Sharper Thinking for Health Plans
That Can't Afford to Guess

Molina Healthcare reported a Q4 2025 adjusted loss of $2.75 per share versus expectations of $0.34 EPS, a 909% miss that triggered a 30% premarket stock decline. The miss was driven by $2.00/share of unexpected California retroactive premium adjustments and persistent medical cost trend pressure across Medicare and Marketplace.

The most striking revelation from Centene’s Q4 2025 earnings call: management explicitly acknowledged that if they only deliver a stable 93.7% Medicaid HBR in 2025, CEO Sarah London will be “very disappointed”—signaling aggressive expectations for margin improvement beyond the conservative guidance baseline.

Elevance Health reported FY 2025 revenues of $197.6 billion, up 13% year-over-year, but faces continued margin pressure with operating margin declining 90 basis points to 3.6% and FY 2025 adjusted EPS is $30.29 while 2026 projected will be $25.50.

Alignment Healthcare delivered 46% revenue growth and transformed from breakeven ($1M adjusted EBITDA in 2024) to $110M adjusted EBITDA in 2025—a 270 basis point margin expansion—while navigating V28 phase-ins, Part D redesign, and industry-wide utilization pressure.

Medicare Advantage Star Ratings have never been more consequential — or more volatile. After years of consistent decline, 2026 ratings stabilized at an average of 3.66. But stabilization isn’t recovery. And the 2027 methodology reset is about to compress margins further for plans that aren’t prepared.

The Medicare Advantage (MA) market continues to evolve as policy changes, reimbursement pressures, and competitive dynamics reshape enrollment trends across major payers.