Elevance Health, Inc. (ELV) — Company Research

Last Updated: 13 November 2026

Elevance Health is one of the largest US health insurers. Its Health Benefits segment runs Anthem Blue Cross and Blue Shield plans in 14 states, Blue Cross plans in California and Wellpoint, Simply and MMM plans across commercial, Medicare and Medicaid markets. Its Carelon businesses sell pharmacy benefit services, behavioural health, home-based care and payment-integrity services to its own members and to outside clients. FY2025 total revenue was $199.1bn, and the company serves about 45 million medical members. This report covers the latest filings, including Q3 2026 results released on 21 Oct 2026. Track the shares on our Live Charts, check market-moving events on the Economic Calendar, and join the discussion in the ChartsView Forum.

1. Company Snapshot

2. Bull Case vs Bear Case

Bull Case

• Guidance raised three times: 2026 adjusted EPS guidance has moved from at least $25.50 in January to at least $29.00 on 21 Oct 2026, and operating cash flow guidance from at least $5.5bn to at least $6.5bn.
• 2027 growth target: Management guided to at least 12% adjusted EPS growth in 2027 from a 2026 baseline of at least $26.75, with Medicaid and Medicare Advantage margins expected to improve.
• Carelon momentum: Carelon operating gain rose 17% in Q3 2026 to a 4.7% margin, and management said it has secured a number of new external services contracts for 2027.
• Cash returns: $4.1bn returned in 2025 (including $2.6bn of buybacks), about $5.0bn of buyback authorisation left at 30 Sep 2026, and a dividend raised every year since FY2021.

Bear Case

• Revenue has stalled: Q3 2026 operating revenue grew just 0.7%, and medical membership fell from 45.2m to 44.9m in 2026, with Medicare members down 10.4% year on year.
• Medical costs still elevated: The FY2025 benefit expense ratio rose 150bp to 90.0%, and the Q3 2026 ratio was 90.6%, leaving thin margins in Health Benefits (2.5% operating margin in FY2025).
• Medicare Advantage headwinds: A $935m accrual for a CMS risk-adjustment notice hit Q1 2026, and only about half of Medicare Advantage members are in 4-star or better plans for the 2027 Stars year.
• Policy exposure: Expired ACA premium subsidies, Medicaid eligibility changes and PBM regulation all bear directly on Elevance's three largest markets.

3. Segments & Revenue Mix

FY2025 segment revenue as a share of operating revenue of $197,584m. Shares add to more than 100% because $41,689m of intersegment revenue (mainly Carelon services to Elevance's own health plans) is eliminated on consolidation.

Within Health Benefits, FY2025 revenue split into Medicaid $56,620m, Commercial $50,401m, Medicare $44,752m and the Federal Employee Program $15,321m. At 30 Sep 2026 medical membership was 44.88m: commercial fee-based 27.6m, commercial risk-based 4.7m, Medicaid 8.2m, Medicare Advantage 1.9m, Medicare Supplement 0.9m and FEP 1.5m.

4. Business Model & Moat

How it makes money. In risk-based plans Elevance collects premiums and keeps what is left after paying medical claims and running costs; the benefit expense ratio was 90.0% in FY2025. In fee-based commercial plans, which cover most of its members, employers carry the medical risk and pay administrative fees. Carelon earns fees and margins on pharmacy, specialty care and services sold both inside the group and to outside health plans.

Blue brand and local scale. As an exclusive Blue Cross Blue Shield licensee in its 14 states, Elevance has dense provider networks and strong brand recognition with employers, which makes its commercial position hard to dislodge. Fee-based commercial membership grew to 27.6m at 30 Sep 2026 from 27.1m at the end of 2025.

Integrated services. Carelon lets Elevance keep more of each healthcare dollar within the group, and selling the same services to other insurers gives it a growing fee-based revenue stream less exposed to medical cost swings.

Capital allocation. Elevance bought back $1.7bn of stock in the first nine months of 2026 (5.2m shares), pays a $1.72 quarterly dividend and had about $2.4bn of cash and investments at the parent company at 30 Sep 2026.

5. Financial Health

Annual figures from Elevance's 10-K filings, SEC XBRL data and Q4 earnings releases. Revenue is total revenue including net investment income.

† FY2021 and FY2022 GAAP EPS are shown as recast for the 2023 insurance accounting change (LDTI); FY2022 adjusted EPS is the recast $28.53 ($29.07 as first reported). FY2021 adjusted EPS is as first reported. Long-term debt excludes the current portion ($1,099m at end-2025). FY2021 growth is measured against FY2020 total revenue of $121,867m.

Quarterly results, most recent first. Revenue is total revenue.

Q1 2026 GAAP EPS includes a $935m ($4.24 per share) accrual for a 27 Feb 2026 CMS notice on historical Medicare Advantage risk-adjustment data; Q1 2026 adjusted EPS includes about $1 per share of non-recurring investment income. Q4 2025 revenue is derived as FY2025 less the nine-month total. Benefit expense ratio: 90.6% in Q3 2026 (91.3% in Q3 2025).

Cash flow and balance sheet. FY2025 operating cash flow was $4,290m, capex (purchases of property and equipment) $1,116m, and depreciation and amortisation $1,546m. Nine-month 2026 operating cash flow was much stronger at $7,512m, with capex of $789m and D&A of $1,083m; full-year guidance is at least $6.5bn. At 30 Sep 2026 total debt was $30,757m ($30,382m long-term plus a $375m current portion, with no short-term borrowings), against cash and cash equivalents of $10,348m and a $25,347m fixed-maturity securities portfolio that largely backs insurance liabilities. Shareholders' equity was $44,681m.

6. Valuation Snapshot

Raw metrics, November 2026. Not opinions on whether the stock is cheap or expensive.

7. What Are They Building

• Carelon growth: Carelon Services' risk-based solutions grew revenue 8.2% in the first nine months of 2026, and new external services contracts have been secured for 2027. Jeff Park, former president of Waltz Health and COO of Optum Rx, takes over as Carelon president on 01 Dec 2026.
• Specialty pharmacy and infusion: CarelonRx is expanding specialty pharmacy and home and alternate-site infusion through Paragon Healthcare, acquired in 2024.
• Home-based care: CareBridge, acquired at the end of 2024, provides home and community-based services for Medicaid and dual-eligible members with complex needs.
• AI and data: Management described AI-enabled workflows in risk-adjustment programmes and AI analytics to detect inappropriate billing, alongside the HealthOS clinical data exchange that links providers and payers.
• Targeted investments: One-time spending in 2026 on medical cost management, provider connectivity and efficiency lifted the adjusted operating expense ratio by 90bp in Q3 2026.
• Mosaic Health: A primary-care joint venture with Clayton, Dubilier & Rice.

8. Competitive Landscape

Elevance competes with UnitedHealthcare, Aetna (CVS), Cigna and Humana for employer and Medicare business, and with Centene and Molina in Medicaid. CarelonRx competes with the three largest PBMs: Optum Rx, CVS Caremark and Express Scripts.

9. Insider Activity

CEO Gail Boudreaux bought about $1.0m of stock in the open market in July 2026, the largest insider purchase of the year. Since the Q3 2026 results, CFO Mark Kaye and Chief Digital Officer Ratnakar Lavu have sold shares. Annual stock awards and tax withholding are excluded.

Source: SEC Form 4 filings for CIK 1156039 and insider-tracking summaries. July and March dates are approximate to the month.

10. Key Risks

• Medical cost trend: Elevated utilisation in ACA, Medicaid and Medicare pushed the benefit expense ratio to 90.0% in FY2025; a further rise would erode already thin Health Benefits margins.
• Medicaid funding and eligibility: Higher member acuity after redeterminations, lagging state rates and new federal eligibility and work-requirement rules could reduce membership and margins; management calls 2026 the trough year.
• Medicare Advantage rates and Stars: Lower Star Ratings for 2027 (about half of members in 4-star plans), CMS risk-adjustment audits and the $935m Q1 2026 accrual show how quickly government decisions move earnings.
• Litigation and regulation: Elevance is suing CMS over 2027 Star Ratings, faces a DOJ-led Medicare Advantage suit, and is exposed to state and federal PBM reform affecting CarelonRx.
• ACA subsidy expiry: Enhanced premium tax credits expired on 31 Dec 2025, raising the risk of a smaller, sicker individual market.
• Partner dependence: CarelonRx relies on CVS Caremark for core PBM services under a contract that runs to 31 Dec 2027, and the group depends on its Blue Cross Blue Shield Association licences.
• Leverage and cyber: About $30.8bn of debt, plus the cyber and data risks that come with holding health records for more than 100 million consumers.

11. Recent Developments

• 06 Nov 2026 — Lawsuit over 2027 Star Ratings. Elevance sued HHS and CMS, arguing CMS used 11 measures without formal rulemaking; it says the ratings cut 2028 quality bonus and rebate payments by about $516m across 12 contracts.
• 22 Oct 2026 — CFO share sale. CFO Mark Kaye sold 10,584 shares for about $4.66m the day after results.
• 21 Oct 2026 — Q3 beat and guidance raised. Adjusted EPS was $6.99 (GAAP $6.27) on operating revenue of $50,440m; 2026 adjusted EPS guidance was raised to at least $29.00, and management guided to at least 12% adjusted EPS growth in 2027.
• 21 Oct 2026 — New Carelon president. Jeff Park was named President of Carelon, effective 01 Dec 2026.
• 20 Oct 2026 — Dividend declared. The board declared a $1.72 quarterly dividend payable 18 Dec 2026.
• 15 Jul 2026 — Q2 results and guidance raise. Adjusted EPS was $7.45 and 2026 adjusted EPS guidance rose to at least $27.00.

12. Key Dates

• 24 Nov 2026 — Next FINRA short-interest release.
• 01 Dec 2026 — Jeff Park starts as President of Carelon.
• 04 Dec 2026 — Ex-dividend and record date for the $1.72 quarterly dividend.
• 18 Dec 2026 — Quarterly dividend payment.
• Expected Jan 2027 — Q4 and FY2026 results with detailed 2027 guidance; date not yet confirmed (FY2025 results were released 28 Jan 2026).
• 31 Dec 2027 — End of the current CVS Caremark PBM services agreement term, which carries a three-year extension option.

A ruling in the Star Ratings lawsuit has no scheduled date.

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