America's largest health insurer. Its revenues from Medicare and Medicaid rose from $70bn in 2014 to $220bn in 2024. These government programmes once brought in nearly three-fifths of UnitedHealth's insurance income; by 2024 they accounted for nearly three-quarters. Medpac, a congressional advisory body, estimates that Medicare Advantage costs taxpayers 20% more per patient than standard Medicare.
In April 2025 UnitedHealth reported unexpectedly disappointing results. Within weeks it had replaced its chief executive and scrapped its profit forecast for the year. Between November 2024 and July 2025 its market value collapsed from $575bn to $240bn.
The crisis spread across the industry. Elevance Health, America's second-largest health insurer, also cut its 2025 profit forecast. Centene swung to a $253m loss from a $1.1bn profit a year earlier. Molina Healthcare lowered its earnings estimates twice in two weeks.
Medical costs are climbing at the fastest rate in over a decade. PwC expects a rise of 8.5% in both 2025 and 2026, fuelled by pricey cancer treatments, growing demand for mental-health care and booming sales of weight-loss drugs. S&P Global forecasts that the medical-loss ratio—the share of premiums spent on care—will hit 88% in 2025 for the big insurers, up from 83% in 2020. Most aim for 80%.
The One Big Beautiful Bill Act includes deep cuts to federal health-care spending. According to the Congressional Budget Office, Medicaid funding will fall by $910bn over the next decade, equivalent to a 14% spending cut. Generous subsidies for Affordable Care Act plans are due to lapse at the end of 2025, and the CBO projects 16m more uninsured Americans by 2034 than would otherwise be the case.
On May 1st 2025 the Department of Justice filed a lawsuit against Aetna, Elevance and Humana, alleging they conspired to steer patients into Medicare Advantage by paying brokers "hundreds of millions of dollars" in kickbacks. In July 2025 UnitedHealth revealed it faces both civil and criminal probes into its billing practices, with the Wall Street Journal reporting that the firm allegedly inflated diagnoses to make patients appear sicker and trigger higher government payments. UnitedHealth says it has "full confidence" in its practices.
In the ACA exchanges, most insurers are seeking premium increases of 10-20% for 2026.
Experience is a good teacher, but she sends in terrific bills.