UnitedHealth Raises 2026 Guidance as Its Medical Care Ratio Improves to 88.4%, but Membership Falls to 48.3 Million

UnitedHealth Group, the largest health insurer in the United States, reported a sharp improvement in third-quarter profit on October 13, 2026 and raised its outlook for the year, even as the number of people it insures and the size of its care-delivery business both shrank. The figures come from the company's earnings release filed with the Securities and Exchange Commission and, for the management commentary, from an AI-assisted transcript of the earnings call published by The Motley Fool, which may contain errors and should be checked against the recording. The company's results matter well beyond its shareholders because it covers tens of millions of people and runs the pharmacy benefit and care businesses that sit under its Optum brand.

The headline numbers are these. Revenue was $112.7 billion, slightly below $113.2 billion a year earlier. Earnings from operations rose to $6.6 billion from $4.3 billion. Net earnings were $4.3 billion, up from $2.5 billion, with $4.1 billion attributable to shareholders. Diluted earnings per share were $4.56, compared with $2.59, and adjusted earnings per share were $4.69, compared with $2.92. The net margin was 3.6%, up from 2.1%. Operating cash flow was $5.1 billion, about 1.2 times net income. Year to date the company has repurchased $5.0 billion of shares and paid $6.2 billion in dividends. Its debt-to-capital ratio was 41.7%, against a target of about 40% by year-end.

The most important ratio for a health insurer is the medical care ratio, which shows how much of each premium dollar is paid out for medical care. UnitedHealth's was 88.4%, down from 89.9% a year earlier. That improvement includes $610 million of favorable prior-period reserve development, meaning the company's earlier estimates of medical costs proved higher than the amounts eventually paid. The operating cost ratio, which measures administrative costs against revenue, fell to 12.8% from 13.5%. Because favorable reserve development is a one-off benefit that lowers the current ratio, the underlying improvement is smaller than the headline change.

On guidance, the company raised its 2026 outlook. It now expects diluted earnings per share of at least $19.50 and adjusted earnings per share of at least $20.50. Management also said, according to the call transcript, that 2027 earnings should grow toward the lower end of its long-term target range of 13% to 16%, and that fuller 2027 guidance will come before the end of the year. It did not give membership guidance yet.

The segments show a mixed picture. UnitedHealthcare, the insurance arm, had revenue of $86.3 billion and operating earnings of $2.8 billion, a margin of 3.3%. It served 48.3 million people, down from 50.1 million a year earlier. Optum, the services arm, had revenue of $66.9 billion and operating earnings of $3.7 billion, a margin of 5.6%. Within Optum, Optum Health, which provides care and manages value-based care arrangements, had revenue of $22.9 billion, down 10% from a year earlier, with earnings of $735 million and a margin of 3.2%. The call transcript says the drop reflects fewer value-based care patients in some markets and that management targets a margin of 6% to 8% over time on a gradual path. Optum Insight, which sells data and technology services, had revenue of $5.5 billion, up 3%, with a margin of 23.4%. Optum Rx, the pharmacy benefit manager, had revenue of $39.9 billion and a margin of 4.3%, and adjusted prescriptions fell to 393 million from 414 million, mainly because of the loss of UnitedHealthcare members, according to the transcript.

What did management say about costs? According to the transcript, the commercial benefit cost trend is above 11%, driven by arbitration awards under the No Surprises Act, greater intensity of care from clinicians and high-cost specialty drugs. Management described the trend as stabilising but still elevated, and said it argues that arbitration awards are excessive and contribute to a lack of affordability while supporting the intent of the law. It also said costs for specialty pharmacy and high-intensity hospital care remain stubbornly high. In Medicare Advantage, it expects its margin near the top of a 2% to 4% range and said about 75% of members are expected to be in plans rated four stars or higher for payment year 2028, compared with a 70% industry average. For Medicaid, the company expects results moderately better than negative 1% in 2026, which it called a trough year, while noting that state funding has not kept pace with cost trends.

Management also pointed to artificial intelligence. The transcript says AI chart summarisation reaches more than 40% of employed clinicians and cuts chart review time by 33%, that appeal cycle times are 26% shorter, and that prior authorisations are expected to fall 30% by the end of 2026. These are company statements that have not been independently verified.

What does this mean for the public? Three points stand out. First, health costs are still rising faster than many employers and individuals would like, and a commercial trend above 11% is likely to feed into premiums for 2027. Second, the shrinking membership suggests the company is pruning where it competes, which can affect the choices available to seniors during Medicare open enrollment, which began on October 15. Third, the improvement in profit came with a smaller revenue base, so it does not show that care has become cheaper.

For investors, the numbers show a company recovering margins after a difficult period, with guidance raised, but with open questions about growth, because membership and Optum Health revenue are falling. This article describes company-reported results and is not a recommendation to buy or sell any security. The company's 2027 guidance, due before year-end, and the premium filings of health plans in the coming weeks will show how much of the recent cost pressure is being passed on to customers.