Clover Health Q4 2025 Earnings Call Summary

1Key Financial Results and Metrics

Membership Growth: Clover Health's Medicare Advantage membership increased by 38% year-over-year, reaching approximately 140,000 members.

Revenue: Q4 insurance revenue was $486 million, a 47% increase year-over-year. Total revenue for 2025 was $1.9 billion, up 41% year-over-year.

Adjusted EBITDA: The company achieved $22 million in adjusted EBITDA for the full year, marking adjusted EBITDA profitability despite new member dilution.

Consolidated Gross Profit: For 2025, consolidated gross profit was $356 million, with a new metric introduced to better reflect operational performance.

Medical Cost Trends: Medical cost trends were well-controlled at 5% year-over-year, although there was cost pressure in outpatient settings.

Adjusted SG&A: Adjusted SG&A for Q4 was $98 million, slightly above expectations, but as a percentage of total revenue, it improved to 20%.

2Strategic Updates and Business Highlights

Clover Health reestablished market-leading membership growth while maintaining profitability and controlling medical costs.

The company emphasized its focus on clinical value and disciplined cost management, contrasting with competitors who may rely on coding intensity.

The Clover Assistant technology continues to drive engagement, with over 95% retention during the annual enrollment period (AEP) and approximately two-thirds of members receiving care through Clover Assistant.

The company is also expanding its Counterpart Health platform, aiming to manage as many members under Counterpart Assistant as under Clover Assistant.

3Forward Guidance and Outlook

For 2026, Clover Health expects Medicare Advantage membership to average between 154,000 and 158,000, reflecting a 46% year-over-year growth at the midpoint.

Total revenue is projected to be between $2.810 billion and $2.920 billion, indicating continued top-line growth of 49%.

The company anticipates achieving its first full year of GAAP net income profitability in 2026, with net income expected between breakeven and $20 million.

Consolidated gross profit for 2026 is expected to be between $470 million and $510 million, with continued improvements in operating leverage.

4Bad News, Challenges, or Points of Concern

Gross Profit Margin Decline: There was a noted decline in gross profit margin of 150 basis points year-over-year, attributed to the dilution from new members and the challenges of managing a large cohort growth.

Regulatory Risks: Concerns were raised regarding the new risk adjustment model proposed by CMS, particularly the lack of data for new members switching plans, which could impact profitability.

Cost Pressures: Continued cost pressures in outpatient settings and seasonal Part D pressures were acknowledged, reflecting broader industry trends.

5Notable Q&A Insights

Cohort Performance: Management expressed confidence that new member profitability is aligning with expectations, despite initial dilution.

Counterpart Health Contribution: While no immediate financial impact from Counterpart Health was disclosed, management highlighted ongoing efforts to scale the platform.

Clover Assistant Engagement: There is an expectation for continued engagement with Clover Assistant, although some pressure on penetration rates is anticipated due to growth in new markets like Georgia.

Regulatory Feedback: Management provided feedback to CMS regarding the need for better data sharing to support risk adjustment for new members, indicating proactive engagement with regulatory changes. Overall, Clover Health demonstrated strong financial performance in 2025 while laying a solid foundation for continued growth and profitability in 2026, despite facing some industry challenges and regulatory uncertainties.