Medical Loss Ratio — Quarterly Trend
Medical Loss Ratio = medical benefits expense / premium revenue. Lower is better for the insurer. HUM and CNC pushed above 91% during the 2024-2025 utilization shock driven by Medicare Advantage cost inflation; UNH followed in mid-2025. Source: 10-Q / 10-K filings, earnings supplements.
The UnitedHealth Collapse
UNH dropped from $610 in Nov 2024 to ~$280 in May 2025 — a $330B+ market-cap evaporation — driven by sequential catalysts: CEO assassination, Q1 2025 earnings miss + guidance pull, and the DOJ Optum/Medicare Advantage probe. Forward P/E compressed from ~21x to below 10x. Sources: Yahoo Finance, FactSet consensus.
Medicare Advantage Enrollment by Carrier
US Medicare Advantage enrollment by parent organization. Total MA enrollment grew from ~24M (2020) to ~36M+ (2026E) as Boomers aged in and CMS subsidies expanded. UNH and Humana lead but Humana intentionally shed ~600K members in 2025-2026 after its 4-star+ contract share collapsed. Source: CMS Monthly Enrollment by Contract.
STAR Ratings Distribution
| Carrier | MA Members | % in 4-star+ (2024) | % in 4-star+ (2025) | YoY | 5 | 4.5 | 4 | 3.5 | 3 | <3 |
|---|---|---|---|---|---|---|---|---|---|---|
UnitedHealthUNHDropped from 87% to 78%; modest revenue headwind | 10.1M | 87% | 78% | -9pp | 1 | 5 | 18 | 12 | 3 | — |
HumanaHUMLost ~$3B in QBP starting 2026; lawsuit filed against CMS; Mar 2025 ruling vacated cut-points but bonuses for 2026 already lost | 5.7M | 94% | 25% | -69pp | 1 | 3 | 6 | 11 | 4 | 1 |
CVS/AetnaCVSBest-performing large MA portfolio in 2025; minimal QBP impact | 4.3M | 87% | 81% | -6pp | 1 | 4 | 11 | 6 | 2 | — |
ElevanceELVFiled lawsuit; 23pp decline | 2.2M | 64% | 41% | -23pp | — | 1 | 5 | 9 | 4 | — |
CenteneCNCOnly major carrier to improve materially YoY; turnaround under new CEO | 1.3M | 22% | 55% | +33pp | — | 1 | 4 | 6 | 3 | 1 |
MolinaMOHSmall MA footprint; Medicaid-focused | 250K | 50% | 35% | -15pp | — | — | 3 | 7 | 2 | — |
Clover HealthCLOVSmall but high-quality MA portfolio; PPO plan rated 4-star | 80K | 80% | 90% | +10pp | — | 1 | 1 | 1 | — | — |
Oscar HealthOSCRACA-marketplace pure-play; exited MA after 2023 | — | — | — | — | — | — | — | — | — | — |
% in 4-star+ drives Quality Bonus Payments (QBP) under MA. Humana's collapse from 94% to 25% triggered a ~$3B annualized QBP loss starting 2026 and was the central catalyst for the company's 2024-2025 crisis. Centene was the sole major carrier with meaningful YoY improvement. Source: CMS MA STAR Ratings 2025 plan year.
Days Claims Payable — Reserve Snapshot
Days Claims Payable measures how long the insurer can cover medical claims from reserves on hand. Industry healthy range is 40-60 days. Lower-DCP carriers (HUM, CLOV) have less cushion if claims surge; Cigna and Oscar are most conservatively reserved. Source: Q1 2026 10-Q filings.