Segment Operating Gain Decline Led by Health Benefits
Total operating gain fell 27.3% to $1,763M in Q2 FY2026 from $2,425M a year ago, primarily due to Health Benefits segment operating gain dropping 42.6% to $896M (from $1,560M), while CarelonRx operating gain grew 8.6% to $582M. Health Benefits operating margin contracted 170bp to 2.1%, and total operating margin fell 140bp to 3.5%.
Medical Membership Declined 1.5% YoY
Total medical membership fell to 44.9M members as of June 30, 2026, down 672K (1.5%) from 45.6M a year earlier, driven by Medicaid attrition from eligibility redeterminations (-375K, -4.3%), Medicare Advantage declines (-358K, -15.9%), and Employer Group Risk-Based declines (-198K, -5.5%), partially offset by Employer Group Fee-Based growth (+347K, +1.7%).
Elevated Medical Cost Trends in Medicaid and Medicare
Benefit expense ratio increased 80bp to 89.7% in Q2 FY2026, primarily due to expected elevated medical cost trend in Medicaid and Medicare businesses, partially offset by improved performance in the Individual ACA business. Membership shifts and lower effectuation rates following ACA subsidy expiration (APTCs expired Dec 31, 2025) have driven market-wide morbidity increases.