2026 EPS Outlook
Company expects full year 2026 adjusted diluted EPS > $3, representing >40% year-over-year growth from 2025 adjusted diluted EPS of $2.08, signaling a planned meaningful margin recovery.
Medicaid Health Benefits Ratio Improvement
Medicaid Q4 health benefits ratio (HBR) improved to 93, a 40 basis point sequential improvement and ~190 basis points improvement versus Q2 2025, with management targeting Medicaid HBR stability in 2026 supported by assumed net rates in the mid-4% range (≈4.5%).
Medicare and PDP Strength
Medicare segment delivered strong 2025 results; Medicare PDP revenue and enrollment growth drove Medicare premium revenue guidance +$7.5 billion for 2026 and Part D enrollment tracking to high single-digit percentage growth; PDP pretax margin assumed ~2% in 2026 (down from high-threes in 2025) while MA is progressing toward breakeven by 2027.
Consolidated HBR and Cost Discipline
Company guides to a consolidated HBR of 90.9%–91.7% for 2026 (midpoint down ~60 basis points vs. 2025) and reported full year adjusted SG&A ratio of 7.4% (110 basis points improvement vs. 2024), demonstrating operating leverage and expense discipline.
Balance Sheet and Liquidity Actions
Ended year with ~$400 million cash available for general corporate use, reduced debt by $189 million in Q4, and finished with a debt-to-capital ratio of 46.5%, indicating active deleveraging and improved balance sheet positioning.
Operational & Data/AI Progress
Built data/AI capabilities to accelerate operations (e.g., faster prior authorization approvals, improved call center operations, advanced payment integrity analytics scoring claims against 75 algorithms) expected to drive future automation, efficiency, and medical economics improvements.