UNH · 10-Q · 2026Q3 · Full report

Medicare Advantage Rate Pressure

UNITEDHEALTH GROUP INC · 2026-11-03 · Importance 44 · Surprise 24

The filing says Medicare Advantage base rates for numerous years have been well below the industry’s forward medical cost trend. The Final Notice for 2027 moved toward that trend but remained below it, while multi-year shortfalls and revisions to the risk-adjustment model continue to pressure funding. UnitedHealth says it may respond through cost management, network and benefit changes, member premiums, and county-by-county decisions about where to offer plans; the funding pressure has contributed to membership contraction.

Key facts

• Multi-year Medicare Advantage rate shortfalls have created sustained program pressure, and substantial risk-adjustment model revisions have resulted and will continue to result in reduced funding and potentially reduced benefits, especially for people with significant health and social challenges. source
• To partially offset Medicare funding pressures, UnitedHealth Group may intensify medical and operating cost management, change provider-network size and composition, adjust benefits, increase member premiums or decide which counties to serve with Medicare Advantage plans. source
• Medicare Advantage industry base rates for numerous years have been well below the industry forward medical cost trend; the 2027 Final Notice moved toward that trend but remains below it. source