UnitedHealth Group UNH, the largest U.S. health insurer, reported mixed fourth-quarter 2024 results. It breezed past the Zacks Consensus Estimate for earnings but missed the same for revenues. UNH shares dropped nearly 6% on the day following the results.

This has put the ETFs having the largest allocation to this health insurance giant, like iShares U.S. Healthcare Providers ETF IHF, Health Care Select Sector SPDR Fund XLV, iShares U.S. Healthcare ETF IYH, Vanguard Health Care ETF VHT and Fidelity MSCI Health Care Index ETF FHLC, in focus.

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Earnings in Focus

Earnings per share came in at $6.81, topping the Zacks Consensus Estimate of $6.71 and higher than the year-ago earnings of $6.16. Revenues grew 6.8% year over year to $100.8 billion but were shy of the estimated $102.2 billion. The revenue miss was due to weakness in its health insurance business (see: all the Healthcare ETFs here).

Optum revenues increased 9.4% to $65.1 billion. Optum Health served 4.7 million people in 2024 with value-based care and expects to grow to serve an additional 650,000 patients in 2025. Medical ratio (a measure of the percentage of premiums paid out for medical services) rose to 87.6%. Management forecast that the ratio will be in the range of 86%-87% for 2025.

The health insurer affirmed its 2025 revenues in the range of $450-$455 billion and earnings per share of $29.50-$30.00.

ETFs in Focus

Let’s delve into each ETF below:

iShares U.S. Healthcare Providers ETF (IHF)

iShares U.S. Healthcare Providers ETF follows the Dow Jones U.S. Select Healthcare Providers Index with exposure to companies that provide health insurance, diagnostics and specialized treatment. The fund holds 67 securities in its basket. UNH occupies the top position with a 23% share (read: Wall Street Dives on Less Dovish Fed: 5 ETF Zones That Win). 

iShares U.S. Healthcare Providers ETF has amassed $691.9 million in its asset base, while volume is light at about 96,000 shares per day, on average. It charges 40 bps in annual fees and has a Zacks ETF Rank #3 (Hold) with a Medium risk outlook.

Health Care Select Sector SPDR Fund (XLV)

Health Care Select Sector SPDR Fund is the most popular healthcare ETF and follows the Health Care Select Sector Index. It holds 61 securities in its basket, with UnitedHealth taking the second spot at 9.7% of the assets. Pharma, healthcare equipment & supplies, healthcare providers & services, and biotechnology take the largest share at 30%, 22.8%, 21.1% and 15.4%, respectively, from a sector look.

Health Care Select Sector SPDR Fund has AUM of $38.2 billion in its asset base and trades in a heavy volume of around 8 million shares. The expense ratio comes in at 0.09%. XLV has a Zacks ETF Rank #1 (Strong Buy) with a Medium risk outlook (read: 4 Sector ETFs & Stocks to Benefit Despite Cooling Inflation).

iShares U.S. Healthcare ETF (IYH)

iShares U.S. Healthcare ETF offers exposure to 105 U.S. healthcare equipment and services, pharmaceuticals, and biotechnology companies by tracking the Russell 1000 Health Care RIC 22.5/45 Capped Gross Index. Here again, UnitedHealth is the second firm, accounting for 9.3% of the total assets. In terms of industrial exposure, pharma takes the top spot at 30%, followed by healthcare equipment (21.8%) and biotech (17.5%). 

iShares U.S. Healthcare ETF has amassed $3.1 billion in its asset base while charging 39 bps in annual fees. It trades in a good volume of around 348,000 shares a day and has a Zacks ETF Rank #2 (Buy) with a Medium risk outlook. 

Vanguard Health Care ETF (VHT)

Vanguard Health Care ETF tracks the MSCI US Investable Market Health Care 25/50 Index and holds 416 stocks in its basket. Of these, UnitedHealth takes the second spot with a 9% allocation. Pharma takes the largest share at 27.3%, while healthcare equipment and biotech round off the top three spots. 

Vanguard Health Care ETF is also one of the most popular and liquid ETFs, with AUM of $17 billion and an average daily volume of about 317,000 shares. It charges 10 bps in annual fees and has a Zacks ETF Rank #1 with a Medium risk outlook.

Fidelity MSCI Health Care Index ETF (FHLC)

Fidelity MSCI Health Care Index ETF provides exposure to 368 healthcare stocks and tracks the MSCI USA IMI Health Care Index. UnitedHealth occupies the second position with 8% of the assets. Pharma accounts for 28.3% share while healthcare equipment and supplies, healthcare providers and services, and biotech round off the top three spots with double-digit exposure each. 

Fidelity MSCI Health Care Index ETF has AUM of $2.6 billion. Its expense ratio is 0.08%, while volume is good at 149,000 shares a day. FHLC has a Zacks ETF Rank #3 with a Medium risk outlook.

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UnitedHealth Group Incorporated (UNH) : Free Stock Analysis Report

Health Care Select Sector SPDR ETF (XLV): ETF Research Reports

iShares U.S. Healthcare ETF (IYH): ETF Research Reports

Vanguard Health Care ETF (VHT): ETF Research Reports

iShares U.S. Healthcare Providers ETF (IHF): ETF Research Reports

Fidelity MSCI Health Care Index ETF (FHLC): ETF Research Reports

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