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UnitedHealth posted a better-than-expected profit in the final quarter of 2024, but a nagging rise in medical costs and care utilization surprised Wall Street.

Shares of the health care giant slid early Thursday after it released its first financial report since the 

 of one of its executives outside a New York City hotel touched a national nerve and brought to the surface American frustration over health care access.

UnitedHealth leaders opened a call with analysts Thursday morning by offering thanks for condolences the company has received since the Dec. 4 death of Brian Thompson, CEO of the company's UnitedHealthcare business.

“Brian helped build this company and forged deep, trusted relationships for over 20 years, and the positive impact he had on people will be felt for years to come,” Chief Financial Officer John Rex said.

In the recently concluded fourth quarter, more than 87 percent of the premiums UnitedHealth collected in the fourth quarter went back out the door to cover medical costs, which was “well above” what analysts expected, TD Cowen analyst Ryan Langston said in a research note.

UnitedHealth said it was still dealing with an increase in prescriptions for expensive specialty drugs and other cost pressures it detailed in previous quarters. The company's net income rose slightly to $5.54 billion in the quarter.

Adjusted results totaled $6.81 per share. The company's revenue climbed about 7 percent to $100.8 billion, which missed expectations.

Analysts expected earnings of $6.73 per share in the fourth quarter on $101.6 billion in revenue, according to the data firm FactSet.

UnitedHealth operates the nation’s largest health insurer, UnitedHealthcare, which covers more than 49 million people in the United States. It also operates a large pharmacy benefit manager that runs prescription drug coverage and a growing business that delivers care and provides technical support.

The company's full-year profit, which had climbed ever year for nearly a decade, sank 36 percent to $14.4 billion in 2024. The bottom line was hurt partly by costs tied to a 

 that hit its Change Healthcare business early in the year

UnitedHealth, based in Minnetonka, Minnesota, 

 early last year by reporting soaring medical costs in the final quarter of 2023. Weeks later, the company discovered the cyberattack, which disrupted business and added more than $2 billion in direct response costs.

 was fatally shot as he walked to the company’s annual investor meeting in mid-town Manhattan. A 26-year-old suspect, 

, faces federal and state charges in connection with Thompson’s death.

Prosecutors have said Mangione, who was not a UnitedHealthcare customer, was 

 expressing hostility toward the health insurance industry and especially wealthy executives when he was arrested.

an outpouring of grievances about insurance companies

 a few weeks after the shooting found that most Americans believe health insurance profits or coverage denials bear some responsibility for Thompson’s death.

Shares of UnitedHealth, a component of the Dow Jones Industrial Average, sank after Thompson’s shooting and fell about 4 percent on the year.

The stock had rallied so far in 2025 before falling about $8 to $535.23 shortly before markets opened Thursday.

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UnitedHealth posted a better-than-expected profit in the final quarter of 2024, but revenue fell short as challenges like Medicare funding cuts and a Medicaid enrollment drop hurt.

UnitedHealth books better-than-expected fourth-quarter profit

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