Models
Visible Alpha broker models via S&P Xpressfeed · 10 brokers · 303 line items · freshest revision 2026-07-14.
FY-2026 is the margin inflection: MLR 86.6% to 82.9%, underwriting margin 13.3% to 17.0%
Consensus keeps grinding the loss ratio and cost ratio lower through FY-2028, but at a fraction of the FY-2026 step - the re-rating in these models is a one-year repricing event, not a trend. The combined ratio row rests on three brokers; the loss ratio has ten.
| Line | FY-2025A | FY-2026E | FY-2027E | FY-2028E | YoY | Brokers |
|---|---|---|---|---|---|---|
| Loss ratio | — | — | — | — | — | — |
| Medical loss ratio(%) | 86.6% | 82.9% | 82.3% | 81.7% | -3.7pt | 10 |
| Underwriting | — | — | — | — | — | — |
| Underwriting profit | $1.57bn | $3.09bn | $3.41bn | $3.85bn | +96.4% | 7 |
| Underwriting margin(%) | 13.3% | 17.0% | 17.6% | 18.0% | +3.7pt | 7 |
| InsuranceCo combined ratio(%) | 104.6% | 99.0% | 98.1% | 97.2% | -5.7pt | 3 |
| Costs | — | — | — | — | — | — |
| SG&A / Sales(%) | 17.5% | 16.2% | 16.0% | 15.7% | -1.2pt | 8 |
| Profit | — | — | — | — | — | — |
| Adjusted EBITDA | $-182.48m | $463.07m | $660.38m | $903.43m | +353.8% | 10 |
| Income / (loss) from operations | $-304.23m | $349.76m | $530.51m | $772.69m | +215.0% | 10 |
Enrollment stops growing after FY-2026 - PMPM of $673 rising to $789 by FY-2028 carries the top line
Individual & small group is effectively the whole company here: the total and segment lines barely differ. Mean and median membership diverge from FY-2027 onward, so at least one broker models a materially smaller book after the ACA subsidy reset.
| Line | FY-2025A | FY-2026E | FY-2027E | FY-2028E | YoY | Brokers |
|---|---|---|---|---|---|---|
| Members | — | — | — | — | — | — |
| Total membership(K#) | 2.08m Number | 2.75m Number | 2.80m Number | 3.02m Number | +32.4% | 10 |
| Total membership - Individual & small group(K#) | 2.08m Number | 2.74m Number | 2.79m Number | 2.93m Number | +31.7% | 10 |
| Price | — | — | — | — | — | — |
| Per member per month (PMPM)($) | $565.9 | $673.1 | $736.6 | $789.2 | +18.9% | 9 |
| Per Member Per Month (PMPM) - Individual & small group($) | $555.1 | $597.4 | $653.0 | $682.8 | +7.6% | 7 |
| Premium | — | — | — | — | — | — |
| Direct and assumed premiums | $14.11bn | $22.70bn | $24.86bn | $27.88bn | +60.9% | 9 |
| Premiums earned | $11.79bn | $18.29bn | $19.66bn | $21.86bn | +55.1% | 10 |
Modeled profit is front-loaded: 1QFY-2027 MLR of 70.3% against 92.8% in 4QFY-2026
Membership peaks in 1QFY-2026 and attrites through the year, so the worst loss ratio lands on the smallest base. Brokers then model an even lower first-quarter loss ratio in FY-2027, which is the single largest swing factor inside the FY-2027 annual numbers.
| Line | 3QFY-2025A | 4QFY-2025A | 1QFY-2026A | 2QFY-2026A | 3QFY-2026E | 4QFY-2026E | 1QFY-2027E | 2QFY-2027E | Brokers |
|---|---|---|---|---|---|---|---|---|---|
| Medical loss ratio(%) | 89.0% | 91.8% | 76.3% | 82.1% | 86.5% | 92.8% | 70.3% | 80.4% | 10 |
| Adjusted EBITDA | $-119.49m | $-209.80m | $468.12m | $171.12m | $-49.92m | $-385.20m | $790.24m | $278.12m | 10 |
| Underwriting profit | $325.92m | $250.32m | $1.12bn | $824.18m | $605.97m | $310.24m | $1.44bn | $978.00m | 7 |
| Premiums earned | $3.03bn | $3.07bn | $4.87bn | $4.67bn | $4.58bn | $4.46bn | $4.90bn | $4.98bn | 10 |
| Total membership(K#) | 2.03m Number | 2.08m Number | 3.12m Number | 2.93m Number | 2.82m Number | 2.72m Number | 2.95m Number | 2.88m Number | 10 |
The FY-2027 dispute is the size of the book and how much margin it carries
The loss-ratio spread alone is worth more than the entire modeled EBITDA at the low end, which is why the profit range is so wide. Free cash flow disagreement is wider still and spans zero, because cash conversion depends on whether the book keeps growing.
| Line | Period | Median | Q1–Q3 | Min–max | Brokers |
|---|---|---|---|---|---|
| Adjusted EBITDA | FY-2027E | $668.66m | $619.72m–$740.72m | $151.09m–$1.11bn | 10 |
| Medical loss ratio(%) | FY-2027E | 82.5% | 81.7%–82.7% | 80.0%–84.7% | 10 |
| Total membership(K#) | FY-2027E | 2.93m Number | 2.65m Number–2.99m Number | 2.29m Number–3.09m Number | 10 |
| Per member per month (PMPM)($) | FY-2027E | $733.7 | $708.3–$742.8 | $680.8–$825.6 | 9 |
| Free cash flow (FCF) | FY-2027E | $1.07bn | $422.88m–$1.14bn | $-249.69m–$2.05bn | 9 |
Everything outside Individual & Small Group is one or two brokers, last revised in 2024
The Medicare Advantage membership and PMPM lines carry one to two brokers with revision dates in 2024, and the Cigna + Oscar lines are a single broker. Read them as one analyst's stub, not as a view of the street. Segment insight in this feed is effectively limited to the Individual & Small Group book.
Headline P&L consensus, momentum and beat/miss live in the CapIQ tab.