Unitedhealth Group Inc (UNH) Q3 2026 Earnings Call Transcript

Good morning, and welcome to the United Health Group Third Quarter 2026 Earnings Conference Call. A question and answer session will follow United Health Group's prepared remarks. As a reminder, this call is being recorded. Here is some important introductory information. This call contains forward-looking statements under U.S. federal securities laws. These statements are subject to risks and uncertainties that could cause actual results to differ materially from historical experience or present expectations. A description of some of the risks and uncertainties can be found in the reports that we file with the Securities and Exchange Commission, including the cautionary statements included in our current and periodic filings. This call will also reference non-GAAP amounts. A reconciliation of the non-GAAP to GAAP amounts is available on the Financial and Earnings Reports section of the company's Investor Relations page at www.unitedhealthgroup.com. Information presented on this call is contained in the earnings release we issued this morning and in our Form 8K dated October 13, 2026, which may be accessed from the Investor Relations page of the company's website. I will now turn the conference over to Chairman and Chief Executive Officer of United Health Group, Steve Hensley.

Good morning and thank you for joining us today. Our third quarter performance reflects actions taken throughout 2026, driving meaningful progress and reinforcing our confidence to sustainably grow in 2027 and beyond within our 13 to 16% long-term target growth range. Our revised full year 2026 guidance reflects continuing improvements in leadership and execution across Optum and UnitedHealthcare as we better align our businesses to serve the demands of the ever-changing U.S. healthcare environment. We are accelerating the modernization of our enterprise by advancing simplified and more responsive policies, processes, and tools, focusing on more effective, integrated, value-based care offerings, and responsibly building modern agentic infrastructure as we seek to ensure people have access to higher quality care at lower costs. And at the same time, clinicians experience a simpler, faster, and more supportive system. Across the businesses, AI-enabled capabilities are beginning to help clinicians spend more time with patients, improve service speed and experience, streamline administration and reduce friction for both consumers and clinicians. A few examples. We have expanded AI-enabled chart summarization to more than 40% of our employed clinicians, reducing chart review time by 33%. AI-enabled information gathering and research has shortened appeal cycle times by 26%, improving both member and clinician experience, and we expect this to accelerate in 2027. And for this year's Medicare Advantage annual enrollment period we are introducing AI powered plan recommendation that use them use a member's care history and local plan options to help simplify their selection by the end of this year we are on track to implement all previously announced prior authorization reforms reducing decision timelines for patients relieving administrative burden for clinicians and delivering better experiences for people collectively these initiatives will reduce total prior authorizations by 30%, including a reduction of two-thirds in prior authorizations for people under the age 18. These efforts are only the beginning. More will follow. They are central to how we're changing our enterprise to be more in line with our mission, creating greater value and positive social impact. In that vein, an important effort is the reimagined UnitedHealth Foundation. With $1 billion committed to date, the foundation's investments, along with the dedicated operational expertise of UnitedHealthcare and Optum, can help facilitate scaled solutions to some of the U.S. health system's greatest challenges, including rural health, maternal and infant health, behavioral health, and workforce education. As just one example, in Tennessee, the foundation is helping expand and operate health hubs across the state, providing access to underserved communities and preventative care and chronic condition support. We will continue to highlight the foundation as part of our commentary on our earnings calls going forward. The broader healthcare environment remains dynamic. Policy-driven regulatory developments, changing consumer expectations, and the rapid evolution of clinical care and advances in technology continue to reshape the industry. These factors are pressuring basic affordability and access as never before. Success requires continuous adaptation, and the pace is accelerating. We recognize this and remain restless in our pursuit of change and improvement. We are challenging our assumptions, revising policies and practices, and repositioning leadership and capabilities to better meet the needs of those we serve and to move faster as an enterprise to adapt to the changing healthcare landscape. That includes opportunities to better align with clinical partners, employers, government benefit sponsors to help improve the experience of all stakeholders in health care. We've made progress in our 2026 performance. We have much to do to approach the full potential of our mission and the positive impact we can make as an enterprise. UnitedHealth Group has a long history of evolution to meet the needs of a changing U.S. health system. We're committed to accelerating these efforts as a stronger, more capable, more mission-centered enterprise. And with that, let me turn the call over to Tim Knoll.

Thanks, Steve. Design healthcare is seeing positive momentum across our Medicare and Medicaid businesses, while our commercial business continues to adjust to a challenging but steadily stabilizing environment. Costs remain stubbornly high across the entire healthcare landscape. in particular areas in areas such as specialty pharmacy and acute health care service intensity. We continue to address the challenge of increasingly expensive care with appropriate medical management, operational discipline, and equipment to identify and remove excess and unnecessary costs from our own enterprise as we advance simpler and more modern services. We are working to deliver stable benefits and value for our members and customers. We believe this positions us for continued organic growth and long-term value creation entering 2027. Let me start with our Medicare business, where the annual enrollment period begins later this week. Medicare Advantage remains the choice of well more than half of eligible American seniors as it offers better and more modern benefits and, importantly, better outcomes in fee-for-service Medicare. Beneficiaries choosing Medicare Advantage save, on average, more than $4,000 annually through lower premiums and cost sharing than those on original Medicare. With adequate funding, we believe Medicare Advantage will continue to be a choice of American seniors, particularly those who are disadvantaged and have chronic care challenges as they seek better value and modern care. Heading into 2026, we made deliberate decisions regarding Medicare Advantage benefit design and market positioning to preserve the long-term sustainability and performance of our Medicare Advantage offerings. We continued this discipline approach for 2027. We believe we are competitively positioned, focused on providing value for seniors in the markets we serve while being mindful of trend dynamics. In 2027, UnitedHealthcare will continue to prioritize high-value HMO, chronic special needs, and dual special needs offerings. Our commitment to serving America's seniors is clear. More than 94% of Medicare-eligible individuals nationwide will have access to UnitedHealthcare Medicare plans, and approximately 90% of Medicare-eligible consumers will have access to one of our Medicare Advantage plans with a $0 premium option. We are maintaining important benefits such as dental, vision, hearing, and additional health and wellness offerings that make a real difference in the lives with seniors. UnitedHealthcare Chronic Special Needs Plans will be available to nearly 50 million Medicare-eligible individuals in 2027, providing specialized support for people living with conditions such as diabetes, cardiovascular disease, and chronic heart failure. These plans offer benefits and access to care tailored to the unique needs of individuals managing chronic conditions, helping them connect with care, medications, and support they need. Much of this work is in coordination with our partners at OptumHealth, where evidence shows chronically complex seniors served by integrated value-based care experience better preventative care while improving health outcomes at lower costs. Medicare Advantage patients in value-based care arrangements are 40% likely than traditional Medicare patients to be hospitalized for acute and chronic conditions, and 40% less likely to be readmitted to a hospital within 30 days of discharge. Moving to stars. Our initial star ratings for payment year 2028 reflect our investment in quality, member experience, and operating execution. As we move through 2027 and into 2028, we expect to approach 75% of total members in four-plus star plans, compared to the industry average of 70%. Our team remains intensely focused on building a best-in-class consumer and clinical experience, and along with better benefit design and stability going forward, we believe those efforts will continue translating into stronger quality performance over time. We will continue to work in support of a CMS quality program efforts to ensure the Medicare Advantage program continues to provide quality experience and stability to the 36 million seniors who depend on it. Turning to medical costs, the actions we've taken to improve and modernize care management, strengthen clinical engagement, and enhance operating discipline are having a meaningful effect. Care intensity remains elevated relative to historical norms, even as we continue to see signs that trends are bending in a more stable direction than what we have recently experienced. We remain respectful of trends and are not assuming any deceleration to historical patterns or to ongoing clinician pricing pressure. Demand for care remains strong, particularly among senior and complex populations, and we fully support appropriate access to care for our members. Turning to the commercial business, performance continues to stabilize as we navigate a challenging market. As we previously noted, trends for commercial benefits are exceeding our initial expectations of 11%, driven by an acceleration of costs related to the Milster Prizes Act, greater cost intensity from clinicians, and high-cost specialty drugs. Of particular concern is the ongoing abuse of the No Surprises Act dispute process by a relatively small number of clinician groups and third-party organizations. Arbitration awards can approach nearly 6% of total medical spend in some regions, translating to billions of dollars in excess costs for consumers, employers, and the health system. The law was intended to protect patients from unexpected bills, and we strongly support that objective. We will continue working with policymakers and regulators to ensure the law functions as intended and that health care dollars are directed towards appropriate patient care rather than significantly inflated market arbitration awards and volumes along with unnecessary administrative expense. Medicaid remains stable through the back half of the year while our team continues to drive greater operational improvements through network curation and more effective behavioral health program initiatives. These actions help to partially offset the primary variable, which continues to be the timing and adequacy of state funding across several markets. As we move through the balance of 2026, we continue to work collaboratively with our state partners to ensure rates appropriately reflect the acuity and health care needs of the families being served, including the impacts of regulatory actions. While progress has been made in many states, the timing of updates remains uneven. Based on our current outlook, we continue to view 2026 as a trough year for core Medicaid margins, which we now expect to be moderately better than negative 1%. Finally, we are focusing intensely on enhancing our support for and relationships with clinicians and health systems. In addition to the prior authorization changes Steve mentioned, which we see as only the beginning, we are meaningfully speeding up our claims processing and payments and re-engineering re-energizing our relationship engagement efforts with more dedicated resources and executive ownership. Our goal is to provide a more seamless experience for clinicians and health systems who work with us and resolve issues more quickly. As we look towards 2027 and beyond, we are shifting our focus to sustainable organic growth underpinned by improving Medicare fundamentals, a stronger commercial outlook, continued opportunities to enhance Medicaid performance in an organization that is operating with greater discipline and accountability for all our stakeholders. With that, I'll turn it over to Patrick.

Thanks, Tim. Our results in the third quarter underscore the important work underway across all of Optum. Optum Health continued to deliver strong performance in the third quarter, driven by the continued return to value-based care principles combined with strong execution across our clinical programs and operational improvements enabling clinicians to focus more on their patients and improve patient experience. A few of the examples for this morning. A 27% increase from last year in online self-scheduling, making it easier for patients. Increase in home health visits. I'm very encouraged by them to co-locate behavioral specialists. The number of patients referred has doubled since last year. As Tim mentioned, it is now more important than ever to provide seamless care and coverage and continue to increase transparency on the PBM side of OptumRx. Through the 2027 selling season, we have seen our industry-first affordability experience unions. Pharmacy care and medical care are aligned, outcomes improve for the patients we serve, access improves, and the total cost of care is lowered. Specifically within the pharmacy service side of OctomRx, Genoa continues to expand its dedicated behavioral health pharmacy footprint and serve patients with serious mental illness and substance use disorders. Specialty pharmacy continues to grow through both volume and mix while improving patient support for increasingly complex therapies. And infusion services are becoming more important as we help shift appropriate care into lower cost and more convenient settings. We will continue to expand our portfolio of integrated pharmacy services and align them as close to medical care settings as possible, delivering better care, convenience. Turning to Optum Insight, 2026 has been both a performance, and 2027 will show meaningful progress, setting the foundation for accelerating growth in 2028. Our investment focus has been on further developing and bringing to market healthcare-specific AI solutions that enhance productivity performance outcomes while improving the patient and clinician experience. Overall, we are looking to 2027 with confidence. Our major remediation is a strong foundation for correctness.

Patrick, and good morning. Third quarter results reflect continued progress across the enterprise and improving execution in our businesses where we have been focused on operating reforms to drive better consumer and clinician experience. For Q3-2026, we reported revenue of $113 billion and adjusted earnings per share of $4.69, up from $2.92 a year ago. Consolidated medical care ratio of 88.4% for the quarter compares to 89.9% last year. The quality of earnings is strong and durable as we head into 2027. At UnitedHealthcare, performance continues to reflect pricing discipline, fundamental medical cost management, and care delivery enhancements. We continue to be respectful of continued elevated utilization trends which typically step up in the back half of the year, particularly in our risk-based businesses. Within OptumHealth, we are seeing steady progress from modernization, a return to a disciplined value-based care approach, and operating improvements as the actions taken through 2026 begin to yield results. In Optum Insight, performance is benefiting from technology and AI-enabled improvements, including payment integrity and broader operating efficiency, while we invest into the new areas to expand and modernize our offerings to drive growth. And in OptumRx, we continue to see the benefits of disciplined execution and the breadth of our pharmacy services model now based on a simpler, more transparent approach to serving these evolving market needs. Turning to the full year, our updated 2026 adjusted EPS guidance of at least $20.50 reflects performance through the third quarter, balanced by expected investments in the final months of the year. From a capital deployment perspective, our priorities remain consistent. First, reinvest in the business through targeted organic growth and steady expansion in care delivery, technology modernization, and broad-based AI adoption. Second, maintain balance sheet strength. And third, return value to shareholders. Our balance sheet remains strong. Our debt-to-cap ratio was 41.7% at the close of the quarter, and we remain on track to approach 40% by year end. We repurchased $5 billion of UNA stock through the third quarter. We have paid $6.2 billion in dividends year-to-date and expect to exceed $8 billion by year-end. Our strategic priorities remain focused on capabilities that align with and strengthen our ability to deliver value to consumers, benefit sponsors, and customers, and support long-term growth for shareholders. We view our 2026 adjusted EPS guidance of at least $20.50 as a solid run rate on which to grow. We would offer that current analyst consensus for 2027 may understate the opportunity ahead, and we see the lower end of our long-term 13% to 16% growth rate as a more reasonable starting point. As we think about 2027 more broadly, we continue to see a balanced set of tailwinds and headwinds. Tailwinds include continued enterprise-level performance progress, share repurchases, value-based care performance improvements, and further gains from AI and modernization that improve both consumer and clinician experiences, drive productivity benefits, reduce costs, and create sustainable performance improvement opportunities for our business and those we serve, as well as product opportunities for optimum insight. On the headwind side, we will accelerate our investments in the policy reforms and modernization of the businesses, particularly in UnitedHealthcare and Optum Insight, and remain respectful of medical trends and the broader external environment, where health benefit funding remains pressured. Overall, we're steadily and methodically improving performance broadly across the portfolio. We are positioned to finish 2026 strongly, and we remain focused on consistently delivering our 13% to 16% long-term growth target. With that, I'll turn it back over to Steve.

Thanks, Wayne. Let me close with a few thoughts before we move to questions. For a little more than a year, our priorities have been clear. Return to our core mission and culture. Better serve the needs of healthcare as one enterprise and one leadership team. Restore financial and operating discipline. Turn around and strengthen our performance business by business across all performance measures. Begin the process of reimagining and modernizing all we do to harness the compelling potential of modern intelligent technologies. Simplify our processes, elevate our service levels, and advance our response and service speed to consumers and clinicians. And finally, reposition all our businesses to return to responsible levels of profitable organic growth. As you've heard today, we are well underway in all those areas, but fully achieving those priorities requires us to get outside our four walls. For a company, we are spending time listening carefully to customers, consumers, clinicians, policymakers, and other stakeholders. We're doing so with humility and with a service mindset, conscious of the positive role we can play and the responsibility we have to improve the health system experience when we operate at our best. Those conversations are helping renew and reinforce the fundamental understanding that success in health care depends on relationships and trust, and we need to continue to build both with all stakeholders. We will continue listening, we will continue learning, and we will continue advancing our business in ways that improve experiences, provide easier access, and lower costs while delivering better outcomes. And for you, our shareholders, all these accountabilities align and create value. The progress we've made in 2026 gives us confidence. Our businesses are improving. Our modernization efforts are gaining traction. Our investments in AI and in integrated value-based care are creating tangible benefits today while positioning us for the future. We remain focused on better managing our businesses, finishing 26 strong, and building that foundation for growth in 27 and 28 and beyond. So we look forward to providing you a more comprehensive update in our outlook for next year before year end. And I'll thank you now. And the operator, let's open the line for questions.

The floor is now open for questions. At this time, if you have a question or comment, please press star 1 on your touchstone phone. You may remove yourself from the queue by pressing star 2 on your touchstone phone. We ask you to limit yourself to one question. If you ask multiple questions, we will only be answering the first question so that we can respond to everyone in the queue this morning. Our first question comes from Justin Lake with Wolf Research.

Thanks. Good morning. I wanted to focus on the government side for a second, specifically your comments around Medicaid. Things were getting better. Curious what you're seeing in terms of your third quarter run rate, what's driving that. Are you actually back to kind of break even, getting your improvement there? And maybe you can also let us know where your MA margins are at this point for 2026.

Mike, do you want to take that? Sure. Thanks, Justin. Good morning, and thank you for the question. As Jim indicated, our membership and overall acuity are within our expectations, and we now expect full 2026 performance moderately better than our forecasted range. The main drivers of that activity, as well as in our focus on complex care cost management, network and services curation, increasing our membership engagement, particularly in our coaching, AI-powered coaching activities, modernization activities and the ongoing identification and removal of broad waste and abuse activities. And we do believe these activities are doable. We did see them improvement in Q3, and we believe that will continue on for the rest of the year. We continue to see elevated trends in the areas of behavioral health care services, specialty pharmacy services, and home and community-based services, and also in inpatient care costs as well. those elevation rates are moderating slightly, and we're continuing to monitor that. We anticipate margin improvement as we look at the next year, and we will continue to work with our state partners to mitigate what has been a severed gap between funding and medical cost trends through the year. And, again, as we think about this for 2028, we're very aspirational to move to rated margins by the end of that year. Thank you for the question.

And, hey, Justin, maybe just this is on the Medicare margin piece that you highlighted. So, given where we've paced through 2026, we do now expect to be near the top end of the 2% to 4% range. I would attribute a lot of that to some of the great recovery actions that the team has executed on here throughout the year. I think the initiatives around medical trend, our cost management focus, and then a broader focus on the durable product offerings that we brought to the marketplace for 26. It also allows us to make investments now to study what we're doing in AI, modernization, provider, and ultimately I feel good about how it says – The question comes from Lance Wilkes with Bernie.

Can you talk a little bit about how you're approaching growth in 2027, in particular in Medicare Advantage as you're approaching the top end of the range, how you're looking at growth there, and then likewise with the selling seasons in for National Council and for PBM, how is that coming along?

We'll start with Bobby. Yeah, hey, thanks for the answer to the question. So, yes, AEP is kind of right around the corner here, and we'll wait until later this year to provide kind of formal membership guidance, maybe a couple of early observations to share with you. So, you know, obviously some of the things we did as we set up for planning in 27 was continue to look at ensuring we have a durable set of product offerings, and that meant some continued footprint refinements and product refinements, really around the residual PPOs that we started kind of moderating a year or two ago. But then as I look at the opportunities, I think that's actually a lot of good growth potential out there. So maybe one important stat for you, even with some of the footprint refinements, we did actually expand our overall footprint. Tim noted it in the prepared remarks. Now more than 94% of American eligibles for Medicare have access to one of our plan offerings. That's an expansion year over year. We also took a more dynamic approach to the product planning this year, and I think there are some real opportunities for smart, durable growth in the market plans right now. We are particularly focused on the dual special needs plan offerings, the chronic special needs plan offerings, and then some of the high value HMO. And I think we're better positioned to capture that growth in some of those key areas as we step into AEP in 2027 than we have been in recent years, and we aligned our go-to-market strategy accordingly. Maybe just last thing to highlight on that, when I think about the overall capabilities of the enterprise, the capabilities that we bring to bear, our emphasis on value-based care, I do think we have an incredible opportunity to make an impact for the members that are on these D-SIMP, C-SIMP and HMO plans, and it really drives some incredible outcomes and quality for those folks.

Thanks, Maggie. Yeah, Lance, this is Tim. I'm going to turn it over to Brandon Flavis, who is our new CEO of our commercial business, for some insights into the commercial selling season and our pricing posture there.

Question. We're coming off of two really, really strong years in national account sales. and our group retention looks very, very strong going into 2027. As we look at our pipeline and our selling season, obviously we're well through that in our national account space. Selling season this year, commercial business, we've had to be very mindful of the trend increases as well as being remarkably focused on affordability. As we look at 2026, it's going to be reflective of some of the increased trend pressures that we've seen in the marketplace. We continue to come in remarkably strong. And so we're having a very strong 2027 in markets selling. The National Council is very strong going next year.

Thank you for the question. Building really on Brandon's comments, we've enjoyed a couple of strong selling seasons, back-to-back years, and we see that trend continuing this year, really driven by the transformation and transparency modernization efforts within the PBM. Those efforts are really resonating in the market, Driven first and foremost by the fact that every OptumRx client gets the benefit that we are putting in. Again, in the high 90s this year, and then success rate remarks while maintaining pricing discipline. We're growing membership now to the north of 50% of our covered lives and expect that trend to continue in 2027. As we wind down the year, we're staying close to our clients. We're in the heat of the enrollment season. Brandon and I still have efforts in flight together. We'll stay close to those clients as we work to update our membership outlook. Thanks for the question.

Thank you. Next question, please.

Our next question comes from Stephen Baxter with Wells Fargo.

Yeah, hi. Just to round out, you know, some of the 2027 color, I think you just spoke pretty clearly to the health plan and TVM assumptions. Can you add some color on how you're thinking about your top line dynamics for health and insight and repositioning those businesses for growth, I think, in 2028 or beyond?

Sure. We'll start out with Kristen, and then we'll go to Cindy.

Yeah, thanks so much for the question, Stephen. I kind of want to just start with highlighting some of the performance that we're actually seeing inside the third quarter. Really strong performance in our clinical programs and medical management. Those programs are going to continue to be durable as we head into 2027. You know, the work we're doing to reduce unnecessary inpatient stays, the work we're doing to improve access to primary care, preventive care, the work we're also doing to improve access to home health and helping serve our patients in community and home settings. As I think about 2027, again, we'll unpack more of this in the coming months, but, you know, I think really confident in our ability to grow earnings inside 2027, and our focus is going to be on just really thoughtful growth. And there's a couple of things I maybe would just point to as growth opportunities for this business in 27, but also just really long-term. You know, first is we serve 20 million patients today. About 4 million of those are in fully accountable relationships. So still room for fully accountable growth, but, you know, even more importantly, lots of opportunity for professional cap, shared savings, and other ways in which we can serve our patients in our integrated model. Second, I would point to is just the high-performing service lines that we have today. So, think examples of home health, hospice, surgery centers, DSNITs, CSNITs, HMOs. Again, lots of opportunity for growth in those services to go deeper in our existing markets and serve kind of more patients more comprehensively. And then last, I would also just point to opportunities where we're launching new products in the market. Maybe just calling out one as an example. This year, in partnership with one of our payers, we've expanded our ability to manage risk across a post-acute continuum, but then from an inpatient hospital stay all the way through SNF and home health. We've seen really strong demand for these products to serve, you know, post-acute care risk comprehensively, and we're also really pleased with the results. We're seeing an improved access to timely care, again, improved access to home health utilization, and I think you'll see those programs also expand inside 2027. So, taken together, you know, this is still a multi-year journey to make sure we're, you know, pacing appropriately towards our 6% to 8% target margin range, but see ample opportunity for girls inside OptinHealth.

And you're really oriented to the new thing. Exactly.

Yeah, Stephen, for Optum Insight, the goal is to simplify healthcare AI for consumers, providers, payers, and life sciences companies. As 2026 is on plan, I want you to think about Insight as a multi-year investment and execution journey. So there's a few moving parts here. We are continuing to rationalize existing products and contracts where they don't make sense. But we are infusing AI into our existing offerings that help make them more competitive and profitable, and then launching new AI-first products and platforms. To give you some examples of the momentum there, our Optum AI consulting firm with a Medicaid plan is helping them adjudicate their most complex claims in seconds instead of days using agentic AI. Another example is a product called Optum Integrity One which automates claims coding in the revenue cycle space. We launched this at the end of 2025. We had two clients at the end of 2025. Today we have 15 clients implemented and another 24 clients implementing. So you see the momentum of some of our new AI clients. We recently launched a partnership joining the Anthropic Partner Network. We had announced similar go-to-market partnerships with Microsoft and Google in recent quarters across products. We are seeing strong discipline execution, new team members that are AI first, and new product teams, et cetera. And in the next two quarters, we'll be seeing a series of product launches. So overall, with those moving parts, we feel confident about our prospects for 2027.

AI is reinventing that business. Next question, please.

We'll take our next question from AJ Rice with UBS.

Thanks. Hi, everybody. I might go back to the commercial business. I think the risk portion, you guys have indicated that maybe that's operating at a below 5% margin. Part of that's the IDR issues that you've highlighted. It sounds like you're saying today that that's stabilizing somewhat, and I know that historically you've talked about that business having a high single-digit 7% to 10% or something margin. And I wonder your thoughts about the pacing of margin recovery there and maybe flesh out a little bit more about the stabilization you're seeing right now.

Do you want to start with that? Yeah, thanks, AJ. Good morning. Yeah, so as we talked about in military remarks, we are seeing a stabilizing of the trends that we're seeing, the medical cost trends that we're seeing in the commercial business, albeit at, you know, levels that are high and significantly higher than historical norms that we've seen in the commercial business. As we priced for 2027, we took the view that we would see these trends continue and persist into 2027 and priced rationally, just consistent with all of that. As we think about our long-term targeted margins and some of these utilizations pressures that we're facing in the commercial business, it is going to stretch out our ability to achieve those long-term objectives or margins for the commercial business. So more color in a couple of months. We'll have an opportunity to dive into some of the detail of that business, but that's how you should be thinking about it right now.

Thank you. How about the next question, please?

Our next question comes from Anne Hines with Mizuho Securities.

Maybe we can fine-tune some of your earlier comments on MA. Just in general, how do you view your competitiveness from a benefit offering versus your peers? And do you believe UNH's decision to deliver overall membership growth from next year?

Thanks for the follow-up question. So, again, we're not going to get to, you know, specific guidance. We'll get to that here in a few months. That said, you know, we took a very deliberate approach for 2027 with a focus on investing in benefits, investing in products and providing stability in products where we know we can make a meaningful impact, a meaningful impact on growth, a meaningful impact on the consumers that we serve, meaningful impact in partnership with, you know, many of our value-based care providers who serve those populations. And think about that, again, in the context of both plans. You know, we have those areas, the broad capabilities that we bring to life in those areas, our ability to get after some of the, you know, the medical costs. So I think as I look to more members in those areas, and that's what we're focused on as we continue to modernize our business.

Next question, please.

We'll take our next question from Kevin Fishbeck with Bank of America.

Great, thanks. I appreciate the earlier comments that, you know, trend tends to be a little bit higher in the back half of the year, but the trend data points that we're tracking kind of really imply that trends start off really low to start the year, but it kind of is accelerated as the year has gone on. And is this consistent with what you're seeing? And if so, you know, why is it maybe accelerating a little bit more than normal? And I guess how comfortable are you that you're pricing 2027 to the exit rate as far as trend goes?

Morning, Kevin. This is Tim. So we are not seeing the dynamic that you're talking about, you know, when you kind of go across each of our businesses. We've talked about commercial kind of continuing at the level of stabilizing somewhat in more recent durations, but still tracking north to 11 percent. We talked about we're seeing moderation and trend in the Medicaid business, and we are seeing some better than expected performance when you start thinking about the Medicare businesses broadly. But in terms of trend acceleration, no, we are not seeing that. And, in fact, we're seeing some moderation in the government programs business and stabilization in the commercial business. And as we think about our forward pricing, right now we are able to incorporate the latest information using better analytical tools, more real-time information on the direction of travel, of medical cost utilization, and are incorporating all of that into our forward pricing assumptions. but not seeing the, you know, elevation that you're referencing as we pace through the year. Thank you. Next question, please.

Our next question comes from Scott Vidal with Goldman Sachs.

Good morning. What's all been just on the Medicaid side, I would be interested in your thinking around, you know, so we think about 27 to 2030, and you have that natural opportunity for cyclical margin recovery and Medicaid clearly with margins still negative, but then sort of – and then having to sort of interface with the implementation of the OB-3 reforms that will sort of scale up from 27 to 30. And maybe sort of walk us through how you sort of see those two upsetting each other and maybe how you think about maybe a reasonable sort of view on sort of, you know, where margins are maybe average over that time period.

Scott, thanks for the question. Lisa, as we look at what's happening over the next four years, there certainly will be a cycle process that goes through the Medicaid business. We've seen this over history, if you look at it, and we expect that to happen through Medicaid for this cycle as well, particularly as we think about OB-3. We think there is an opportunity to get back to rated margins in 2028. We're continuing to focus on our efforts around clinical care management, cost management, leveraging AI tools to do that as well. We do think that over time there will be opportunities for us to look at markets, to look at ways we can tie into our strategy around duals and make sure that this can be effective. But overall, we think getting back to those margins and remaining at those margins will be an opportunity for us and will be our goal through 2030.

And in the long term, Medicaid is a good, durable marketplace. It's going to continue to grow. Next question, please.

Our next question comes from Lisa Gill with JPMorgan.

Thanks very much. I have a question on specialty pharmacy.

You brought it up on the cost side, but Patrick also talked about it on the opportunity side. And just really want to understand two things here. One, you talked about infusion. I'm curious about capabilities today and what you see around infusion. Two, what do you see around potential opportunities and biosimilars? And then lastly, the comment around integrated medical and pharmacy together, you talked about the fact that 50% are now external clients. I'm curious about how you bring the two entities together if they're not under a single umbrella of UnitedHealth Group.

Sure. So, why don't we start with Patrick and then we'll go to John and then we might come back to Patrick on the integrated piece.

So, Lisa, thanks for the question. We'll call out a few areas. First, specialty pharmacy, as you know well, with the drug pipeline and the patient need is a growing market. What we talked about in the opening comments is we're increasingly bringing that closer and closer with our care delivery enterprise and clinicians broadly across the marketplace. So John and the team have led terrific efforts, both in LDD drugs, where we have high win rates, in the Optum Health team, also working with external clinicians and physicians and prescribers. So we see that market continuing to grow, and it's about service, infusion, you also alluded to. That's a lower-cost setting, as you know, and more convenient for patients. So what we hear from payers and our other customers is they want infusion to grow because of lower cost and better experience for patients. And once again, we have a robust clinical care model and growth in that area. I'll let John talk a little bit more about the sort of PBM and pharmacy linkage, and then we'll go from there.

Yeah, very good. Thank you, Patrick. You know, I'll start, Lisa, with the strength within – Patrick started with this. The strength within our specialty pharmacy led by Mike Einachoffer and the team. You know, we're winning on experience there, Lisa. So if you look at overall volumes, well, volumes might have been down 5% for the quarter. Specialty volumes actually up 2.6% for the quarter. And that's driven by a couple of initiatives. We're winning on provider choice, which, again, is strong LDD win rates, our strongest in years there, Lisa, coupled with the continued build-out of our centers of excellence, our therapeutic centers of excellence. Then we went on consumer experience. We recently won the specialty pharmacy of the year from the NAMP competitive award.

I'm kind of similar to you asked about that. We're seeing robust uptake across our clients, lowest net cost, our Optum specialty distribution. if we get that thing I'll call out a cross in between the OptumHealth.

Thank you. Next question.

We'll take our next question from Erin Wright with Morgan Stanley.

Great. So, as you continue to make progress on the OptumHealth turnaround, I guess, how should we think about OptumHealth margins where they land in 2027 relative to that 6 to 8? And just longer term, how you think about potential margins exceeding even that range? Are there any structural constraints to further kind of margin expansion and with the evolution of that business, the business mix alongside what you're doing with automation and AI? I guess could that support even higher margins over time?

And before Kristen gets to that, maybe just a general comment. There's only so much we can say about 2027 that we will have a conversation with you before the end of the year where we'll be able to give you, let's say, more color on 2027, which we do very positively, but we've already provided probably more forward-looking views than we probably have ever done on a call at this stage. So, with that, I think very positive outlook. Kristen, might you want to start?

Yeah, thanks, Steve, and thanks, Eric, for the question. And, you know, again, I think just kind of anchoring back to the work we've been doing to reposition this business for long-term success, again, really pleased the performance we're seeing inside 2026. Third quarter is another great example of that. That core performance improvement is durable and will contribute meaningfully to our, you know, kind of outlook in 2027. And, again, I think 2027 is a year where we'll see a strong pace towards that 6% to 8% by 2028. That is really our focus. And then, you know, as I alluded to in the earlier question, I'm optimistic and see a lot of opportunities for growth in this business kind of across the domains I mentioned. But, again, look forward to unpacking more detail around those. And I see some of that starting in 27, but also, you know, opportunity in 2028 and beyond for this business across those three domains I mentioned.

So very positive, but we can't really get to precision at this range. Next question, please.

Our next question comes from Andrew Mock with Barclays.

Optum Health's EBIT guidance still appears to imply a meaningfully negative fourth quarter. Can you walk through what's driving that sharp seasonality and help quantify for two investments that might be impacting that segment?

Yeah, thanks for the question. So I mentioned the third quarter performance will be durable into the fourth quarter, but fourth quarter does reflect risk seasonality, which is normal course for this business, and some additional investments that we're making for long-term performance. So inside those additional investments, think things like technology, AI, but more specifically even workflow improvements for our clinicians to ensure that we're providing the appropriate expanded access that we're focused on, but also make it easier to care for our patients to deliver strong quality outcomes and support that integrated experience that we're talking about. So think of things like AI-enabled care summaries to make it easier for clinicians to prepare for visits. Ambient, we've talked a lot about how can that translate from, you know, just listening and documentation to kind of next best action insights for our clinicians. also doing quite a bit of work on scheduling that I mentioned, and there's a handful of other investments that we're making in our clinician workflows, again, really just to enable durable performance for the long term in this business. And those are the things that are really part of the fourth quarter. I would say, you know, overall, again, third quarter will be kind of durable into fourth, but, you know, some kind of performance reflected with our risk seasonality. Thanks.

Thank you. Next question.

We'll take our next question from Matthew Gilmore with KeyBank.

Hey, thanks. I wanted to follow up on some of the policy items that Tim Nolan referenced. I think you talked about your work with CMS on quality efforts. You have also talked about the issues on the IDR side.

I'm just hoping you can give us a sense for how you'd like to see those programs evolve over the next few years in a way that would be constructive to the system.

Yeah, thanks, Matthew, for the question. Yeah, so with respect to the IDR process, we're really referring to the dispute resolution process. You know, the spirit of the legislation is one that we're certainly aligned on, but the result and outcomes that we're seeing where the awards are significantly more multiples, 10, 11 times what Medicare would pay in some of those instances is excessive, and it's contributing to the lack of affordability in health care that we're seeing right now. So our issue with the IDR process relates specifically to the dispute resolution and the inefficiencies of it, the costs associated with it, and the outcomes that it's resulting in generating, but not with the spirit of the law, because that is something that we're totally aligned to and I'll turn it over to Bobby to talk a little bit about some of the modernization of the Medicare program.

Yeah thanks Tim. So Matthew you alluded to it but you know very appreciative of the active and ongoing dialogue that we have with CMS that we have here from us as we are supportive of modernization we are supportive of reform that advances the program and ensures the sustainability of the program in that regard the opportunities, payment opportunities, affordability opportunities, administrative efficiency, tech interoperability, and the, you know, kind of paced through these reforms and modernization opportunities thoughtfully and with broad stakeholder engagement. And that doesn't just mean plans, looking at healthcare, that means with providers, clinicians.

Thank you.

Next question, please.

Our next question comes from Ryan Langston with TD Cowan.

Great, thank you. You recently talked about making some unique investments in the STARS program. Now that the details are out, I'm sorry if I missed this, but can you give us any insight into the size and maybe types of investments you're making in the STARS program? And any commentary you can provide on your broker strategy heading into open enrollment would be helpful as well. Thank you.

Yeah, hey, Ryan. Bobby here. So I'll hit the STARS one, and then I'll hit the broker one quickly as well. You know, so overall, very pleased with how we executed on the controllables for this STARS season. You know, we take a long-term view of quality, no different than our approach to products and pricing. And so, while we knew there could be some star pressure related to the repositioning of benefits we did for 26 in response to the funding and policy headwinds impacting the overall industry, that's also why we made the investments we did to drive improvements in key areas like clinical outcomes, pharmacy outcomes. And what you saw is we actually there for, you know, year-over-year improved nearly every this star season but you know we're not satisfied there there's more work to be done there's more opportunity there's more opportunity to invest and further improve as we pace forward and that is what we're we're focused on in that regard so think of our continued investment in 26 Q4 into 27 is you know continuing to accelerate not slow down given the critic and maybe lastly just your question on broker positioning more dynamic you know really more strategically positioned for 27 than perhaps in recent years with key, you know, growth opportunities in the D-SNF, C-SNF, and HMO space. Accordingly, we are going to market with that to drive, you know, good stability with our base business and good growth opportunity in those areas where we think it, you know.

Thank you. So, I think we will, I appreciate the questions this morning on the level of engagement. I think we'll close this now, but we will be around as a team for the rest of the day if you have again we thank you for your time today I can I hope you get a sense of the momentum we're bringing into 27 as our emphasis on discipline execution kind of and very much improved and I think we'll just build on this to providing with a more complete outlook we'll meet before the end of the year this does conclude today's conference we thank you for your

participation and have a great day