Big Insurance Q1 2026 Earnings Round Up

The most recent numbers the nation’s largest for-profit health insurers have shared with investors tell a story the industry is eager to tell Wall Street: the worst is over. After two brutal years of earnings misses, executive firings, and stock price collapses driven by unexpectedly high medical spending, the seven biggest publicly traded health insurers have now completed their first-quarter earnings reports for 2026 and their shareholders are cheering.

Every one of them beat analysts’ expectations in various ways, and most raised their full-year 2026 guidance. But before you read the company-by-company results, it is worth examining the mechanisms behind that recovery because the story the earnings releases tell is not quite the same as the story they leave out.

To get back into Wall Street’s good graces, insurers have:

• raised premiums

• cut benefits

• narrowed their provider networks

• exited markets that weren’t meeting investors’ profit expectations, and

• shed members they deemed too costly to cover.

Across the seven companies, total medical membership fell by roughly four million people between the first quarter of 2025 and the first quarter of 2026, and from what executives signaled to investors, many more people likely will be dumped by the end of the year. The patients who already have lost coverage through market exits or who found their benefits reduced this year do not appear as line items in an earnings release. They appear in the year-over-year membership declines and skimpier benefits that analysts note with approval.

The key metric driving the recovery is the medical loss ratio — the percentage of premium revenue that insurers actually spend on medical care. When that number falls, profits rise and investors get richer. Across the sector, medical loss ratios came down in the first quarter, or at least came in lower than Wall Street feared. Insurers credited tighter cost management, a milder flu season, and “repricing” — the practice of raising premiums and cutting benefits, particularly in Medicare Advantage plans, to close the gap between what they collect and what they pay out. (Financial analysts’ term for this is benefit buydown, which is unique among American industries.) Higher revenue coupled with devalued benefits produces better medical loss ratios from investors’ perspective.

The stock market has responded — but the picture is more complicated than a simple sector rebound. Most of these stocks are up year to date, measured from deeply depressed December 31 baselines. But look back a full year and a different story emerges: four of the seven companies are still worth less today than they were a year ago. Molina is down 43% over that period. Cigna and Elevance are each down about 6%. The “recovery” is real in the sense that stocks have bounced off their bottoms.

For much of the sector, it is not yet a return to full health, but the companies clearly are making good on their assurances to investors that they will do whatever it takes to improve their profit margins, regardless of the consequences to patients.

Here is what each of the seven reported — and what each report left out.

UnitedHealth Group, the nation’s largest health insurer, reported first-quarter 2026 revenues of $111.7 billion, with adjusted earnings of $7.23 per share and a medical loss ratio of 83.9% — well below the 85.5% analysts had expected. The company raised its full-year adjusted earnings guidance to more than $18.25 per share.

UnitedHealth attributed the year-over-year declinedecline in its medical loss ratio to strong medical cost management and favorable reserve development, while acknowledging “consistently elevated utilization and unit cost trends.” In plain terms: patients are still using more care than the company would prefer, but UnitedHealth is getting better at managing around it.

The stock’s 17% year-to-date gain requires context. UnitedHealth ended 2025 at $327.56 — the result of a punishing year that included the Change Healthcare cyberattack, the killing of its insurance CEO, and mounting federal scrutiny of its Medicare Advantage risk-scoring practices. Then this past January, a disappointing fourth-quarter 2025 earnings report sent shares plunging nearly 20% in a single session, pushing the stock to its recent lows before the partial recovery began to take hold. The May 11 close of $384.44 leaves the stock about 4% above where it was a year ago — a modest gain that reflects recovery from a deep hole rather than a return to anything resembling its former heights.

CVS Health reported first-quarter net income of more than $2.9 billion as costs slowed for subscribers of its Aetna health plans. The company’s medical loss ratio fell to 84.6%, compared to 87.3% in the same period a year ago.

CVS attributed thedecline primarily to better underlying performance in its government business and the absence of a premium deficiency reserve recorded in the prior year — a liability an insurer must set aside when anticipated claims are expected to exceed the premiums it has collected. Its absence is itself a sign of improved financial positioning.

Total revenue grew more than 6% to $100.4 billion. CVS raised its diluted earnings per share guidance and confirmed it is exiting the individual Affordable Care Act marketplace after this year. Total medical enrollment fell by roughly 600,000 members compared to year-end 2024, and more than one million year-over-year. This marked CVS’s fifth consecutive quarterly earnings beat.

CVS tells the clearest turnaround story in the group. Its stock is up 18% year to date and up nearly 48% from where it traded a year ago, when the company was in the depths of its earnings crisis and had just replaced its CEO. The trajectory is unambiguous — and so is the strategy behind it.

“Margins over membership”

That recovery was not an accident. It was a stated strategy. CVS CEO David Joyner has said repeatedly over the past year that the company is prioritizing “margins over membership” in its Medicare Advantage business. That means exactly what it says: CVS would rather have fewer, more profitable enrollees than a larger membership it cannot price to break even. On the commercial side, Joyner made the same calculus equally plain. “We do see elevated trends. We took a disciplined pricing approach to that in 2025, which has pressured membership, but we’re going to stay disciplined in our pricing approach,” he told investors last August.

“Pressured membership” is the corporate euphemism. What it describes is people being priced out of their plans, and what it means is that Aetna is once again purging customers it considers a drag on profit margins. (It has done that frequently over the past 25 years.)

The membership losses CVS reported this quarter — roughly 600,000 members gone, more than a million year-over-year — are the direct result of that strategy. Wall Street loved it.

Cigna beat analysts on both earnings and revenue in the first quarter, posting $1.65 billion in profit. Its medical loss ratio came in at 79.8%, a favorable shift from the 82.2% posted a year earlier.

Cigna’s unusually low medical loss ratio reflects both aggressive cost management and a significant structural change. The MLR decline is partly attributable to the removal of its Medicare Advantage business, following Cigna’s sale of that book of business to Health Care Service Corporation. Medicare Advantage has been the primary driver of elevated medical costs across the industry. Cigna’s complete exit from MA made the numbers look cleaner.

Cigna also announced it will exit the individual ACA exchange market beginning in 2027. The company raised its full-year 2026 adjusted earnings guidance to at least $30.35 per share.

Evernorth, Cigna’s pharmacy benefit management and health services arm, generated $58.4 billion in revenue for the quarter, far more than the company’s health plan division. Like its peers, Cigna is increasingly a pharmacy and services company that also sells health insurance — not the other way around. (CVS now takes in more revenue from its PBM, Caremark, than from Aetna’s health plans and the company’s 9,000 retail stores.) Cigna’s stock has recovered to a 5.6% year-to-date gain but remains down about 6.5% from a year ago. A strong quarter has not answered the underlying question investors are asking: now that Cigna has exited Medicare Advantage and is exiting the ACA market, where does future growth come from?

Elevance Health (previously known as Anthem) reported $1.8 billion in first-quarter profit, down about 19% from the same period a year earlier, though the results exceeded Wall Street expectations. The company, which operates Blue Cross plans in 14 states, posted a medical loss ratio of 86.8% — slightly higher than a year ago, reflecting elevated costs in its Medicaid business, but better than analysts had feared.

Adjusted earnings per share came in at $12.58, above analysts’ consensus expectations. Elevance also raised its full-year 2026 adjusted earnings guidance.

One significant complication: Elevance’s results included a $935 million accrual tied to Medicare Advantage risk-adjustment data the company had previously submitted to federal regulators, where the ultimate liability remains uncertain. Risk-adjustment data — the system by which Medicare Advantage plans submit diagnosis codes to justify higher payments — has come under increasing regulatory scrutiny as a driver of what federal analysts estimate are tens of billions of dollars in annual overpayments to private insurers.

CEO Gail Boudreaux told investors that the company saw “moderately stronger retention” in its ACA segment and attributed better-than-expected results partly to a shift by remaining enrollees toward bronze-tier coverage — lower-premium, higher-deductible plans that tend to see lower utilization in the early months of the year. The stock is up nearly 10% year to date but remains about 6% below where it traded a year ago, with the risk-adjustment liability an unresolved overhang.

Humana’s first-quarter results were the most complicated of the group — a beat on paper, but with enough asterisks to keep analysts cautious.

The company’s insurance segment MLR came in at 89.4%, edging out its own target of just under 90%, with medical and pharmacy cost trends running somewhat lower than anticipated. Revenue for the quarter reached $39.6 billion, up sharply from $32.1 billion a year earlier, driven largely by a 25% surge in Medicare Advantage enrollment.

But Humana did not raise its full-year guidance, unlike most of its peers. The company said it expects its second-quarter medical loss ratio to come in slightly above 91%, a deterioration from the first quarter — a signal that the cost pressures driving last year’s sector-wide crisis have not fully abated – and the expectation that Humana picked up many of the more costly MA enrollees that its competitors dropped.

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Humana confirmed it expects to earn at least $9 per share for the full year and projects a full-year medical loss ratio of 92.75%, far higher than its rivals. Humana executives said the company’s primary objective is returning to a sustainable individual Medicare Advantage margin of at least 3% by 2028. Getting there will require continued benefit cuts, premium increases, and geographic retreats — all of which bear directly on the Medicare beneficiaries enrolled in Humana’s plans. What that means is that Humana likely will purge many of its new MA enrollees in the same way it did in 2025 after it disappointed Wall Street the year before.

Humana’s stock recovered sharply after the Q1 report, closing Monday at $274.24 — up nearly 8% year to date and up about 10% from a year ago. But investors’ enthusiasm should be tempered by one number: Humana’s aggressive Medicare Advantage membership growth this quarter mirrors exactly what CVS did in 2024, just before badly missing its cost targets as expenses came in far higher than expected. If that pattern repeats, the recovery will be short-lived.

Centene kicked off the year with better-than-expected revenue and adjusted earnings, signaling a recovery from a rough 2025. Its stock rose more than 13% the day after its earnings call — and at nearly 37% year to date, it is the strongest year-to-date performer in the sector so far in 2026.

The company posted total revenues of $49.9 billion, with its consolidated medical loss ratio falling slightly to 87.3%. Adjusted diluted earnings per share came in at $3.37, and Centene raised its full-year adjusted EPS guidance to above $3.40.

Centene is primarily a Medicaid and ACA marketplace insurer, and its recovery story is rooted in those markets. The company’s Medicaid medical loss ratio fell half a percentage point — driven by rate increases from states and continued cost management.

The ACA marketplace, however, remains a source of volatility. Centene’s ACA enrollment fell sharply as the expiration of enhanced premium tax credits pushed many lower-income consumers out of the market — a policy shift that, for Centene, paradoxically helped near-term financial results by reducing exposure to a segment that had been generating losses.

As with the rest of the sector, context matters. Centene ended 2025 at $41.15, deeply depressed from its year-ago price of $62.87. The stock has bounced hard off that bottom but remains down more than 10% from where it stood a year ago. The recovery is real but the hole it is recovering from is also real.

Molina is the outlier in the sector’s recovery narrative — the one company whose headline numbers looked genuinely bad, even as management insisted the underlying story was better than it appeared.

Molina reported a 95% year-over-year drop in net income for the first quarter, falling to just $14 million from $298 million in the same period last year. The collapse was driven primarily by a one-time charge: a $93 million impairment of intangible assets tied to the company’s planned 2027 exit from the Medicare Advantage–Part D market.

Total revenue was $10.8 billion, with premium revenue down about 4% year over year. The consolidated medical loss ratio rose to 91.1%, up from 89.2% in the first quarter of 2025.

The company’s executives reaffirmed full-year guidance for about $42 billion in premium revenue and at least $5 in adjusted earnings per share, and CEO Joe Zubretsky called the quarter “solid under the circumstances.” Molina has described 2026 as a “trough year” for its Medicaid margins, with the expectation that new contracts and the exit from unprofitable Medicare lines will improve results in 2027.

The stock market has rendered a harsher verdict. Molina’s shares are down 43% from where they traded a year ago — by far the worst one-year performance in the sector. The 7% year-to-date gain is recovery from a floor, not a foundation. Investors who held the stock through 2025 have lost nearly half their money.

From Wall Street’s perspective, the industry has stabilized. Whether the companies’ management teams have learned anything different is a question the second quarter will begin to answer.

Analysts have flagged Q2 as especially critical — particularly for Humana, whose aggressive Medicare Advantage membership growth while holding benefits stable mirrors a pattern CVS followed in 2024, before badly missing its medical loss ratio targets. If that pattern repeats, the stock gains of recent months will not hold.

More broadly, the mechanisms driving this quarter’s “recovery” — premium hikes, benefit cuts, member shedding, and structural exits from unprofitable markets — are not cost reductions. They are cost shifts. The medical spending did not go away. It was simply transferred: onto patients through higher out-of-pocket costs, onto states through Medicaid pressure, and onto the federal government through the ongoing overpayment dynamics in Medicare Advantage that regulators have not yet fully addressed.

Wall Street calls this a recovery but it is worth being precise about what has actually been recovered and what has simply been moved off the balance sheet and onto someone else’s.