Alignment Healthcare (ALHC) Q4 2025 earnings summary

Executive summary

• Health plan membership reached 236,300 in Q4 2025, up 25% year-over-year, driving Q4 revenue of $1.01 billion, a 44.4% increase year-over-year.

• Full-year 2025 revenue was $3.95 billion, up 46.1% year-over-year, with adjusted EBITDA of $109.9 million, a significant improvement from $1 million in 2024.

• The company exceeded the high end of guidance across all profitability metrics in Q4 2025, with adjusted gross profit of $125 million and adjusted EBITDA of $11 million.

• Membership outside California more than doubled, now representing 16% of total membership, with strong star ratings in multiple states.

• Recognized on the 2026 Fortune World's Most Admired Companies list for innovation in senior health care.

Financial highlights

• Adjusted gross profit for 2025 was $494.8 million, with an MBR of 87.5%, improving 130 basis points year-over-year.

• Adjusted EBITDA margin expanded by 270 basis points to 2.8% in 2025.

• Operating cost ratios improved significantly; adjusted SG&A as a percentage of revenue declined from 11.1% in 2024 to 9.7% in 2025.

• Positive free cash flow was generated in 2025, ending the year with $604 million in cash and investments.

• Net loss per share improved to $0.00 for the year, compared to a loss of $0.67 per share in the prior year.

Outlook and guidance

• 2026 full-year guidance: health plan membership of 292,000–298,000, revenue of $5.14–$5.19 billion, adjusted gross profit of $615–$650 million, and adjusted EBITDA of $133–$163 million.

• Q1 2026 guidance: membership of 281,000–285,000, revenue of $1.21–$1.23 billion, adjusted gross profit of $138–$148 million, and adjusted EBITDA of $26–$36 million.

• Year-end membership guidance raised by 2,000 at the midpoint due to strong OEP results and retention.

• 2026 revenue growth expected at 31% year-over-year, driven by membership growth and balanced by benchmark rate increases and Part D subsidies.