Cigna Executives See Little ’26 Movement in Enrollment, Cost Ratio

The leaders of Cigna Inc. say price hikes they’ve pushed through in various parts of the company’s insurance operations, which last year pulled in more than $47 billion in revenue, won’t lower the company’s medical care ratio this year. But they are forecasting that the Cigna Healthcare group will grow pre-tax operating profits by at least 8 percent this year.

Chairman and CEO David Cordani and his team told analysts and investors Feb. 5 that they aren’t counting on Cigna Healthcare’s member base to grow from the roughly 18.1 million people enrolled at the end of 2025. Inside that group, however, the company expects to add members in its middle, select and international markets while losing some national accounts and again shrinking its individual exchange business. (On the latter, President and COO Brian Evanko said the Cigna team expects to finish 2026 with fewer than 300,000 customers on exchanges. That’s down from about 400,000 a year ago and nearly 1 million in 2023.)

Cigna Healthcare last year posted a full-year medical care ratio, which measures medical costs’ share of premium revenues, of 84.4 percent. That was an increase of 120 basis points from 2024 that executives said was primarily due to higher medical costs in Cigna’s individual and family plans lines of business. For 2026, leaders are forecasting a medical care ratio between 83.7 percent to 84.7 percent. That number and the premium increases should, they said, let Cigna Healthcare’s pre-tax adjusted operating income grow to “at least” $4.5 billion from 2025’s $4.15 billion.

On a conference call, CFO Ann Dennison said the essentially unchanged range for medical costs versus 2025 reflects pricing improvements in some lines being negated by some member mix factors as well as the absence of some one-time benefits that Cigna booked last year.

But Dennison also noted the bigger picture for Cigna Healthcare—which accounts for about 40 percent of Cigna Inc.’s profits and has no exposure to Medicare after selling its Medicare business to Health Care Service Corp. for $3 billion last March—and other heath insurers. Utilization and cost trends, which have been rising for several years, are still leaning heavily against them.

“Overall, our assumptions incorporate appropriate prudence given the continued elevated cost environment,” Dennison said.

Adding to the general theme of stability around Cigna Healthcare, Evanko also noted that the insurer’s teams haven’t raised any red flags around macroeconomic conditions or layoffs filtering into member enrollments or losses.

“We are not seeing anything out of the ordinary,” Evanko said. “Obviously, we continue to monitor economic data and unemployment data. But to date, we have not seen anything out of the ordinary and our 2026 outlook reflects our current view of what the economy will do.”

Shares of Cigna (Ticker: CI) finished trading last week at $292.05, up more than 6 percent from the previous Friday. Over the past six months, they are up about 8 percent and the company’s market capitalization is now about $78 billion.