UnitedHealth (UNH) vs Healthcare Sector (XLV)
UnitedHealth closed at $350.82 on April 21, 2026, with a market cap of $276.23 billion. XLV traded near $147.77 the same week.
Also known as: UnitedHealth (UNH) (STK_UNH, UnitedHealth) · Healthcare (XLV) (ETF_XLV, healthcare)
Why This Comparison Matters
UnitedHealth closed at $350.82 on April 21, 2026, with a market cap of $276.23 billion. XLV traded near $147.77 the same week. UNH represents 6.10 percent of XLV, the fourth-largest position after Eli Lilly at 13.80 percent, Johnson and Johnson at 10.55 percent, and AbbVie at 6.74 percent. The pair captures managed care versus the broader healthcare complex (pharma, biotech, medical devices). UNH 2026 EPS guidance is at least $18.25, with Morgan Stanley naming UNH a Top Pick at $375 target. Year-to-date 2026, UNH has stabilized after a roughly 30 percent peak-to-trough drawdown across 2024-2025 driven by DOJ investigations and Medicare Advantage margin compression. The pair is one of the most actively traded healthcare single-stock vs sector trades.
UNH Position in XLV
UNH at 6.10 percent of XLV is the fourth-largest position. The XLV top five hierarchy: Eli Lilly 13.80 percent (GLP-1 obesity drug franchise), Johnson and Johnson 10.55 percent (diversified pharma + medtech), AbbVie 6.74 percent (post-Humira immunology), UnitedHealth 6.10 percent (managed care leader), Merck 5.40 percent (Keytruda oncology).
The UNH/XLV ratio currently trades at approximately 2.37 (UNH $350.82 / XLV $147.77). The ratio peaked near 3.50 in late 2023 (before the 2024 DOJ investigation overhang) and bottomed near 2.05 during the worst of the 2024-2025 drawdown. The current 2.37 reflects partial recovery as Q1 2026 results stabilized and management raised guidance.
The 2024-2025 UNH Drawdown
UNH lost roughly 30 percent peak-to-trough during 2024-2025 from its October 2023 peak near $530. Three drivers compounded.
First, Medicare Advantage margin compression: 2024 MA reimbursement updates were less generous than expected, and rising medical-cost trends (post-COVID delayed care surge) pressured insurer margins across the industry. UnitedHealthcare margins compressed from approximately 6 percent in 2023 to approximately 5 percent in 2024.
Second, the Change Healthcare cyber incident: February 2024 ransomware attack on UNH-owned Change Healthcare disrupted claims processing across the US healthcare system. The incident produced approximately $2 billion in remediation costs plus reputation damage and Senate hearings.
Third, the DOJ investigation: announced 2024 into UnitedHealthcare's Medicare Advantage billing practices, focusing on diagnoses that increased federal payments. Allegations include inflated risk scores and diagnoses added without physician confirmation, raising potential fraud questions. The Senate Permanent Subcommittee on Investigations also accused UnitedHealth of "aggressively gaming" Medicare Advantage to inflate reimbursement.
The combined drag pulled XLV by approximately 2 percentage points given UNH's 6.10 percent weight.
The 2026 Stabilization Story
UNH year-to-date 2026 is approximately +5 percent versus XLV approximately flat. The recovery reflects three factors. First, management raised 2026 EPS guidance to at least $18.25, indicating margin recovery from 2024-2025 trough. Second, Q1 2026 results showed Medicare Advantage cost trends moderating from the 2024-2025 peak, suggesting the worst of the margin compression has passed.
Conditional Forward Response (Tail Events)
How Healthcare (XLV) has historically behaved in the 5 sessions following a top-decile or bottom-decile daily move in UnitedHealth (UNH). Computed from 1,289 aligned daily observations ending .
Following these triggers, Healthcare (XLV) rises 0.09% on average over the next 5 sessions, versus an unconditional baseline of +0.11%. 129 qualifying events; Healthcare (XLV) closed positive in 52% of them.
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Frequently Asked Questions
What is UNH's current price and market cap?+
UnitedHealth closed at $350.82 on April 21, 2026, with a market cap of $276.23 billion. The stock traded between $351.39 and $358.20 on April 25, 2026. UNH 2026 EPS guidance is at least $18.25, with Morgan Stanley naming UNH a Top Pick at $375 target. UNH is 6.10 percent of XLV, the fourth-largest position. The UNH/XLV ratio is approximately 2.37 (12-month range 2.05-2.50, 5-year range 2.05-3.50). The current 2.37 reflects partial recovery from the 2024-2025 drawdown that took UNH from October 2023 peak near $530.
What caused the 2024-2025 UNH drawdown?+
UNH lost roughly 30 percent peak-to-trough during 2024-2025 from its October 2023 peak near $530. Three drivers compounded. First, Medicare Advantage margin compression: 2024 MA reimbursement updates were less generous than expected, and rising medical-cost trends pressured insurer margins. UnitedHealthcare margins compressed from ~6 percent in 2023 to ~5 percent in 2024. Second, the Change Healthcare cyber incident: February 2024 ransomware attack disrupted claims processing across US healthcare. Cost ~$2 billion in remediation. Third, the DOJ investigation into UnitedHealthcare Medicare Advantage billing practices, focusing on diagnoses that increased federal payments.
What is the DOJ investigation about?+
The DOJ is investigating UnitedHealthcare Medicare Advantage billing practices, focusing on diagnoses that increased federal payments. Allegations include inflated risk scores and diagnoses added without physician confirmation, raising potential fraud questions. The Senate Permanent Subcommittee on Investigations also accused UnitedHealth of aggressively gaming Medicare Advantage to inflate reimbursement, with staffers reviewing 50,000 pages of documentation. The investigation has moved from initial-reporting phase to lengthy procedural phase without immediate adverse rulings. Resolution within 12-18 months is possible but timing is uncertain. The market has partially priced in the worst-case scenario.
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