UnitedHealth Group (NYSE: UNH) today reported full year and fourth quarter 2025 results and issued its 2026 outlook.
“We confronted challenges directly and finished 2025 as a much stronger company, giving us the momentum to better serve those who count on us and continue to improve our core performance,” said Stephen Hemsley, Chief Executive Officer of UnitedHealth Group.
Consolidated revenues for 2025 were $447.6 billion, representing 12% growth year-over-year. Earnings from operations were $19.0 billion and net margin was 2.7%, while cash flows from operations were $19.7 billion, or 1.5x net income. The 2026 outlook was set for more than $439.0 billion in revenues, with earnings from operations greater than $24.0 billion and an adjusted earnings outlook greater than $17.75 per share.
2025 Key Performance Metrics
UnitedHealthcare, which served 49.8 million consumers in 2025, grew revenues 16% to $344.9 billion.
Optum expanded revenues 7% to $270.6 billion and supported more than 123 million consumers across its businesses.
Full year and fourth quarter 2025 net earnings were $13.23 and $0.01 per share.
Full year and fourth quarter 2025 adjusted net earnings were $16.35 and $2.11 per share.
The reported medical care ratio of 89.1% included a 20 basis point negative impact from loss contracts included in the charge, resulting in an adjusted medical care ratio of 88.9%, or an increase of 340 basis points year-over-year.
The operating cost ratio of 13.3% included a negative 40 basis points impact from the one-time charge, resulting in an adjusted operating cost ratio of 12.9%, which was flat year-over-year.
Key Factors & Charges Affecting Results
UnitedHealth took significant one-off charges in Q4 2025 impacting profitability, including $1.6 billion net charge related to restructuring costs and final expenses tied to the 2024 cyberattack. Additional restructuring costs and business exits that weighed on earnings.
Market & Investor Reaction
Shares of UnitedHealth fell sharply after the earnings release, reflecting investor concern over profit miss and outlook risks. Stock dropped more than 12% in pre-market trading, hitting multi-month lows. Investor disappointment was compounded by guidance and policy pressures, particularly around Medicare Advantage payments.
2026 Outlook & Challenges
Guidance & Strategy
UnitedHealth forecasted 2026 revenues above $439 billion and adjusted earnings per share above $17.75, slightly stronger than consensus. However, the outlook is shaped by several headwinds:
Policy pressures, including a minimal 0.09% increase in Medicare Advantage payments proposed for 2027, which could limit near-term revenue growth.
Rising medical costs and elevated medical care ratios, reflecting broader cost pressures in U.S. healthcare delivery.
Management indicated that refocusing operations, aligning pricing discipline, and strengthening cost controls will remain priorities as the company navigates into 2026 and beyond.
Key Takeaways
Positives
Full-year revenue growth remained strong at 12% year-over-year.
Adjusted EPS modestly beat expectations despite significant charges.
Solid outlook with growth planned for both UnitedHealthcare and Optum segments.
Challenges
Reported Q4 earnings were severely impacted by one-time restructuring charges.
Revenue slightly missed estimates, dampening confidence.
Stock weakness reflects broader policy and cost headwinds facing the healthcare industry.
Bottom Line
UnitedHealth Group’s Q4 2025 results illustrated both resilience in revenue growth and significant near-term pressures on profitability. Strong full-year performance was tempered by sizable charges and industry-wide cost challenges, leading to mixed investor sentiment and a cautious, yet still profitable outlook heading into 2026.