ELV: Margin Recovery Will Drive Upside Despite ACA Headwinds And Premium Increases

Key Takeaways

• Technology investments in analytics, digitization, and AI are boosting efficiency, reducing costs, and improving margin stability across operations.
  
• Expansion into value-based care, behavioral health, and government programs supports revenue growth, earnings diversity, and long-term margin improvement.
  
• Persistent cost pressures, regulatory uncertainty, and integration challenges from acquisitions threaten margin stability, revenue growth, and long-term earnings despite efforts to manage expenses and expansion.

Catalysts

Operates as a health benefits company in the United States.

• The company is aggressively leveraging advanced analytics, digitization, and AI-enabled tools to streamline clinical workflows, automate processes, reduce fraud, and improve cost management. These initiatives are expected to lower administrative costs, increase operational efficiency, and gradually stabilize or expand net margins.
  
• Elevance's ongoing expansion of value-based care arrangements, particularly within behavioral health and oncology, and the scaling of risk-based contracts through its Carelon division, position the company to benefit from increased cost predictability, better care coordination, and reduced volatility in medical cost ratios, supporting future margin expansion.
  
• Strategic investments in digital consumer engagement and Carelon's diversified health services (e.g., pharmacy, care management, behavioral health) are accelerating revenue growth and providing higher-margin, recurring income streams, which should drive both topline and earnings diversity as industry healthcare spending and complexity continue to rise.
  
• Demographic shifts, notably the aging U.S. population and increasing chronic disease prevalence, underpin long-term growth opportunities in Medicare Advantage and Medicaid. Elevance's disciplined approach to pricing and rate negotiations, combined with proactive engagement with state partners, is expected to drive sustainable revenue growth and margin recovery in these government-backed segments.
  
• The anticipated market-wide recalibration in ACA and Medicaid following policy changes (e.g., enhanced subsidy expirations, Medicaid redeterminations) is being proactively addressed by Early repricing and data-driven risk adjustment actions. These are likely to restore pricing power and foster margin normalization as utilization stabilizes and state rate updates catch up, supporting future earnings growth.

Elevance Health Future Earnings and Revenue Growth

Assumptions

• Analysts are assuming Elevance Health's revenue will grow by 6.8% annually over the next 3 years.
• Analysts assume that profit margins will increase from 2.8% today to 3.2% in 3 years time.
• Analysts expect earnings to reach $7.4 billion (and earnings per share of $33.98) by about September 2028, up from $5.4 billion today. However, there is some disagreement amongst the analysts with the more bearish ones expecting earnings as low as $4.9 billion.
• In order for the above numbers to justify the analysts price target, the company would need to trade at a PE ratio of 12.5x on those 2028 earnings, down from 13.2x today. This future PE is lower than the current PE for the US Healthcare industry at 21.0x.
• Analysts expect the number of shares outstanding to decline by 2.91% per year for the next 3 years.
• To value all of this in today's terms, we will use a discount rate of 6.78%, as per the Simply Wall St company report.

Elevance Health Future Earnings Per Share Growth

Risks

• Persistent elevated medical cost trends in both ACA and Medicaid, including higher morbidity and utilization (especially ER visits and behavioral health), are driving up the benefit expense ratio and pressuring both short
• and medium-term margins; if these trends persist without sufficient rate increases or effective cost controls, long-term earnings and net margins could remain structurally lower.
  
• Delays and lags in Medicaid rate recovery, with states slow to adjust rates even as member acuity and utilization rise post-redetermination, could result in a prolonged period of under-compensated risk, dragging on operating margins and limiting revenue growth despite constructive negotiations.
  
• The possible expiration of enhanced ACA subsidies and the implementation of Medicaid work requirements, as well as ongoing and potential future regulatory and policy changes, introduce significant uncertainty to risk pools and membership; this could cause further deterioration in revenue stability and risk higher costs without commensurate premium increases.
  
• Elevated levels of aggressive and potentially inappropriate provider coding-sometimes amplified by new AI-assisted tools and manipulation of IDR processes-are increasing claims costs and inflating allowed amounts, presenting an ongoing risk to cost containment efforts and negatively impacting medical loss ratios and profitability.
  
• Integration risk and margin pressure from recent and ongoing acquisitions in Carelon (including CareBridge and specialty pharmacy), where rapid top-line growth is coupled with margin dilution and execution risk, could dampen expected improvements in earnings diversity and structural operating leverage.

Valuation

• The analysts have a consensus price target of $370.444 for Elevance Health based on their expectations of its future earnings growth, profit margins and other risk factors. However, there is a degree of disagreement amongst analysts, with the most bullish reporting a price target of $507.0, and the most bearish reporting a price target of just $297.0.
• In order for you to agree with the analyst's consensus, you'd need to believe that by 2028, revenues will be $230.4 billion, earnings will come to $7.4 billion, and it would be trading on a PE ratio of 12.5x, assuming you use a discount rate of 6.8%.
• Given the current share price of $315.09, the analyst price target of $370.44 is 14.9% higher.
• We always encourage you to reach your own conclusions though. So sense check these analyst numbers against your own assumptions and expectations based on your understanding of the business and what you believe is probable.