UnitedHealth Group: Understanding the 20% Post-Earnings Selloff

UnitedHealth Group (UNH) released its Q4 and full-year FY2025 earnings on January 27, 2026, and the market reaction was brutal: the stock fell nearly 20% in a single session.

At first glance, the headline numbers did not look disastrous.

• Q4 revenue came in at $113.2 billion, up 12% year-over-year
  
  

• Adjusted EPS was $2.11, slightly beating consensus of $2.09
  
  

• However, EPS was down sharply from $6.81 a year ago due to elevated medical costs and several charges
  
  

• Medical Care Ratio (MCR) jumped to 89.1% reported (88.9% adjusted), significantly higher than prior periods
  
  

For FY2025, the company reported:

• Revenue of $447.6 billion, up 12% YoY
  
  

• Adjusted EPS of $16.35 (reported EPS: $13.23)
  
  

• Results included $1.6 billion in after-tax charges (~$1.78 per share) related to the cyberattack, divestitures, restructuring, and loss contracts
  
  

The real shock came from FY2026 guidance:

• Revenue guidance of ~$439 billion, implying a 2% YoY decline
  
  

• Well below Street expectations of approximately $456 billion
  
  

• Management cited business right-sizing, divestitures (South America and Europe), and the Medicare V28 coding transition, which alone represents a ~$6 billion revenue headwind
  

I currently hold UNH shares, so rather than reacting emotionally, I decided to dig deeper and filter out the noise.

In my view, the selloff is driven by three core issues:

1. Rising Medical Care Ratio (MCR)
   
   

2. Structural changes in Medicare Advantage
   
   

3. The transition to V28 risk-adjustment coding

Rise in Medical Care Ratio (MCR)

MCR (also called Medical Loss Ratio) measures the percentage of premium revenue spent on medical claims and care. In simple terms, it tells us how much of every dollar collected by the insurer is paid out to hospitals, doctors, and drug providers.

MCR = Medical costs ÷ Premiums earned

Under the Affordable Care Act, insurers must maintain an MCR of 80–85%, or rebate the excess to customers. While that regulation caps extreme profitability, it also means insurers have limited ability to absorb cost shocks.

In 2025, medical claims grew faster than premiums, pushing UNH’s adjusted MCR to 88.9%, up from 85.5% in 2024. This margin compression was driven largely by:

• Higher healthcare utilization as seniors caught up on delayed procedures
  
  

• Persistent medical cost inflation
  
  

• Less flexibility to reprice premiums in the near term

The result: revenue growth without commensurate profit growth, a red flag for investors.

2. Changes in Medicare Advantage

Medicare Advantage (MA), also known as Medicare Part C, is a privately managed alternative to traditional Medicare. It bundles Part A (hospital), Part B (outpatient), and usually Part D (prescription drugs) into a single plan.

Today, about 34 million Americans, roughly half of all Medicare beneficiaries, are enrolled in Medicare Advantage.

As the largest Medicare Advantage insurer in the US, UnitedHealth is disproportionately exposed to changes in this program.

Several pressures converged in 2025:

• Lower-than-expected reimbursement increases
  The US government proposed a net average payment increase of just 0.09% — far below what the market had priced in.
  
  

• Elevated medical utilization
  Seniors resumed postponed treatments, pushing claims higher than actuarial assumptions.
  
  

• Coding system changes (V28)
  The transition to the new coding framework will reduce industry-wide reimbursement.
  

These factors contributed to UnitedHealth’s 2025 net profit falling to $12.1 billion, down from $14.4 billion the prior year, its lowest annual profit since 2018.

3. V28 Coding Changes: A Structural Revenue Headwind

The V28 coding system represents a fundamental overhaul of how Medicare pays insurers for covering higher-risk patients.

Beginning in 2026, CMS is fully transitioning from V24 to V28, which:

• Eliminates roughly 2,000 diagnosis codes, including common conditions like depression and anxiety
  
  

• Reduces payment weights for prevalent chronic diseases such as diabetes
  
  

• Requires far more detailed clinical documentation to qualify for reimbursement
  
  

The intent is clear: curb “upcoding” and slow Medicare Advantage spending growth.

CMS estimates that risk scores across the system will decline by approximately 3%, which translates to an estimated $6 billion revenue hit for UnitedHealth, with about $2 billion directly impacting UnitedHealthcare.

In short, insurers can no longer claim the same level of reimbursement for conditions that were previously compensated under the old framework. This is not a one-off issue, it is a structural reset.

Optum: UNH’s Crown Jewel — With Growing Scrutiny

Optum is UnitedHealth Group’s health services arm and accounts for nearly half of total revenue. It spans care delivery, pharmacy services, and health technology, effectively acting as the company’s operating engine.

Think of Optum as the operating system of the US healthcare ecosystem.

Optum’s Three Segments

Optum Health

• Provides direct care through physician practices, clinics, and urgent care centers
  
  

• Expanding value-based care, with ~650,000 new patients expected in 2025
  
  

• Focused on primary, specialty, and ambulatory care
  
  

Optum Rx

• One of the “Big Three” pharmacy benefit managers (PBMs)
  
  

• Manages prescription benefits for employers, insurers, and government programs
  
  

• Uses formulary management, mail-order, and specialty pharmacy to control costs
  
  

Optum Insight

• Delivers data analytics, revenue cycle management, and compliance solutions
  
  

• Supports risk adjustment, clinical analytics, and system efficiency

Vertical Integration Advantage — and Risk

The brilliance of Optum lies in its vertical integration:

• UnitedHealthcare enrolls a Medicare Advantage member
  
  

• That member visits an Optum Health clinic
  
  

• Prescriptions are filled by Optum Rx
  
  

• Billing and analytics are handled by Optum Insight
  
  

Instead of money flowing out to third parties, UNH keeps most of the economics within its own ecosystem.

However, this model is now under intense regulatory scrutiny.

The FTC alleges that PBMs, including Optum Rx, create perverse incentives by extracting large rebates from drug manufacturers in exchange for formulary placement. Critics argue this system inflates drug prices, particularly for essential medications like insulin.

Recent legislation aims to force PBMs toward transparent, flat-fee pricing, eliminating profit structures tied to drug list prices. For Optum Rx, this is a material shift.

Moving from opaque spreads to transparent fees is akin to transitioning from a high-stakes casino to a fixed-fee consulting business, still profitable, but far less lucrative.

Conclusion

In my investing journey, this is the first time holding a stock that faces so many simultaneous headwinds.

In an article I wrote on 4 July 2025, I already highlighted several of these issues. Since then, many risks have intensified rather than faded. UnitedHealth is grappling with:

• Structural reimbursement pressure
  
  

• Rising medical costs
  
  

• Regulatory scrutiny
  
  

• A reset in how Medicare Advantage economics work

While the stock may appear cheap on traditional valuation metrics, the risk profile has changed materially.

For now, I plan to continue holding my position, fully aware that a turnaround, if it comes, will likely take time. All I can do is hope management navigates these challenges successfully and proves the market wrong.

Meta: A Deeper Look at Its Strategy, AI Spending, and Moat

 I’ve always had reservations about investing in Meta, largely for two reasons:

1. Leadership strategy – Mark Zuckerberg often appears to lack a clear roadmap for executing Meta’s growth ambitions. The metaverse initiative, for instance, consumed billions of dollars without delivering concrete results. A similar pattern seems to be emerging with AI, where he has assembled a superstar team and poured in capital, yet the overarching strategy remains vague.

2. Business moat – Social media doesn’t strike me as a sector with a strong moat. It competes not only with other apps like TikTok but also with alternative entertainment platforms such as video games, Netflix, and movies. Unlike essential products or services, social media is not a “must-have.”

That said, I recently decided to take a deeper dive into Meta rather than dismiss it outright. Please note: this is not a buy or sell recommendation, do your own due diligence before making investment decisions.

Meta’s Spending on the Metaverse

Meta’s Reality Labs division, tasked with leading the metaverse push, remains deeply unprofitable. In 2024, it lost approximately $17 billion, and in 2025 continues to post quarterly losses of $4–5 billion. Horizon Worlds, its flagship metaverse social space, struggles with technical issues and weak user engagement. By late 2025, Meta announced a 30% budget cut for metaverse projects.

However, the metaverse strategy is less about virtual worlds and more about owning the operating system layer. Zuckerberg’s vision is to control hardware through devices like the Quest VR headset and Ray-Ban Meta smart glasses, so Meta isn’t beholden to Apple’s privacy rules. Apple’s App Tracking Transparency (ATT), introduced in 2021, severely impacted Meta’s ad targeting, costing the company an estimated $10 billion in 2022 alone. By building its own hardware ecosystem, Meta hopes to escape this dependency.

Still, consumer hardware is notoriously difficult, with entrenched competitors like Apple, Google, and Samsung. The Quest headset hasn’t proven transformative, but the Ray-Ban Meta glasses show promise. Whether they can evolve into a mainstream wearable platform remains to be seen.

Meta’s AI Strategy

Meta has aggressively invested in AI, offering multimillion-dollar contracts to attract top talent and raising AI capex to $66–72 billion in mid-2025, including a $14.3 billion acquisition of Scale AI. Its flagship product is the Llama model, released as open source. Yet despite the heavy spending, many developers gravitate toward Chinese models like DeepSeek and Qwen.

On closer inspection, Meta’s AI play is more nuanced than it first appears:

• Enterprise adoption – Llama is gaining traction among enterprises. Goldman Sachs uses it for customer service and document review, while AT&T leverages it for customer support and operational efficiency. Enterprise adoption opens monetization avenues, including revenue-sharing with cloud partners like AWS and Microsoft.

• Advertising optimization – The most critical application of AI at Meta is enhancing ad delivery. By late 2025, Meta’s AI-powered ad tools reached an annual run rate exceeding $60 billion, underscoring the effectiveness of AI in strengthening its core business.

• Future models – Meta is developing two flagship LLMs: Avocado, a high-end reasoning model focused on complex coding and logic, and Mango, a multimodal model for image and video generation. These may represent a shift toward closed-source monetization via API sales.

Rethinking Meta’s Moat

My earlier view that Meta has a “weak” moat now feels incomplete. Meta’s family of interconnected apps, Facebook, Instagram, WhatsApp, and Threads creates a powerful network effect, with over 3 billion daily active users. Even if engagement shifts between platforms, the ecosystem keeps users within Meta’s orbit.

That said, competition remains fierce. TikTok has captured younger audiences, reshaping content consumption, while YouTube dominates long-form video. Meta cannot rely solely on acquisitions to neutralize rivals, as it did with Instagram and WhatsApp.

Yet for small businesses, Meta is often the most efficient way to reach customers. That reliance is a formidable moat. Consumers can skip a Netflix show, but businesses cannot easily skip the platform where their customers spend time.

Meta’s financials

From the table summary below, Meta is a business that generates enormous free cash flows and is growing its revenue consistently over the past few years. This enables it to fund the AI initiatives without taking on too much leverage.

Year	Revenue (USD B)	YoY revenue growth	Free cash flow (USD B)	YoY FCF growth
2020	~84	–	~23.5	–
2021	~115	~+37%	~39.0	~+66%
2022	~114	~−1%	~19.1	~−51%
2023	~134.9	~+18%	~44.1	~+131%
2024	~164.5	~+22%	~54–55	~+23%
2025 (TTM)	~189.5	~+21%	~52–53	Slightly negative vs. 2024 peak

Conclusion

With a much clearer understanding of Meta’s business, I now have a more balanced viewpoint on the stock. Meta’s strategy may appear scattered, but beneath the surface lies a coherent attempt to secure independence from Apple, monetize AI through advertising, and leverage its massive network effect. The risks are real, hardware competition, developer preferences, and shifting consumer trends. But the scale of Meta’s ecosystem and its ability to adapt suggest it may be stronger than skeptics assume.

However, I still have lingering concerns that Meta might suffer another Metaverse-scale misfire on its AI initiatives and will probably just keep a close watch on the stock price until a more attractive entry price emerges.