Elevance Health, Inc. (ELV) Risk Factors

Recent key developments

Concrete developments — dated events, named agreements and instruments, legal proceedings — that Elevance Health, Inc. surfaced in its latest filing.

• Potential changes from expiration of enhanced PTCs at end of 2025 could affect results.2025
• CMS released 2026 Star Ratings in October 2025, to be used for quality bonus payments in 2027.October 2025
• Approximately 59% of Medicare Advantage members are in plans rated at least 4.0 stars under 2026 Star Ratings, compared to approximately 40% under 2025 Star Ratings.2026
• Final RADV Audit rule issued in 2023 may change audit conduct and result in data corrections or payment adjustments.2023
• CMS made significant changes to the hierarchical condition category model in version 28, impacting RAF scores for a larger percentage of Medicare Advantage beneficiaries.
• CMS will require in future years that health plans offering certain dual-eligible products must also align with integrated Medicaid products in the same service area.
• Congress passed the Consolidated Appropriations Act of 2026, requiring pharmacy benefit managers to remit all rebates, fees, and other remuneration to commercial plan sponsors and provide detailed commercial claims reporting, effective thirty months after enactment.2026
• The Consolidated Appropriations Act of 2026 delinks pharmacy benefit manager compensation in Medicare Part D by prohibiting remuneration related to Part D drugs in any form other than bona fide service fees not based on drug price, effective in 2028.2026
• A re-establishment fee of $98.33 per licensed enrollee would be imposed upon termination, totaling approximately $3 billion based on 34 million enrollees as of December 31, 2025.December 31, 2025
• As of December 31, 2025, we had approximately $39.5 billion of goodwill and other intangible assets, representing 32.5% of total consolidated assets.December 31, 2025