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Elevance Health sells health plans to employers and individuals and provides coverage through government programs such as Medicare and Medicaid. Its Health Benefits business collects premiums and pays for covered medical care; these premiums supply most of the company’s revenue. Employers that fund their own workers’ healthcare instead pay Elevance fees to process claims, provide access to doctor and hospital networks, and administer benefits. U.S. government agencies are a substantial source of revenue.
Its Carelon businesses also serve Elevance’s own health plans and outside customers. CarelonRx supplies prescription drugs and manages pharmacy benefits, earning drug revenue and service fees. Carelon Services earns fees for managing and delivering care, including in-home and virtual care for people with chronic or complex conditions. CarelonRx relies on CVS Health subsidiary CaremarkPCS Health for core functions such as processing pharmacy claims and administering pharmacy networks and rebates.
The insurance business depends on setting premiums high enough to cover medical costs: prices are generally fixed before coverage begins, and Elevance bears the cost when claims exceed its assumptions. Government payment rates and program requirements also shape the business. Elevance needs insurance licenses and regulatory approvals to sell certain products and raise certain premiums. It sells Blue Cross and Blue Shield coverage under licenses that limit where it may use those brands and require it to meet operating and brand-use rules.
The risk section is the longest, dullest part of the filing. This keeps only what can really hurt you: where it hits, how hard, when it plays out.
Every company claims an edge. Each one is checked against hard numbers like margins and returns: which hold, and which line gives way first.
UnitedHealth competes with Elevance for Medicare Advantage members, while its Optum pharmacy, care-management and analytics services compete with Carelon for health-plan and other customers. Optum’s pharmacy and care-service results offer a comparison for Elevance’s business beyond insurance premiums.
Elevance both competes with and relies on CVS Health: Aetna sells health coverage to employers, government programs and individuals, while CVS’s Caremark supplies core pharmacy services to CarelonRx. Watch that service agreement, whose current term runs through December 31, 2027; Elevance can elect a three-year extension if either party terminates or does not renew.
Centene competes with Elevance for Medicaid, ACA Marketplace and Medicare members, making its government-funded health coverage a useful comparison. Medicaid supplied 57% of Centene’s total external revenue in 2025, so that business is the clearest place to watch for pressures shared with Elevance.
Molina competes with Elevance for state Medicaid contracts and members, collecting premiums to arrange and pay for covered care; it also sells Medicare and Marketplace coverage. Medicaid accounted for 75% of Molina’s consolidated premium revenue in 2025, making its state contract awards and rates especially relevant to Elevance’s Medicaid business.
Cigna competes with Elevance for employers’ health-benefit business, while Evernorth provides pharmacy and care services that overlap with CarelonRx and Carelon Services. Watch the drug rebates Express Scripts secures for clients: some contracts guarantee a rebate value, leaving it to bear the risk if negotiations fall short—a useful comparison for CarelonRx’s rebate-administration business.
Humana competes with Elevance for Medicare insurance members, while its CenterWell pharmacy, primary-care and home-health services overlap with Carelon. Its Medicare insurance results are a useful comparison for Elevance’s exposure to government reimbursement, Star Ratings and seniors’ use of medical care.
Oscar Health competes with Elevance for individuals and families buying ACA coverage, with premiums paid by members and federal advance premium tax credits. Watch whether those premiums cover members’ medical costs: Oscar’s insurance results offer a direct comparison for the ACA cost pressure that drove much of Elevance’s higher benefit expense ratio in 2025.
Elevance Health, Inc. earningsThis company
Elevance’s report will show whether the premiums it collects can keep its health-plan business profitable as medical costs rise.
Read Health Benefits premium revenue alongside its benefit expense ratio—the share of premium revenue spent on benefits. In 2025, that ratio rose to 90.0%, and Health Benefits reported operating gain of $4,158 million. If premiums grow while the ratio steadies or falls and operating gain holds up, pricing is keeping pace with medical costs; if the ratio rises and operating gain shrinks, medical spending is growing faster than premiums and leaving less profit in the health-plan business.
Molina Healthcare, Inc. earningsMOH
Molina’s report will show how state Medicaid rates and enrollment affect the economics of the coverage it sells, a direct comparison for Elevance’s Medicaid business.
Compare Molina’s Medicaid enrollment and premium revenue with the medical costs for that coverage. Stable enrollment and premiums that cover care would suggest state contracts and rates can still support the business; falling enrollment or medical costs rising faster than premiums would make Medicaid harder to run profitably and signal possible pressure for Elevance in shared markets, though it would not establish that the two companies have the same contract outcomes.
CVS HEALTH CORPORATION earningsCVS
CVS’s report will show how its pharmacy-benefit business is doing, offering a view of the supplier behind some of CarelonRx’s core services.
Look at CVS’s discussion of Caremark’s pharmacy-benefit business and service arrangements. Steady performance and continuity would suggest that the supplier handling some core services for CarelonRx remains on firm footing; pressure on the business or changes in service arrangements would put supplier capacity and commercial terms in focus, but CVS’s report alone would not establish the specific terms or status of Elevance’s agreement.
The Cigna Group earningsCI
Cigna’s report will show whether Express Scripts secures enough drug rebates to meet client commitments, a useful read on pricing pressure in CarelonRx’s rebate-administration business.
Compare the rebates Express Scripts commits to clients with the rebates it secures. Meeting commitments would show that negotiated drug discounts can support those arrangements; falling short would expose the cost of promising more than negotiations deliver and highlight a similar risk for CarelonRx’s rebate-administration business, without implying that the two companies have the same contracts.
Oscar Health, Inc. earningsOSCR
Oscar Health’s report will show whether ACA premiums keep pace with members’ medical costs, a comparison for the cost pressure in Elevance’s own ACA business.
Compare Oscar Health’s ACA premium revenue with its medical costs. Premiums that cover costs would suggest pricing is keeping pace with members’ care needs; costs rising faster than premiums would show that ACA medical-cost pressure persists and could also squeeze Elevance’s related business, though the two companies do not have identical members or pricing.
Humana Inc. earningsHUM
Humana’s report will show how care costs, government payments and Star Ratings affect its Medicare plans, a comparison for Elevance’s business serving seniors.
Compare Humana’s Medicare premiums with its medical costs, and read its discussion of government payments and Star Ratings alongside them. Costs contained relative to premiums and steady business performance would suggest the insurer can absorb the demands of senior care and government rules; costs growing faster than premiums or pressure tied to ratings would put Elevance’s Medicare business in focus, but would not establish that the two companies have the same costs or ratings.
