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The largest U.S. health insurer kicked off earnings season for the sector, reporting $46.23 billion in sales in its insurance business, an 11.1 percent rise from a year earlier.
Revenue from Optum, which includes a pharmacy benefits management business, grew 13 percent to $27.56 billion in the quarter, benefiting from growth in care delivery, behavioral health and health financial services, the company said.
UnitedHealth and its Optum unit are set to face tough competition this year, as health insurer rivals Cigna Corp and Aetna Inc entered into separate deals with large benefit managers.
UnitedHealth's 2018 medical care ratio, or the percentage of premiums paid out for medical services, improved to 81.6 percent from 82.1 percent last year.
The health insurer also affirmed its 2019 profit forecast.
"Despite the beat, management did not increase its 2019 guidance. This is not surprising to us. Over the years, UnitedHealth has typically been conservative," Cantor Fitzgerald analyst Steven Halper said in a client note, calling the results a "solid finish" to 2018.
et earnings attributable to shareholders fell 16 percent to $3.04 billion, or $3.10 per share, in the quarter ended Dec. 31.
Excluding items, the company earned $3.28 per share. Total revenue rose about 12 percent to $58.42 billion.
Analysts on average were expecting earnings of $3.21 per share and revenue of $58.01 billion, according to IBES data from Refinitiv.
Shares of the Hopkins, Minnesota-based company rose 1.6 percent to $252 in light trading before the opening bell.
(Reporting by Tamara Mathias in Bengaluru; Editing by Arun Koyyur)