UnitedHealth Group (NYSE:UNH) stock is already under pressure after the U.S. Centers for Medicare & Medicaid Services on Monday signalled essentially unchanged rates for Medicare insurers next year.

On Tuesday, the insurance mammoth reported fourth-quarter 2025 earnings and fiscal 2026 guidance.

The company reported adjusted earnings of $2.11, down from $6.81 a year ago, beating the consensus of $2.10. Revenues increased 12% year over year to $113.215 billion, missing the consensus of $113.817 billion.

The reported medical care ratio for fiscal 2025 was 89.1% which included a 20 basis point negative impact from loss contracts included in the charge, resulting in an adjusted medical care ratio of 88.9%, or an increase of 340 basis points year-over-year. Fourth quarter MCR stood at 92.4%.

The operating cost ratio for the year was 13.3%, while the adjusted ratio was 12.9%, which was flat year-over-year. For the quarter, the operating cost ratio was 15%.

"We confronted challenges directly and finished 2025 as a much stronger company, giving us the momentum to better serve those who count on us and continue to improve our core performance," said Stephen Hemsley, CEO of UnitedHealth Group, in a press release on Tuesday.

Segment Performance

UnitedHealthcare revenues grew 17.50% year-over-year to $87.11 billion. The segment served 49.8 million people in 2025, an increase of 415,000 year-over-year.

Optum revenues grew 8% year-over-year to $70.33 billion.

Outlook

UnitedHealth issued its fiscal 2026 earnings outlook, with adjusted earnings expected to be over $17.75 per share compared to the consensus of $17.74 per share. The company expects a GAAP earnings outlook of $17.10 per share.

The company forecasts 2026 sales to be more than $439 billion, versus the consensus of $454.60 billion.

"UnitedHealth Group's 2026 outlook reflects a business delivering durable performance improvement and margin expansion through greater operating discipline and precise execution," said Wayne DeVeydt, CFO of UnitedHealth Group.

Consolidated medical care ratio is expected to be 88.8% +/- 50 basis points, improving 30 basis points from the 2025 medical care ratio of 89.1% and reflective of repricing efforts across the enterprise.

Operating cost ratio is expected to be 12.8% +/- 50 basis points, reflecting a 10 basis point improvement from the 2025 adjusted operating cost ratio, supported by disciplined cost management and benefits from ongoing productivity initiatives.

Price Action: UNH stock is down 15.79% at $296.11 during the premarket session at the last check on Tuesday, according to Benzinga Pro data.

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