** Shares of health insurers are on track for a second straight year of declines as they grapple with elevated medical costs

** UnitedHealth UNH.N, Humana HUM.N, CVS Health CVS.N and Cigna CI.N have seen high medical costs as people sought care under government-backed Medicare Advantage plans for older adults or those with disabilities

** Costs have also been higher for companies such as Centene CNC.N and Elevance ELV.N, which offer Medicaid plans, as states re-determined eligibility for low-income people, leaving behind those who require more medical services

** The S&P 500 Managed Health Care .SPLRCHMO index has fallen 10.85% YTD, with Humana being the bigger loser

** Insurers, which own pharmacy benefit management units, have also come under scrutiny for their influence over prescription drug prices

** Some health insurers may benefit from the Trump administration in 2025, however, investor focus will likely remain on costs, which are expected to remain elevated

** Uncertainty for Medicare Advantage continues in 2025 and should remain a focal point, J.P.Morgan analysts said in note earlier this month

(Reporting by Sriparna Roy in Bengaluru)

((Sriparna.Roy@thomsonreuters.com))