How Does UnitedHealth Group Make Money?
CHONGQING, CHINA - APRIL 14: In this photo illustration, the UnitedHealthcare logo is displayed on a ... More smartphone screen, with the company's latest stock price performance and candlestick chart visible in the background, reflecting market volatility and investor sentiment on April 14, 2025, in Chongqing, China. (Photo by)
UnitedHealth Group stock (NYSE: UNH) has recently faced significant scrutiny, with its stock experiencing a decline of over 50% since April. While the reasons for this drop are explored in more detail here – What Sparked UNH Stock Crash? – this analysis focuses on how UnitedHealth Group generates its revenue by examining its key segments. We'll also assess the size of the Medicare segment, which is currently under criminal investigation.
UnitedHealth Group operates two primary businesses: UnitedHealthcare and Optum.
UnitedHealthcare encompasses four divisions:
Optum consists of three main segments:
UNH Value Breakdown
Revenue generation is roughly balanced between these two main businesses. In 2024, Optum accounted for 46% of total revenues, while UnitedHealthcare contributed 54%. However, Optum's contribution to overall sales has been growing, increasing from 41% in 2021 to 46% in 2024. Conversely, UnitedHealthcare's share decreased from 59% to 54% over the same period. Our dashboard on How Does UnitedHealth Group Make Money has more details. We will delve into the specific performance and contributions of each segment. For investors looking for potential gains with less volatility, the High Quality portfolio has comfortably outperformed the S&P 500, delivering over 91% returns since inception.
The UnitedHealthcare segment within UnitedHealth Group primarily focuses on providing a full range of health benefits and insurance products. This is also the business currently facing the pressure on its profit margins, amid rising medical costs.
This division serves individuals aged 65 and older with Medicare Advantage plans, Medicare Part D (prescription drug plans), Medicare Supplement plans, and group retiree services. This is the segment currently under criminal investigation for possible fraud. In 2024, Medicare & Retirement generated $139.5 billion in revenue and $8.4 billion in EBITDA, representing 25% of the company's total revenue and 23% of its EBITDA.
This segment offers health benefit plans and services to large national employers, small businesses, and individuals. It garnered $74.5 billion in gross revenue and $4.5 billion in EBITDA in 2024, accounting for 13% of the company's revenue and 12% of its total EBITDA.
This division serves state programs for economically disadvantaged and medically underserved populations, primarily managing Medicaid programs. In 2024, Community & State reported $80.6 billion in revenue and $4.9 billion in EBITDA, making up 15% of the company's total revenue and 13% of its EBITDA.
This segment provides international health insurance benefits and related services to multinational companies and globally mobile populations. In 2024, International revenues were $3.7 billion with EBITDA of approximately $222 million. This segment now accounts for less than 1% of the company's sales and profits, following UnitedHealth Group's exit from Brazil in the first quarter of 2024.
The Optum segment of UnitedHealth Group is focused on modernizing and improving the healthcare system through technology, data, and direct care delivery. Unlike UnitedHealthcare, which primarily deals with health insurance and benefits, Optum provides a range of health services and solutions to various stakeholders, including patients, providers, payers, employers, and life sciences companies.
Optum's business can be broken down by its three key sub-segments:
This segment delivers comprehensive, patient-centered care through its own medical groups, clinics, and physician practices. It emphasizes value-based care models, behavioral health services, in-home care, and population health management. Optum Health has been a key growth driver for UnitedHealth Group, with sales rising at an average rate of 25% since 2021 (compared to 14% for the overall company). Its contribution to overall sales increased from 14% to 19% over this period. Last year, it generated $105.4 billion in gross revenue and, notably, enjoys higher margins, accounting for 24% of the company's total EBITDA.
This segment focuses on data, analytics, and technology-enabled services for the healthcare industry. It provides solutions for revenue cycle management, data analytics, consulting, and software to enhance efficiency and decision-making for healthcare organizations. Last year, Optum Insight sales were $18.8 billion, accounting for just 3% of total revenues. However, it garnered $3.6 billion in EBITDA, contributing an estimated 9% of the company's total EBITDA.
This segment operates as a pharmacy benefit manager (PBM), aiming to provide access to affordable prescription medications. Optum Rx manages pharmacy benefits, negotiates with drug manufacturers, operates home delivery pharmacies, and offers programs to control specialty drug costs and promote medication adherence. Potential calls to eliminate or significantly curtail PBM services could have a profound impact on Optum Rx. In 2024, this segment generated $133.2 billion in gross revenue and $6.8 billion in EBITDA, accounting for 24% of the company's overall revenues and 18% of total EBITDA. This segment operates on high volume and thin margins.
Overall, UnitedHealth Group is at a pivotal moment, with intense scrutiny directly impacting its stock. Our analysis has highlighted the clear division of its core businesses: UnitedHealthcare, which provides a wide array of health benefits (including Medicare & Retirement), and Optum, the innovative engine behind healthcare services, technology, and pharmacy management.
While UnitedHealth Group's diverse structure has historically offered stability, the current climate demands significant strategic shifts. Optum's increasing contribution to overall sales underscores its crucial role in the company's future growth and innovation. However, this growth faces considerable challenges, particularly from the potential political dismantling or major changes to the PBM landscape impacting Optum Rx.
Separately, the outcome of the criminal investigation into Medicare fraud, which falls under UnitedHealthcare, also presents a significant challenge that could independently alter the company's trajectory.
In fact, regulatory risk is just a small part of risk assessment framework we apply while constructing the Trefis High Quality (HQ) Portfolio which, with a collection of 30 stocks, has a track record of comfortably outperforming the S&P 500 over the last 4-year period. Why is that? As a group, HQ Portfolio stocks provided better returns with less risk versus the benchmark index; less of a roller-coaster ride as evident in HQ Portfolio performance metrics.
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