UnitedHealth tops profit forecasts but medical costs linger for health care giant

UnitedHealth posted a better-than-expected profit in the final quarter of 2024, but a nagging rise in medical costs and care utilization surprised Wall Street.

Shares of the health care giant slid Thursday after it released its first financial report since the brazen shooting of one of its executives outside a New York City hotel touched a national nerve and brought to the surface American frustration over health care access.

UnitedHealth leaders opened a call with analysts Thursday by offering thanks for condolences the company has received since the Dec. 4 death of Brian Thompson, CEO of the company's UnitedHealthcare business.

''Brian helped build this company and forged deep, trusted relationships for over 20 years, and the positive impact he had on people will be felt for years to come,'' Chief Financial Officer John Rex said.

In the recently concluded fourth quarter, more than 87% of the premiums UnitedHealth collected went back out the door to cover medical costs. That was ''well above'' what analysts expected, TD Cowen analyst Ryan Langston said in a research note.

UnitedHealth said it was still dealing with an increase in prescriptions for expensive specialty drugs, rate cuts to its federally funded Medicare business and other cost pressures it detailed in previous quarters.

The company's enrollment in the state and federally funded Medicaid programs dropped by about 400,000 people. UnitedHealth leaders said rate updates from states to cover costs from those remaining have lagged.

UnitedHealth's adjusted results, which exclude one-time items, totaled $6.81 per share in the quarter. The company's revenue climbed about 7% to $100.8 billion, which missed expectations.

Analysts expected earnings of $6.73 per share on $101.6 billion in revenue, according to the data firm FactSet.

UnitedHealth Group Inc. operates the nation's largest health insurer, UnitedHealthcare, which covers more than 49 million people in the United States. It also operates a large pharmacy benefit manager that runs prescription drug coverage and a growing business that delivers care and provides technical support.

The company's full-year profit sank 36% to $14.4 billion in 2024 after climbing every year for nearly a decade. The bottom line was hurt partly by costs tied to a massive cyberattack that hit its Change Healthcare business early in the year

UnitedHealth, based in Minnetonka, Minnesota, surprised Wall Street early last year by reporting soaring medical costs in the final quarter of 2023. Weeks later, the company discovered the cyberattack, which disrupted business and added more than $2 billion in direct response costs.

Then in early December, Thompson was fatally shot as he walked to the company's annual investor meeting in mid-town Manhattan. A 26-year-old suspect, Luigi Mangione, faces federal and state charges in connection with Thompson's death.

The shooting gave rise to an outpouring of grievances about insurance companies. A survey conducted a few weeks after the shooting found that most Americans believe health insurance profits or coverage denials bear some responsibility for Thompson's death.

Shares of UnitedHealth, a component of the Dow Jones Industrial Average, sank after Thompson's shooting and fell about 4% on the year.

The stock had rallied so far in 2025 before falling nearly 5% to $517.76 Thursday morning. Shares of other other health care conglomerates like CVS Health and Cigna also were down.