GLOBAL RESEARCH ARCHIVE
Neutral but See 560 BPS of Individual MA Margin Expansion Opp Across CY27-CY28
Research evidence excerpt
Neutral but See 560 BPS of Individual MA Margin Expansion Opp Across CY27-CY28
low.
CenterWell PCO. In CY25, CenterWell PCO was breakeven to slightly negative margin. We believe
The Villages Health acquisition is a ($70.0M) PCO operating income headwind in CY26, MaxHealth
is a slight tailwind. We believe MaxHealth is incremental to CY26 CenterWell revenue and operating
income guide. Excluding The Villages, we believe CY26 PCO operating margins are expected to be
largely flat y/y. Based on proprietary KOL diligence, we describe the headwinds facing highly
optimized capitated primary care providers like The Villages in note here on Optum Health.
Insurance segment MLR and operating cost ratio cadence. From an MLR perspective, we
believe HUM is guiding up a few hundred BPS every quarter similar to CY25. We believe 2Q26
guidance calling for just above 91.0% implies ~91.2%. We are modeled slightly favorable to that at
91.1%. We model a 684 BPS spread between 1Q26 reported Insurance segment MLR and 4Q26E
Insurance segment MLR. See Row 45 in Segment Earnings tab of PSC model. We believe HUM is
assuming operating efficiencies y/y improve over the course of the year; while MLR deteriorates due
to typical seasonality, in addition to what ends up being a compounding Stars headwind as the dollar
Stars headwind is ratable but medex increases seasonally.
Trend and completion rates. We believe HUM is thinking about trend at a 6.0% level for medical
and LDD for pharmacy. That is consistent with CY25 and remains the expectation for CY26.
Everything the company is seeing YTD suggests that estimate is correct to slightly conservative.
From a visibility perspective, HUM can see pharmacy claims almost immediately. Pharmacy claims
complete with in a week or so.
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