Revenue has grown from $681.3 million in 2024Q2 to $1.4 billion in 2026Q3, yet quarterly net income remains volatile, ranging from negative $31.1 million to positive $36.6 million, with a combined ratio of 100.3% in the latest quarter suggesting underwriting profitability is still fragile.
Alignment Healthcare, Inc. (ALHC) annual income statement — 7-year revenue, gross profit & net income history
| Metric | TTM | Dec'25 | Dec'24 | Dec'23 | Dec'22 | Dec'21 | Dec'20 | Dec'19 |
|---|
| Revenue | 4.94B | 3.95B | 2.7B | 1.82B | 1.43B | 1.17B | 959.22M | 756.96M |
| Revenue Growth % | 35.87% | 46.06% | 48.25% | 27.16% | 22.81% | 21.74% | 26.72% | - |
| Medical Costs & Claims | 4.35B | 3.46B | 2.41B | 1.62B | 1.25B | 1.04B | 792.99M | 661.39M |
| Medical Cost Ratio % | 88.07% | 87.63% | 89.03% | 88.98% | 87.15% | 88.98% | 82.67% | 87.37% |
| Gross Profit | 589.43M | 488.56M | 296.69M | 201.03M | 184.28M | 128.73M | 166.23M | 95.57M |
| Gross Margin % | 11.93% | 12.37% | 10.97% | 11.02% | 12.85% | 11.02% | 17.33% | 12.63% |
| Gross Profit Growth % | - | 64.67% | 47.59% | 9.09% | 43.15% | -22.56% | 73.93% | - |
| Operating Expenses | 545.91M | 473.81M | 398.25M | 328.85M | 312.92M | 306.8M | 171.49M | 125.06M |
| OpEx / Revenue % | 11.05% | 12% | 14.73% | 18.03% | 21.82% | 26.27% | 17.88% | 16.52% |
| Depreciation & Amortization | 31.67M | 30.48M | 27.06M | 21.67M | 17.49M | 16.03M | 15.46M | 16.58M |
| Combined Ratio % | 99.12% | 99.63% | 103.76% | 107.01% | 108.97% | 115.25% | 100.55% | 103.9% |
| Operating Income | 43.52M | 14.75M | -101.56M | -127.82M | -128.64M | -178.07M | -5.26M | -29.48M |
| Operating Margin % | 0.88% | 0.37% | -3.76% | -7.01% | -8.97% | -15.25% | -0.55% | -3.9% |
| Operating Income Growth % | - | 114.53% | 20.55% | 0.64% | 27.76% | -3283.47% | 82.15% | - |
| EBITDA | 75.19M | 45.23M | -74.49M | -106.15M | -111.15M | -162.04M | 10.2M | -12.9M |
| EBITDA Margin % | 1.52% | 1.15% | -2.76% | -5.82% | -7.75% | -13.88% | 1.06% | -1.7% |
| Interest Expense | 16.57M | 15.8M | 23.55M | 21.23M | 18.29M | 17.44M | 16.93M | 14.9M |
| Non-Operating Income | -1K | -89K | 2.95M | -853K | 2.37M | -229K | 732K | 351K |
| Pretax Income | 26.96M | -958K | -128.05M | -148.19M | -149.3M | -195.29M | -22.93M | -44.73M |
| Pretax Margin % | 0.55% | -0.02% | -4.74% | -8.13% | -10.41% | -16.72% | -2.39% | -5.91% |
| Income Tax | -1.96M | 20K | 21K | -22K | 339K | 0 | 0 | 0 |
| Effective Tax Rate % | -7.26% | -2.09% | -0.02% | 0.01% | -0.23% | 0% | 0% | 0% |
| Net Income | 28.92M | -724K | -128.03M | -148.02M | -149.55M | -195.29M | -22.93M | -44.73M |
| Net Margin % | 0.59% | -0.02% | -4.74% | -8.12% | -10.43% | -16.72% | -2.39% | -5.91% |
| Net Income Growth % | 238.97% | 99.43% | 13.5% | 1.02% | 23.42% | -751.81% | 48.75% | - |
| EPS (Diluted) | 0.14 | -0.00 | -0.67 | -0.79 | -0.83 | -1.14 | -0.12 | -0.29 |
| EPS Growth % | 212.49% | 99.45% | 15.19% | 4.82% | 27.19% | -850% | 58.62% | - |
| EPS (Basic) | - | -0.00 | -0.67 | -0.79 | -0.83 | -1.14 | -0.12 | -0.29 |
| Diluted Shares Outstanding | 208.56M | 198.01M | 190.79M | 186.21M | 181.21M | 171.96M | 187.27M | 152.13M |
Quick answers to the most common questions about buying ALHC stock.
For fiscal year 2025, Alignment Healthcare, Inc. (ALHC) reported total revenue of $3.95B. This represents a 421.7% increase compared to $757.0M in 2019.
Alignment Healthcare, Inc. (ALHC) reported a net loss of $0.7M for the fiscal year ending 2025.
Alignment Healthcare, Inc. (ALHC) reported an operating income of $14.8M, resulting in an operating profit margin of 0.4%. This margin reflects the operational efficiency of the business before interest and taxes.
Alignment Healthcare, Inc. (ALHC) generated $488.6M in gross profit for the year, representing a gross profit margin of 12.4%. This demonstrates the company's core pricing power and production efficiency.
Key Metrics
Top Statement Risk
Medicare Advantage risk adjustment exposure
Metrics are mathematically derived from official filings.
Top-Line Growth Moderating From Peak Levels
Based on reported quarterly figures, ALHC's revenue growth has eased from roughly 51% year-over-year in 2024Q4 to about 37% in 2026Q3, suggesting membership expansion is maturing even as absolute revenue continues to climb past $1.4 billion per quarter.
The deceleration in growth rate, while revenue still expands in absolute dollars, suggests the company is moving past its most aggressive enrollment phase and into a period where growth depends more heavily on retention and annual CMS rate resets. Investors should interpret the guidance raise to $1,300–$1,320 million as supportive of near-term volume, but the narrowing growth rate warrants monitoring for signs that new-market entries in North Carolina and Nevada are not replacing the momentum from the California base.
Underwriting Margins Hover Near Breakeven
As reported in financial statements, ALHC's loss ratio has ranged between 86% and 90% across recent quarters, with the combined ratio oscillating above and below 100%, leaving underwriting profitability highly sensitive to utilization swings.
A combined ratio that crosses 100% in several quarters, including 2026Q3 at 100.3% and 2025Q4 at 101.0%, indicates the company frequently loses money on medical care relative to premiums received. The narrow band between a strong quarter like 2026Q2 at 96.8% and a loss-making quarter suggests that small shifts in inpatient admissions or pharmacy costs can determine whether the period is profitable. Investors should track whether the expense ratio scales down as revenue grows, since that is the primary lever available to convert top-line growth into durable net income.
Reserve Adequacy Shapes Reported Earnings Quality
Based on ALHC's reported figures, quarterly earnings swing materially between profit and loss, which may partly reflect estimation sensitivity in incurred but not reported medical claim reserves and risk-adjustment reconciliations.
Because medical claims payable and IBNR estimates are inherently subjective, small changes in assumed utilization can move reported loss ratios by meaningful amounts within a single quarter. The pattern of alternating profit and loss quarters suggests that reported earnings may not yet reflect a stable underlying run-rate. Analysts should scrutinize prior-period development disclosures before extrapolating any single quarter's margin into forward estimates.
Investment Income Data Not Disclosed
Investment income and yield figures are unavailable in the supplied quarterly data, so the contribution of investment returns to total earnings cannot be assessed from the reported figures.
Without disclosed investment income, the analysis cannot determine whether ALHC relies on float income to offset underwriting losses in quarters where the combined ratio exceeds 100%. Investors seeking this assessment should consult the full filing for portfolio composition and yield detail before drawing conclusions about the role of investment returns.
Reported Growth May Mask Margin Fragility
The strongest challenge to ALHC's earnings narrative is that headline revenue growth of 37% coexists with a combined ratio above 100% in recent quarters, suggesting volume expansion has not yet translated into underwriting profit.
Growth at this pace can carry hidden cost pressure, since newly enrolled members may carry higher utilization before risk-adjusted payments fully reflect their health profile under CMS reconciliation timing. If the V28 transition and tighter Star Rating cut points compress reimbursement, the current revenue trajectory could coincide with weaker margins than the top line implies. Investors should weigh whether the recent guidance raise reflects durable clinical trends or favorable timing that may reverse.