
191
Changes in operating assets and liabilities
(3,680
)
(1,719
)
Other non-cash items
487
(28
)
Net cash provided by operating activities
4,290
5,808
Investing activities
Proceeds from sale of investments, net of maturities
69
586
Net purchases of subsidiaries, net of cash acquired/sold
88
(4,446
)
Purchases of property and equipment
(1,116
)
(1,256
)
Other, net
(385
)
(51
)
Net cash used in investing activities
(1,344
)
(5,167
)
Financing activities
Net change in short-term and long-term borrowings
629
6,200
Repurchase and retirement of common stock
(2,605
)
(2,900
)
Cash dividends
(1,529
)
(1,508
)
Other, net
1,767
(599
)
Net cash provided by (used in) financing activities
(1,738
)
1,193
Effect of foreign exchange rates on cash and cash equivalents
(5
)
(6
)
Change in cash and cash equivalents
1,203
1,828
Cash and cash equivalents at beginning of period
8,288
6,526
Cash and equivalents included in assets held for sale at end of period
—
(66
)
Cash and cash equivalents at end of period
$
9,491
$
8,288
REPORTABLE SEGMENTS
Elevance Health has four reportable segments: Health Benefits (comprised of Individual, Employer Group risk-based, Employer Group fee-based, BlueCard®, Medicare, Medicaid, and Federal Employee Program businesses); CarelonRx; Carelon Services; and Corporate & Other (comprised of businesses that do not individually meet the quantitative thresholds for an operating division as well as corporate expenses not allocated to our other reportable segments).
Elevance Health
Reportable Segment Details
(Unaudited)
(In millions)
Three Months Ended December 31
Twelve Months Ended December 31
2025
2024
Change
2025
2024
Change
Operating Revenue
Health Benefits
$41,835
$37,580
11.3%
$167,094
$150,275
11.2%
CarelonRx
11,644
9,977
16.7%
43,400
35,961
20.7%
Carelon Services
7,015
4,769
47.1%
28,316
17,961
57.7%
Corporate & Other
(83)
(14)
NM6
463
309
49.8%
Eliminations
(11,100)
(7,323)
NM6
(41,689)
(29,302)
NM6
Total Operating Revenue1
$49,311
$44,989
9.6%
$197,584
$175,204
12.8 %
Operating Gain (Loss)
Health Benefits2
($220)
$207
NM6
$4,158
$6,243
(33.4%)
CarelonRx3
724
533
35.8%
2,418
2,172
11.3%
Carelon Services2,3
(150)
35
NM6
960
717
33.9%
Corporate & Other2,3
(45)
(102)
NM6
(337)
(1,270)
NM6
Total Operating Gain1,4
$309
$673
(54.1%)
$7,199
$7,862
(8.4%)
Operating Margin
Health Benefits
(0.5%)
0.6%
(110) bp
2.5%
4.2%
(170) bp
CarelonRx
6.2%
5.3%
90 bp
5.6%
6.0%
(40) bp
Carelon Services
(2.1%)
0.7%
(280) bp
3.4%
4.0%
(60) bp
Total Operating Margin1
0.6%
1.5%
(90) bp
3.6%
4.5%
(90) bp
Health Benefits Revenue Details
(In millions)
Three Months Ended December 31
Twelve Months Ended December 31
2025
2024
Change
2025
2024
Change
Health Benefits Operating Revenue
Commercial
$12,747
$11,851
7.6%
$50,401
$46,816
7.7%
Individual5
2,248
2,117
6.2%
9,295
8,295
12.1%
Medicare
10,762
9,054
18.9%
44,752
36,795
21.6%
Medicaid
14,500
12,755
13.7%
56,620
51,937
9.0%
Federal Employee Program
3,826
3,920
(2.4%)
15,321
14,727
4.0%
Total Health Benefits Operating Revenue1
$41,835
$37,580
11.3%
$167,094
$150,275
11.2%
1.
See “Basis of Presentation.”
2.
Operating Gain for the three and twelve months ended December 31, 2024 included $90 and $281 million, respectively, of 2024 business dispositions and related items; including $74 and $215 million, respectively, for the Carelon Services segment; and $16 and $66 million, respectively, for the Health Benefits segment. Operating Gain for the three and twelve months ended December 31, 2024 included $66 and $224 million, respectively, of transaction and integration related costs, $12 and $692 million, respectively, of litigation and settlement expenses, and $0 and $268 million, respectively, of business optimization charges, all of which reside in the Corporate & Other reportable segment.
3.
Operating Gain for the three and twelve months ended December 31, 2025 included $41 million of 2025 business dispositions and related items; including $45 million for the CarelonRx segment; ($7) million for the Carelon Services segment; and $3 million for the Corporate & Other segment. Operating Gain for the three and twelve months ended December 31, 2025 included $54 and $236 million, respectively, of transaction and integration related costs, $5 and $24 million, respectively, of litigation and settlement expenses, and ($34) and ($38) million, respectively, of business optimization charges, all of which reside in the Corporate & Other reportable segment.
4.
Operating Gain for the three and twelve months ended December 31, 2025, and December 31, 2024, included items excluded from adjusted shareholders' net income. See "GAAP Reconciliation."
5.
The Individual business, including ACA products, is reported as part of Commercial Operating Revenue.
6.
"NM" = calculation not meaningful.
Elevance Health
Reconciliation of Medical Claims Payable
Years Ended December 31
2025
2024
2023
(In millions)
(Unaudited)
Gross medical claims payable, beginning of year
$
15,580
$
15,865
$
15,348
Ceded medical claims payable, beginning of year
(13
)
(7
)
(6
)
Net medical claims payable, beginning of year
15,567
15,858
15,342
Business combinations and purchase adjustments
344
143
—
Net incurred medical claims:
Current year
145,566
125,370
121,798
Prior years redundancies1
(1,290
)
(1,731
)
(1,571
)
Total net incurred medical claims
144,276
123,639
120,227
Net payments attributable to:
Current year medical claims
130,265
110,930
107,146
Prior years medical claims
13,141
13,143
12,565
Total net payments
143,406
124,073
119,711
Net medical claims payable, end of year
16,781
15,567
15,858
Ceded medical claims payable, end of year
48
13
7
Gross medical claims payable, end of year2
$
16,829
$
15,580
$
15,865
Current year medical claims paid as a percentage of current year net incurred medical claims
89.5
%
88.5
%
88.0
%
Prior year redundancies in the current year as a percentage of prior year net medical claims payable less prior year redundancies in the current year
9.0
%
12.3
%
11.4
%
Prior year redundancies in the current year as a percentage of prior year net incurred medical claims
1.0
%
1.4
%
1.4
%
Negative amounts reported for net incurred medical claims related to prior years result from claims being settled for amounts less than originally estimated.
Excludes insurance lines other than short duration.
Elevance Health
GAAP Reconciliation
(Unaudited)
This document references non-GAAP measures, including “Adjusted Shareholders’ Net Income,” “Adjusted Shareholders’ Net Income Per Share,” “Adjusted EPS,” “Adjusted Operating Gain,” “Adjusted Operating Expense” and “Adjusted Operating Expense Ratio,” which are non-GAAP measures. These non-GAAP measures are intended to aid investors when comparing Elevance Health’s financial results among periods and are not intended to be alternatives to any measure calculated in accordance with GAAP. Reconciliations of these non-GAAP measures to the most directly comparable measures calculated in accordance with GAAP are available below. In addition to these non-GAAP measures, references are made to the measures “Operating Revenue” and “Operating Gain/Loss,” “Operating Margin” and “Adjusted EPS”. Operating revenue and operating gain/loss are the key measures used by management to evaluate performance in each of its reportable segments, allocate resources, set incentive compensation targets and to forecast future operating performance. Operating gain/loss is calculated as total operating revenue less benefit expense, cost of products sold and operating expense. It does not include net investment income, net gains/losses on financial instruments, interest expense, amortization of other intangible assets and gains/losses on extinguishment of debt or income taxes, as these items are managed in a corporate shared service environment and are not the responsibility of operating segment management. Each of these measures is provided to further aid investors in understanding and analyzing Elevance Health’s operating and financial results. A reconciliation of Operating Revenue to Total Revenue is set forth in the Consolidated Statements of Income herein. A reconciliation of the non-GAAP measures to the most directly comparable measures calculated in accordance with GAAP, together with a reconciliation of reportable segments operating gain to income before income tax expense, is provided below. Prior amounts may be grouped differently to conform to the current presentation. Net adjustment items per share may not sum due to rounding. A reconciliation of Operating Revenue to Total Revenue is set forth in the Consolidated Statements of Income herein.
Three Months Ended
December 31
Twelve Months Ended
December 31
(In millions, except per share data)
2025
2024
Change
2025
2024
Change
Shareholders' net income
$
547
$
418
30.9
%
$
5,662
$
5,980
(5.3
%)
Add / (Subtract):
Amortization of other intangible assets
164
180
628
580
Net losses on financial instruments
57
74
653
445
Transaction and integration related costs1
54
66
236
224
Business dispositions and related items2
41
90
41
281
Litigation and settlement expenses1
5
12
24
692
Gain on sale of business
—
—
—
(201
)
Business optimization charges1
(34
)
—
(38
)
268
Tax impact of non-GAAP adjustments
(95
)
(93
)
(402
)
(575
)
Net adjustment items
192
329
1,142
1,714
Adjusted shareholders' net income
$
739
$
747
(1.1
%)
$
6,804
$
7,694
(11.6
%)
Shareholders' earnings per diluted share
$
2.47
$
1.81
36.5
%
$
25.21
$
25.68
(1.8
%)
Add / (Subtract):
Amortization of other intangible assets
0.74
0.78
2.80
2.49
Net losses on financial instruments
0.26
0.32
2.91
1.91
Transaction and integration related costs1
0.24
0.29
1.05
0.96
Business dispositions and related items2
0.18
0.39
0.18
1.21
Litigation and settlement expenses1
0.02
0.05
0.11
2.97
Gain on sale of business
—
—
—
(0.86
)
Business optimization charges1
(0.15
)
—
(0.17
)
1.15
Tax impact of non-GAAP adjustments
(0.43
)
(0.40
)
(1.79
)
(2.47
)
Net adjustment items
0.86
1.42
5.08
7.36
Adjusted shareholders' earnings per diluted share
$
3.33
$
3.23
3.1
%
$
30.29
$
33.04
(8.3
%)
Three Months Ended
December 31
Twelve Months Ended
December 31
(In millions)
2025
2024
Change
2025
2024
Change
Income before income tax expense
$
215
$
606
(64.5
%)
$
6,710
$
7,904
(15.1
%)
Net investment income
(493
)
(527
)
(2,194
)
(2,051
)
Gain on sale of business
—
—
—
(201
)
Net losses on financial instruments
57
74
653
445
Interest expense
366
340
1,402
1,185
Amortization of other intangible assets
164
180
628
580
Reportable segments operating gain
$
309
$
673
(54.1
%)
$
7,199
$
7,862
(8.4
%)
1.
Adjustment item resides in the Corporate & Other reportable segment.
2.
Adjustment item resides in the Health Benefits, CarelonRx, Carelon Services, and Corporate & Other reportable segments.
Elevance Health
GAAP Reconciliation
(Unaudited)
Three Months Ended
December 31
Twelve Months Ended
December 31
(In millions)
2025
2024
Change
2025
2024
Change
Reportable segments operating gain
$
309
$
673
(54.1
%)
$
7,199
$
7,862
(8.4
%)
Add / (Subtract):
Transaction and integration related costs1
54
66
236
224
Business dispositions and related items2
41
90
41
281
Litigation and settlement expenses1
5
12
24
692
Business optimization charges1
(34
)
—
(38
)
268
Net adjustment items
66
168
263
1,465
Reportable segments adjusted operating gain
$
375
$
841
(55.4
%)
$
7,462
$
9,327
(20.0
%)
Three Months Ended
December 31
Twelve Months Ended
December 31
(In millions)
2025
2024
Change
2025
2024
Change
Operating expense
$
5,415
$
4,804
12.7
%
$
20,984
$
20,025
4.8
%
Add / (Subtract):
Transaction and integration related costs1
(54
)
(66
)
(236
)
(224
)
Business dispositions and related items2
(41
)
(90
)
(41
)
(281
)
Litigation and settlement expenses1
(5
)
(12
)
(24
)
(692
)
Business optimization charges1
34
—
38
(268
)
Net adjustment items
(66
)
(168
)
(263
)
(1,465
)
Adjusted operating expense
$
5,349
$
4,636
15.4
%
$
20,721
$
18,560
11.6
%
Operating revenue
$
49,311
$
44,989
9.6
%
$
197,584
$
175,204
12.8
%
Operating expense ratio
11.0
%
10.7
%
30 bp
10.6
%
11.4
%
(80) bp
Adjusted operating expense ratio
10.8
%
10.3
%
50 bp
10.5
%
10.6
%
(10) bp
Full Year
2026 Outlook
Shareholders' earnings per diluted share
At least $22.30
Add / (Subtract):
Amortization of other intangibles3
$2.00
Net losses on financial instruments3
$1.15
Transaction and integration related costs1,3
$0.90
Litigation and settlement expenses1,3
$0.10
Tax impact of non-GAAP adjustments3
Approximately ($0.95)
Net adjustment items
$3.20
Adjusted shareholders' earnings per diluted share
At least $25.50
1.
Adjustment item resides in the Corporate & Other reportable segment.
2.
Adjustment item resides in the Health Benefits, CarelonRx, Carelon Services, and Corporate & Other reportable segments.
3.
Adjustment item represents the midpoint of a projected range and serves as the estimated full year adjustment amount.
Elevance Health
Financial Guidance Summary
(Unaudited)
Full Year 2025 Actual
Full Year 2026 Outlook
Premium Revenue
$164.6 billion
Mid single digit decline
Product Revenue
$24.5 billion
Mid single digit growth
Service Fees
$8.5 billion
Mid single digit growth
Total Operating Revenue
$197.6 billion
Low single digit decline
Benefit Expense Ratio
90.0%
90.2% +/- 50 bps
Adjusted Operating Expense Ratio
10.5%
10.6% +/- 50 bps
Adjusted Operating Gain
$7.5 billion
At least $6.8 billion
Other Pre-Tax Items:
Net Investment income
$2,194 million
$1,875 million
Interest Expense
($1,402) million
($1,530) million
Amortization of Intangible Assets
($628) million
($440) million
Adjusted Effective Tax Rate
17.6%
22.0% - 24.0%
GAAP Diluted EPS
$25.21
At least $22.30
Adjusted Diluted EPS
$30.29
At least $25.50
Diluted Shares
224.6 million
219-220 million
Operating Cash Flow
$4.3 billion
At least $5.5 billion
Segment Level Guidance Metrics
Operating Revenue Growth Rate
Health Benefits
$167.1 billion
Low single digit decline
CarelonRx
$43.4 billion
Low single digit growth
Carelon Services
$28.3 billion
Low single digit growth
GAAP Operating Margin vs. 2025
Health Benefits
2.5%
(50) - (25) bps
CarelonRx
5.6%
(25) - 0 bps
Carelon Services
3.4%
0 - 25 bps
Elevance Health
Membership Guidance Summary
(Unaudited)
Full Year 2025 Actual
Full Year 2026 Outlook
Year-End Medical Enrollment (in 000s)
Commercial Fee-Based
27,092
27,200 - 27,500
Commercial Risk-Based
4,924
4,150 - 4,250
Medicaid
8,500
7,650 - 7,850
Medicare Advantage
2,230
1,775 - 1,875
Medicare Supplement
882
Approximately 850
Federal Employee Program
1,604
Approximately 1,550
Fee-Based
27,092
27,200 - 27,500
Risk-Based
18,140
15,975 - 16,375
Total
45,232
43,175 - 43,875
Forward-Looking Statements
This document contains certain forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. Forward-looking statements reflect our views about future events and financial performance and are generally not historical facts. Words such as “expect,” “feel,” “believe,” “will,” “may,” “should,” “anticipate,” “intend,” “estimate,” “project,” “forecast,” “plan,” “potential,” “predict” and similar expressions are intended to identify forward-looking statements. These statements include, but are not limited to: financial projections and estimates and their underlying assumptions; statements regarding plans, objectives and expectations with respect to future operations, products and services; and statements regarding future performance. Such statements are subject to certain risks and uncertainties, many of which are difficult to predict and generally beyond our control, that could cause actual results to differ materially from those expressed in, or implied or projected by, the forward-looking statements. You are cautioned not to place undue reliance on these forward-looking statements that speak only as of the date hereof. You are also urged to carefully review and consider the various risks and other disclosures discussed in our reports filed with the U.S. Securities and Exchange Commission from time to time, which attempt to advise interested parties of the factors that affect our business. Except to the extent required by law, we do not update or revise any forward-looking statements to reflect events or circumstances occurring after the date hereof. These risks and uncertainties include, but are not limited to: trends in healthcare costs and utilization rates; reduced enrollment; our ability to secure and implement sufficient premium rates; the impact of large scale medical emergencies, such as public health epidemics and pandemics, and other catastrophes; the impact of new or changes in existing federal, state and international laws or regulations, including laws and regulations impacting healthcare, insurance, pharmacy services and other diversified products and services, or their enforcement or application; the impact of cyber-attacks or other privacy or data security incidents or our failure to comply with any privacy, data or security laws or regulations, including any investigations, claims or litigation related thereto; failure to effectively maintain and modernize our information systems; failure of our information systems or technology, including artificial intelligence, to operate as intended; failure to effectively maintain the availability and integrity of our data; changes in economic and market conditions, as well as regulations that may negatively affect our liquidity and investment portfolios; competitive pressures and our ability to adapt to changes in the industry and develop and implement strategic growth opportunities; risks and uncertainties regarding Medicare and Medicaid programs, including those related to non-compliance with the complex regulations imposed thereon; our ability to maintain and achieve improvement in Centers for Medicare and Medicaid Services Star Ratings and other quality scores and funding risks with respect to revenue received from participation therein; a negative change in our healthcare product mix; costs and other liabilities associated with litigation, government investigations, audits or reviews; our ability to contract with providers on cost-effective and competitive terms; risks associated with providing healthcare, pharmacy and other diversified products and services, including medical malpractice or professional liability claims and non-compliance by any party with the pharmacy services agreement between us and CaremarkPCS Health, L.L.C.; the effects of any negative publicity or sentiment related to the health benefits industry in general or us in particular; risks associated with mergers, acquisitions, joint ventures and strategic alliances; possible impairment of the value of our intangible assets if future results do not adequately support goodwill and other intangible assets; possible restrictions in the payment of dividends from our subsidiaries and increases in required minimum levels of capital; our ability to repurchase shares of our common stock and pay dividends on our common stock due to the adequacy of our cash flow and earnings and other considerations; the potential negative effect from our substantial amount of outstanding indebtedness and the risk that increased interest rates or market volatility could impact our access to or further increase the cost of financing; a downgrade in our financial strength ratings; events that may negatively affect our licenses with the Blue Cross and Blue Shield Association; intense competition to attract and retain employees; risks associated with our international operations; and various laws and provisions in our governing documents that may prevent or discourage takeovers and business combinations.
View source version on businesswire.com: https://www.businesswire.com/news/home/20260127316603/en/
Elevance Health Contacts:
Investor Relations
Nathan Rich
Investor.Relations@elevancehealth.com
Media
Leslie Porras
Leslie.Porras@elevancehealth.com
Original: Elevance Health Reports Fourth Quarter and Full Year 2025 Results; Sets Full Year 2026 Outlook
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