UnitedHealth tops first-quarter estimates, raises full-year profit outlook

UnitedHealth Group delivered a better-than-expected first quarter and a slightly higher full-year profit outlook, a result that investors are treating less as a victory lap than as a credibility test for the company’s turnaround.

The health insurer reported revenue of $111.7 billion for the quarter, up 2% from a year earlier, with adjusted earnings of $7.23 a share and GAAP earnings of $6.90 a share. It also raised its 2026 adjusted profit forecast to greater than $18.25 per share, from a prior target of greater than $17.75, after previously warning that revenue could fall for the first time since 1989. Shares rose nearly 6% in premarket trading after the results.

The most encouraging sign was in medical costs. UnitedHealth said its medical cost ratio was 83.9% in the quarter, down 90 basis points from the same period a year earlier and below analyst expectations. That matters because the company’s recent problems have centered on whether claims costs and utilization were outrunning payments, especially in government-backed Medicare Advantage plans and Medicaid. Operating cash flow reached $8.9 billion, while the company’s debt-to-capital ratio stood at 42.9% as of March 31.

Still, the quarter did not erase the broader strain. UnitedHealth said it expects to lose 1.3 million Medicaid members, even as higher state payments lifted revenue by 4%. Its operating cost ratio rose to 13.8% from 12.4% a year earlier, reflecting investments in consumer and care-provider experience as well as efficiency work. That combination suggests the business is spending more to stabilize service and operations at a moment when customers are watching premiums, claims handling and access to care more closely.

Wayne DeVeydt, the company’s chief financial officer, said UnitedHealth wants to “remain prudent” and watch trends into April and May before becoming more aggressive with guidance. That caution fits the company’s recent history. In July 2025, UnitedHealth disclosed it was cooperating with criminal and civil investigations by the U.S. Department of Justice and had launched third-party reviews of risk-assessment coding, managed-care practices and pharmacy services.

The company said its overhaul, begun in the second half of 2025, has included refocusing on U.S. health care, exiting non-U.S. businesses, refreshing nearly half of the top 100 leadership roles, simplifying operations and investing in artificial intelligence and cybersecurity. It also created a Public Responsibility Committee of the board, added an independent director and announced plans to buy back at least $2 billion of stock. The quarter showed that disciplined spending and improved payments can still steady the company, but the real measure of the turnaround will be whether those gains hold under pressure.