Elevance Health (ELV) Q4 2024 earnings summary

Executive summary

• Fourth quarter and full-year 2024 results aligned with guidance, with operating revenue of $45.0B for 4Q and $175.2B for the year, up 6% and 3% year-over-year, respectively.

• Adjusted diluted EPS for Q4 was $3.84 and for the full year was $33.04, both in line with expectations and nearly flat year-over-year.

• Membership ended at 45.7M, down 2% year-over-year due to Medicaid redeterminations, but flat sequentially.

• Medicaid cost trends remained elevated but stable; Medicare Advantage saw strong retention and is expected to grow 7%-9% in 2025.

• Commercial and ACA exchange businesses experienced strong growth and record retention.

Financial highlights

• Fourth quarter GAAP diluted EPS was $1.81; adjusted diluted EPS was $3.84.

• Full-year adjusted diluted EPS was $33.04; full-year GAAP diluted EPS was $25.68.

• Total operating revenue for 2024 was $175.2B, a 3% increase year-over-year.

• Operating cash flow for the year was $5.8B, about 1.0x GAAP net income.

• Benefit expense ratio for Q4 was 92.4%; full-year ratio was 88.5%, up 150 bps year-over-year.

Outlook and guidance

• 2025 adjusted diluted EPS guidance is $34.15–$34.85; GAAP diluted EPS outlook is $30.40–$31.10.

• Projected year-end 2025 medical membership is 45.75–46.6M, with Medicare Advantage membership expected at 2.2–2.25M.

• Operating revenue is anticipated to grow in the high single- to low double-digit percentage range, driven by premium yield increases and acquisitions.

• Consolidated medical loss ratio (MLR) expected around 89.1% ±50 bps; adjusted operating expense ratio at 10.4% ±50 bps.

• Operating cash flow for 2025 is expected to be about $8.0B.