UnitedHealth Group operates two interrelated businesses: UnitedHealthcare, a health insurer, and Optum, a health services and technology business. UnitedHealthcare sells health plans across commercial, Medicare, and Medicaid markets. It collects premiums from employers, individuals, and government programs, then pays medical claims on behalf of members. The key earnings driver is the spread between premiums collected and medical costs paid, measured by the medical care ratio (MCR). Optum operates three segments: Optum Health delivers care directly to patients through primary care, specialty care, home health, and behavioral health, primarily through value-based care (VBC) arrangements where Optum assumes full financial responsibility for patient outcomes in exchange for a fixed monthly premium per member. Optum Rx is a pharmacy benefit manager (PBM) that negotiates drug pricing and rebates on behalf of employer, government, and health plan clients. Optum Insight sells data analytics, technology, and managed services to health plans, hospitals, and governments. A key feature of UnitedHealth's model is the integration between UnitedHealthcare and Optum Health — Optum manages many UnitedHealthcare Medicare members in VBC arrangements, giving the enterprise a financial stake in both the premium collected and the medical cost managed. The company is currently executing a multi-year recovery plan after Medicare Advantage medical costs significantly exceeded pricing assumptions in 2024-2025, prioritizing repricing, membership contraction, and operating model simplification across all segments.