Alignment Healthcare Takes ‘Step Forward’ Despite Medicare Advantage Headwinds

Alignment Healthcare reported an $11 million fourth quarter loss, but its top executive says the provider of Medicare Advantage is “taking a positive step forward in profitability” as it grows in a market where larger rivals are struggling.

Alignment said its health plan membership at the end of the fourth quarter was up 25% to 236,300 compared to the year-ago period. Meanwhile, total revenue in the fourth quarter was up 44% to a little more than $1 billion.

The boost in revenue and membership helped Alignment narrow its losses to a net loss of $11 million, or a loss of 5 cents a share, in the fourth quarter of last year compared to a net loss of $31 million, or 16 cents a share in the fourth quarter of 2024. For all of 2025, Alignment reported a small loss of $724,000 compared to a loss of $128 million in all of 2024.

The improving enrollment and financial performance of Alignment is in sharp contrast to most of its rivals in the health insurance industry, particularly those who sell Medicare Advantage plans and have been seeing higher costs.

Medicare Advantage plans contract with the federal government to provide extra benefits and services to seniors, such as disease management and nurse help hotlines with some also offering vision, dental care and wellness programs. In the last two years, these insurers in the Medicare Advantage business have seen an uptick in medical claims from an influx of patients including those seeking treatment they put off during the Covid-19 pandemic

But Alignment’s earnings report indicates the company may be better managing its medical costs than rivals.

Alignment said its “medical benefits ratio based on adjusted gross profit was 87.7%” in the fourth quarter. Such a ratio, which is the percentage of premium revenue that goes toward medical costs, has been well above 90% for most of Alignment’s rivals who sell Medicare Advantage, according to earnings reports.

While costs are rising at other Medicare Advantage providers, Alignment’s medical benefits ratio wasn’t much different than in the fourth quarter of 2024 when the company said it was 87.5% For the full year 2025, the ratio was 87.5% compared to 88.8% in 2024.

“Our fourth quarter and full-year 2025 results show what Medicare Advantage done right looks like,” Alignment Healthcare founder and chief executive officer John Kao said. “We once again exceeded industry expectations and delivered continued momentum on revenue growth while taking a positive step forward in profitability and margin expansion, including producing free cash flow on a full-year basis. By leading with our care model, we are putting our seniors first and lowering costs by delivering more care, not less.”

Unlike many of its rivals that reduced their geographic footprints to sell Medicare Advantage in fewer states and counties, Alignment expanded. That appears to be helping Alignment grow for this year with the company announcing Thursday that is raised its “health plan membership guidance by 2,000 at the midpoint.” Alignment also said its annual revenue will eclipse $5 billion as the company disclosed “2026 revenue guidance of $5.14 billion to $5.19 billion, representing 30%-31% growth year-over-year, and adjusted EBITDA of $133 million to $163 million.”