Molina Healthcare Inc. (MOH) stock plummeted over 9% in the pre-market trading session on Thursday, following the healthcare insurer's mixed fourth-quarter results and disappointing earnings guidance for 2025.

While Molina's Q4 revenue of $10.499 billion exceeded analysts' estimates, the company's adjusted earnings per share (EPS) of $5.05 missed the consensus forecast of $5.72. Higher-than-expected medical costs, particularly in the Medicaid business, were cited as the primary reason for the earnings shortfall. Molina's medical care ratio (MCR) rose to 90.2% in Q4, up from 89.1% a year ago, reflecting the impact of acuity shifts and increased utilization related to Medicaid redeterminations.

Furthermore, Molina's adjusted EPS guidance of at least $24.50 for 2025 fell short of analysts' expectations of around $26.07, despite the company forecasting revenue of approximately $44 billion, ahead of estimates. The weaker earnings outlook is attributed to anticipated costs associated with recent contract wins and acquisitions.