Humana Inc. (HUM) had a rough Wednesday, with shares sliding to a fresh 52-week low after the health insurer delivered a 2026 earnings outlook that badly missed Wall Street's expectations. The disappointing guidance overshadowed what was otherwise a solid fourth-quarter performance, leaving investors focused squarely on the profitability challenges ahead.

The Outlook Problem

Here's where things get uncomfortable for Humana: The company expects fiscal 2026 adjusted earnings per share of at least $9, compared to Wall Street's estimate of $11.92. That's not a small miss—it's a massive gap that represents nearly 25% below analyst expectations.

What's driving this expected decline from 2025's $9.84 earnings? Star Ratings headwinds for Bonus Year 2026, even after mitigation efforts. For the insurance segment, Humana expects a benefit ratio of 92.75%, plus or minus 25 basis points, paired with an operating cost ratio of 10%.

It's not all bad news on the operational front, though. The company anticipates strong individual Medicare Advantage membership growth of approximately 25% over 2025 levels, driven by new sales and better retention thanks to what management calls a "customer-led benefit strategy" and improvements to customer service. Additionally, Humana expects Group Medicare Advantage growth of approximately 150,000 members and Individual Medicare stand-alone PDP growth of roughly 1 million.

On the revenue side, the company projects 2026 sales of at least $160 billion, which actually exceeds the consensus estimate of $145.31 billion. So revenue is growing—it's the profitability that's taking a hit.

Fourth-Quarter Results

The fourth-quarter numbers told a mixed story. Humana reported an adjusted loss of $3.96 per share, wider than last year's $2.16 loss but actually slightly better than the consensus estimate of a $4.00 loss.

Revenue came in strong at $32.64 billion, up from $29.19 billion a year ago and beating the consensus of $32.08 billion. The increase came from higher per-member Medicare and state-based contract premiums, with the Medicare bump driven primarily by a higher direct subsidy under the Inflation Reduction Act. Membership growth in state-based contracts and stand-alone PDP businesses also contributed.

Membership and Operational Metrics

The membership picture shows some notable shifts. Humana ended the quarter with 14.99 million in total medical membership, down from 16.34 million a year ago. Individual Medicare Advantage membership stood at 5.25 million, compared to 5.66 million in the prior year. Total Medicare members declined to 8.28 million from 8.49 million.

The insurance segment benefit ratio came in at 93.1%, essentially in line with the previously disclosed expectation of approximately 93.5%. The ratio reflects a shift in business mix toward state-based contracts and stand-alone PDP businesses, which carry higher benefit ratios, combined with the reduction in individual Medicare Advantage membership. The operating cost ratio for the quarter was 10.8%.

For the full fiscal year 2025, the insurance segment benefit ratio landed at 90.4%, right at the top end of the guidance range of 90.1% to 90.5%.

Management Commentary

"We were pleased with our solid financial performance and operational progress in 2025," said Humana President and CEO Jim Rechtin. "We continue to feel good about our consumer-focused strategy and our individual Medicare Advantage membership growth in 2026..."

That optimism, however, didn't prevent the stock from taking a beating. Shares were down 4.22% at $173.65 at the time of publication Wednesday, hitting a new 52-week low. The market's message was clear: membership growth is great, but investors care about earnings, and right now those earnings projections look pretty grim.

The disconnect between Humana's operational momentum and its profitability outlook highlights the challenge facing the company—growing the business while managing the Star Ratings headwind that's putting significant pressure on the bottom line.