Elevance Health vs. UnitedHealth: how they make money

• State Medicaid programs · 28.4% of revenuePremiums for Medicaid plans that states run with federal matching money: $56.6 billion, 28.4% of FY2025 total revenues (Cityfort calculation from the FY2025 10-K). Elevance does not give a figure for any single state.
• Employers and individuals · 25.3% of revenueCommercial premiums and fees, including individual plans: $50.4 billion, 25.3% of total revenues.
• Medicare members and the federal government · 22.5% of revenueMedicare Advantage, Medicare Supplement and drug plan premiums: $44.8 billion, 22.5% of total revenues.
• Carelon's outside customers and other · 15.3% of revenueDrug-benefit and care services sold outside Elevance's health plans, and other revenue: $30.5 billion, 15.3% of total revenues (Cityfort calculation from the FY2025 10-K: total operating revenue minus Health Benefits revenue).
• Federal Employee Program · 7.7% of revenuePremiums for health plans for federal government employees and their families: $15.3 billion, 7.7% of total revenues.
• Investment income · 0.8% of revenueNot a customer: net investment income of $2.2 billion less $653 million of net losses on financial instruments, $1.5 billion or 0.8% of total revenues.

• Medicare & Retirement members and CMS · 38.3% of revenuePremiums and fees for UnitedHealthcare's Medicare plans: $171.3 billion, 38.3% of FY2025 revenue (Cityfort calculation from the FY2025 10-K). UnitedHealthcare's business figures include its investment income.
• Optum's outside customers · 22.5% of revenueHealth plans, employers, care providers and others outside the group that buy Optum's care, data and drug-benefit services: $100.9 billion, 22.5% of revenue.
• States and CMS for Medicaid · 21.1% of revenueCommunity & State premiums for Medicaid plans: $94.4 billion, 21.1% of revenue. The company does not split this between state and federal money.
• Employers and individuals · 17.7% of revenueEmployer & Individual premiums and fees: $79.2 billion, 17.7% of revenue, including $3.3 billion from the global business.
• Optum investment income · 0.4% of revenueNot a customer: Optum's investment and other income of $1.7 billion, 0.4% of revenue.

FY2025

FY2025

Not on the Elevance Health page.

Debt

$74.3B

Cash and investments

$25.8B

On Sep 30, 2026.

At Sep 30, 2026, UnitedHealth's debt exceeded its cash by $48.5 billion (Cityfort calculation from the Q3 FY2026 10-Q). That is about 1.9 times the $26.2 billion of cash from operations in the four quarters to Sep 30, 2026 (Cityfort calculation from the Q4 FY2025 and Q3 FY2026 earnings releases). The company stated a debt-to-capital ratio of 41.7%, and the company said on Oct 13, 2026 that it targets about 40% by year-end.

• One class of shares.
• Officers and directors as a group: 0.4% of shares (as of Mar 13, 2026).
• Vanguard Capital Management: 7.1% (as of Mar 31, 2026).
• BlackRock, Inc.: 7.8% (as of Apr 17, 2025).

• One class of shares.
• Officers and directors as a group: 0.2% of shares (as of Apr 2, 2026).
• BlackRock, Inc.: 8.0% (as of Feb 6, 2024).
• Vanguard Capital Management LLC: 7.5% (as of Mar 31, 2026).
• State Street Corporation: 5.0% (as of Jun 30, 2026).

• Reliance on CVS for pharmacy services (customer or supplier concentration)A CVS Health subsidiary does core pharmacy services for CarelonRx, such as claims and pharmacy networks, under a contract running through Dec 31, 2027. The 10-K says a CVS failure to perform could hurt the business.
• Investment losses (other)Net losses on financial instruments were $653 million in FY2025, including $435 million of impairments on other investments. The company estimates that a 1-point rise in interest rates would lower the market value of its bonds by about $1.6 billion.

• Cyberattacks and data (technology)The February 2024 Change Healthcare attack led to $9.0 billion of loans to care providers in 2024, $2.2 billion of direct response costs that year and a $799 million loan reserve in Q4 FY2025.
• Goodwill write-downs (other)Goodwill was $113.0 billion at Sep 30, 2026, 36% of total assets. The 10-K says an impairment could reduce equity and affect credit ratings.
• New leadership (execution)The CEO changed in May 2025, the Optum CEO in May 2025 and the CFO in September 2025. The 10-K names keeping key employees and succession as a risk.