UnitedHealth Group earned $17.3B in 2021, according to earnings report

Photo: Courtesy of UnitedHealth Group

After posting a $4.1 billion in profit in the fourth quarter of 2021, UnitedHealth Group ended the year with $17.3 billion in total profit, according to the payer’s latest earnings report.

The company’s full-year revenue grew more than $30 billion, or 11.8%, to $287.6 billion year over year (YOY), with growth seen especially in the Optum and UnitedHealthcare businesses. Full-year earnings from operations were $24 billion, with Optum accounting for more than half of that total.

The full-year medical care ratio was 82.6% compared to 79.1% in the year prior, with the increase attributable to higher COVID-19 costs and the repeal of the health insurance tax, said UHG. The medical care ratio was 83.7%. 

Meanwhile, the full-year operating cost ratio of 14.8% decreased from 16.2% in 2020 due to the repeal of the health insurance tax, COVID-19 effects and continued advances in productivity, though this was offset by business mix and future investments.

Cash flows from operations for the full year were $22.3 billion, or 1.3 times net income.


Full-year revenues for UHG’s two biggest subsidiaries, UnitedHealthcare and Optum, also showed growth throughout 2021, with the former seeing revenues climb 11% YOY, to $222.9 billion.

In all, UnitedHealthcare served 2.2 million more people in 2021, which the company attributed to strong growth in Medicare Advantage and dual special needs plans, as well as expansion in the broader Medicaid market. Including DSNPs, Medicare Advantage membership grew by more than 900,000 additional people throughout the year, with especially strong gains seen in both individual and group offerings. 

New regions served in Indiana, Kentucky and North Carolina contributed to that Medicaid growth, and new Medicaid contracts were awarded in Minnesota, Nevada, Ohio and Tennessee, with expansion in Missouri. Commercial benefits served 360,000 more consumers across its portfolio during the year.

Full-year operating earnings for UnitedHealthcare were down slightly, to $12 billion, from $12.4 billion in 2020.

At the same time, Optum’s full-year revenue hit $155.6 billion, up $19.3 billion (14.1%) from the prior year, while full-year operating earnings increased $1.9 billion, to $12 billion for the year.

OptumHealth served 100 million people at year’s end, compared to 98 million a year ago. Revenue per consumer served for the full year increased 33%, driven by further expansion of people served in value-based care arrangements and the continued build-out of care delivery capabilities, including in-home physical and digital offerings.

Optum Insight’s revenue backlog increased by $2.2 billion in 2021 to $22.4 billion, driven by growth in comprehensive managed services.

OptumRx continued to expand into community-based behavioral pharmacies and across e-commerce, infusion and specialty pharmacy services. OptumRx fulfilled 1.37 billion adjusted prescriptions in 2021, a growth of 58 million (4.4%) over the prior year.


On January 5, 2021, OptumInsight and Change Healthcare announced their proposal to combine, though in December UnitedHealth Group delayed the deadline for its pending acquisition, likely owing to an ongoing investigation into the merger by the Department of Justice.

A filing with the Securities and Exchange Commission indicates the deal may now be finalized in April 2022. Prior to the filing there had not been a specific date set, though officials from both companies had expected the deal to go through sometime during the first part of next year.

This isn’t the first time the merger agreement has been delayed. In November 2021, the two companies agreed not to consummate their merger before February 22, 2022, unless they receive written notice from the Department of Justice prior to the date that the DOJ has closed its investigation. The merger is also subject to the potential unavailability of certain data requested by the DOJ.

The right to push back the final date was established in the original merger agreement.

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