ELV, Elevance Health, Inc.
Elevance Health and its direct and indirect subsidiaries, referred to throughout this document as "we," "us," "our," the "Company" or "Elevance Health," is a leading health company bringing together the concepts of elevate and advance.
Read top to bottom, the owner's questions in the order an owner asks them: what the business is, whether the record holds, whether it survives and is any good, and what you would be paying. New to the questions? Start with the Method.
The business in brief
read the 10-K →What this business is and what moves its needle, read from the numbers in its filings. The quantitative detail is in the sections below; the verdict is left to you.
- What it is
- An insurance business, read on its underwriting result, the combined ratio, and the float it invests, rather than an earnings multiple.
- What moves the needle
- Underwriting discipline and the float. What decides it: whether the combined ratio stays below 100% so the policies make money on their own, how large the float is against equity, and what that float earns once it is invested.
- Is it a good business?
- It runs an underwriting loss, about a 117% combined ratio, and must earn the difference back on the float. Book value per share, the measure Berkshire is judged on, has compounded about 9% a year across the record. The float runs about 0.4× equity, the leverage that magnifies both the underwriting and the investing. Whether the discipline holds through a soft market, and how the float is invested, are what the 10-K decides.
Every line here is arithmetic from the company's own filings, not a model's opinion, and each figure appears in full in the sections below.
The record, 2016–2025
realized figures from each filing, no estimates| 2016’16 | 2017’17 | 2018’18 | 2019’19 | 2020’20 | 2021’21 | 2022’22 | 2023’23 | 2024’24 | 2025’25 | TTMTTMMar 2026 | |
|---|---|---|---|---|---|---|---|---|---|---|---|
| RevenueRevenue | $84.9B | $90.0B | $92.1B | $104.2B | $121.9B | $138.6B | $156.6B | $171.3B | $177.0B | $199.1B | $200.4B |
| Premiums earnedPremiums | $78.9B | $83.6B | $85.4B | $94.2B | $104.1B | $117.4B | $133.2B | $142.9B | $144.2B | $164.6B | $164.8B |
| Net incomeNet inc. | $2.5B | $3.8B | $3.8B | $4.8B | $4.6B | $6.2B | $5.9B | $6.0B | $6.0B | $5.7B | $5.2B |
| Combined ratioCombined | ≈ 102% | ≈ 103% | ≈ 102% | ≈ 104% | ≈ 111% | ≈ 111% | ≈ 112% | ≈ 115% | ≈ 117% | ≈ 117% | ≈ 118% |
| Loss ratioLoss | 85% | 86% | 84% | 87% | 85% | 87% | 88% | 87% | 88% | 90% | 90% |
| Return on equityROE | 10% | 15% | 13% | 15% | 14% | 17% | 16% | 15% | 14% | 13% | 12% |
| Investment incomeInv. inc. | $779M | $867M | $970M | $1.0B | $877M | $1.4B | $1.5B | $1.8B | $2.1B | $2.2B | $2.4B |
| Float (reserves)Float | $7.9B | $8.0B | $7.5B | $8.8B | $11.4B | $13.5B | $15.6B | $16.1B | $15.7B | $17.1B | $18.4B |
| Book value / shareBVPS | $93.63 | $98.97 | $108.03 | $121.89 | $130.55 | $146.11 | $149.27 | $165.57 | $177.39 | $195.38 | $199.19 |
| Dividends / shareDiv/sh | $2.55 | $2.63 | $2.94 | $3.14 | $3.75 | $4.47 | $5.06 | $5.88 | $6.47 | $6.81 | — |
Owner’s Scorecard
Is it a good business?
- Combined ratio ≈ 117%Underwriting lossTotal benefits, losses and expenses $192.4B ÷ premiums earned $164.6B
The heart of an insurer: claims and costs as a share of premiums. Below 100% means it is paid to hold the float, the gold standard; above 100% means it loses money on the policies and must make it back on investments. Approximate here, taken from the filer's total benefits, losses and expenses over premiums, so it can sit a point or two off the company's headline figure; a number held below 100% across cycles is the mark of a disciplined underwriter, the rarest thing in the business.
- Return on equity 13%SolidNet income $5.7B ÷ equity $43.9B
What it earns on shareholders' capital, the underwriting result plus what the float earns invested. Durably above the ~10% cost of equity is what compounds book value.
The float
- Float (reserves) $17.1B0.4× equityLoss and claim reserves $17.1B, 0.4× equity
Money collected as premiums and held against future claims, invested in the meantime. Buffett's insight was that good underwriting makes this float cost less than nothing, a pool of other people's money the owners earn on. The larger it is against equity, the more that leverage works, for better or worse.
- Investment income $2.2B12.8% on the floatNet investment income $2.2B, 12.8% on the float
What the float and capital earned this year. This is the second engine: an insurer that breaks even on underwriting still wins if the float is large and invested well.
Solvent is not the same as cheap; growing is not the same as good. These are vital signs, not a verdict, the judgment is yours, and the filing is one click away.
Management & pay
Two questions Buffett actually asks about pay: is stock compensation, a real expense, whatever the income statement pretends, quietly large, and is the top wildly out of line with the floor. He's no populist about it; he just wants pay that's rational and earned, and comp committees that aren't lapdogs.
- Stock-based compensation$276M
The slice of the business handed to employees in shares this year, 0% of revenue, equal to 4% of operating profit. Buffett's oldest accounting fight: this is compensation, compensation is an expense, real whether or not the headline earnings admit it. And note the trap, the cash-flow statement adds SBC back, so the operating cash, and the owner earnings drawn from it, are flattered by exactly this amount; counted as the cost it is, what an owner keeps is lower.
What the price implies
price / tangible bookAn insurer is worth a multiple of its tangible book value, and the multiple it deserves is set by the return it earns on that book. Type today’s price; we show what you would be paying against what Elevance Health, Inc.’s record justifies. Nothing is stored; the number stays in your browser.
Enter a price above to run it.
The justified multiple is (return on tangible equity − growth) ÷ (cost of equity − growth). An insurer earning exactly its cost of equity is worth about one times tangible book; every point of durable excess return above that is worth paying up for. Raise the cost of equity and the justified multiple falls: that is interest-rate gravity on an insurer.
Tangible book $4.5B on 220M shares, a 217% normalized return on it. This is a lens, not a target. It assumes the insurer keeps earning that return; an underwriting cycle, a reserve shortfall or a bad year on the float changes it, which is what the record and the 10-K are for.
What the filing emphasizes, FY2025
read the 10-K →Each year a 10-K must name what could go wrong, in the company's own words. Here are the ones Graham and Buffett would stop on, each set against the figure from the same filings that bears on it, anchored to a period you can find in the record above. We point; the judgment is yours.
- Customer concentrationMD&A
Who the revenue leans on. When one buyer is a large slice of sales, that buyer holds the pricing power, and its troubles become the company's.
“Local Group consists of those employer customers with less than 5% of eligible employees located outside of the headquarter state, as well as customers with more than 5% of eligible employees located outside of the headquarter state with up to 5,000 eligible employees.”
From the recordRevenue exposed (TTM)$200.4B - Pricing power & competitionBusiness
Whether the company sets its price or takes it. Durable pricing power is the surest mark of a moat; price competition is the surest mark there isn't one.
“We utilize group-specific script data, formulary, network and clinical care program selection combined with administrative expense, risk and profit guidance to set market competitive pricing discounts and rebate projections.”
From the recordOperating margin3.1% now (TTM), off a 5.9% peak (FY2018) - Concentrated dependenceRisk Factors
What the whole business leans on, a product, a platform, a partner. Concentration cuts both ways, and the filing is where management has to admit it.
“Our business depends significantly on effective information systems, and we have many different information systems for our various businesses, including those that we have acquired as a result of our merger and acquisition activities.”
From the recordOwner-earnings margin at stake (TTM)3% - Debt terms & refinancingMD&A
The fine print behind the debt. Covenants and near-term maturities decide who is really in control when a year goes badly.
“As of December 31, 2025, we were in compliance with all of our debt covenants under the 5-Year Facility.”
From the recordBalance sheet (TTM)$22.4B meaningful net debt · interest covered 5.1× - Litigation & contingenciesMD&A
Claims an owner inherits. Most disclosure is boilerplate; this fires only on an actual matter, a named suit, a settlement, a contingency, a number.
“These cases have been consolidated into a single, multi-district proceeding captioned In re Blue Cross Blue Shield Antitrust Litigation ("BCBSA Litigation") that is pending before the U.S.”
A judgment, not a number, weigh it against the filing yourself. - Cyclicality & demandRisk Factors
How the business behaves when the economy turns. A cyclical earns its keep across the whole cycle, not at the peak.
“Due to this concentration of business in these states, we are exposed to potential losses resulting from the risk of state-specific or regional economic downturns or healthcare coverage changes impacting these states.”
From the recordWorst year on record3.6% operating margin (FY2025) - Regulation & policyBusiness
Rules that can rewrite the economics, tariffs, antitrust, data, export controls.
“The Inflation Reduction Act of 2022 The Inflation Reduction Act of 2022 ("IRA") includes several provisions that have impacted, and continue to impact, our business.”
A judgment, not a number, weigh it against the filing yourself.
What changed, FY2025 vs FY2024
read the 10-K →Most of a 10-K is boilerplate carried over verbatim; the signal is in what's new. These lines appear this year and weren't there last, figure updates filtered out, so only the language shift remains.
- “Premium rate decreases are recognized in the period the change in premium rate becomes effective and the change in the rate is known, which may be prior to the period in which the contract amendment affecting the rate is finalized. -46- Affordable Care Act : We continue to participate in the Individ…”
- “The decrease in operating gain was primarily a result of higher medical cost trends and increased investments to support and strengthen our workforce and accelerate technology adoption, partially offset by higher revenue . -55- CarelonRx Operating revenue increased primarily as a result of higher pr…”
- “Membership shifts from Medicaid into our Individual ACA (as defined below) business following the redetermination process that began in April 2023, together with lower membership effectuation rates, particularly in geographies with high concentrations of highly subsidized members, have driven a mark…”
- “Our operating expense ratio decreased primarily due to operating leverage associated with growth in operating revenue and non-recurrence of the BCBSA provider settlement recorded in 2024, partially offset by increases in premium tax expenses and assessments and increases in targeted investments to s…”
- “Furthermore, legislative or regulatory actions intended to address rising health-care costs or affordability concerns may result in the imposition of additional requirements on health insurers, including mandated benefits, restrictions on premium increases, or other pricing limitations, which could …”
Classic text analysis over the filing itself, no model wrote a word of this, and every quote is the company's own.
Peers, Health insurance
The same industry, side by side on the underwriting lens, compare, don't rank by a single number.● marks best in the group.
| Company | Revenue | Combined ratio | Loss ratio | ROE |
|---|---|---|---|---|
| UNHUnitedhealth Group Incorporated | $447.6B | — | 89% | 12% |
| CIThe Cigna Group | $274.9B | — | 85% | 14% |
| ELVElevance Health, Inc. | $199.1B | 117% | 90% | 13% |
| CNCCentene Corporation | $174.6B | — | 364% | -33% |
| HUMHumana Inc | $129.7B | 103% | 90% | 7% |
| AFLAflac Inc | $17.2B | 93% | 54% | 12% |