This report captures the latest 12 months of payer performance through Q3 2025. Drawing on NAIC Financial Statement Filings, the analysis highlights financial patterns among national and regional payers, along with the associated implications for provider negotiations, product strategy, and capital allocation.

Here are three takeaways from our Q3 2025 report:

• Regional plans and provider-sponsored health plans (PSHPs) continue to face cost pressures with rising medical and administrative expenses. While many of these plans have already experienced layoffs, they continue to evaluate initiatives that improve their overall cost structure and trend, including key areas such as poorly performing provider contracts and other high-cost drivers.
• All payer categories except for Aetna have experienced a substantial decline in pretax operating margins. Regional plans and PSHPs, which were already operating in negative territory last year, have seen their margins deteriorate even further.
• UnitedHealthcare (UHC) has realized substantial growth, outpacing other major payers with an increase in net premiums written of over 20% year over year. Meanwhile, Cigna is the only major payer to see a decline in total net premiums written, a trend that should continue with the recent divestiture of its Medicare Advantage business to Health Care Service Corporation.

Although the Q3 2025 data is reported with a slight delay, it remains the most complete and up-to-date source for evaluating payer performance. The key reason is that all health insurers—not only publicly traded companies but also regional carriers and PSHPs—are mandated to submit quarterly financial reports to the NAIC by early June (three months postquarter close).

This uniform reporting obligation guarantees widespread transparency across all payer categories, regardless of whether they release public disclosures.

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