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UnitedHealth ranks fourth on Fortune 500, earnings fall as breakup bill looms
UnitedHealth said its full-year 2025 earnings from operations dropped to $19.0 billion, down from $32.3 billion in 2024, even as its adjusted medical care ratio rose to 88.9%.
UnitedHealth Group is ranked fourth on the 2026 Fortune Global 500, with $447.6 billion in fiscal year 2025 revenue, Fortune said. The company’s revenue was up nearly 12% year over year, trailing only Amazon, Walmart, and Chinese state utility State Grid.
Despite the revenue milestone, Insurance Business reports that UnitedHealth’s 2025 earnings from operations fell to $19.0 billion from $32.3 billion in 2024. The insurer also reported a higher adjusted medical care ratio of 88.9% versus 85.5% the prior year, driven by Medicare funding reductions and elevated medical cost trends.
In its insurance segment, UnitedHealthcare posted a 2.7% operating margin for 2025, down from 5.2% in 2024. The business served 49.8 million members and generated $344.9 billion in revenue, while earnings from operations declined from $15.6 billion to $9.4 billion.
The article also links the results to shifting scrutiny of UnitedHealth’s vertical integration. A $2.8 billion charge in 2025 covered final direct costs tied to the Change Healthcare cyberattack, divestitures, and restructuring, and Congress is considering the Break Up Big Medicine Act introduced on February 10, 2026, which would bar firms from simultaneously owning a health insurer or PBM and a medical provider organization, according to Congress.gov.