UnitedHealth Group beat estimates for fourth quarter profit as the Eden Prairie, Minnesota-based health care giant released its first earnings report since the fatal ambush last month of top executive Brian Thompson in New York City.

Despite the earnings result, the company’s stock price fell in early trading Thursday as its massive UnitedHealthcare insurance business reported a surprisingly high ratio of medical costs to premium revenue at the end of last year — a potentially worrying sign about medical cost trends.

“There may be some investors that may be taking a wait-and-see attitude, to see how cost trends unfold over the course of the year,” John Boylan, an analyst with Edward Jones, said in an interview.

Around 10:30 a.m. Central Time on Thursday, UnitedHealth Group shares were trading down about 4%. Stock prices declined by smaller margins for Indiana-based Elevance Health, Kentucky-based Humana and other health insurers.

Executives cited a number of factors, including rebates during the fourth quarter to group customers who hire the company to run Medicare Advantage health plans for retirees. These payments lowered net revenue and thereby impacted the “medical loss ratio” — a widely watched measure of cost trends and profitability for health insurers, called “MLR” for short.

Yet higher cost drivers that boosted the MLR during the third quarter persisted through the end of the year, chief financial officer John Rex said. In October, UnitedHealth Group said Medicare beneficiaries were being prescribed more costly specialty drugs and hospitals were more aggressively coding procedures in ways that boost their revenues, thereby hurting insurers.

“What people want to see is a normalization of medical loss ratio over time,” Boylan said.

Rex said the company is confident it has adequately set premium prices for 2025 to account for medical cost trends.

During the fourth quarter, UnitedHealth Group posted a profit of $5.54 billion on $100.8 billion in revenue.

Excluding one-time items, adjusted earnings per share of $6.81 was 7 cents better than expected among analysts surveyed by LSEG Data and Analytics.

That beat happened even as revenue trailed expectations for the quarter. Analysts were expecting revenue of $101.7 billion.

The financial details came as UnitedHealth Group’s insurance business UnitedHealthcare and the broader industry continue to confront questions and anger over the nation’s health care system that surged in the wake of Thompson’s killing, particularly on social media.

Last week, a group representing faith-based shareholders petitioned UnitedHealth Group to develop a report on the human and economic toll stemming from limits and delays to accessing health care paid for by UnitedHealthcare.

Thompson was CEO of UnitedHealth’s insurance business. The company has not yet named an interim successor.

UnitedHealth says critics have spread misinformation about its track record denying health insurance claims.

“The people of UnitedHealth Group remain focused on making high-quality, affordable health care more available to more people while making the health system easier to navigate for patients and providers, positioning us well for growth in 2025,” said Andrew Witty, the company’s chief executive officer, in a news release.

UnitedHealth Group runs the UnitedHealthcare insurance business, as well as Optum, a large division for health care services including outpatient medical care and pharmacy benefits management.

Thompson was killed Dec. 4 while walking to UnitedHealth Group’s annual investor conference.

At the meeting, company officials had started to discuss their newly issued financial guidance for 2025 when word of the shooting started to spread. UnitedHealth Group says it’s expecting an adjusted profit of about $27.1 billion to $27.7 billion on revenue of $450 billion to $455 billion.

UnitedHealth Group on Thursday affirmed the outlook, which Witty last month said was more cautious than normal due in part to pressure in the company’s large Medicare Advantage business.

The fourth quarter results released Thursday were better than year-ago quarterly earnings of $5.46 billion on $94.4 billion in revenue.

UnitedHealth Group is one of the largest companies in the country, with about 400,000 workers overall, including about 19,000 in Minnesota.

At the end of December, about 49.3 million people in the U.S. had coverage from UnitedHealthcare, up slightly from the total at the end of September.

The company said Optum was serving about 100 million consumers during the fourth quarter.

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