UNH · 10-Q · 2026Q1 · Full report

Medicare Advantage Funding Pressure

UNITEDHEALTH GROUP INC · 2026-05-05 · Importance 65 · Surprise 60

Medicare Advantage rate notices for numerous years have produced industry base rates below the industry forward medical cost trend, and although the Final Notice for 2027 moved toward the expected trend it remains below the industry forward medical cost trend. Substantial revisions to the CMS risk adjustment model have resulted and will continue to result in reduced funding and potentially reduced benefits for higher-need people. UnitedHealth cites multi-year rate shortfalls as creating sustained pressure on the Medicare Advantage program and notes management responses including intensified medical and operating cost management, network changes, benefit adjustments and premium increases, and that county-by-county participation decisions are made annually. These dynamics have contributed to contractions in Medicare Advantage membership in Q1 2026 and management expects continued pressure through 2026 and beyond.

Key facts

• Company expects Medicare Advantage membership contraction in the first quarter and expects it to continue throughout 2026 due to Medicare Advantage funding pressures and benefit and pricing actions. source
• The company said Medicare Advantage rate notices for numerous years have resulted in industry base rates well below the industry forward medical cost trend, and the Final Notice for 2027 moved towards the expected trend but remains below. source