The country’s biggest payers have been branching out beyond insurance for years. Now, that trend is becoming even more pronounced.
Second-quarter earnings have kicked off yet again, signaling how reliant these companies have become on their services units — and how much they keep investing there. UnitedHealth Group and Elevance Health reported earnings earlier this month, with Humana, Cigna and Centene releasing results in the coming days. The earnings give hints as to how these businesses are evolving.
UnitedHealth
UnitedHealth overall brought in nearly $5.5 billion in profit for the quarter. UnitedHealthcare’s revenue was $86 billion but remained flat year over year. However, earnings from operations were $3.9 billion, a 90% year-over-year increase spurred by cost management, pricing discipline and benefit design changes, according to the company.
Despite that growth with health benefits, UnitedHealthcare’s 4.6% operating margin still trailed Optum’s.
While Optum’s revenue dipped about 2% year over year, earnings from operations grew 32%, reaching $4 billion. Optum’s operating margin was 6.2% compared to 4.6% in the second quarter of 2025. Optum Insight, the company’s consulting and data division, managed to grow revenue about 3% and posted an operating margin of 25.3% in the second quarter.
Optum has the nation’s largest physician network, made up of directly employed, contracted and affiliated physicians. While UnitedHealth scaled back its subsidiary disclosures this year, a past report indicated nearly 2,700 subsidiaries.
UnitedHealth is also pouring $3 billion into AI investments in 2026 and 2027. These investments became even more concrete July 13, when Optum confirmed a partnership with Anthropic.
Elevance
Elevance as a whole posted nearly $1.5 billion in profit in the second quarter, down about 16% year over year, with total medical membership falling 1.5% to 44.9 million. The health benefits segment grew operating revenue modestly thanks to higher premium yields. Its operating margin was 2.1%.
Carelon, Elevance’s health services arm, had a compelling story, boasting an operating revenue of $19.2 billion, up 6% year over year, with a 4.9% operating margin. Pharmacy benefit manager CarelonRx was the one segment where operating margins widened compared to the same time last year, reaching 5.2%.
Peter Haytaian, Carelon’s president at the time, said in 2025 the unit had “many areas of interest” for further acquisitions, on top of deals like the CareBridge home-health purchase, which CEO Gail Boudreaux has called a foundation for Carelon’s expansion into home-based care.
Cigna
While Cigna has not released its second-quarter earnings yet, the company has been leaning into its services arm, Evernorth Health Services. For example, the company has been making headlines with pharmacy initiatives, including a rebate-free model. When Cigna kicked off a GLP-1 management program in 2024, former CEO David Cordani told CNBC the company believed “pharmaceutical or pharmacological innovation was going to define the next decade.”
In 2025, Cigna’s Evernorth Health Services had nearly $235 billion in revenue, including more than $132 billion from pharmacy benefit services and almost $103 billion from specialty and care services.
Meanwhile, insurance division Cigna Healthcare is exiting the exchange business at the end of 2026 and sold its Medicare Advantage business in 2025.
The big question
The picture looks a bit different for Centene and Humana. Humana’s CenterWell division — focused on primary care, home health and pharmacy — had revenue increase about $1 billion year over year in the first quarter. Still, it’s a fraction of Optum’s and Carelon’s scale, and CenterWell’s income from operations dropped from $392 million in first-quarter 2025 to $289 million in first-quarter 2026. Centene’s business model is fundamentally different, lacking the same services infrastructure.
Between Cigna, Elevance and UnitedHealth, though, the harder question isn’t whether these companies sell insurance. It’s whether that’s still the part of the business they’re betting on.
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