UnitedHealth (UNH) Earnings Tuesday: Optum, Medical Cost Trends, 2026 Guidance
UnitedHealth (UNH) Earnings Tuesday: Optum, Medical Cost Trends, 2026 Guidance
By:Gus Downing
- UnitedHealth Group (UNH) is set to report their FY2025 Q4 earnings on Tuesday, January 27, before market open.
Analyst consensus expectations call for an earnings per share (EPS) of $2.12, on revenue of $113.8 billion.
UNH had one of the most turbulent years of any company in 2025, sinking 36.4% in the calendar year following the assassination of former CEO Brian Thompson and subsequent battles with the U.S. Department of Justice.
Warren Buffett’s Berkshire Hathaway acquired 5 million shares of UNH in Q2 of 2025.
What’s Priced in After a Turbulent Year
UnitedHealth’s EPS expectations constitute a sharp step down year-over-year (YoY), spurred by the bearish catalysts mentioned above. Q4 of the 2024 fiscal year yielded an EPS of $6.81, a mark over three times higher than what is being priced in for Q4 of 2025.
In addition to the aforementioned assassination and DoJ investigation, UnitedHealth also continues to cite the 2024 Change Healthcare cyberattack as a headwind to earnings and operations, and investors continue to ask about it in the context of risk controls and one-off costs.
Scrutiny remains elevated around risk adjustment, and just this month the Senate added a fresh inquiry into the company, and even more headline risk along with it. However, UNH has already finalized +5.06% payment growth to Medicare Advantage plans for the 2026 calendar year, and there are no shortage of other potential bullish variables that could UNH to a relative recovery throughout the year.
What to watch on the call
Claims Intensity: Did Utilization Cool?
Medical loss ratio (MLR) is always one of the most important factors for any company in this sector. Investors will be acutely listening to hear whether outpatient and physician visits cooled into Q4, or if the intensity and frequency has stayed elevated. Any information on procedure mix among the senior demographic and flu/COVID seasonality will also feed the MLR view that drives EPS. In early 2025, Medicare Advantage utilization came in higher than planned, which hurt results and guidance; investors will want proof that that trend is stabilizing.
Medicare Advantage Outlook: Turning Rate Gains Into Margin
Staying on the topic of Medicare Advantage, management’s first pass at 2026 Medicare Advantage profitability (beyond the +5.06% rate update) will matter a great deal. Pricing, benefit design, star ratings, broker channel costs, and administrative savings will all be in play. Investors want a clear and credible path from 2025 pressure to 2026 stability.
Core vs. Growth: Insurance vs. Optum Snapshot
UNH has two primary revenue segments: UnitedHealthcare and Optum Health. With regards to UnitedHealthcare, the most influential pieces will be enrollment mix (Medicare Advantage vs. commercial enrollment), premium yields, and prior-year development. With regards to Optum Health, critical factors include backlog and booking trends, margin cadence, and any remaining costs to remediate the 2024 Change Healthcare cyberattack. If management indicates that execution is steadying at Optum, that could help to offset any volatility in insurance at UnitedHealthcare, and vice versa.
Headlines and Hurdles: What Regulators Want
Insurance companies are always risk-centric, and UNH has more risks than usual as of late with increased scrutiny from Capitol Hill. Any updates on audits, inquiries, or compliance changes to Medicare Advantage would move the multiple, even if raw dollar impacts are modest. Investors will be carefully listening to parse any risk information from management.
2026 Framework: FCF, CapEx, and Margin Targets
Lastly, guidance for the full 2026 fiscal year will come into play. Commentary on free cash flow conversion, capital deployment like dividends and buybacks, and capital expenditure on tech and security following the cyberattack will all be major factors, as will initial 2026 EPS framing and margin guardrails.
Gus Downing is host of the tastylive Network show Risk and Reward. @GainsByGus
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