--- title: "Managed Health Care Industry: Companies" description: "7 SEC filers are classified under the Standard Industrial Classification code that describes the managed health care industry." canonical: https://www.getswoopr.com/stocks/industries/health-care/managed-health-care/ source: "Swoopr Investment: https://www.getswoopr.com" --- # Managed Health Care Industry ## Direct Answer 7 SEC filers are classified under the Standard Industrial Classification code that describes the managed health 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 health care insurers cover employers and government program members and control costs through contracting and care management. Results follow premium pricing, medical cost trend and government payment rules. The first numbers to compare across companies here are medical care ratio, membership and revenue growth. ## Key Industry Metrics - **Medical care ratio**: Share of premiums spent on members' medical claims. A higher ratio means less left for profit, and it moves with utilization and price setting. - **Membership**: Number of people enrolled across employer, individual and government plans. Growth drives premium revenue, but new members can carry higher costs. - **Revenue growth**: Change in total revenue from premiums and services. Compare it with membership growth and rate changes to see what is driving it. - **Operating margin**: Share of revenue left after claims and administrative expenses. It is thin in insurance, so small shifts in cost trend change profit meaningfully. - **Cash flow from services and pharmacy segments**: Cash generated by non-insurance units such as care delivery and pharmacy benefits. It shows how much earnings depend on businesses outside insurance. ## Primary Macro Drivers - **Medical utilization**: More doctor visits, hospital stays and drug use raise claims, so utilization trends move the medical care ratio. - **Medicare and Medicaid rate updates**: Annual government rate updates set payments for public plan members, which move revenue per member and margin. - **Pricing cycles**: Insurers reprice employer and individual plans each year, so the pace of price increases against costs shifts margin. - **Pharmacy and care services**: Owning pharmacy and care businesses adds income streams and lets insurers influence cost, which shows in service-segment cash flow. ## Major Risks - **Cost trend spikes**: A sudden jump in claims cost can outrun pricing for a full year; watch the medical care ratio and reserve development. - **Policy and regulatory change**: Changes in rules on coverage, payment or pricing can affect revenue across many members; watch legislative and regulatory developments. - **Medicare Advantage rate pressure**: If the government raises rates less than costs rise, margin on those plans falls; watch rate notices and the medical care ratio in that line. - **Antitrust and investigations**: Investigations into pricing and mergers can lead to fines or block deals; watch legal proceedings and regulatory notes. ## Industry Characteristics | Characteristic | Profile | | --- | --- | | Cyclicality | Defensive | | Capital Intensity | Low | | Regulatory Intensity | High | | Industry Maturity | Mature | | Geographic Importance | U.S. | ## Managed Health 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](https://www.getswoopr.com/stocks/companies/cigna/) | $274.9 billion | 11.2% | 3.3% | 2.2% | FY 2025 | | [Elevance Health, Inc.](https://www.getswoopr.com/stocks/companies/elevance-health/) | $199.1 billion | 12.5% | 3.6% | 2.8% | FY 2025 | | [Centene Corp](https://www.getswoopr.com/stocks/companies/centene-corporation/) | $194.8 billion | 19.4% | -3.9% | -3.4% | FY 2025 | | [Humana Inc](https://www.getswoopr.com/stocks/companies/humana/) | $129.7 billion | 10.1% | 2.1% | 0.9% | FY 2025 | | [Molina Healthcare, Inc.](https://www.getswoopr.com/stocks/companies/molina-healthcare-inc/) | $45.4 billion | 11.7% | 1.7% | 1.0% | FY 2025 | | [Oscar Health, Inc.](https://www.getswoopr.com/stocks/companies/oscar-health-inc/) | $11.7 billion | 27.5% | -3.4% | -3.8% | FY 2025 | | [Clover Health Investments, Corp.](https://www.getswoopr.com/stocks/companies/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 Health 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. ### More in Health Care - [Health Care sector overview](https://www.getswoopr.com/stocks/industries/health-care/) - [Medicaid Managed Care](https://www.getswoopr.com/stocks/industries/health-care/medicaid-managed-care/) - [Managed Care](https://www.getswoopr.com/stocks/industries/health-care/managed-care/) - [Medical Devices](https://www.getswoopr.com/stocks/industries/health-care/medical-devices/) - [Life Sciences Tools & Services](https://www.getswoopr.com/stocks/industries/health-care/life-sciences-tools-and-services/) - [Medical Imaging Equipment](https://www.getswoopr.com/stocks/industries/health-care/medical-imaging-equipment/) - [Life Sciences Tools](https://www.getswoopr.com/stocks/industries/health-care/life-sciences-tools/) - [Medical Supplies](https://www.getswoopr.com/stocks/industries/health-care/medical-supplies/) - [Large-Cap Pharmaceuticals](https://www.getswoopr.com/stocks/industries/health-care/large-cap-pharmaceuticals/) ### Put it to work - [How to analyze a stock](https://www.getswoopr.com/stocks/how-to-analyze-a-stock/) - [Fundamental analysis guides](https://www.getswoopr.com/learn/fundamental-analysis/) - [Company research](https://www.getswoopr.com/stocks/companies/) - [All industries](https://www.getswoopr.com/stocks/industries/) ## Frequently Asked Questions What are the main KPIs for the Managed Health Care industry? Key performance indicators for the Managed Health Care industry include: Medical care ratio, Membership, Revenue growth, Operating margin, Cash flow from services and pharmacy segments. 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 Health Care industry? The Managed Health 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 Health Care industry? The primary risks for Managed Health Care companies include: Cost trend spikes, Policy and regulatory change, Medicare Advantage rate pressure, Antitrust and investigations. Investors should assess each company's exposure to these factors and its track record of navigating them. **[Swoopr Editorial Team](https://www.getswoopr.com/authors/swoopr-editorial-team/)** Swoopr's editorial team produces independent investment education content reviewed for accuracy and clarity. We do not provide personalized financial advice. See our [editorial policy](https://www.getswoopr.com/legal/editorial-policy/) and [corrections policy](https://www.getswoopr.com/legal/corrections-policy/).