Direct Answer
7 SEC filers are classified under the Standard Industrial Classification code that describes the managed care industry, and their latest annual reports show $857.5 billion of combined revenue and a median operating margin of 1.7%. Investors should still evaluate its revenue model, industry-specific KPIs, valuation framework and the risks that can change the group's economics.
Industry Overview
Managed care companies run health plans that collect premiums and pay for members' care while managing costs through networks and utilization controls. Profit depends on the medical loss ratio and government rate setting. The first numbers to compare across companies here are medical loss ratio, membership by plan type and premium growth.
Key Industry Metrics
- Medical loss ratio: Share of premium revenue paid out for members' medical care. A rising ratio compresses profit, while a falling one widens it.
- Membership by plan type: Number of members split among commercial, Medicare, Medicaid and other plans. Each has different pricing and risk, so mix shapes margins.
- Premium growth: Change in premiums collected. It should be read against medical cost trend, since premiums must rise enough to cover higher claims.
- Administrative cost ratio: Share of revenue spent on running the plan, such as claims processing and sales. Lower ratios show scale efficiency, but cutting too far can hurt service.
- Operating margin: Share of revenue left after claims and administrative costs. Small changes in the medical cost ratio move it a lot, because margins are thin.
Primary Macro Drivers
- Medical cost trend: Medical costs per member set what insurers must pay out of premiums, so trend above pricing assumptions raises the medical loss ratio.
- Government rate notices: Government sets payment rates for public plans each year, so rate notices change premium growth and margin for those lines.
- Enrollment growth: More members spread fixed administrative cost, but new members can also bring higher use at first; watch membership and the medical loss ratio.
- Utilization: Use of hospitals, drugs and procedures sets claims paid, so a rise in visits or admissions raises costs unless premiums reflect it.
Major Risks
- Rising medical cost: If claims grow faster than premiums, the medical loss ratio rises and margin falls; watch the medical loss ratio and reserve changes.
- Rate cuts in government programs: Lower government rates or tougher rules reduce premiums per member in public programs; watch rate notices and revenue per member.
- Regulatory scrutiny: Reviews of claims handling, coverage denials and pricing can lead to fines and changes to practices; watch legal proceedings and regulatory disclosures.
- Risk adjustment changes: If the government scores member health lower or audits risk coding, payments can fall; watch risk adjustment revenue and audit notes.
Industry Characteristics
| Characteristic | Profile |
|---|---|
| Cyclicality | Defensive |
| Capital Intensity | Low |
| Regulatory Intensity | High |
| Industry Maturity | Mature |
| Geographic Importance | U.S. |
Managed Care Filers in the SEC Record
7 companies with annual reports in the dataset are classified by the SEC in the Standard Industrial Classification code 6324. Their latest fiscal years end in 2025, and together they reported $857.5 billion of revenue. Median revenue growth over the prior year was 12.5%. Median operating margin was 1.7% and median net margin 0.9%. Median total liabilities were 73% of total assets, and 4 of 7 reported a profit in their latest year.
| Company | Revenue | Growth | Operating margin | Net margin | Year |
|---|---|---|---|---|---|
| Cigna Group | $274.9 billion | 11.2% | 3.3% | 2.2% | FY 2025 |
| Elevance Health, Inc. | $199.1 billion | 12.5% | 3.6% | 2.8% | FY 2025 |
| Centene Corp | $194.8 billion | 19.4% | -3.9% | -3.4% | FY 2025 |
| Humana Inc | $129.7 billion | 10.1% | 2.1% | 0.9% | FY 2025 |
| Molina Healthcare, Inc. | $45.4 billion | 11.7% | 1.7% | 1.0% | FY 2025 |
| Oscar Health, Inc. | $11.7 billion | 27.5% | -3.4% | -3.8% | FY 2025 |
| Clover Health Investments, Corp. | $1.9 billion | 40.3% | -4.4% | -4.4% | FY 2025 |
Source: each company's own annual report as filed with the SEC (XBRL data), figures in U.S. dollars. A company's SIC code reflects its main business as the SEC records it, so it can differ from how an index provider or analyst classifies the company, and a diversified group appears under only one code.
Where to Go Next
The Managed Care guide describes how the industry earns money, what to measure and what can go wrong. To see how it compares, read the neighbouring industries in the same sector, then apply the same checks to a specific company.
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Frequently Asked Questions
What are the main KPIs for the Managed Care industry?
Key performance indicators for the Managed Care industry include: Medical loss ratio, Membership by plan type, Premium growth, Administrative cost ratio, Operating margin. Which matter most depends on the company's model, so compare them across several companies rather than relying on one.
How cyclical is the Managed Care industry?
The Managed Care industry is generally defensive, meaning demand tends to remain relatively stable regardless of the economic cycle. Companies in this space can provide portfolio stability during recessions, though growth may lag in strong expansions.
What are the biggest risks in the Managed Care industry?
The primary risks for Managed Care companies include: Rising medical cost, Rate cuts in government programs, Regulatory scrutiny, Risk adjustment changes. Investors should assess each company's exposure to these factors and its track record of navigating them.