Insight

Q2 2026 Earnings, the competitive view

MA strategy has converged around margin over membership, UnitedHealth and CVS are both deliberately trading enrollment for margin, while Humana and Alignment are the visible outliers still guiding double-digit MA growth.

Be the first to read our insights

Get the latest Medicare Advantage, Medicaid, and Marketplace intelligence delivered straight to your inbox — no spam, just insight.

Q2 2026 Health Plan Earnings: 7 Payers Compared | HealthWorks AI

Q2 2026 Health Plan Earnings: How Seven Major Payers Compare

This Q2 2026 health plan earnings report from HealthWorks AI compares UnitedHealth Group, CVS Health (Aetna), Elevance Health, Centene, Humana, Molina Healthcare, and Alignment Healthcare, covering Medicare Advantage, Medicaid, and Marketplace strategy across earnings calls held July 15 through August 5, 2026. For official Medicare Advantage program data, see CMS.gov. To benchmark your own plan against this peer set, contact your HealthWorks AI Client Success Manager, explore the HealthWorks AI platform, or visit the HealthWorks AI Insights hub.

Six of seven beat or raised and still traded down

Every payer in this set beat estimates or raised guidance this quarter. Six of seven still saw their stock fall the same day, only UnitedHealth was rewarded, rising about 7.6% on a clean, broad beat. CVS, Elevance, Centene, Humana, Molina, and Alignment all beat or raised and still fell, each for a different reason: one-time items propping up the headline number, Medicaid sustainability doubt, a second straight GAAP guidance cut, a sharp Marketplace reversal, or a flagged second-half spending step-up. The market is no longer rewarding a beat on its own, it is pricing in how much of that beat is real and repeatable versus one-time.

Medicare Advantage strategy has converged around margin over membership, UnitedHealth and CVS are both deliberately trading enrollment for margin, while Humana and Alignment are the visible outliers still guiding double-digit MA growth. Elevance's overall membership decline is concentrated outside MA, in commercial, ACA, and Medicaid, its MA margin target actually held. Medicaid is the quarter's clearest stress point across the board, and one-time items, CVS, UnitedHealth, Centene, Elevance, and Alignment all leaned on some form this quarter, are doing more work in these headline numbers than most coverage is giving credit for.

How the seven compare

CompanyMBR / MCR (Q2 2026)Full-year guidanceCore membership trendStock reaction
UnitedHealth Group 86.7% (incl. $860M one-time benefit) Raised, 2nd time MA down 9.4% YoY, deliberate Rose ~7.6%, only riser in the set
CVS Health (Aetna) 87.4% (vs 89.9% prior year) Raised, 2nd straight qtr Total company membership flat at 26.0M; not MA-specific Fell 6%+ despite beat
Elevance Health 89.7% (up 80 bps YoY) Raised MA margin target held; decline concentrated in commercial/ACA/Medicaid, D.C. exit confirmed Fell ~10.6% despite beat
Centene 89.6% (vs 93.0% prior year) Raised (Medicaid attrition worsened) Medicaid shrinking faster than guided Fell ~8.2% despite beat
Humana 91.2% (in line with guide) Adjusted EPS held, GAAP cut 2nd qtr (Star Ratings) Individual MA +23.4% YoY, growing Fell ~8% despite beat
Molina Healthcare 92.2% (sits below the consolidated) Raised overall, Marketplace cut sharply Medicaid + Marketplace both shrinking Fell ~5.3% despite beat
Alignment Healthcare 86.3% (+40 bps YoY, entirely the CMS risk-adjustment sweep) Raised (H2 spend step-up flagged) +31% YoY, fastest grower in the set Fell despite EPS beat (revenue missed consensus)

MBR/MCR figures are as each company defines and discloses them (consolidated, segment, or insurance-only), they are not perfectly apples-to-apples across companies with different lines-of-business mix.

What's actually driving this quarter, industry-wide

Beats are no longer protecting stock price

Six of seven payers beat estimates or raised guidance and still traded down the same day, each for a distinct reason: one-time items, Medicaid sustainability doubt, a repeated GAAP guidance cut, a sharp Marketplace reversal, or a flagged spending step-up. Only UnitedHealth was rewarded. The market is discounting headline beats harder than it has in recent quarters. (CVS, Elevance, Centene, Humana, Molina, Alignment)

One-time items are propping up several "beats"

A meaningful share of this quarter's headline strength across the group leans on non-recurring items rather than pure operating improvement, worth discounting before assuming any trend repeats into Q3 or 2027. CVS's MBR beat included of prior-year estimate changes, including risk adjustment and favorable development. UnitedHealth's MCR included of favorable prior-period development. Centene's guidance raise includes about .50 of EPS from one-time settlements. Elevance's beat included a .80 per-share below-the-line benefit it plans to redeploy into one-time H2 investment. Alignment's 40 bps MBR improvement is entirely the CMS new-member risk-adjustment sweep, excluding it, Alignment was flat year over year.

Star Ratings are becoming a hidden GAAP tax

Humana cut full-year GAAP EPS guidance for a second consecutive quarter, now $6.52 versus $8.36 in April and $8.89 in February, a 27% reduction from where the year started, driven specifically by a Medicare Advantage Star Ratings headwind for Bonus Year 2026 that lowers quality bonus payments. With CMS's next Star Ratings release expected around October 2026, this is worth watching across the rest of the set, not just Humana.

Margin over membership is now the default MA playbook

UnitedHealth and CVS are both deliberately trading Medicare Advantage enrollment for margin this cycle. Only two plans in this set are still guiding real MA growth, and both are smaller, more concentrated books. Elevance sits apart from the shrinking group, its MA margin target actually held, the overall membership decline traces to commercial, ACA, and Medicaid, not a deliberate MA pullback. (Shrinking: UnitedHealth, CVS. Growing: Humana +23.4%, Alignment +31%)

Medicaid is the clearest, most broad-based stress point

Every Medicaid-exposed payer in this set flagged real membership or margin pressure this quarter, whether through widening attrition, confirmed state exits, or missed enrollment targets. This is the line of business with the least good news anywhere in the peer set. (Centene, Elevance, Molina, UnitedHealth)

Marketplace/ACA is the most volatile, least consistent line

No shared direction here. Centene's margin recovery is partly a one-time accounting true-up, Molina cut its full-year Marketplace guidance sharply on an acuity mismatch, and Elevance raised its ACA membership target mid-call. Treat any single company's Marketplace read as company-specific, not a market signal. (Centene, Molina, Elevance)

Consumer technology is becoming the next competitive front

The two most PBM/tech-forward players in the set are both leaning into AI-powered consumer engagement as a differentiator beyond price or benefit richness, aimed at becoming the default front door to care regardless of which plan a member holds. (CVS: Health100, Haio. UnitedHealth: Optum Insight, Alegeus)

Who's growing, who's shrinking on purpose, and who's mixed

PostureCompaniesWhat it means
Growing, on purpose Alignment (+31% YoY), Humana (+23.4% MA) Both guiding continued growth mid-year, running counter to the broader margin-over-membership trend among larger national plans.
Deliberately shrinking MA UnitedHealth, CVS Both trading Medicare Advantage enrollment for margin. CVS shows signs of stabilizing rather than continuing to shrink.
Mixed, multi-directional Centene, Molina, Elevance Medicaid, Marketplace, and commercial books moving in different directions within the same company. Elevance's decline is concentrated outside MA, its MA margin target held.

The quarter, one card per company

UnitedHealth Group

Only riser, up ~7.6%

MCR 86.7%, includes $860M of favorable prior-period development

A broad, clean beat, adjusted EPS $6.38 vs $4.08 a year ago, across every segment, but the margin story still leans partly on a one-time reserve tailwind flagged as fading. The one payer in the set actually rewarded by the market this quarter.

“Our reported medical care ratio of 86.7% includes $860 million of net favorable prior period medical development, the majority of which is in-year development.”

Wayne DeVeydt, CFO, UnitedHealth Group

Watch: Q3 MCR holding without further reserve support, and whether more state Medicaid exits follow Louisiana.

CVS Health (Aetna)

Fell 6%+ despite beat

MBR 87.4%, down from 89.9% a year ago

Two consecutive quarters of real MBR improvement now, tightened guidance signals management trusts it. The $500M MBR benefit is prior-year estimate changes, including risk adjustment and favorable development, not a simple reserve release. Caremark is the one soft spot, real 340B pressure and value pulled forward from H2.

“Second quarter results reflect pressure in our 340B business and a pull-forward of value previously expected to occur in the second half.”

Brian O. Newman, CFO, CVS Health

Watch: Whether 340B pressure deepens or stabilizes, and 2027 AEP bid behavior on the remaining 25% of Aetna's book.

Elevance Health

Fell ~10.6% despite beat

Benefit expense ratio 89.7%, up 80 bps year over year

A clean beat, adjusted EPS $7.45 versus roughly $6.21 expected, that the market ignored, most analyst attention focused on Medicaid sustainability and confirmed state exits rather than the headline number. The beat included a $0.80 per-share below-the-line benefit management plans to redeploy into one-time H2 investment. Its Medicare Advantage margin target actually held this quarter, the overall enrollment decline traces to commercial, ACA, and Medicaid, not a deliberate MA pullback.

A widely cited CEO quote about this result could not be independently confirmed against the primary transcript in time for this draft, pull the transcript directly before using any direct quote from this call externally.

Watch: Further state-level Medicaid exits beyond D.C. over the next 12 to 18 months.

Centene

Fell ~8.2% despite beat

HBR 89.6%, down from 93.0% a year ago

A real but concentrated beat, about $0.50 of EPS comes from one-time settlements management says will not repeat, layered over Medicaid membership shrinking faster than guided.

“The $0.50 will be a reconciling item when we provide a bridge from 2026 to 2027.”

Drew Asher, EVP and CFO, Centene

Watch: Whether Medicaid attrition holds at 8-9%, or widens further.

Humana

Fell ~8% despite beat

Insurance segment benefit ratio 91.2%, exactly in line with guide

Beat both EPS lines and hit its benefit ratio guide exactly, but shares fell as GAAP EPS guidance was cut a second consecutive quarter, now $6.52 versus $8.36 in April and $8.89 in February, driven by a Medicare Advantage Star Ratings headwind for Bonus Year 2026 that lowers quality bonus payments. Separately flagged 2027 MA plan exits affecting about 600,000 members, roughly 40% (about 240,000) typically get recaptured into other Humana plans, so the genuinely contestable pool is closer to 360,000.

“Our No. 1 priority is to make the necessary progress to remain on track to deliver on our 2028 commitment of returning to a sustainable margin of at least 3%.”

Celeste Mellet, CFO, Humana

Watch: Whether GAAP EPS guidance is cut a third time, and the October Star Ratings release, the direct driver of this quarter's cut.

Molina Healthcare

Fell ~5.3% despite beat

Consolidated MCR 92.2%

A genuine 8.6% EPS beat, largely offset in market reaction by a 450 bps Marketplace MCR guidance deterioration, cutting full-year Marketplace guidance to a $0.75 per share loss. For 2027, Molina flagged premium revenue of about $46.5 billion, down from the $48 billion Investor Day target, mainly on planned Marketplace reduction and California's shift of undocumented members from managed Medicaid to fee-for-service, plus a planned exit from its Medicare Advantage prescription drug (MAPD) product.

“We're seeing high cost drug utilization without corresponding HCC to drive risk adjustment, which is creating an imbalance.”

Joe Zubretsky, President and CEO, Molina Healthcare

Watch: Whether Marketplace guidance holds at a $0.75 loss, or slips further, and how the MAPD exit lands in 2027 guidance.

Alignment Healthcare

Fell despite EPS beat

Adjusted MBR 86.3%, +40 bps YoY, flat year over year excluding the sweep

Surpassed the high end of its own guidance across key metrics and raised full-year guidance, though revenue came in modestly below consensus. The MBR improvement is entirely the CMS new-member risk-adjustment sweep, excluding it, Alignment was flat year over year. Also flagged a lower share of EBITDA landing in H2 versus a year ago, driven by new incremental investment, enough to send shares down despite the beat.

“We expect approximately 30% of our full year adjusted EBITDA to be generated in the second half, compared to approximately 40% a year prior.”

James Head, CFO, Alignment Healthcare

Watch: Whether the H2 investment step-up holds EBITDA guidance, spanning Care Anywhere clinical operations, earlier hiring, automation, AI, and 2027 market-launch prep, potentially another double-digit millions of spend across H2.

Reading the peer set against your own book

If you compete in Medicare Advantage

Margin-over-membership is now the default posture among the largest national plans. Contestable membership exists, roughly 600,000 members are affected by Humana's 2027 plan exits, though Humana typically recaptures about 40% of exited members into its own other plans, so the genuinely contestable pool is closer to 360,000. Do not assume broad share is up for grabs everywhere, most players are still actively repricing rather than retreating.

If you're Medicaid-exposed

Every Medicaid-exposed peer in this set flagged real stress this quarter. Confirmed state exits (Elevance in D.C., UnitedHealth in Louisiana) and widening attrition guidance (Centene, Molina) point to a genuinely harder Medicaid environment heading into 2027 rate cycles, not a one-company story.

If you're in Marketplace/ACA

This is the least consistent line of business in the set this quarter. Discount any single company's margin recovery until you can see how much is one-time accounting true-up versus durable pricing power, Centene and Molina both show meaningfully different pictures once you separate the two, and Molina's planned 2027 Marketplace reduction is a further data point on how unsettled this line still is.

If you're benchmarking cost management

CVS's 87.4% MBR and UnitedHealth's tightened guidance are now the public bar for a credible MA cost turnaround. If your own Stars and utilization discipline can't point to a comparable trend, expect that gap to get asked about, and note that Star Ratings performance itself is now a direct GAAP earnings lever, as Humana's guidance cut shows.

Across the full peer set

ThemeWhat to watch
Q3 2026 earnings Late October through early November for most of the set. Watch whether tightened MBR/MCR guidance across CVS, UnitedHealth, and others holds, or whether H2 costs run hotter than currently guided.
Medicaid state exits Whether Elevance names further exits beyond Washington D.C., and whether UnitedHealth's Louisiana exit is followed by others, over the next 12 to 18 months.
2027 AEP bid behavior Aetna has repriced roughly 75% of its book already. Watch which markets it, and other deliberately-shrinking plans, hold, exit, or re-enter as bids finalize.
Star Ratings, CMS October release This is the direct driver of Humana's GAAP guidance cut. Watch for a read-through to bonus payments and GAAP profit across the rest of the set, not just Humana.
Marketplace repricing Centene and Molina's 2027 Marketplace guidance bridges, plus Molina's planned Marketplace footprint reduction, will show how much of this quarter's margin swings were one-time versus durable, state by state.
Caremark's 340B pressure Whether CVS's disclosed 340B headwind deepens or stabilizes through H2, the clearest live PBM cost signal in the set.

Where Market, Product, and Network Actionable Insights Intersect

HealthWorksAI connects competitive market signals, benefit validation, and network intelligence in one platform.

Q2 2026 health plan earnings - Market, Product, and Network intersection diagram by HealthWorks AI
25+
MA payers served
91%
Enrollment prediction accuracy
12 hrs
Insights from CMS releases
3x
Faster growth than industry

More From Our Insights

Insights

Q2 2026 Earnings, the competitive view

MA strategy has converged around margin over membership, UnitedHealth and CVS are both deliberately trading enrollment for margin, while Humana and Alignment are the visible outliers still guiding double-digit MA growth.

Read More →