Teladoc Health Inc. (TDOC) shares plummeted 18.29% in the pre-market session on Thursday following the virtual healthcare provider's disappointing fourth-quarter 2024 earnings results and lackluster outlook for 2025.

For the fourth quarter of 2024, Teladoc reported a wider-than-expected net loss of $0.28 per share, compared to analysts' expectations of a $0.23 loss. While revenue of $640.5 million narrowly beat estimates, it declined by 3% year-over-year. The company's adjusted EBITDA also fell across its Integrated Care and BetterHelp segments.

The earnings miss was primarily driven by a 10% revenue decline in Teladoc's direct-to-consumer BetterHelp mental health segment, reflecting decreased demand for its services. The company's gross margin slipped to 65.7% from 68.8% a year earlier, further pressuring profitability.

Looking ahead, Teladoc provided 2025 revenue guidance of $2.468 billion to $2.576 billion, mostly below the $2.570 billion it reported in 2024. Its adjusted EBITDA forecast range of $278 million to $319 million is largely below the $310.7 million achieved last year.

The disappointing results and weak guidance underscore the challenges Teladoc faces in a highly competitive virtual healthcare market. While the company aims to stabilize its BetterHelp business and focus on international growth opportunities, concerns over slowing demand weighed heavily on the stock.