UNH (US)

While Medicaid and ACA enrollment concerns have dominated the policy overhang for hospitals this year, Medicare-related risks could move higher on investors’ radar with the release of CY27 hospital outpatient prospective payment system (OPPS) proposed…

Last week’s federal court ruling in favor Clover Health (CLOV) against CMS injects fresh uncertainty into the Medicare Advantage (MA) Star Ratings and quality bonus payment framework [UNH, HUM, ELV, CVS, ALHC, CNC, MOH]. While…

UNH’s new Optum Rx model, which shifts PBM and group purchasing organization compensation in its commercial business toward transparent flat fees, appears designed to modestly outpace similar transparency initiatives from CI and CVS while aligning…

With 1Q26 earnings now largely complete for the major Medicare Advantage (MA) insurers [UNH, HUM, ALHC, CVS, ELV, CNC, MOH], near-term MA policy risks remain less acute, though far from extinguished. Congressional cuts remain unlikely…

A wave of state actions (AR, IA, ID, IN, MO, MT, NC, NE, NH) on Medicaid community engagement requirements (aka work requirements), spanning both accelerated implementation like today’s launch in NE and in some cases,…

While the passage of another ban on PBM ownership of pharmacies – this time in Tennessee – could reignite some headline risk for CVS, CI, and UNH, we think the actual risk of it going…

UnitedHealth’s (UNH) comments on its earnings call this morning, responding to a question about potential participation in CMS’s BALANCE obesity drug model, suggest that further design changes will be required for it – and likely…

The final CY27 Medicare Advantage (MA) rate announcement, reflecting a net 2.48% YoY benchmark increase, landed within our expectations and alleviates some of the near term-pressure on MA insurers [HUM, ALHC, UNH, CVS, ELV, CNC]…

We continue to expect CMS’s final CY27 rate announcement for Medicare Advantage (MA) insurers [HUM, ALHC, UNH, CVS, ELV, CNC], affecting their contracted value-based care providers [PRVA, ASTH, EVH], to produce a low single-digit increase…

CMS’s warning letter against ELV of potential sanctions on new Medicare Advantage (MA) enrollment underscores another enforcement lever the agency can deploy to curb improper risk adjustment behaviors and overpayments. As the agency remains committed…