Elevance Health (ELV) Q1 2026 earnings summary

Executive summary

• First quarter 2026 operating revenue reached $49.5 billion, up 1.5% year-over-year, exceeding expectations due to strong business fundamentals, ACA seasonality, and improved claims experience.

• Adjusted diluted EPS for Q1 2026 was $12.58, including ~$1 per share of non-recurring investment income, driven by business strength and favorable claims.

• Full-year 2026 adjusted diluted EPS guidance raised to at least $26.75, reflecting confidence in business trajectory and cost management.

• Returned $1.5 billion to shareholders in Q1 2026 through share repurchases and dividends.

• Leadership realignment and operational streamlining implemented to sharpen execution and accountability.

Financial highlights

• Operating revenue increased by $0.7 billion year-over-year to $49.5 billion, driven by higher premium yields and CarelonRx product growth, partially offset by declines in government and employer risk membership.

• Net income for Q1 2026 was $1.76 billion, down 19.2% year-over-year, primarily due to decreased operating gain and increased interest expense.

• Benefit expense ratio was 86.8%, up 40 basis points year-over-year, reflecting elevated Medicaid medical cost trends.

• Operating cash flow was $4.3 billion, up significantly year-over-year, reflecting strong business and favorable working capital.

• Share repurchases totaled $1.1 billion in Q1 2026; $5.6 billion of Board-approved authorization remained at quarter-end.

Outlook and guidance

• 2026 adjusted diluted EPS guidance raised to at least $26.75; 2027 expected to return to at least 12% adjusted EPS growth off a $25.75 baseline.

• Full-year Medicaid operating margin outlook at -1.75%; Medicare on track for at least 2% margin in 2026.

• Reaffirmed FY 2026 operating cash flow guidance of at least $5.5 billion.

• FY 2026 diluted EPS guidance set at least $19.85, including estimated CMS matter impact.

• Second quarter EPS expected to be ~23% of full-year guidance.