Adjusted EBITDA Profitability in 2025
Delivered full year adjusted EBITDA profitability of $22 million and adjusted net income of $20 million for 2025, demonstrating profitability while scaling membership.
Strong Membership Growth
Medicare Advantage membership increased 38% year-over-year to approximately 140,000 members at year-end 2025; AEP growth of 53% year-over-year referenced for the 2026 enrollment period. 2026 membership guidance averages 154,000–158,000 (≈46% growth at midpoint).
Robust Top-Line Growth
Q4 insurance revenue was $486 million (+47% year-over-year); 2025 insurance revenue was $1.9 billion (+41% year-over-year); total revenue for 2025 increased ~40% year-over-year; 2026 total revenue guidance of $2.81B–$2.92B (≈49% YoY growth at midpoint).
Introduction of Consolidated Gross Profit and Strong Level
Introduced consolidated gross profit as primary operating metric; consolidated gross profit for full year 2025 was $356 million and 2026 guidance is $470 million–$510 million, signaling material expansion expected.
Controlled Underlying Medical Cost Trend
Reported underlying medical cost trend excluding pharmacy well controlled at 5% year-over-year in 2025 despite elevated industry utilization.
Improving Cohort Economics
Returning member contribution profit remained strong at $200 PMPM year-over-year; new member contribution loss improved to $145 PMPM, with management expecting meaningful improvement in new member contribution profit in 2026 as cohorts mature.
Operating Leverage and SG&A Efficiency
Adjusted SG&A improved: Q4 adjusted SG&A of $98 million; adjusted SG&A as a percentage of total revenue improved 560 basis points YoY to 20% in Q4 and was 17% for the full year (improving 410 basis points YoY); 2026 target to reduce adjusted SG&A as a % of revenue by ~100–150 bps YoY.
High Retention and Technology Adoption
AEP retention above 95% entering 2026 and ~2/3 of members received Clover Assistant-powered care in 2025; management expects deeper Clover Assistant and Counterpart Assistant penetration to drive improved outcomes and economics.
Balance Sheet and Liquidity
Ended Q4 with $320 million in cash and investments (including $122 million at an unregulated subsidiary); capital allocation focused on preserving liquidity and selective reinvestment to strengthen cohort economics.
2026 Profitability and Guidance
Company expects 2026 to be first full year of GAAP net income profitability with net income guidance between breakeven and $20 million, adjusted EBITDA guidance $50 million–$70 million, and material consolidated gross profit improvement.