Section 1: Executive Summary & Investment Thesis Framework

Overview

Elevance Health Inc. (ELV), a titan in the U.S. managed care industry, finds itself at a pivotal moment, presenting a complex and dichotomous scenario for investors. The company’s formidable market position is anchored by its immense scale, a portfolio of trusted brands including exclusive Blue Cross Blue Shield (BCBS) licenses in 14 states, and a rapidly expanding, high-margin health services division, Carelon.¹ This integrated model serves over 109 million consumers, creating a powerful ecosystem for growth and cost management.¹

However, this structural strength is currently overshadowed by significant industry-wide headwinds. Elevance is navigating a period of intense pressure on profitability, driven primarily by elevated medical cost trends within its government-sponsored business lines—specifically Medicaid and the Affordable Care Act (ACA) marketplace plans. These challenges culminated in a material downward revision of the company’s full-year 2025 earnings guidance, a development that has weighed heavily on its stock performance and crystallized the central debate surrounding its investment merits.¹

Investment Thesis Framework (The Core Debate)

The current market sentiment towards Elevance Health can be distilled into two opposing viewpoints, which form the core of this analytical report.

• The Bull Case: The prevailing market valuation represents a significant overreaction to near-term, manageable headwinds. Investors are focusing excessively on the current margin compression in the Health Benefits segment while underappreciating the durable, long-term earnings power of this core business and, more critically, the substantial growth trajectory and value-creation potential of the Carelon health services platform. The company’s disciplined capital allocation strategy, which includes aggressive share repurchases and a growing dividend, combined with a strong investment-grade balance sheet and strategic investments in technology and value-based care, positions it for a powerful earnings recovery. Proponents of this view expect Elevance to deliver on its long-term target of double-digit adjusted earnings per share (EPS) growth, suggesting the current stock price offers a compelling value proposition.¹
• The Bear Case: The recent downward earnings revision is not a transient issue but rather a harbinger of a structural degradation in the risk profile of government-sponsored health plans. This perspective posits that persistently high medical cost inflation, a significant lag in Medicaid rate adjustments by state partners, and a heightened regulatory environment will continue to compress margins for the foreseeable future.⁶ The path to restoring historical profitability levels is viewed as uncertain and fraught with execution risk. Furthermore, there is concern that the impressive growth of the Carelon segment, while notable, may prove insufficient to fully offset the profitability challenges within the much larger Health Benefits segment, leading to a prolonged period of stagnant or declining earnings.

Report Objective

This report will systematically dissect these opposing theses. Through a data-driven analysis of the managed care industry, Elevance Health’s specific strategic initiatives, its detailed financial health, and its valuation from multiple perspectives, this document aims to equip the sophisticated investor with the necessary framework and insights. The ultimate goal is to facilitate an informed assessment of the probabilities associated with each scenario, enabling a well-founded investment decision regarding Elevance Health.

Section 2: The Managed Care Industry: A Sector Under Pressure

The U.S. managed care industry is currently navigating one of its most challenging operating environments in recent history. A confluence of macroeconomic factors, post-pandemic utilization shifts, and an evolving regulatory landscape has created significant headwinds for payers, directly impacting profitability and creating substantial uncertainty.

Macroeconomic Environment & Cost Inflation

The sector is contending with broad inflationary pressures that have permeated the U.S. economy. For healthcare, this manifests not only in higher general and administrative expenses but, more critically, in escalating medical costs. Healthcare providers, from large hospital systems to local physician groups, are facing acute labor shortages and rising input costs for supplies and services.⁶ These higher costs are inevitably passed on to payers like Elevance Health in the form of demands for higher reimbursement rates.

Simultaneously, healthcare utilization patterns are normalizing after the disruption of the COVID-19 pandemic. While utilization rates for certain high-cost procedures remained below pre-pandemic levels in 2023, the overall trend is one of a rebound as patients seek care that was previously deferred.⁶ This dynamic creates a challenging scenario for payers: they face both a higher volume of claims and a higher cost per claim. This combination exerts direct and significant upward pressure on the Medical Loss Ratio (MLR)—the percentage of premium revenue spent on clinical services—which is the single most critical determinant of profitability for a managed care organization.

Medicare Advantage (MA) Dynamics

The Medicare Advantage market remains a crucial long-term growth driver for the industry, underpinned by strong demographic tailwinds as the U.S. population ages. MA enrollment has grown at a 9% annual clip from 2019 to 2023 and is projected to increase from 54% of the eligible Medicare population in 2024 to 64% by 2034.⁶

However, this attractive growth profile is currently tempered by a series of profitability headwinds:

• Constrained Reimbursement: The Centers for Medicare & Medicaid Services (CMS) has implemented limited rate increases, restricting revenue growth for MA plans.⁶
• Inflation Reduction Act (IRA) Impact: The IRA introduces new costs for payers, most notably the $2,000 annual cap on out-of-pocket prescription drug costs for beneficiaries and coverage for adult vaccines without cost sharing, which directly increase plan expenses.⁶
• Regulatory Adjustments: Changes to risk-adjustment models, which determine payment rates based on member acuity, and modifications to the Star Ratings system, which dictates quality bonus payments, have added further revenue pressure.⁶

The cumulative effect of these pressures was a sharp drop in MA margins to an estimated 1% to 1.5% in 2024.⁶ The industry is now in a transitional phase, moving from a “growth at all costs” mindset to a more disciplined focus on “profitable growth.” This is expected to involve payers optimizing plan benefits, exiting unprofitable counties, and could lead to market consolidation as smaller, less-efficient carriers withdraw. While this may slow headline enrollment growth, it is a necessary step toward restoring long-term margin stability, with analysts forecasting a rebound to a more sustainable 3% to 3.5% margin by 2028.⁶

Medicaid Redetermination & Acuity Shift

The most acute near-term challenge for managed care organizations with significant government business, including Elevance Health, has been the unwinding of the Medicaid continuous enrollment provision. This policy, which was paused during the public health emergency, prevented states from disenrolling members. Its resumption in 2023 has led to a substantial decline in Medicaid membership nationwide.⁶

The impact extends far beyond a simple reduction in enrollment numbers. The process has triggered a significant and adverse shift in the risk profile of the remaining Medicaid population. Evidence suggests that healthier individuals, who are often more mobile and may have gained employer-sponsored coverage, are more likely to be disenrolled during the redetermination process. This leaves behind a pool of members with higher acuity, more chronic conditions, and consequently, greater healthcare needs.³

This acuity shift creates a critical mismatch with reimbursement rates. State-level rate-setting processes are inherently backward-looking and have lagged the rapid change in the risk profile of the covered population. As a result, payers are receiving premiums that are insufficient to cover the medical costs of this sicker membership base. This phenomenon is a primary driver of the elevated MLRs and negative earnings revisions seen across the sector, and it directly explains the pressure Elevance Health is currently experiencing in its Medicaid business.³ The key variable for investors is the duration of this rate-setting lag and the ability of payers to successfully negotiate adequate rate adjustments with their state partners.

Regulatory Environment & Political Risk

Regulatory risk is a permanent and pervasive feature of the managed care investment landscape. The industry operates under a complex and constantly evolving framework of federal and state laws that govern nearly every aspect of its operations, from product design and pricing to provider networks and claims processing.¹⁴

Key regulatory areas of focus include the ongoing implementation of the ACA and the IRA, new rules promoting price transparency and data interoperability, and scrutiny of practices like prior authorization.⁸ A significant point of uncertainty is the scheduled expiration of enhanced ACA premium tax credits at the end of 2025, which could impact affordability and enrollment in the individual market.⁸ Furthermore, potential legislative actions, such as proposals to tighten Medicaid eligibility requirements, could introduce additional headwinds for the government business segment.⁷ Given the persistent political focus on healthcare costs, the risk of further pressure on government reimbursement rates remains elevated.

Section 3: Elevance Health: Business Model and Strategic Positioning

Elevance Health has strategically evolved from a traditional health insurer into a more diversified and integrated health solutions company. Its business model is built upon two complementary segments designed to create a synergistic “enterprise flywheel” that leverages scale to improve outcomes and manage costs.

Segment Breakdown

Elevance Health reports its operations across two primary segments: Health Benefits and Carelon. The recent performance of these two segments tells a divergent story that is central to understanding the company’s current challenges and future opportunities.

• Health Benefits: This is the company’s foundational insurance business, providing a comprehensive suite of medical, pharmacy, and ancillary benefit plans to a diverse customer base across Commercial (Employer Group and Individual), Medicare, and Medicaid lines of business. As of the second quarter of 2025, this segment served approximately 45.6 million medical members and generated operating revenue of $41.6 billion.¹ While it remains the primary driver of the company’s total revenue, it is also the segment most exposed to the industry-wide pressures of rising medical cost trends and is currently experiencing significant margin compression.¹
• Carelon: This is the high-growth, high-margin health services arm of the company, which is further divided into two key components:

• CarelonRx: The company’s in-house Pharmacy Benefit Manager (PBM). CarelonRx has been a source of strong growth, driven by the successful onboarding of new external clients and the expansion of its specialty pharmacy offerings.¹
• Carelon Services: This unit provides a broad array of specialized healthcare services, including complex and chronic care management, behavioral health solutions, and the promotion of value-based care delivery models. This segment is scaling rapidly, both through organic initiatives and through strategic, tuck-in acquisitions such as the home health venture CareBridge.¹

In the second quarter of 2025, the Carelon segment generated $18.1 billion in revenue, marking a remarkable 36% year-over-year increase. More importantly, its operating gain grew by a robust 25% to $0.9 billion, starkly contrasting with the decline in profitability within the Health Benefits segment.¹ This performance highlights Carelon’s role as the primary engine of growth and profitability for the enterprise.

The strategic intent behind this structure is the creation of an “Enterprise Flywheel”.⁴ The Health Benefits segment provides the massive and stable membership base. Carelon then leverages this captive audience to sell its higher-margin services, such as pharmacy management and complex care solutions. In turn, the effective deployment of Carelon’s services helps to better manage medical costs and improve health outcomes for the members in the Health Benefits segment, which should theoretically improve the MLR and strengthen the insurance business over the long term. This integrated model is a key strategic differentiator from less-integrated peers and is designed to emulate the highly successful synergy between UnitedHealthcare and Optum at UnitedHealth Group.

Geographic Footprint & Market Presence

Elevance Health is one of the largest and most prominent health insurers in the United States, with its affiliated companies serving over 109 million consumers through a diverse portfolio of solutions.¹ A cornerstone of its market presence is its exclusive license to operate under the Blue Cross Blue Shield brand in 14 states.² This license is a significant competitive asset, providing powerful brand recognition and consumer trust that is difficult for competitors to replicate. The company is not resting on its established footprint; it is actively pursuing geographic expansion, with plans to enter new markets in Florida, Maryland, and Texas in 2025 under its Simply Healthcare and Wellpoint brands.¹²

Vertical Integration & Care Delivery

The company’s overarching strategy is to deliver “whole health,” an approach that goes beyond traditional medical claims processing to address the physical, behavioral, and social drivers of an individual’s health.² This strategy is being executed through a deliberate push into vertical integration and the direct provision of care, primarily housed within the Carelon Services segment.

Key acquisitions, such as the purchase of specialty pharmacy BioPlus and home health provider CareBridge, are prime examples of this strategy in action.¹ By owning these assets, Elevance gains greater control over the cost and quality of care in high-spend areas. The company is also aggressively expanding its value-based care arrangements with providers. In these models, provider compensation is tied to quality and cost-efficiency rather than the volume of services performed. As of mid-2025, over one-third of the company’s total benefit expense was channeled through arrangements that include downside financial risk for providers, demonstrating a significant commitment to aligning incentives across the healthcare ecosystem to control costs.³

Technology & Digital Capabilities

Digital transformation is a core pillar of Elevance Health’s strategy, viewed as essential for both improving operational efficiency and enhancing the member experience.¹⁸ Management has emphasized significant investments in artificial intelligence (AI) and advanced data analytics. These technologies are being deployed through platforms like “Health OS” to achieve several key objectives: streamline the historically burdensome prior authorization process, reduce administrative costs, and more effectively identify and combat fraud, waste, and abuse within the healthcare system.³

On the consumer-facing side, digital tools like the Sydney Health mobile application are designed to improve member engagement, provide personalized health insights, and guide individuals toward high-quality, cost-effective care options.²⁴ While all major peers are pursuing similar technological advancements, Elevance Health’s ability to deploy these tools across its vast, integrated platform—spanning both the Health Benefits and Carelon segments—could be a source of durable competitive advantage. The 140 basis point year-over-year improvement in the adjusted operating expense ratio in the second quarter of 2025, achieved amidst strong revenue growth, offers early evidence of the potential for this technology-driven operating leverage.¹

Section 4: Competitive Position & Market Share

Elevance Health operates in a highly concentrated and competitive industry, where scale and market density are critical determinants of success. The company holds a formidable position, but faces intense competition from a handful of national players and numerous regional health plans.

Market Position vs. Peers

Elevance Health is firmly entrenched as the second-largest health insurer in the United States by overall market share, trailing only industry leader UnitedHealth Group.²⁵ An analysis of market share across different business lines reveals a more nuanced competitive landscape:

• National Commercial Market Share: In the commercially insured market, which includes employer-sponsored and individual plans, Elevance holds a strong number two position with a 12% share. This places it just behind UnitedHealth Group (14%) and slightly ahead of CVS/Aetna (11%) and Cigna (10%).²⁷
• Medicare Advantage Market Share: The MA market is more concentrated at the top, and Elevance is a smaller, though still significant, participant. The market is led by UnitedHealth Group (29% share) and Humana (18% share). Elevance ranks fifth with a 6% market share.¹⁰ This position presents a dual-edged sword: it signifies less scale and pricing power relative to the leaders, but it also provides a substantial runway for future market share gains, particularly as the company focuses on profitable growth in this segment.
• Public Exchange (ACA) Market Share: In the ACA marketplace, Elevance holds the sixth position with a 4% national market share, in a segment led by Centene with a 14% share.²⁷

Competitive Advantages (Moats)

Elevance Health’s competitive position is fortified by several durable advantages, or “moats,” that create high barriers to entry and protect its long-term profitability.

• Scale and Network Effects: With over 45 million medical members, Elevance possesses immense scale. This allows it to negotiate favorable reimbursement rates with healthcare providers (hospitals, physician groups), creating a cost advantage that is exceedingly difficult for smaller competitors to replicate. For members and employers, the breadth and depth of the company’s provider network is a primary factor in plan selection, creating a virtuous cycle where a large member base attracts a broad network, which in turn attracts more members.¹⁷
• Exclusive BCBS Brand License: A powerful and unique competitive moat is the company’s exclusive license to market products under the Blue Cross Blue Shield brand in 14 states.² The BCBS brand is one of the most recognized and trusted names in American healthcare, conferring significant competitive advantages in marketing, member retention, and pricing power within those specific geographies.
• Integrated Business Model (Carelon): The strategic development of the Carelon health services segment is a key differentiating factor. This integrated model, which combines a massive insurance arm with a rapidly growing PBM and care delivery business, allows Elevance to compete more effectively with the industry’s most successful integrated player, UnitedHealth Group (and its Optum segment). It provides a pathway to manage costs more effectively and offer a more comprehensive suite of products than pure-play insurance competitors.

Pricing Power & Member Retention

The current inflationary environment is a critical test of Elevance’s pricing power. Management has explicitly stated a focus on “disciplined pricing” across all business lines to ensure that premiums are set at a level sufficient to cover rising medical cost trends.³ The company’s ability to implement these necessary rate increases without suffering significant membership losses will be a key indicator of its competitive strength and the value proposition of its products. The reported membership decline of 212,000 in the second quarter of 2025 was primarily attributed to the mandated Medicaid redetermination process and some attrition in the ACA market, highlighting the challenges of retaining members in a volatile environment.¹

Differentiation Strategy

Elevance’s core differentiation strategy revolves around its “whole health” approach, which is operationalized through its integrated business model.² The Carelon segment is the primary vehicle for this strategy. By moving beyond the role of a traditional insurance company that simply pays claims, Elevance aims to become a comprehensive health solutions partner that actively manages the full spectrum of its members’ health needs. This strategy is not only designed to improve health outcomes but also to create a more integrated and “sticky” relationship with customers. This strategic pivot is a direct and necessary competitive response to UnitedHealth Group, whose Optum-driven strategy has been richly rewarded by the market. A central component of the bull thesis for Elevance Health rests on the belief that as Carelon continues to scale and demonstrate its value, the market will eventually recognize and re-rate Elevance’s stock to reflect the higher multiples typically associated with health services businesses, unlocking significant shareholder value.

Section 5: Financial Performance & Growth Analysis

An examination of Elevance Health’s financial performance over the past several years reveals a narrative of consistent top-line growth and strong cash generation, recently punctuated by significant near-term profitability pressures. The company’s ability to navigate these pressures while executing on its long-term growth initiatives is the central focus of its financial story.

Multi-Year Financial & Operational Summary

The following table provides a consolidated overview of Elevance Health’s key financial and operational metrics over the last three fiscal years and the latest twelve months (LTM), offering a clear perspective on its performance trends.

Metric	FY 2022	FY 2023	FY 2024	LTM (as of Q2 2025)
Total Operating Revenue ($M)	$156,595	$171,340	$175,204	$189,250
Health Benefits Revenue ($M)	$138,000 (approx)	$148,000 (approx)	$156,000 (approx)	N/A
Carelon Revenue ($M)	$41,000 (approx)	$47,000 (approx)	$48,000 (approx)	N/A
Operating Income ($M)	$7,719	$7,904	$7,904	$8,740
Net Income ($M)	$6,099	$5,989	$5,971	$5,360
Diluted EPS ($)	$24.73	$25.10	$25.68	$23.39
Medical Membership (Millions)	47.5	47.3	45.8	45.6
Commercial & Specialty	31.6	31.4	30.2	30.0 (approx)
Government Business	15.9	15.9	15.6	15.6 (approx)
Medical Loss Ratio (MLR)	87.0%	87.0%	88.5% (approx)	88.9% (Q2 2025)
Operating Expense Ratio	11.3%	11.1%	11.1% (approx)	10.1% (Q2 2025)
Net Cash from Operations ($M)	$8,290	$7,984	$4,500 (approx)	$6,450

Note: Data is compiled from company 10-K filings, quarterly earnings releases, and presentations.¹ Some segment revenue figures are approximated based on reported growth rates. The LTM period reflects the most recently available public data.

Revenue & Membership Growth Trajectory

Elevance has demonstrated a consistent ability to grow its top line. Operating revenue reached $175.2 billion in fiscal year 2024, a 2.9% increase over the prior year.² This growth accelerated significantly in the first half of 2025. In the second quarter of 2025, operating revenue surged 14.3% year-over-year to $49.4 billion.¹ This acceleration was not primarily driven by membership growth but by a combination of higher premium yields—a direct result of pricing actions to cover anticipated cost trends—continued growth in the high-flying Carelon segment, and the contribution from recent acquisitions.

Total medical membership has seen a slight decline, standing at 45.6 million at the end of Q2 2025.¹ This modest attrition is almost entirely attributable to the Medicaid redetermination process, which has been a headwind for the entire industry. This membership decline has been partially offset by growth in the Medicare Advantage and Commercial risk-based businesses, demonstrating resilience in other key areas.

Profitability Analysis (MLR & Margins)

Profitability is where the company faces its most significant current challenge. The Medical Loss Ratio (MLR), which measures medical costs as a percentage of premium revenues, is the most critical metric to watch. After remaining stable at 87.0% in 2022 and 2023, the MLR has come under severe pressure. In the second quarter of 2025, the MLR spiked to 88.9%, a substantial 260 basis point increase compared to the same period in the prior year.¹ Management has directly attributed this deterioration to the previously discussed issues: higher-than-expected medical cost trends stemming from the increased acuity of the Medicaid and ACA populations.¹ This sharp rise in the MLR is the fundamental reason behind the company’s downward revision of its full-year 2025 earnings guidance.

In stark contrast, the company has shown exceptional discipline in managing its administrative costs. The adjusted operating expense ratio has steadily improved, falling by 140 basis points year-over-year to just 10.0% in Q2 2025.¹ This improvement highlights successful cost control initiatives and the positive operating leverage generated from strong revenue growth.

The opposing trends in these two key ratios tell a crucial story. Management is effectively controlling the costs within its direct operational purview (administrative expenses). However, these internal efficiencies are currently being overwhelmed by external pressures on medical costs. The long-term investment thesis for Elevance Health hinges on its ability to eventually bring the MLR back under control through a combination of disciplined repricing, the cost-management capabilities of its Carelon segment, and an eventual stabilization of the risk pools in its government businesses.

Cash Flow Generation

Despite the pressures on net income, Elevance Health continues to be a formidable cash-generating enterprise. Year-to-date operating cash flow as of the end of the second quarter of 2025 was a robust $3.1 billion, representing a $0.6 billion increase over the same period in the prior year.¹ For the full year 2025, management has guided to approximately $6.0 billion in operating cash flow, a figure that was revised downward to reflect the lower earnings outlook but still represents substantial cash generation.¹⁹ The company’s free cash flow yield stands at an attractive level of over 8%, indicating that it generates a significant amount of cash relative to its market capitalization, providing ample flexibility for capital allocation.⁵

Section 6: Growth Opportunities & Strategic Initiatives

Despite the near-term headwinds that have dominated recent headlines, Elevance Health is actively pursuing a multi-pronged growth strategy designed to drive long-term value creation. This strategy is centered on expanding its presence in government programs, aggressively scaling its high-margin Carelon services business, and leveraging technology and strategic acquisitions to enhance its competitive position.

Medicare Advantage Growth

The Medicare Advantage market remains a significant long-term growth vector for the company. While the industry is currently navigating profitability challenges, the demographic tailwind of an aging U.S. population ensures sustained demand for MA products. Elevance’s current market share of approximately 6% places it as a smaller player compared to industry leaders UnitedHealth Group and Humana.¹⁰ This position, however, provides a long runway for growth. As the market rationalizes and smaller, less-profitable plans potentially exit, Elevance has an opportunity to capture market share by leveraging its strong brand, broad provider networks, and integrated care model.

Medicaid Opportunities

Although the Medicaid segment is the primary source of the company’s current margin pressure due to the redetermination-driven acuity shift, it remains a fundamentally attractive business over the long term. State governments continue to rely on managed care organizations to control costs and manage care for their Medicaid populations. Elevance’s deep experience and established presence in this market position it well to compete for and win new state contracts and expand its services into new geographies. The key to unlocking this growth potential lies in achieving appropriate rate alignment with its state partners to reflect the true cost of care for the covered population.

Carelon – The Primary Growth Engine

The Carelon segment is unequivocally the centerpiece of Elevance Health’s growth narrative and the most critical element of the bull thesis. This health services platform is designed to transform Elevance from a traditional insurance underwriter into a diversified health solutions company, with a corresponding positive impact on its growth profile and valuation multiple.

Carelon’s performance has been exceptionally strong, acting as a powerful offset to the challenges in the Health Benefits segment. In the second quarter of 2025, Carelon’s revenue surged by 36% year-over-year.¹ Management has laid out an ambitious long-term plan for the segment, targeting a mid-teens compound annual growth rate (CAGR) for revenue through 2027, coupled with an expansion of operating margins into the 5.5% to 6.5% range.⁴ This growth is expected to come from two primary sources: deepening the penetration of Carelon’s services within Elevance’s own 45-million-member base and aggressively growing its roster of external, third-party clients. The successful scaling of Carelon is paramount, as it not only provides a high-growth revenue stream but also enhances the company’s ability to manage medical costs, directly benefiting the core insurance business.

Acquisition Strategy

Strategic, value-accretive mergers and acquisitions (M&A) are a core component of the company’s growth strategy, with a clear focus on building out the capabilities of the Carelon platform. Elevance has a demonstrated track record of using M&A to enter new service areas and acquire new technologies. The recent acquisitions of CareBridge, a provider of home and community-based care solutions, and BioPlus, a specialty pharmacy, are prime examples of this strategy in action.¹ These deals vertically integrate key components of the care continuum, giving Elevance greater control over cost and quality in high-spend categories. The company’s ability to successfully identify, execute, and integrate these types of acquisitions will be a key determinant of its ability to accelerate the growth of Carelon.

Technology & Innovation

Elevance is making significant investments in technology and innovation, viewing them not just as tools for cost savings but as fundamental drivers of growth. The deployment of artificial intelligence and advanced data analytics is central to this effort. These technologies are being used to create more personalized care plans for members, provide actionable insights to providers at the point of care, and streamline administrative processes.³ By improving health outcomes and creating a more seamless healthcare experience, these technological investments are designed to create stickier relationships with both members and providers. Furthermore, these advanced data capabilities are essential for the successful scaling of value-based care models, which represent a key long-term opportunity for both growth and margin expansion.

Section 7: Capital Allocation & Shareholder Returns

Elevance Health adheres to a balanced and disciplined capital allocation framework designed to fund organic growth, pursue strategic acquisitions, and consistently return a significant amount of capital to its shareholders. The company’s strong cash flow generation and investment-grade balance sheet provide substantial flexibility to execute this strategy, even amidst the current operating challenges.

Capital Deployment Summary

The following table illustrates the company’s capital allocation priorities over the past several years, highlighting the flow of capital from operations to investments and shareholder returns.

Metric ($ in Millions)	FY 2022	FY 2023	FY 2024	YTD (as of Q2 2025)
Net Cash from Operations	$8,290	$7,984	$4,500	$3,100
Capital Expenditures	($1,100)	($1,200)	($1,200)	N/A
Free Cash Flow (approx.)	$7,190	$6,784	$3,300	N/A
Cash Spent on Acquisitions	($2,500)	($2,100)	($1,500)	N/A
Cash Spent on Share Repurchases	($3,500)	($3,000)	($4,400)	($1,259)
Cash Paid for Dividends	($1,230)	($1,380)	($1,500)	($771)
Total Capital Returned	$4,730	$4,380	$5,900	$2,030
Payout Ratio (% of FCF)	~66%	~65%	>100%	N/A

Note: Data is compiled from company 10-K filings, quarterly earnings releases, and proxy statements.¹ Figures are approximated for clarity and trend analysis. The payout ratio exceeding 100% in 2024 reflects a year of lower operating cash flow combined with a continued strong commitment to returns.

Shareholder Return Policy

Returning capital to shareholders is a cornerstone of Elevance’s financial strategy. The company has demonstrated a consistent commitment to this policy, even during the challenging operating environment of 2025.

• Share Repurchases: The company has an active and substantial share repurchase program. In the second quarter of 2025 alone, Elevance bought back $379 million of its common stock. Year-to-date, repurchases have totaled $1.26 billion.¹ As of June 30, 2025, the company had a formidable $8.0 billion remaining on its board-approved share repurchase authorization, signaling a strong and ongoing commitment to reducing its share count and boosting EPS.¹
• Dividends: Elevance has a long and reliable history of paying and growing its dividend. The company has increased its dividend for 14 consecutive years, a testament to the long-term confidence management has in its cash-generating capabilities.²⁸ The current quarterly dividend is $1.71 per share, translating to a dividend yield of approximately 2.4%.¹

Debt & Financial Leverage

Elevance Health maintains a strong and stable financial position, underscored by its investment-grade credit ratings. S&P Global Ratings assigns the company an ‘A’ long-term issuer credit rating, while Moody’s Investors Service assigns a ‘Baa2’ rating.³¹ In March 2024, S&P revised its outlook on the company to “negative” from “stable,” a change it attributed primarily to the implementation of a revised capital model methodology rather than a fundamental deterioration in the company’s credit profile.³¹

Management prudently manages its financial leverage, targeting a debt-to-capital ratio in the range of 40%.³² This level is considered appropriate for the industry and provides the company with ample financial flexibility to pursue its strategic objectives without taking on excessive balance sheet risk.

Management’s Capital Allocation Philosophy

The company’s capital allocation philosophy is clear and hierarchical. The first priority is to fund organic growth, with a particular emphasis on investments in technology, digital capabilities, and the expansion of the Carelon platform. Following organic investment, the company seeks to deploy capital towards value-accretive M&A, again with a focus on acquiring assets that enhance and accelerate the Carelon strategy. Finally, all excess free cash flow is consistently returned to shareholders through the combination of dividends and share repurchases. This balanced approach is designed to support management’s stated long-term financial goal of achieving at least 12% average annual growth in adjusted diluted EPS.¹

Section 8: Comprehensive Risk Assessment

An investment in Elevance Health is subject to a range of significant risks inherent to the managed care industry and specific to the company’s operations. These risks are detailed extensively in the company’s public filings and are critical for any investor to understand.⁸

Regulatory and Political Risks

This category represents the most pervasive and unpredictable set of risks facing the company.

• Reimbursement Risk: The profitability of Elevance’s substantial government business (Medicare and Medicaid) is directly dependent on payment rates set by federal and state governments. These rates are subject to political and budgetary pressures and could be set at levels that are insufficient to cover the underlying medical costs of the covered population, severely impacting margins.⁸
• CMS Star Ratings: A significant portion of Medicare Advantage revenue is tied to the CMS Star Ratings program, which provides quality-based bonus payments. The criteria for these ratings are constantly changing, making it increasingly difficult to achieve and maintain high scores. As evidenced by the decline in the percentage of its members in 4-star or higher plans for 2025, a lower rating directly reduces revenue and can negatively impact a plan’s marketability and future enrollment.⁸ This is a material and immediate headwind for the company.
• Policy and Legislative Changes: The U.S. healthcare landscape is in a constant state of political debate and regulatory flux. Potential changes to the Affordable Care Act, modifications to Medicare risk-adjustment models, new regulations governing Pharmacy Benefit Managers (PBMs), or other unforeseen legislative actions could fundamentally alter the operating environment and adversely affect the company’s business model and financial results.⁸

Medical Cost & MLR Pressures

The core operational risk for any health insurer is the ability to accurately predict and manage medical costs.

• Prediction and Pricing Inaccuracy: As demonstrated by the recent earnings guidance revision, a failure to accurately forecast medical utilization and cost trends can have a severe and immediate impact on profitability. Premiums are set months in advance, and if costs come in higher than projected, the losses cannot be recovered in the current contract year.³
• Medical Inflation: Sustained inflation in the cost of medical services, pharmaceuticals, and labor that outpaces the company’s ability to increase premiums will lead to ongoing margin compression.
• Public Health Crises: Large-scale medical emergencies, such as pandemics, can cause unpredictable and significant surges in healthcare utilization and costs, disrupting financial projections.¹

Competition & Market Share Erosion

The managed care industry is intensely competitive on both a national and local level.

• Intense Competition: Elevance competes with other large, well-capitalized national players like UnitedHealth Group, Humana, and Cigna, as well as numerous strong regional and not-for-profit health plans. Competition is fierce across price, product offerings, provider network access, and brand recognition.⁸ Aggressive actions by competitors could lead to pricing pressure and the loss of market share.
• Provider Consolidation: The ongoing consolidation among hospitals and physician groups gives these providers greater negotiating leverage. This can make it more difficult for Elevance to secure favorable reimbursement rates, potentially driving up its medical costs.⁸

Technology & Operational Risks

• Cybersecurity Threats: As a custodian of vast quantities of sensitive personal health and financial information, Elevance is a prime target for sophisticated cyber-attacks. A significant data breach could result in massive regulatory fines, extensive litigation, severe reputational damage, and a loss of customer trust.⁸
• M&A Integration Risk: The company’s growth strategy is heavily reliant on successfully integrating its acquisitions, particularly within the Carelon segment. A failure to realize expected synergies or a problematic integration of a newly acquired company could impair the value of the transaction and disrupt operations.
• Economic Sensitivity: A significant economic downturn leading to widespread job losses would likely result in a decline in enrollment in the company’s more profitable Commercial insurance segment as individuals lose employer-sponsored coverage. This could create an unfavorable mix shift towards government-sponsored plans.

Section 9: Management Quality & Corporate Governance

The quality of a company’s leadership and the robustness of its governance practices are critical factors in assessing its long-term investment potential. Elevance Health is led by an experienced management team and governed by a board with strong credentials and a commitment to shareholder-friendly policies.

Executive Leadership

• Chief Executive Officer, Gail K. Boudreaux: Ms. Boudreaux is a highly respected and experienced leader in the healthcare industry. She has served as President and CEO of Elevance Health since 2017. Her strategic vision is the driving force behind the company’s transformation towards a “whole health” model and the significant investment in and expansion of the Carelon services platform. The company’s 2025 proxy statement credits her with navigating the enterprise through a dynamic and challenging operating environment.²
• Broader Management Team: The senior executive team possesses deep and varied experience across the key facets of the managed care and health services industries, including government programs, commercial benefits, and pharmacy services.² This depth of expertise is crucial for managing a complex and diversified enterprise like Elevance.
• Communication and Guidance: The management team’s credibility has been tested by the recent downward revisions to its 2025 earnings guidance. In their communications, executives have framed this revision as a disappointing but necessary step to provide investors with clear visibility into the current challenges and to reset expectations based on prevailing conditions rather than hopes for a near-term recovery.³ The market will be closely watching the company’s ability to meet this revised guidance and the transparency of its future communications.

Corporate Governance

Elevance Health has implemented a strong corporate governance framework that aligns with best practices and promotes shareholder interests.

• Board Composition and Independence: The company’s Board of Directors is composed of highly qualified individuals with a diverse range of relevant skills, including experience in healthcare, finance, technology, and public policy. The board is notably diverse, with 8 of its 11 directors being diverse based on gender and/or ethnicity, and it maintains a high degree of independence, with 10 of the 11 directors qualifying as independent under NYSE and SEC rules.²
• Independent Board Leadership: Elevance maintains a separate CEO and an independent Board Chair, a structure that is widely considered a governance best practice as it enhances board oversight. Following the retirement of the current chair, Elizabeth Tallett, Mr. Ramiro Peru, a long-serving independent director, is set to assume the role of independent Chair.²
• Shareholder Alignment: The company has several policies in place to ensure that the interests of its leadership are aligned with those of its shareholders. Executive compensation programs include a significant equity component, tying a large portion of executive pay to the company’s stock performance. Furthermore, robust stock ownership guidelines are in place for both executive officers and directors, requiring them to hold a significant amount of company stock.² While aggregate insider ownership is low (less than 1%), this is typical for a company of Elevance’s large market capitalization.²
• Shareholder-Friendly Policies: The company has adopted a number of other positive governance features, including a robust “clawback” policy that allows it to recoup incentive compensation in certain circumstances, majority voting for uncontested director elections, and proxy access for shareholders.²

Section 10: Valuation Analysis Framework

The valuation of Elevance Health is at the heart of the investment debate. The company’s stock currently trades at multiples that suggest significant market pessimism regarding its near-term earnings outlook. A comprehensive valuation analysis requires looking beyond a single metric and employing multiple methodologies to ascertain whether the current price reflects a temporary dislocation or a permanent impairment of its earnings power.

Comparative Valuation Multiples

A comparison to its direct peers provides essential context for Elevance’s current valuation. The company consistently trades at a discount to its primary competitor, UnitedHealth Group, and its multiples are currently compressed relative to its own historical averages.

Metric	Elevance (ELV)	UnitedHealth (UNH)	Humana (HUM)	Cigna (CI)	CVS Health (CVS)	Peer Average
Market Cap ($B)	~$63	~$460	~$40	~$85	~$130	~$155
Enterprise Value ($B)	~$85	~$500	~$45	~$110	~$200	~$188
P/E (LTM)	~12.0x	~18.2x	~10.5x	~15.0x	~12.8x	~13.7x
P/E (Forward)	~8.7x	~14.5x	~9.5x	~10.0x	~9.0x	~10.3x
EV/EBITDA (LTM)	~9.8x	~13.5x	~9.1x	~11.5x	~8.0x	~10.4x
EV/EBITDA (Forward)	~6.6x	~12.0x	~8.6x	~9.5x	~7.5x	~8.8x
P/S (LTM)	~0.34x	~1.2x	~0.4x	~0.5x	~0.3x	~0.54x
Dividend Yield (%)	~2.4%	~3.0%	~1.0%	~2.1%	~3.5%	~2.4%

Note: Data is compiled and synthesized from multiple financial data providers as of late 2025.²⁵ Multiples are approximate and subject to market fluctuations. Peer Average excludes ELV.

The data clearly illustrates that Elevance Health trades at a notable discount to the peer average, and a particularly steep discount to UnitedHealth Group, on forward-looking earnings and EBITDA multiples. Its forward P/E of 8.7x is well below its own historical range and suggests that the market is pricing in a high degree of uncertainty and risk related to its near-term profitability.

Discounted Cash Flow (DCF) Analysis Framework

A discounted cash flow analysis provides a measure of a company’s intrinsic value based on its ability to generate cash over time. A DCF valuation for Elevance Health would be constructed based on the following framework ⁴¹:

• Projection Period: A 5 to 10-year forecast of the company’s unlevered free cash flow.
• Key Assumptions:

• Revenue Growth: Projections would incorporate a period of mid-single-digit growth, reflecting near-term membership pressures and pricing actions, followed by an acceleration toward the company’s long-term targets as Carelon scales and market conditions normalize.
• Operating Margins: The model would factor in near-term margin compression, consistent with the elevated MLR, followed by a gradual recovery toward historical norms over the forecast period. This recovery would be driven by the combined effects of disciplined pricing, cost-management initiatives, and the growing contribution from the higher-margin Carelon segment.
• Discount Rate (WACC): The weighted average cost of capital would be calculated using the Capital Asset Pricing Model (CAPM). Given Elevance’s low stock volatility (beta of ~0.61), the resulting WACC would likely be in the mid-to-high single digits.²⁸
• Terminal Value: The value of the company’s cash flows beyond the explicit forecast period would be calculated using a conservative perpetual growth rate, typically in the range of long-term GDP growth (e.g., 2.0% to 2.5%).⁴¹
• Sensitivity Analysis: The final output would include sensitivity tables to demonstrate how the calculated intrinsic value per share changes based on different assumptions for the discount rate and the terminal growth rate, providing a range of potential valuations.

Sum-of-the-Parts (SOTP) Valuation Framework

Given the divergent growth and profitability profiles of Elevance’s two main business segments, a sum-of-the-parts valuation is a particularly relevant and powerful analytical tool. This methodology avoids valuing the company with a single blended multiple and instead values each segment individually before summing them up.⁴³

• Methodology:

1. Value the Health Benefits Segment: This mature, lower-growth insurance business would be valued using a multiple appropriate for its peer group. A price-to-earnings (P/E) or enterprise value-to-EBIT (EV/EBIT) multiple in the range of other large, stable health insurers would be applied to the segment’s projected earnings or operating income.
2. Value the Carelon Segment: This higher-growth, higher-margin health services business would be valued using a more aggressive multiple in line with its distinct peer group, which includes PBMs and other health services companies. An EV-to-EBITDA or EV-to-Sales multiple, likely benchmarked against a company like UNH’s Optum segment, would be applied to Carelon’s projected financials.
3. Aggregate and Adjust: The calculated enterprise values of the two segments would be summed. From this total, unallocated corporate costs would be subtracted, and an adjustment for the company’s net debt would be made to arrive at a total implied equity value. Dividing this by the number of shares outstanding would yield an SOTP-based intrinsic value per share.

This SOTP analysis is highly likely to produce a valuation that is significantly above the current market price. The rationale is that the market currently appears to be applying a single, lower “insurance company” multiple to the entire enterprise, thereby failing to properly recognize the substantial and growing value of the Carelon services business.⁴⁴ The SOTP framework explicitly unpacks and quantifies this potential hidden value.

Analyst Consensus

The Wall Street analyst community, despite acknowledging the near-term challenges, remains broadly constructive on Elevance Health’s long-term prospects. Even after a series of downward revisions following the Q2 2025 earnings report, the consensus 12-month price target for the stock remains in a range of approximately $360 to $405 per share.⁴⁵ This represents a significant potential upside from its current trading level. The overall consensus rating from analysts is a “Moderate Buy” or “Strong Buy,” indicating a belief that the current operational headwinds are temporary and that the stock is attractively valued relative to its long-term growth potential.⁴⁸

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