UnitedHealth Group ranked fourth on the 2026 Fortune Global 500, with $447.6 billion in revenue for fiscal year 2025, according to Fortune. That figure was up nearly 12% from the prior year and placed the company behind only Amazon, Walmart, and Chinese state utility State Grid.
The milestone arrives as the company faces pressure on multiple fronts that benefits brokers should watch closely.
Full-year 2025 earnings from operations came in at $19 billion, against $32.3 billion in 2024, according to UnitedHealth Group's earnings release. The company's adjusted medical care ratio rose to 88.9% from 85.5% the prior year, driven by Medicare funding reductions and elevated medical cost trends.
UnitedHealthcare, the company's insurance segment, posted a 2.7% operating margin in 2025, down from 5.2% in 2024. Its earnings from operations fell from $15.6 billion to $9.4 billion over the same period. The segment served 49.8 million members and generated $344.9 billion in revenue for the year.
A $2.8 billion charge recorded in 2025 covered the final direct costs tied to the Change Healthcare cyberattack, divestitures, and restructuring actions. Those actions included workforce reductions and real estate rationalization, according to the earnings release.
UnitedHealth reported only 10 subsidiaries for fiscal year 2025, down from thousands the year before. A July 2025 report had placed its corporate structure at nearly 2,700 entities spanning insurance, care delivery, pharmacy, technology, and administrative assets.
CEO Stephen Hemsley and four other payer executives faced bipartisan questioning over vertical integration at two House hearings in January. Senators Elizabeth Warren and Josh Hawley introduced the Break Up Big Medicine Act on February 10, 2026, according to Congress.gov. The bill would bar companies from simultaneously owning a health insurer or pharmacy benefit manager and a medical provider organization, and remains under consideration.
Optum Rx, UnitedHealth's pharmacy benefit arm, generated $154.7 billion in revenue and processed 1.66 billion adjusted prescriptions in 2025. UnitedHealth controls more than 20% of the US PBM market through the unit. Benefits brokers advising self-funded employer clients on pharmacy benefit contracts have a direct stake in how that market structure evolves.
Despite the 2025 earnings decline, UnitedHealth reported $112 billion in second-quarter 2026 revenue and $5.5 billion in net income, according to CNBC. The medical care ratio improved to 86.7% from 89.4% in the prior-year quarter. The company raised its full-year 2026 adjusted earnings outlook to between $19.50 and $20 per share.
Other health care companies placed high on the Fortune list as well. McKesson ranked seventh at $403 billion, CVS Health ninth at $402 billion, Cencora 16th at $321 billion, and Cigna Group 21st at $274 billion.
CFO Wayne DeVeydt said in a CNBC interview that medical costs "remained elevated over historical levels" in the quarter. That trend has weighed on the broader insurance industry for more than two years. For benefits brokers, it feeds directly into premium pressure for employer clients heading into renewal season.
