Elevance Health: how the business works

Each line = amount ÷ total money in × 100. Lines may not add to exactly $100 because of rounding.

Employers, people, states and the federal government pay Elevance Health premiums and fees for health coverage, drug benefits and care services; $74.44 of every $100 that came in during FY2025 paid members' medical bills, and $2.84 was left as net income.

• 01Elevance Health has health plans (its Health Benefits segment) and Carelon, which manages drug benefits (CarelonRx) and sells care and data services (Carelon Services).
• 02About 32% of FY2025 total revenues came from US government agencies, as the FY2025 10-K states.

• State Medicaid programs

  28%

  of revenue

  Premiums 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%

  of revenue

  Commercial premiums and fees, including individual plans: $50.4 billion, 25.3% of total revenues.

• Medicare members and the federal government

  23%

  of revenue

  Medicare Advantage, Medicare Supplement and drug plan premiums: $44.8 billion, 22.5% of total revenues.

• Carelon's outside customers and other

  15%

  of revenue

  Drug-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

  8%

  of revenue

  Premiums for health plans for federal government employees and their families: $15.3 billion, 7.7% of total revenues.

• Investment income

  1%

  of revenue

  Not 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.

Medical care ratio = medical costs ÷ premiums, as the company reports it. Net investment income is interest and dividends on the money the company holds before paying claims; realized and unrealized gains are shown apart because they move with markets. Net income is the amount for common stockholders. Fiscal years are the company's own (December 31. Elevance Health's fiscal year matches the calendar year: FY2025 ended Dec 31, 2025, and Q3 FY2026 ended Sep 30, 2026.).

• Premiums are Elevance's premium revenue; claims are its benefit expense (members' medical care). Operating costs are its whole operating expense line, which also covers the Carelon businesses.
• Fees and other are product revenue (mostly CarelonRx drug sales) plus service fees.
• Realized gains are the results on bonds and stocks sold; unrealized gains are changes on stocks still held. Losses on other investments ($502 million in FY2025, including $435 million of impairments) are in neither column but are part of total revenues. The split is not shown for FY2021 and FY2022.
• Book value per share and ROE are Cityfort calculations from the FY2023 and FY2025 10-Ks: shareholders' equity ÷ year-end shares outstanding, and net income ÷ average shareholders' equity. Elevance does not report ROE.
• FY2021 and FY2022 are restated for the accounting change for long-duration insurance contracts adopted in 2023. Members are medical members at year end; FY2023 is as restated in the FY2025 10-K.

Download Elevance Health's yearly and quarterly numbers (CSV, with source ids)

Learn: How to read a US earnings release: Nvidia's Q2 fiscal 2027 · What is return on equity? Profit on equity, with real US companies

• Gail K. Boudreaux

  President and Chief Executive Officer · since 2017

  CEO and a director since November 2017. She was earlier CEO of UnitedHealthcare and an executive vice president of UnitedHealth Group. Her 2025 total pay was $22,582,314; the CEO pay ratio was 286 to 1.

• Mark B. Kaye

  Executive Vice President and Chief Financial Officer · since 2023

  CFO since November 2023, after serving as CFO of Moody's Corporation.

• Felicia F. Norwood

  Executive Vice President and President, Government Health Benefits · since 2018

  Runs the Medicare and Medicaid business since June 2018. She earlier ran the Illinois state agency for health care and family services.

• Peter D. Haytaian

  Special Advisor; President of Carelon and CarelonRx until May 4, 2026 · since 2021

  Led Carelon and CarelonRx from October 2021. The company said on Feb 26, 2026 that he would leave the role on May 4, 2026 and stay as Special Advisor until Dec 31, 2026.

• Ramiro G. Peru

  Independent Chair of the Board · since 2025

  Became Independent Chair after the retirement of director Elizabeth Tallett, as the 2026 proxy describes. The chair and CEO roles are held by different people.

• Pricing

  Medical costs above premiums

  Premiums are set in advance, so higher use of care cuts profit. The benefit expense ratio rose from 87.0% in FY2023 to 90.0% in FY2025, which the 10-K links to higher medical cost trend across all lines of business.

  Watch The benefit expense ratio each quarter: 90.6% in Q3 FY2026, against a full-year 2026 guide of 90.2%, plus or minus 0.5 points (Sep 10, 2026).

• Regulation

  Government programs and their rules

  About 32% of FY2025 total revenues came from US government agencies, and Medicaid depends on state budgets. CMS rules on Medicare Advantage data and star ratings affect payments; a CMS notice in February 2026 led to a $935 million accrual.

  Watch Medicare star ratings: about 49% of Medicare Advantage members in plans rated 4 stars or more for 2028 payments, against about 55% the year before.

• Legal

  Lawsuits on Medicare data, antitrust and guidance

  The DOJ's False Claims Act suit, filed in March 2020, alleges inaccurate Medicare Advantage diagnosis data. Blue antitrust opt-out cases and a shareholder class action over 2024 guidance are also pending; the company says they are without merit.

  Watch Fact discovery in the DOJ case, due Nov 20, 2026, and the California antitrust trial set for March 2027.

• Demand

  Fewer Medicaid and Medicare Advantage members

  Medicaid members fell from 11.6 million at the end of FY2022 to 8.2 million at Sep 30, 2026. Medicare Advantage members fell 15.5% in the year to Sep 30, 2026, to 1.9 million.

  Watch Membership by line in each earnings release.

• Debt

  More debt, less operating cash

  Total debt rose from $23.0 billion at the end of FY2021 to $32.0 billion at the end of FY2025, while cash from operations fell from $8.4 billion to $4.3 billion. S&P lowered its rating from A to A- between October 2025 and February 2026.

  Watch Cash from operations against the company's 2026 guide of at least $6.5 billion; it was $7.5 billion in the first nine months.

• Concentration

  Reliance on CVS for pharmacy services

  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.

  Watch Any renewal, extension or change of the CVS agreement before Dec 31, 2027.

• Other

  Investment losses

  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 (what this means)market valueShare price × number of shares: what all the shares were worth at one dated price. Learn more of its bonds by about $1.6 billion.

  Watch Net gains or losses on financial instruments in each 10-Q.

What does Elevance Health do?

Elevance Health, Inc., formerly Anthem, Inc., sells health plans to employers, individuals, Medicare and Medicaid members and federal employees, and is a Blue Cross and/or Blue Shield licensee in 14 states (Blue Cross only in California). Its Carelon businesses manage drug benefits and sell care services. It had 45.2 million medical members at Dec 31, 2025 and total revenues of $199.1 billion in FY2025.

How does Elevance Health make money?

Elevance Health's business model is collecting premiums and fees for health coverage and paying members' medical bills: in FY2025, premiums were $164.6 billion of its $199.1 billion of total revenues, and medical bills took $74.44 of every $100 that came in. CarelonRx drug sales and service fees bring in most of the rest, and $2.84 of every $100 was left as net income.

Who are Elevance Health's customers?

In FY2025, state Medicaid programs brought in 28.4% of Elevance Health's total revenues, employers and individuals 25.3%, Medicare 22.5%, Carelon's outside customers and other 15.3%, the Federal Employee Program 7.7% and investment income 0.8% (Cityfort calculation from the FY2025 10-K). About 32% of total revenues came from US government agencies.

Is Elevance Health profitable?

Yes. Elevance Health reported net income of $5.66 billion in FY2025, with diluted EPS of $25.21, down from $5.98 billion in FY2024, on total revenues of $199.1 billion. In the first nine months of FY2026 its net income was $4.59 billion.

What is Elevance Health's revenue by segment?

Elevance Health reports four segments. In FY2025, Health Benefits had operating revenue of $167.1 billion, CarelonRx $43.4 billion, Carelon Services $28.3 billion and Corporate & Other $463 million; $41.7 billion of sales between the segments is removed in the consolidated total.

How many members does Elevance Health have?

Elevance Health had 44.9 million medical members at Sep 30, 2026, against 45.4 million a year earlier. Of these, 27.6 million were in fee-based commercial plans, including BlueCard members of other Blue plans, where Elevance earns fees and does not carry the medical cost.

What is CarelonRx?

CarelonRx is Elevance Health's pharmacy benefits business: it runs drug benefits, home delivery and specialty pharmacy for Elevance's own health plans and outside customers. In FY2025 it had operating revenue of $43.4 billion and an operating gain of $2.4 billion.

What is Carelon Services?

Carelon Services is Elevance Health's care and data services business: behavioral health, home and post-acute care management, care for people with complex conditions, and payment checking for health plans. Its operating revenue was $28.3 billion in FY2025, up from $18.0 billion in FY2024, with an operating gain of $960 million.

What is Elevance Health's benefit expense ratio?

Elevance Health's benefit expense ratio, the share of premiums paid out for members' medical care, was 90.0% in FY2025, up from 88.5% in FY2024 and 87.0% in FY2023. It was 90.6% in Q3 FY2026.

Who owns Elevance Health?

Elevance Health has one class of common stock, with 216.1 million shares at Oct 15, 2026 and no controlling holder. Vanguard Capital Management reported 7.13% as of Mar 31, 2026 and BlackRock 7.8% in an April 2025 filing; directors and executive officers held less than 1% at Feb 1, 2026, as the 2026 proxy states.

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