By Josh Nathan-Kazis and Elsa Ohlen

UnitedHealth stock fell after the healthcare company Thursday reported a mixed quarter.

Shares were down 3.2% to $526.28 in premarket trading following the release.

Fourth-quarter adjusted earnings per share were $6.81 on revenue of $100.8 billion, beating expectations of adjusted profit of $6.73, but missing revenue expectations of $101.6 billion, according to FactSet.

UnitedHealth affirmed the 2025 performance outlook established in December, including revenue of between $450 billion and $455 billion, and adjusted net earnings of between $29.50 to $30 a share.

This is breaking news. Read a preview of UnitedHealth below and check back for more analysis soon.

UnitedHealth Group is scheduled to report its financial results on Thursday, a month and a half after the killing of the head of its health insurance division.

The Dec. 4 shooting of UnitedHealthcare CEO Brian Thompson on a Manhattan sidewalk came as a shock to the public. But expressions of public sympathy for Thompson's alleged killer, Luigi Mangione, were surprisingly strong, revealing deep resentment of the health insurance industry and the role UnitedHealth plays in it.

That threatens a major reckoning for UnitedHealth and its peers. UnitedHealth shares have fallen 10% from their closing level before Thompson's murder.

Recent months have raised other challenges for UnitedHealth, which is the largest healthcare company in the country, and has operations that touch virtually every corner of the healthcare system. It owns an insurer, a pharmacy benefit manager, a key software provider, and physician practices, among other businesses.

In mid-December, President-elect Donald Trump threatened to "knock out" pharmacy-benefit managers from their role as middlemen in the drug market, a risk for UnitedHealth because its OptumRx is among the largest such companies. The healthcare news website STAT reported in late December that a number of Democratic U.S. senators were calling for a potential breakup of UnitedHealth.

The advent of the Trump administration could bring other changes. Investors are anticipating a friendlier atmosphere for Medicare Advantage, where UnitedHealth is a major player, but potential cuts to Medicaid and other programs.

UnitedHealth will have a chance to discuss those risks, potentially reassuring investors, on Thursday. The company has scheduled an investor call for 8:45 a.m. Eastern, after it has disclosed its results.

Analysts expect UnitedHealth to report earnings of $6.73 per share and sales of $101.6 billion for the fourth quarter, according to FactSet. They expect the company to report an 86.1% medical loss ratio, a closely-tracked metric that calculates the proportion of premiums that insurers pay out to cover medical expenses.

That would compare with a medical loss ratio of 85% in the fourth quarter of 2023, and 85.2% in the third quarter of 2024.

On Dec. 3, the day before Thompson was killed, the company released financial guidance for 2025. It said at the time that it expects 2025 revenue of between $450 billion and $455 billion, and 2025 adjusted net earnings of between $29.50 and $30 per share.

Write to Josh Nathan-Kazis at josh.nathan-kazis@barrons.com

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January 16, 2025 06:14 ET (11:14 GMT)

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