This report captures the latest 12 months of payer performance through Q4 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 ECG’s Q4 2025 Health Plan Quarterly Report:

• Financial pressure was broadly based across all major health plan categories, marking a shift from the prior year when performance deterioration was more concentrated among regional plans and provider-sponsored health plans (PSHPs).
• National, regional, and provider-sponsored plans all experienced margin compression driven by rising medical expenses, administrative cost pressures, and continued affordability challenges.
• While the magnitude and drivers varied by payer category, the overall trend points to a more challenging operating environment across the sector, increasing the importance of disciplined cost management, provider contract performance, product positioning, and capital allocation.

Because Q4 filings are submitted as part of the year-end reporting cycle, they typically take longer to become fully available than Q1 through Q3 results. Q4 results are reported alongside annual statements, which extends the posting timeline to approximately four to five months before all payer filings are available.

Even with this delay, NAIC reporting remains the most comprehensive source for assessing payer financial performance, providing a consistent, comparable view across national carriers, regional plans, and PSHPs, regardless of whether plans issue public disclosures.

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