What Elevance Health, Inc. told the SEC could break it.

Elevance's results depend on CMS Star Ratings, which influence Medicare Advantage reimbursement and quality-bonus eligibility; ~59% of its MA members are in plans rated 4.0 Stars or higher per 2026 Stars, and a MA payment formula prevents reimbursement rates from rising as much as otherwise expected.

“Our 2026 Stars Ratings reflect that approximately 59% of our Medicare Advantage members are enrolled in plans rated at least 4.0 Stars or higher, or the equivalent. The implementation of a Medicare Advantage payment formula, which prevents reimbursement rates from increasing as much as otherwise would be expected.”

Elevance faces rising healthcare costs (new/higher-cost pharmaceuticals, tariffs, discount changes) against pressure to contain premium rates — customers may renegotiate or switch on price (Public Exchange selection is highly price-sensitive), and federal/state regulators may restrict premium increases, while Public Exchange depends on federal subsidies and market stability.

“Our customers may renegotiate their contracts to seek to contain their costs or may move to a competitor to obtain more favorable premiums. Public Exchange plan selection by our customers is also highly price sensitive. Further, federal and state regulatory agencies may restrict or prevent entirely our ability to implement changes in premium rates.”

Elevance outsources pharmacy-benefit-manager services — including rebate administration and advanced home-delivery back-end dispensing — to CVS under the CVS Agreement; if CVS fails to provide PBM services as contractually required, Elevance may be unable to meet its customers' full demands, harming its business and reputation.

“If CVS fails to provide pharmacy benefit manager services as contractually required, we may not be able to meet the full demands of our customers, which could have an adverse effect on our business, reputation and results of operations.”

Elevance is party to the centralized BCBSA antitrust multi-district litigation; separately, state insurance holding-company acts restrict change of control of its insurance/HMO subsidiaries without prior regulatory approval, and those subsidiaries face regulatory limits on dividends/distributions (~$2,100M estimated to be paid up to the parent in 2026).

“ave been centralized in the BCBSA Litigation multi-district proceeding. For additional information regarding the BCBSA Litigation, see Note 14, “Commitments and Contingencies – Litigation and Regulatory Proceedings – Blue Cross Blue Shield Antitrust Litigation”