Wayne DeWitt will walk through the details of our full-year 2025 financial performance and 2026 outlook before we turn to Q&A. These actions and others are intended to improve the value we offer to all those we serve and drive sustainable growth for many years to come. We finished 2025 with adjusted earnings per share of $16.35, which was slightly ahead of our expectations. Full year 2025 results exclude a $1.6 billion net of tax and largely non-cash charge, very consistent with what we discussed on our third quarter earnings call.
Addressing the elements of this charge was important in setting a solid foundation for returning to the historical earnings quality and growth you've come to expect from us. Looking to 2026, we expect adjusted earnings per share of greater than $17.75 for growth of at least 8.6%. Our initial outlook reflects measured growth across all four of our reporting business segments, with double-digit improvements at UnitedHealthcare and low to high single-digit adjusted growth across our Optum segments. UnitedHealthcare finished 2025, having made progress to more effectively serve our members and network partners, another important element in building sustainable growth.
We closed the year with medical care patterns in each business in line with our updated outlook and ultimately supportive of our pricing decisions for 2026. We now expect UHC Medicare Advantage contraction will be in the range of 1.3 million-1.4 million members for the full year, including group, individual, and dual special needs plans. Our 2026 approach favored margin recovery, and these membership trends are a result of these actions. We will continue to work with CMS to ensure an appropriate final growth rate calculation to avoid a profoundly negative impact on seniors' benefits and access to care.
| Metric | Period | Current guidance |
|---|---|---|
| Adjusted EPS | FY2026 | greater than $17.75 (>=8.6% growth) (initiated) |
| Net EPS | FY2026 | at least $17.10 (initiated) |
| Revenues | FY2026 | approximately $440 billion |
| Medical care ratio | FY2026 | 88.8% ±50 bps (improving) |
| Operating cost ratio | FY2026 | 12.8% ±50 bps (improving) |
| Cash flow from operations | FY2026 | at least $18 billion (~1.1x net income) |
| AI investment | FY2026 | nearly $1.5 billion (at least as much in 2027) |
| Medicaid membership | FY2026 | contraction ~565,000-715,000 |
| Metric | YoY | Note |
|---|---|---|
| Adjusted EPS (FY2025) | $16.35, slightly ahead of expectations | continued solid execution across the enterprise |
| Revenues (FY2025) | +12% to nearly $448 billion | domestic membership growth of over 415,000 people |
| Medical care ratio (FY2025) | 89.1%, slightly better than expected | includes ~20 bps of negative charge impact from the lost-contract reserve |
| Operating cost ratio (FY2025) | 13.3% | ~40 bps of charge-related impacts including ~$800 million of incentives and Foundation funding |
| Cash flow (FY2025) | $19.7 billion (~1.5x net income) | strong operating performance |
| Q4 Optum Health adjusted earnings | ~$1.5 billion new baseline (came in below the ~$3 billion guide) | fourth-quarter restructuring actions and one-time items now behind the business |
| Topic | Previous mention | Current period | Trend |
|---|---|---|---|
| Medicare Advantage trend and margins | 2025 trend ~7.5% | 2026 priced at 10% trend, expecting ~50 bps MA margin improvement | Recovering |
| Optum Health turnaround | Q3 restructuring plan | ~$1.5 billion baseline, ~9% earnings growth and ~30 bps margin expansion expected in 2026 | Stabilizing |
| Optum Financial realignment | announced in Q3 | moved into Optum Insight to capture technology and fintech synergies | Implemented |
| AI and technology | accelerating investment | nearly $1.5 billion in 2026, ~$1 billion UHC operating cost reductions, 80%+ of calls leverage AI | Scaling |
| Transparency and governance | independent reviews launched | will publish prior-auth, claim approval, rebate and other metrics in 2026 | Expanding |
| 2027 MA rate environment | — | Advance Notice viewed as insufficient; will engage CMS to avoid benefit and access cuts | Headwind |