US insurers including UnitedHealth and Humana are cutting benefits for older clients and raising prescription drug costs for 2027, weeks before the midterm elections. Both insurers scrapped hundreds of plans and tightened coverage as older voters began choosing their plans. UnitedHealth and Humana raised maximum out-of-pocket costs by 11% and 8% respectively, according to investment bank Leerink. Both raised prescription drug coverage costs by about 30%. The changes affect 35 million Americans on Medicare Advantage plans, and the two firms hold about 46% of that market. The changes should help insurers' profits. UnitedHealth's healthcare division operating margin rose to 3.3% from 2.1% a year earlier, and Humana's shares are up 57% this year.

Humana shares surged 15% after the insurer announced 95% of its Medicare Advantage members will be in plans rated four stars or higher for 2027, up from just 20% a year ago. The result significantly exceeded J.P. Morgan analysts' expectations of 60% to 70%. Plans with four-star ratings or higher qualify for government bonus payments worth billions across the industry. The industry average for 2027 stands at roughly 71%. However, these ratings will determine bonus payments for 2028, not 2027. The improved ratings are particularly significant given Humana's thin margins. The company's EBIT margin has declined from 4.3% in 2023 to 2.3% on a last-twelve-months basis. Meanwhile, competitors moved in the opposite direction. UnitedHealth's four-star share is estimated to fall to approximately 67% from 81%, whilst CVS Health's drops to around 70% from 84%. CVS shares declined roughly 3%.

The health insurance industry may have recovered from high medical costs, with analysts predicting strong growth through 2030. Morningstar forecasts 16% annual earnings per share growth for major insurers, above the industry's typical low-double-digit target. Health insurers are improving profitability by raising rates to cover increased medical utilisation. UnitedHealth Group reported over $5 billion in second-quarter net income, with its medical care ratio falling to 86.7% from 89.4% year-over-year. The outlook also improved for pharmacy benefit management operations at companies like UnitedHealth, CVS Health, and Cigna. Despite increased regulatory scrutiny, the "big three" PBMs maintain strong competitive positions. Third-quarter earnings reports next month should provide further clarity on the industry's financial health.