Elevance Health Outlines 2026 Guidance, Expects Medicaid Margin Trough

Company highlights 'execution and repositioning' as key focus for the year ahead.

Jan. 28, 2026 at 9:31am

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Elevance Health (NYSE:ELV) executives emphasized 'execution and repositioning' as the central theme for 2026, outlining a guidance framework that reflects portfolio actions across Medicaid, Medicare Advantage, and the individual ACA market alongside continued investment in Carelon. The company established 2026 adjusted diluted earnings per share guidance of at least $25.50, noting that 2025 results included approximately $3.75 per share of favorable non-recurring items.

Why it matters

Elevance Health's 2026 guidance and strategic priorities provide insight into the challenges and opportunities facing the broader health insurance industry, particularly around managing membership shifts, cost trends, and margin pressures across different government and commercial lines of business.

The details

For the fourth quarter, Elevance reported operating revenue of $49.3 billion, up 10% year over year, driven by premium rate adjustments and acquisitions. The company ended 2025 with 45.2 million members, a decline of about 500,000 year over year, primarily due to lower Medicaid membership tied to eligibility reverifications. Management described 2026 as a trough year for Medicaid, with rates continuing to lag elevated acuity and utilization, and expects a Medicaid operating margin of approximately -1.75% in 2026. In Medicare Advantage, the company expects membership to decline in the high teens percentage range in 2026, reflecting deliberate portfolio actions. For the individual ACA business, Elevance repositioned for higher expected morbidity following the expiration of enhanced subsidies and expects at least 900,000 individual ACA members at year-end 2026.

  • Elevance Health established 2026 adjusted diluted earnings per share guidance of at least $25.50.
  • The company reported adjusted diluted EPS of $3.33 for the fourth quarter and $30.29 for the full year 2025.
  • Elevance repurchased 1.4 million shares in the fourth quarter for $470 million, bringing full-year repurchases to $2.6 billion.

The players

Elevance Health

A large U.S.-based health benefits company that provides a broad range of health insurance products and related services.

Gail Boudreaux

The chief executive officer and president of Elevance Health, leading the company's strategic focus on integrated health care and benefit delivery.

Mark Kaye

The chief financial officer of Elevance Health.

Felicia Norwood

The president of Government Health Benefits at Elevance Health.

Pete Haytaian

The president of Carelon, Elevance Health's healthcare services subsidiary.

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What they’re saying

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What’s next

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