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ELV FY2025 Q3 IN LINE

Elevance Health, Inc. earnings call

Oct 21, 2025 · 04:30 ET Felicia NorwoodGail BoudreauMark Kay
Buzzberg read

Medicaid margin expected to decline at least 125 bps in 2026

Elevance Health reported Q3 2025 adjusted EPS of $6.03, in line with expectations, and reaffirmed full-year EPS of approximately $30. Management provided a cautious 2026 planning outlook, notably guiding for at least a 125 bps decline in Medicaid margins, while also planning several hundred million in strategic investments. The call focused on Medicaid headwinds, Medicare positioning, ACA subsidy uncertainty, and progress in Carillon (pharmacy/services) and AI partnerships. Medicaid operating margin expected to be ~negative 50 bps in 2025 and decline at least 125 bps in 2026 due to elevated acuity and rate lags.

Buzzberg read Medicaid margin expected to decline at least 125 bps in 2026 Elevance Health reported Q3 2025 adjusted EPS of $6.03, in line with expectations, and reaffirmed full-year EPS of approximately $30. Management provided a cautious 2026 planning outlook, notably guiding for at least a 125 bps decline in Medicaid margins, while also planning several hundred million in strategic investments. The call focused on Medicaid headwinds, Medicare positioning, ACA subsidy uncertainty, and progress in Carillon (pharmacy/services) and AI partnerships. Medicaid operating margin expected to be ~negative 50 bps in 2025 and decline at least 125 bps in 2026 due to elevated acuity and rate lags. Read full analysisCollapse analysis

Elevance Health reported Q3 2025 adjusted EPS of $6.03, in line with expectations, and reaffirmed full-year EPS of approximately $30. Management provided a cautious 2026 planning outlook, notably guiding for at least a 125 bps decline in Medicaid margins, while also planning several hundred million in strategic investments. The call focused on Medicaid headwinds, Medicare positioning, ACA subsidy uncertainty, and progress in Carillon (pharmacy/services) and AI partnerships. Medicaid operating margin expected to be ~negative 50 bps in 2025 and decline at least 125 bps in 2026 due to elevated acuity and rate lags.

  • Medicare Advantage: disciplined plan exits (~150k members) and improved star ratings (55% in 4+ star contracts for 2027).
  • ACA market: high single-digit margin decline expected in 2025; enhanced subsidy expiration could significantly reduce membership.
  • Carillon (pharmacy & services) continues strong external revenue growth (Rx +20%, services +50% YoY).
Revenue $50.711B reported
EPS $6.03 reported
Gross margin 24.79% reported
Op margin 3.46% reported

What changed this quarter

01
Margins

Medicaid margin expected to decline at least 125 bps in 2026

Reported gross margin was 24.79%, reinforcing the quarter's better-than-guided profitability.

02
Guidance

2025 adjusted EPS reaffirmed at approximately $30; baseline $27

Guidance tone

03
Guidance

2027 expected to return to balanced earnings growth

Guidance tone

04
Capex

Discrete 2026 investments of several hundred million dollars (~$1 EPS)

Management discussed several hundred million dollars of incremental investments in 2026, primarily focused on technology adoption (AI, core systems), expanding Carelon capabilities, and operational/quality initiatives like improving star ratings. These are front-loaded…

AI, capex & demand read

AI

Platform & monetization

Management emphasized AI as a strategic enabler, deploying AI and digital tools to enhance member experience, reduce provider burden, and drive efficiency. They highlighted significant adoption, with more than 10 million members having access to their AI-enabled virtual assistant, and noted partnerships like OpenAI to train associates. These investments are positioned to improve operating leverage

Demand

Bookings & conversion

Management reaffirms 2025 EPS but warns of Medicaid margin deterioration and investment spending in 2026, creating a cautious near-term outlook.

Capex

Investment and capacity

Management discussed several hundred million dollars of incremental investments in 2026, primarily focused on technology adoption (AI, core systems), expanding Carelon capabilities, and operational/quality initiatives like improving star ratings. These are front-loaded investments aimed at driving long-term operating leverage and future growth.

Tone · Cautious

Management acknowledged challenging dynamics in Medicaid and ACA, provided prudent planning assumptions for 2026, and emphasized discipline and focus, while maintaining confidence in long-term strategy.

Forward guidance

In LineGuidance tone
Forward guidance
MetricPeriodRangeMidpointStatus
EPSFY2025$30.00$30.00MAINTAINED

Guidance credibility

100%historical hit rate
100%
Gail Boudreau

1 of 1 · +1.0% average bias

Company read-throughs

OPENAI
Private company
Partners

Elevance Health is partnering with OpenAI to train employees on AI tools, reflecting a focus on AI adoption across operations.

“We just signed a partnership with OpenAI where we're going to actually train our folks to be able to use these skills appropriately.”
Gail Boudreau