Clover Health reported third‑quarter revenue of $496.6 million, a 50% year‑over‑year increase that beat consensus estimates of $467–$475 million by roughly $22 million, or 4.6–4.7%. The jump was largely driven by a 35% rise in Medicare Advantage enrollment, which lifted the premium mix and offset modest pricing pressure in the HMO segment.
Membership rose to 109,226, up 35% from 79,000 in Q3 2024. The higher proportion of new members—who typically incur higher utilization costs—contributed to the elevated cost base and the sharp rise in the Insurance Benefit Expense Ratio (BER) to 93.5% from 82.8% in the prior year.
Profitability metrics slipped: Adjusted EBITDA fell to $2.1 million from $2.7 million in Q3 2024, and GAAP net loss widened to $24.1 million versus $33.6 million a year earlier. The loss was driven by higher member acquisition costs and the elevated utilization of new members, which pushed the BER higher and compressed margins.
GAAP earnings per share were –$0.05, missing consensus estimates of –$0.01 to $0.02 by $0.04–$0.07. The miss reflects the combination of higher-than‑expected utilization and cost inflation that offset the revenue growth, leaving the company with a negative EPS despite a profitable adjusted EBITDA for the quarter.
Management revised its full‑year 2025 guidance, lowering Adjusted EBITDA to $15–30 million from the previously projected $50–70 million, and raising the Insurance BER guidance to 90–91%. The adjustments signal caution about near‑term margin pressure while maintaining confidence that the company will achieve profitability in 2026 as member cohorts mature and the 4‑star rating for PPO plans provides a tailwind.
Investors reacted negatively to the announcement, with analysts citing the sharp EBITDA miss and EPS miss as primary concerns. The 4‑star rating for PPO plans was noted as a tailwind, but the margin compression and higher BER dominated the market’s assessment of the quarter’s results.
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