Cigna Tops Q4 Revenue Forecasts but Issues Cautious Full-Year Outlook
NEW YORK – Health insurer The Cigna Group (NYSE: CI) delivered a mixed financial performance for the fourth quarter of 2025, beating revenue expectations but issuing a full-year forecast that underscores the complex landscape for managed care providers.
The company posted Q4 revenue of $72.47 billion, a 10.3% year-over-year increase that surpassed analyst consensus by 3.7%. Adjusted earnings came in at $8.08 per share, also above estimates. For the full year, however, Cigna projected revenue of approximately $280 billion at the midpoint, about 0.9% below current Wall Street expectations.
"Our 2025 results reflect focused execution on expanding access, lowering costs, and enhancing transparency for the people we serve," said Chairman and CEO David M. Cordani in the earnings release.
The quarterly strength was fueled not by customer growth—its membership base has seen modest declines—but by higher per-customer spending across its pharmacy benefits (Evernorth) and medical plans (Cigna Healthcare). This trend suggests success in cross-selling services and managing premium pricing, even as the overall customer count dipped to 16.42 million.
Analysts note that Cigna's long-term sales growth remains solid, with an 11.4% compound annual growth rate over five years. More recently, a two-year annualized growth rate of 18.6% indicates accelerating demand. Yet, profitability remains a concern. The company's operating margin has contracted over the past five years, averaging around 4%, which is considered narrow for the healthcare sector. The Q4 operating margin held steady at 3% year-over-year.
Looking ahead, sell-side analysts project a significant slowdown, forecasting only 3.8% revenue growth over the next 12 months. This cautious outlook reflects anticipated headwinds, including regulatory scrutiny, pharmacy benefit manager (PBM) pricing reforms, and intense competition in government-sponsored health plans.
The stock showed little immediate reaction to the earnings, trading flat around $270.78 after the report.
Market Voices: Reaction from the Street
Michael Torres, Senior Analyst at Clearwater Capital: "The quarter itself was fine—solid top-line execution. But the guide is the story. It signals that management sees margin pressure continuing. In this environment, beating on EPS via share buybacks isn't enough; investors want to see core profit expansion."
Dr. Anya Sharma, Healthcare Policy Fellow at The Brookfield Institute: "Cigna's results mirror the industry's paradox: revenue up, margins squeezed. The PBM segment is a cash engine but faces political and regulatory threats. The slight guidance miss tells me they're bracing for impact. The era of easy growth in managed care is over."
Gary Rickman, Independent Investor & Former Pharma Executive: "This is classic 'manage the expectations' play. Beat the easy quarterly numbers, then guide conservatively so you can 'beat and raise' later. I'm not buying it. Their margin story is weak, and hiding behind 'customer value' rhetoric doesn't change that. The stock is going nowhere until they fix the cost structure."
Lisa Chen, Portfolio Manager at Horizon Health Fund: "The per-member spending increase is the positive takeaway here. It shows their integrated model is working—they're becoming more essential to their existing customers. The long-term EPS growth track record is strong. Short-term guidance noise doesn't change that durable foundation."