When medical insurance provider Centene (CNC) opened its books to investors on Friday, the company reported a surprising loss and an uptick in usage.
The latter is a broader problem for the industry.
In the second quarter, Centene reported an adjusted loss of $79 million and a “health benefits ratio” of 93%. Its benefits ratio, or the amount of its revenue derived from premiums that it pays out for medical care, jumped from 87.6% in the same quarter last year.
Moves in that figure can have outsized effects on health insurers’ financial performance.
“Because of the narrow margins of our health plan business, relatively small changes in our HBR can create significant changes in our financial results,” Centene wrote in its Q2 earnings report.
And the problem is not isolated to Centene.
Elevance Health (ELV), which offers plans including Blue Cross and Blue Shield, reported a similar jump in its “benefit expense ratio” to 88.9% in the second quarter, up from 86.3% in the same quarter last year.
Both Centene and Elevance attributed the jump to their government-subsidized offerings under the Medicaid and Medicare programs.
Molina Healthcare (MOH), which reported Q2 earnings earlier this month, reported a similar outlook, attributing its lowered earnings guidance to the same trend facing other medical insurers.
“The short-term earnings pressure we are experiencing results from what we believe to be a temporary dislocation between premium rates and medical cost trend which has recently accelerated,” Molina CEO Joseph Zubretsky said in a statement.
Elevance stock dropped by roughly 12% after its report earlier this month, while Molina stock dropped by roughly 8%. Both stocks have remained depressed since.
Health Care (XLV) is the worst-performing sector in the S&P 500 this year.
Centene stock dropped by roughly 15% in premarket trading after its earnings release before recovering to a positive gain of roughly 6% by the closing bell on Friday.
The buoy was led by CEO Sarah London’s announcement that Centene was reinstating earnings guidance after pulling this forecast earlier in the month. The company also reported revenue of $48.7 billion, which topped estimates for $44.2 billion, and said it expects to be able to raise the payments it gets from states for Medicaid plans, which would improve its margins.
UnitedHealth’s MCR challenge
The premium-to-cost ratio will be closely watched at UnitedHealth Group (UNH), which refers to this measure as its “medical care ratio” (MCR) and is slated to release Q2 earnings next week.
After seeing its medical care ratio rise to 85.1% in the second quarter last year, UnitedHealth is expected to see its ratio jump to 89.3% this year, according to Bloomberg consensus estimates.
An increase like that would mean tighter margins and less overhead for a company that already slashed its forecast earlier this year. That news sent its stock price down by 22%, its biggest drop in a single day since 1998.
“Management noted care activity trends continue to run ahead of its previous expectations driven by a greater than expected impact at UHC from new members, further acceleration of [Medicare Advantage] utilization and indications of potential broadening trend among adjacent, complex populations,” Truist Securities analysts wrote in a May analyst note about UnitedHealth.
Investors and analysts will also closely watch how UnitedHealth leadership addresses its disclosure Thursday morning that the insurer is facing and complying with a criminal and civil investigation by the Department of Justice over potential fraudulent billing practices in its Medicare Advantage program. The stock dropped 4.7% through Thursday trading after the disclosure.
The probe comes after reporting by the Wall Street Journal earlier this year that documented the potentially fraudulent activity by UnitedHealth, among other medical insurers, which included insurers’ staff doctors and nurses adding diagnoses to patients’ profiles on top of those documented by the patients’ doctors.
UnitedHealth may have to answer investor inquiries about the investigation on its earnings call on Tuesday, though these are far from the only challenges facing the insurance giant.
According to former federal prosecutor Scott Hogan, now an attorney at Dykema Gossett, the DOJ’s Medicare probe will be looking to establish a prolonged pattern of wrongdoing by the insurer.
“If everything comes back good for the company, if the department [closes its investigation], I think the company will be able to reassure the marketplace,” Hogan, who specialized in fraud investigations, told Yahoo Finance on Friday.
Even if UnitedHealth is eventually cleared of wrongdoing, he said, “If the investigation takes next steps, whether it’s a lawsuit or prolonged investigation, I don’t think there are many companies that desire those kinds of headlines.”