Elevance Health ended September with about 44.9 million people in its medical plans, 487,000 fewer than a year earlier. The Anthem parent says the loss came from Medicaid, Medicare Advantage and employer plans where it carries the risk, offset by gains in plans it only administers. The shrinking enrollment did not shrink revenue, which is where the story gets interesting.
Where the 487,000 members went
The insurer’s third-quarter release says medical membership fell 487,000 from September 30, 2025. Its supplemental presentation sets the comparison at 44.9 million now against 45.4 million then, a decline of 1.1%. The company serves about 103 million consumers in total once Carelon pharmacy and other services are counted.
Elevance names three sources of the decline: lower enrollment in Medicaid, Medicare Advantage and what it calls Employer Group risk-based business. In each, the insurer takes the claims cost. Growth in commercial fee-based membership, where employers fund the claims and Elevance runs the plan, pushed the other way but did not close the gap.
The company does not publish member counts for Medicaid, Medicare Advantage or commercial coverage in either document. So the 487,000 cannot be split by program. What Elevance does show is the direction, and that two of the three shrinking groups, Medicaid and Medicare Advantage, are the ones where older and lower-income Americans get their coverage.
Members of an Elevance or Anthem Medicare Advantage plan that changes for 2027 can move only inside the annual window. Medicare.gov sets it at October 15 through December 7 for joining, dropping or switching a Medicare Advantage plan, with the request due by December 7 and the new coverage starting January 1.
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Fewer members, more revenue
Operating revenue still rose 0.7% to $50.4 billion in the quarter. Elevance credits higher premium yields, growth at its CarelonRx pharmacy unit and service fees, partly offset by the lost risk membership. Premium yield is the amount collected per member, so a smaller book can bring in more money if rates rise faster than enrollment falls.
The supplemental breaks out the lines. Medicaid revenue grew 5.7% to $14.98 billion even as Medicaid enrollment fell, and Medicare revenue rose 0.8% to $11.23 billion. Commercial revenue was up 3.8% to $13.34 billion and individual ACA plans gained 6.6% to $2.51 billion. Only the Federal Employee Program fell, down 7.0% to $3.81 billion.
Carelon, Elevance’s services arm, shows the other side of shrinking membership. The supplemental counts 91.0 million consumers served by Carelon, down 6.8% from 97.6 million, and 82.6 million adjusted prescriptions, down 2.8% from 85.0 million. Carelon’s operating revenue was nonetheless $19.3 billion, up 5%.
For a reader on Medicare Advantage or Medicaid, the revenue figures carry a plain message: revenue per member is rising in lines where membership is falling. Elevance’s statement of lower enrollment in those lines does not say whether the company chose that or lost customers to rivals.
What Elevance said about its margins
The benefit expense ratio, the share of premiums paid out for care, was 90.6% in the quarter, an improvement of 70 basis points from 91.3%. Elevance credits Medicare Advantage and individual ACA business. Days in claims payable stood at 44.9, up 3.5 days from a year earlier, meaning more claims were waiting to be paid at quarter’s end.
Spending on the business rose. The adjusted operating expense ratio was 11.3%, up 90 basis points, which the company attributed to one-time investments in long-term capabilities along with growth and quality spending. Health Benefits operating margin slipped 40 basis points to 1.0%, and the segment’s operating gain of about $0.4 billion was lower than a year ago.
Chief executive Gail Boudreaux said third-quarter results “reflect stronger execution across our diversified portfolio.” Adjusted earnings were $6.99 a share against $6.03 a year earlier, and GAAP earnings were $6.27. The release counts a $1.85 a share net non-operating benefit in the gap between the two measures.
Management looks ahead rather than at the member count. It expects at least 12% growth in adjusted earnings per share in 2027, built on a 2026 baseline of at least $26.75. Boudreaux said the company is “confident in delivering” that growth, and the supplemental points to Carelon’s value-based programs and operating efficiency.
Is the plan on your card the one that stays?
Elevance has not said which markets or products lost the 487,000 members, or whether more reductions are planned for 2027. The company is giving investors a picture of steady revenue, rising profit and a smaller risk book. A member has no such picture of their own plan, which is why the annual notice of changes matters.
The worry for a household is cost, not corporate results. A plan that trims benefits or adds to premiums for 2027 is a bill the member pays. The question after reading the insurer’s numbers is whether the plan currently covering a household still fits, and what help exists if it does not.
Will your Medicare Advantage plan look the same on January 1?
Elevance is letting Medicaid and Medicare Advantage enrollment fall while revenue per member rises, and a member who does not compare plans by December 7 takes whatever the insurer sets for 2027. A higher premium or drug bill is then a household cost to cover from somewhere.
This story’s money question is a household one, which is the job The Benefits Checklist finishes. It scans 11 benefit programs retirees most often miss, including Medicare Savings Programs and Extra Help, with the 2026 income limits and a 50-state phone directory, so help with premiums can be applied for beside a new plan.
See which of 11 opt-in programs could ease health-cost bills with the Benefits Checklist →
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This article was produced with AI assistance and edited for accuracy against the sources linked above.
Warren Cohen is a finance writer based in Phoenix, Arizona, covering personal finance topics including credit, banking, and beginner investing. He earned his degree in business administration from Arizona State University and began his career working in consumer finance, where he gained direct experience with lending and credit systems. He now writes for personal finance websites and fintech platforms, focusing on clear, practical content that helps readers make informed financial decisions.
