Major payers reported mixed third-quarter results amid rising medical costs and operational headwinds, a stark contrast to the more robust performance seen by some of the largest for-profit health systems.
Becker’s compared Q3 performance across six major payers — UnitedHealth Group, Cigna, Elevance Health, CVS Health, Centene and Humana — and four major for-profit hospital operators: HCA Healthcare, Tenet Healthcare, Community Health Systems and Universal Health Services.
Payers: Revenue growth meets margin compression
All six insurers reported year-over-year revenue increases in Q3, yet several faced margin pressures from elevated utilization, Medicare Advantage volatility and impairment charges:
- Centene recorded a $6.6 billion loss, driven by a $6.7 billion noncash impairment charge related to the healthcare delivery reporting unit under its health services segment. However, revenue increased 18% year over year to $49.7 billion.
- UnitedHealth Group reported $113.2 billion in third-quarter revenue — up 12% year over year — but saw net profit fall to $2.3 billion, down from $6.1 billion
- Cigna Group reported $1.9 billion in profit, up from $739 million in Q3 2024, fueled by growth at Evernorth Health Services.
- Elevance Health earned $1.2 billion in net profits, up nearly 18% year over year, with total revenue up 12% year over year to $50.7 billion.
- Humana reported a sharp profit decline to $195 million — compared to $480 million during the same quarter in 2024 — citing Medicare Advantage challenges.
- CVS Health posted a $4 billion net loss due to a $5.7 billion goodwill impairment in its health services segment, despite $103 billion in revenue.
Hospitals: Cost controls and volume growth drive gains
All four hospital chains saw improved performance in Q3, helped by stronger volumes, favorable payer mix and cost control efforts.
- Nashville, Tenn.-based HCA Healthcare led in net income at $1.6 billion, with an 8.6% net margin, and reported $19.2 billion in revenue, up 9.6% year over year.
- Dallas-based Tenet Healthcare posted the highest operating margin at 16.8%, though its $342 million net income was down from the previous year.
- Franklin, Tenn.-based Community Health Systems swung to profitability, reporting $130 million in net income (4.2% margin) after a $391 million loss (-4.8% margin) in Q3 2024.
- King of Prussia, Pa.-based Universal Health Services reported a $373 million net income, up 44% year over year, and an 11.6% operating margin.
Behavioral health, ambulatory services and high-acuity volumes were cited as key growth drivers, with most systems raising guidance for full-year revenue or earnings.
A widening payer-provider divide
As both sectors look to 2026, the Q3 divergence underscores the different operating models and financial levers of payers and providers. It also reflects growing friction between payers and providers over utilization trends, rate negotiations and evolving risk-sharing frameworks, including those shaped by AI and value-based care.
