Elevance Health, Inc. (ELV) SEC Filings & Earnings Calls

CMS Sanction Risk

“We are subject to a CMS Notice of Possible Sanction related to our Medicare Advantage plans.”

Investment Portfolio Losses

“Net unrealized investment losses of $1,555 million in fixed maturity securities at September 30, 2026.”

Membership decline in Medicare Advantage, Medicaid, and Employer Group risk businesses

“Medical membership decreased by 487 thousand compared to the prior year, reflecting lower enrollment in Medicaid, Medicare Advantage, and Employer Group risk-based businesses.”

Operating expense ratio increase due to targeted investments

“Adjusted operating expense ratio increased 90 bps year over year, reflecting targeted one-time investments.”

Healthcare cost trends and utilization rates could pressure the benefit expense ratio and overall profitability.

“trends in healthcare costs and utilization rates; reduced enrollment; our ability to secure and implement sufficient premium rates” · word for word

Elevated medical cost trend in Government businesses pressuring margins

“benefit expense ratio of 89.7 percent increased 80 basis points year over year, driven by expected elevated medical cost trend in our Government businesses” · word for word

Membership declines in Medicare Advantage, Medicaid, and Employer Group risk

“anticipated declines in our Medicare Advantage, Medicaid, and Employer Group risk membership” · word for word

Operating expense ratio increase from targeted investments

“adjusted operating expense ratio was 11.0 percent, an increase of 100 basis points, driven primarily by targeted investments in our workforce and in capabilities” · word for word

Medical cost pressure

“Benefit expense increased to $37,024 million for the three months ended June 30, 2026 from $36,706 million for the same period in 2025, indicating higher utilization or cost trends.”

Regulatory risk

“We are subject to various federal and state regulations, including those related to the Affordable Care Act and Medicare/Medicaid.”

Investment portfolio risk

“Net losses on financial instruments were $56 million for the three months ended June 30, 2026, driven by market volatility.”

Operating Model Transformation execution risk

“In the first quarter of 2026, we incurred $129 of costs towards the Transformation Program, primarily for personnel-related charges for the reduction and/or relocation of staff, which included severance and related costs.” · word for word

Investment portfolio losses

“Net losses on financial instruments ($78) million for Q1 2026 vs ($464) million for Q1 2025.”

Medical cost trend pressure

“Benefit expense $35,615 million on premiums $41,024 million for Q1 2026 vs $35,312 million on $40,887 million for Q1 2025.”

Medical Cost Trend Exceeding Expectations

“Medicaid cost trend increased more than 200% over the performance period from the historical average, which was compounded by a highly uncertain regulatory environment” · word for word

Regulatory and Reimbursement Uncertainty

“state reimbursement actions outside the control of management, and the impact of the recommencement of Medicaid-eligibility redeterminations” · word for word

PSU Adjustment Risk (Governance/Compensation)

“the Committee approved an increase to the PSU awards above the percentage calculated using the as-reported results for the performance measures from 41.0% of target to 62.5% of target.” · word for word

Potential CMS sanctions on Medicare Advantage enrollment could impact revenue and earnings

“CMS notified of intent to impose intermediate sanctions suspending enrollment of Medicare beneficiaries into the Company’s Medicare Advantage-Prescription Drug plans effective March 31, 2026”

Regulatory risk from CMS sanction for alleged noncompliance with risk adjustment data submission requirements

“CMS has indicated that the proposed sanctions relate to alleged noncompliance by the Company with certain Medicare Advantage risk adjustment data submission requirements for dates of service prior to April 3, 2023” · word for word

Medical cost trend risk

“Net incurred medical claims: Current year $145,566 million.”

Regulatory risk

“Approximately 32% of total consolidated revenues from agencies of the U.S. government.”

Investment portfolio risk

“Fixed maturity securities $27,005 million; equity securities $740 million.”

Elevated medical cost trends pressuring margins, especially in ACA and Medicare Part D lines.

“Benefit expense ratio up 110 bps in Q4; Health Benefits segment operating margin negative.”

Medicaid membership attrition due to redeterminations; uncertainty in state funding.

“Medical membership down 0.5M YoY driven by Medicaid attrition.”

FY2026 guidance implies significant EPS decline; recalibrated segment margin targets suggest structural margin pressure.

“FY2026 adjusted EPS guidance at least $25.50 vs FY2025 $30.29.”

Guidance depends on market conditions, regulatory landscape, and cost trends; changes could materially affect results.

“these expectations reflect management's current view of market conditions, operational performance, the regulatory and policy landscape, and refinement of key business assumptions, including cost trends and medical claims payable estimates.” · word for word