The country’s biggest payers have been branching out beyond insurance for years — and the investments keep mounting.
As insurers partake in health services, the line between coverage and care delivery blurs. But, while some bets pay off and position companies as players beyond health insurance, some companies are taking steps back.
Cigna
Cigna is a prime example of a broad focus beyond insurance. The company has been leaning into its services arm, Evernorth, in recent years. For example, the company has been making headlines with pharmacy initiatives, including a rebate-free pharmacy benefit model. When Cigna kicked off a GLP-1 management program in 2024, former CEO David Cordani told CNBC the company believed “pharmaceutical or pharmacological innovation was going to define the next decade.”
In 2025, Evernorth had posted nearly $235 billion in revenue, including more than $132 billion from pharmacy benefit services and almost $103 billion from specialty and care services.
Meanwhile, insurance division Cigna Healthcare is exiting the exchange business at the end of 2026 and sold its Medicare Advantage business to Health Care Service Corp. in 2025. Cigna previously moved away from its Medicaid business, as well.
UnitedHealth Group
Optum has spent years buying its way into nearly every corner of care delivery. The company has the nation’s largest physician network, made up of directly employed, contracted and affiliated physicians. While UnitedHealth scaled back its subsidiary disclosures this year, a past report indicated nearly 2,700 subsidiaries.
For example, home health and hospice came into Optum’s purview with the 2023 $5.4 billion purchase of LHC Group. On the outpatient side, subsidiary SCA Health has kept growing through deals like its 2025 acquisition of gastroenterology platform U.S. Digestive Health.
UnitedHealth is also pouring $3 billion into AI investments in 2026 and 2027. These investments became even more concrete July 13, when Optum confirmed a partnership with Anthropic.
However, expansions come with more opportunities for vulnerabilities: While Optum gained the country’s largest medical claims clearinghouse through the $7.8 billion Change Healthcare transaction in 2022, a significant ransomware attack in 2024 rattled the industry, delaying authorizations and causing notable financial fallout.
UnitedHealth has been pivoting to a more disciplined approach with Optum Health, in particular. In recent years, Optum’s strategy has centered on working with more engaged physicians and stepping away from those lacking alignment, executives have said. According to a January earnings call, Optum Health slimmed its affiliated provider network by almost 20% in one year, as well as lowered its risk-based membership by about 15% through market exits, concluded PPO contracts and pivots away from risk-sharing deals with insurers where the company could not reach sustainable terms.
Elevance Health
Elevance President and CEO Gail Boudreaux has called Carelon, Elevance’s health services arm, the company’s “flywheel for enterprise growth.” Carelon has been bolstering its capabilities in recent years through acquisitions, spanning specialty pharmacy with BioPlus and Kroger, infusion centers with Paragon Healthcare, and home health with myNEXUS and CareBridge. In 2025, former Carelon President Peter Haytaian said Elevance had “many areas of interest” for further acquisitions.
Pharmacy benefit manager CarelonRx was the company’s only segment in the second quarter where operating margins widened compared to the same time last year, reaching 5.2%.
Humana
Humana’s CenterWell has been consistently building out its portfolio for older adults. Humana closed its acquisition of MaxHealth, a Florida primary care network, in February 2026. The transaction was estimated to be roughly $1 billion, according to Bloomberg. It is the latest in a series of CenterWell deals, such as the acquisition of The Villages Health, a Florida retirement community health system. CenterWell planned to open up to 30 primary care clinics in 2025.
Centene
Centene’s business model has never had the same services infrastructure as its peers, and its recent moves have gone further in the opposite direction, unwinding pieces of its behavioral health platform.
Following the company’s acquisition of behavioral health company Magellan Health, the company offloaded Magellan Rx to Prime Therapeutics in 2022 and Magellan Specialty Health to Evolent Health in 2023. Centene shared plans in 2026 to divest the rest of Magellan Health.
At the Becker's 5th Annual Fall Payer Issues Roundtable, taking place November 2–3 in Chicago, payer executives and healthcare leaders will come together to discuss value-based care, regulatory changes, cost management strategies and innovations shaping the future of payer-provider collaboration. Apply for complimentary registration now.