Most major payers improved profitability in the third quarter of 2026, while three of the four largest publicly traded for-profit health systems saw operating margins narrow.
Becker’s compared Q3 performance across seven major payers — UnitedHealth Group, CVS Health, Cigna Group, Elevance Health, Centene, Humana and Molina Healthcare — and four for-profit hospital operators: HCA Healthcare, Tenet Healthcare, Community Health Systems and Universal Health Services.
Payers: Membership shrinks, earnings recover
Medicaid and ACA membership losses hit most of the largest insurers. Net income, however, improved at four of the seven, and six raised their full-year earnings guidance. All figures compare with Q3 2025.
- UnitedHealth Group: Net income rose 75% to $4.1 billion, while revenue dipped 0.4% to $112.7 billion. The medical loss ratio improved to 88.4% from 89.9%, and medical membership fell to 48.3 million from 50.1 million.
- CVS Health: Net income came in at $2.2 billion, compared with a $4 billion net loss a year earlier that included a $5.7 billion goodwill impairment. Revenue grew 5.4% to $108.4 billion, and Aetna’s MLR improved to 91.3% from 92.8%.
- Cigna Group: Revenue rose 6% to $73.7 billion, but net income fell 23% to $1.4 billion, largely because Q3 2025 included an after-tax gain on a sale. Cigna Healthcare’s MLR ticked up to 85% from 84.8%.
- Elevance Health: Net income rose 14.8% to nearly $1.4 billion on revenue of $51.4 billion, up 1.4%. The MLR improved to 90.6% from 91.3%.
- Centene: The net loss narrowed to $71 million from $6.6 billion. Revenue rose 1.9% to $50.6 billion, the MLR held at 92.7%, and membership fell to 25.7 million from 28 million.
- Humana: Revenue jumped 26% to $41.2 billion as medical membership grew to 18 million from 15 million. Net income fell 17% to $162 million as the insurance segment MLR climbed to 93.7% from 91.1%.
- Molina Healthcare: Net income fell 52% to $38 million, and revenue declined 3.4% to $11.1 billion. Molina was the only payer that reaffirmed its outlook rather than raising it.
Health systems: Tenet stands out as margins tighten
Tenet Healthcare was the only one of the four operators to widen its operating margin. Community Health Systems swung to a net loss.
- Nashville, Tenn.-based HCA Healthcare: Net income dipped to $1.58 billion from $1.64 billion, while revenue rose 3.6% to $19.8 billion. The operating margin narrowed to 11.9% from 12.6%. A payer mix shift tied to exchange coverage losses cut pretax income by about $400 million.
- Dallas-based Tenet Healthcare: Net income rose to $1 billion from $342 million, and the operating margin reached 31.1%, up from 16.8%. Results included $646 million in revenue from the early end of Conifer’s revenue cycle contract with CommonSpirit Health.
- Franklin, Tenn.-based Community Health Systems: CHS posted an $86 million net loss, compared with $130 million in net income a year earlier. Revenue fell 10.7% to $2.76 billion amid divestitures, and the operating margin slipped to 5.3% from 7.9%.
- King of Prussia, Pa.-based Universal Health Services: Net income fell to $309 million from $373 million, while revenue rose 5.3% to $4.73 billion. The operating margin narrowed to 9.6% from 11.6%.
Outlooks diverge
While payers’ guidance moves were almost all upward, hospital operators were split. Tenet raised its adjusted EBITDA guidance for the second straight quarter, to between $5.05 billion and $5.2 billion. HCA now expects results in the upper half of its July outlook. CHS cut its guidance for the second consecutive quarter, and UHS expects to land toward the lower end of its range.
