eHealth at Noble Capital Markets: Navigating Medicare Disruption

On Thursday, 09 October 2025, eHealth Inc. (NASDAQ:EHTH) presented at the Noble Capital Markets Emerging Growth Virtual Investor Conference. The company outlined its strategic initiatives amid market disruption in the Medicare Advantage space, emphasizing both challenges and growth opportunities. CEO Derek highlighted the firm’s omni-channel capabilities and brand-driven approach while addressing market dynamics and future growth prospects.

Key Takeaways

• eHealth targets an 8%-10% revenue CAGR and EBITDA margin by 2026, focusing on Medicare Advantage scaling and product diversification.
• The "Medicare Matchmaker" campaign drove 80% of Q4 2024 Medicare applications through branded channels, enhancing profitability.
• eHealth reported $111 million in cumulative EBITDA improvement and $99 million in operating GAAP net income over three years.
• The company is expanding into year-round products like Medicare Supplement and ancillary products to mitigate business seasonality.
• eHealth ended Q3 with over $100 million in cash and extended its term loan maturity to Q1 2027.

Financial Results

• Cumulative EBITDA improvement of $111 million over the past three years.
• $99 million improvement in operating GAAP net income over the same period.
• 2024 guidance indicates approximately 3% revenue growth at the midpoint with stable profitability.
• Targeting an 8%-10% revenue CAGR and EBITDA margin by 2026, with a current margin of approximately 14%.
• Positive tail adjustments exceeding $250 million since adopting ASC 606.

Operational Updates

• 80% of Q4 2024 Medicare applications came through eHealth branded channels.
• AI-powered voice agent launched in April 2024, set for deployment this AEP.
• Online unassisted enrollments accounted for 26% of total Medicare Advantage enrollments last year.
• Product diversification includes Medicare Supplement and ancillary products like hospital indemnity plans, showing significant growth.

Future Outlook

• CMS projects Medicare Advantage penetration to reach 60% by 2030, with an addressable market of 80 million members.
• eHealth anticipates a reduction in broker capacity as competitors exit the market.
• Favorable 2026 Medicare Advantage rates expected to positively impact broker commissions.
• The ICRA market is growing at an estimated 60% CAGR.
• The company holds over $100 million in cash and has extended its term loan maturity to Q1 2027.

Q&A Highlights

• Medicare Advantage remains crucial for care coordination and improved outcomes.
• Market disruption offers opportunities due to carrier underwriting changes.
• eHealth captured market share during previous disruptions and expects a dynamic AEP.
• Success depends on scale and high-quality enrollments, with retention awards from top carriers.
• Brand investments enhance retention, boosting cash flow per policy over its lifetime.

For a complete understanding of eHealth’s strategic direction and financial performance, readers are encouraged to refer to the full transcript.

Full transcript - Noble Capital Markets Emerging Growth Virtual Investor Conference:

Operator: Before we get started, I just wanted to remind everyone, if you have any questions, you can enter those in at the bottom of your screen, and we will get to those at the end during the Q&A portion. Without further ado, I will hand the floor over to Derek. Go ahead, Derek.

Derek, CEO, eHealth: Pat, thank you, and thanks to the Noble Capital team for the invitation today, and thank you to all that have joined for taking time today to either learn about eHealth possibly for the first time or certainly maybe to learn more. Before we start, I just wanted to give you a brief overview of my background. I’m roughly 60 days into the start of my journey as becoming the CEO of eHealth. I’ve spent 36 of my 37-year business career in the life and health space, most recently as Chief Executive Officer of Magellan Health, which is in the payer services business. Prior to joining Magellan, I had spent the previous 16 years at an organization called HealthMarkets, which at the time was privately owned by Blackstone, Goldman, and the old DLJ Merchant Banking group, and was a competitor of eHealth.

It was really the first time that I got introduced to eHealth as a competitor and had great respect for them. I’m honored to have had the opportunity to join this incredible leadership team that Fran Soistman put together. Thank you again for the time that you’re spending with us today to learn more about our company. Now, before we begin, please note that today’s presentation includes forward-looking statements. These are based on current expectations and are subject to risk and uncertainties. We certainly encourage you to review our filings with the SEC for more detail. I want to start with giving a little bit of a company overview. eHealth is a leading direct-to-consumer health insurance marketplace. Our mission is to guide consumers through a complex decision process to help them choose the best health plan that meets their needs, when, where, and how they prefer.

We believe eHealth differentiates itself from other market participants on three key points: our omni-channel capabilities that combine at scale online enrollment with licensed advisor support, our brand-driven approach to demand generation while most of our competitors rely on third-party lead generation, and last but not least, the strength of our commission receivable asset with a limited history of write-offs. In fact, we have consistently recognized positive tail adjustments over the tenure of the asset. I’ll expand on each of these points in future slides. Now, selecting health insurance is a high-stakes decision. At the same time, it is an incredibly complex market in Medicare, which covers a vulnerable demographic. Multiple carriers compete for attention, each with numerous plan iterations and plan benefits, and then each plan further has multiple data points to consider, whether that’s network, deductible, or supplemental benefits. Further complexity is added by a condensed enrollment period.

Millions of Americans have a few weeks to transact, in the midst of an overwhelming cycle of advertising. Those ads are often generic, aggressive, and confusing. eHealth addresses these pain points with a consumer-centric brand, proprietary tools to compare and select plans, and by meeting consumers where they feel comfortable transacting, whether it’s by speaking to someone or transacting online or a hybrid solution. There is a continuous support opportunity throughout the rest of the year and their journey through a dedicated team at eHealth. eHealth operates in a large and growing market. Over 10,000 people age into Medicare every day. They are increasingly selecting Medicare Advantage as an option. In addition, we see increased shopping activity from existing beneficiaries, which further expands the top-of-the-funnel opportunity. Despite recent disruption, it remains a very important and popular program for seniors, and it’s also an important part of the carrier’s businesses.

Beyond the over 65 segment, we see significant opportunity in the under 65 market, particularly through Individual Coverage Health Reimbursement Arrangements, otherwise known as ICRA. That opportunity, maybe the best way to think about that or describe it is it’s the healthcare insurance opportunity to take defined benefits and turn it into a defined contribution, much like the 401(k) market did in the retirement market. That emerging opportunity is growing at an estimated 60% compound annual growth rate, and we believe our platform lends itself well to this market. Now, just a minute on the competitive landscape. Key players in our market include the direct-to-carrier channel, where each carrier has its own sales capabilities, feet on the street distribution, sometimes referred to as field marketing organizations, and telebrokers, which is the eHealth category. We believe eHealth has the broadest plan choice of all private platforms.

We have relationships with approximately 180 total carriers, 50 of which are in the Medicare Advantage market. Having multiple carriers and a wide geographic presence is critical, given the sector disruption that was experienced last year and that we believe will be underway again during this open enrollment period. We continue to be the only broker with an end-to-end online unassisted capability. That’s important as seniors increasingly expect and demand comparison shopping and online access. Large national carriers offer online unassisted capabilities, but in a single carrier environment, there’s no comparison shopping available to the consumer. Even carriers don’t have our advanced hybrid solutions. Historically, carriers have enjoyed brand recognition in this space. However, we believe that with disruption, consumer loyalty is starting to shift from carriers to brokers. One constant relationship amongst plan changes.

Brand will play an increasingly important role in the distribution market, and we believe that we have a strong advantage here. Our branded marketing is an important element of the overall strategy and a key differentiator. Launched in 2023, it is quickly gaining traction. If you haven’t seen our Medicare Matchmaker ads, I encourage you to do so. In the fourth quarter of 2024, 80% of Medicare applications came through eHealth branded channels, whether that was TV, paid search, or direct mail. Prior to 2023, the company relied on predominantly third-party sources. Why is that important? Branded channels deliver higher profitability through better conversion and stronger retention.

In fact, given the disruption in the market last year and what we expect this year, we strongly believe that we have yet to realize the full impact on retention that will be related to the branded marketing investment that the company has made. Customers know who they’re working with and they trust us, resulting in stickier enrollments. In fact, brand is one of the key drivers behind our recent margin expansion. Ahead of this year’s open enrollment, we are cascading our brand down to our online platform. Match Finder will complement Medicare Matchmaker, bringing together brand and technology. Our omni-channel platform is designed to meet consumers’ diverse needs. A wide range of preferences and tech proficiency exists in the consumer market.

I would especially call out features that are unique to eHealth: our co-browsing capabilities, our live chat with licensed advisors, our one-way video calls where agents can give live advice and protect the privacy of the consumer, and then our hybrid approach that has text links capabilities to apply. In addition to providing superior consumer experience, digital capabilities also allow for greater scalability during peak times when industry wait times can be over an hour. This also removes the agent component of the acquisition cost related to online unassisted enrollments. We continue to invest in technology. Our AI-powered voice agent, launched in April of 2024, is ready for deployment this open enrollment. We’ve gotten great feedback from our consumers during the pilot, and it enhances the customer experience as well as expanding telesales capability during peak periods and all the while reducing costs.

Now, I’ll spend a moment on our financial summary. We’ve made tremendous progress on profitability over the past three years, including $111 million in cumulative EBITDA improvement and $99 million of improvement in operating GAAP net income, both achieved while continuing to grow our revenue. Our 2024 guidance reflects a tough comp versus last year’s open enrollment, which had unprecedented disruption that drove consumer activity in our sector. That disruption allowed us to pull forward some of the growth that we previously earmarked for future years. Current guidance ranges call for approximately 3% revenue growth at the midpoint and flattish profitability year over year. We thought last year was unique, but we’re just days away from this year’s open enrollment, and it’s shaping up to be another unprecedented enrollment period. We think we are very well prepared.

Having a diverse portfolio will be more critical than ever, given that carriers are doing more cuts and market exits. We’ll be opportunistic and we’ll lean into demand if there is an opportunity to accelerate growth, but we will not chase enrollments below our LTV to CAC targets. Our three-year targets provided last year call for revenue compound annual growth of roughly 8% to 10% and 8% to 10% EBITDA margin. By 2026, we’re currently ahead of this goal with margins of roughly 14% last year. That translates into a 50% to 60% EBITDA compound annual growth rate. Our top-line expansion and margin improvement are driven by scaling Medicare Advantage, diversifying our product offerings, and leveraging our fixed costs and expanding enrollment margins through further brand adoption and tech impact. We’re currently on track to deliver these goals.

We expect to update our targets and extend the forecast in the next few months following open enrollment completion. Now, just a second on our receivable asset. This is a very important slide as it shows a significant discount at which we are trading to the contract receivable. The contract receivable represents receivables from the top insurers in the country. If anything, book value understates the true cash flow potential of the asset as we continue to generate cash above and beyond original expectations. We’ve experienced over $250 million of positive tail adjustments that we’ve booked since the adoption of ASC 606. With that, I’ll turn it back over to Pat.

Thank you, Derek. We’ll get right into questions. First one is kind of an open-ended question. There has been a well-publicized market disruption in the Medicare Advantage space. How do you think about the future of that program and the role of Medicare Advantage distribution?

Yeah, that’s a great question, Pat. Our perspective is that Medicare Advantage remains a very important program for seniors. Those products have great benefits. They have care coordination, and we believe the data shows and suggests better outcomes compared to traditional Medicare. I think it’s important to know that since the inception of Medicare Advantage, that penetration into that product type has grown to over 50% now. While the recent year and the expectation of this year’s disruption may cause that penetration to drop just a little bit, we don’t expect much, but maybe a little, it is important to note that CMS itself still expects penetration to grow to approximately 60% by 2030. That’s in the face of continued high number of Medicare eligible agents on a daily basis. We think the full sort of addressable market, if you will, will grow to roughly 80 million members by 2030.

The opportunity continues to grow because of the increased disruption in the space, where carriers are making their own decisions around underwriting choices that they need to make. That’s why a carrier-agnostic advisor like eHealth plays a very critical role. The top of that funnel is going to continue to increase, but at the same time, we also expect meaningful reduction in broker capacity as competitors exit and downsize, which again will create significant opportunity for eHealth to gain market share. Lastly, Pat, we would say that regulatory headwinds are easing in this market under this current administration. We would note that 2026 Medicare Advantage rates are favorable, which has a positive flow through to broker commission around fair market value of the products that we sell.

Excellent. Something else that you talked about a little bit was the upcoming AEP and how that is looking like it also may be a bit of a unique period once again. Could you talk a little bit more about what you expect from AEP this year and what it means for your business?

Yeah, we’d love to address that. Certainly, everyone now knows that last year’s open enrollment or AEP was very disruptive, with many carriers changing plans, some leaving markets, and some terminating products. Others discontinued broker commissions on unprofitable plans. I think it’s important to note that eHealth navigated that disruption better than brokers with a more concentrated geographic and carrier offering in their portfolio. We captured market share at attractive unit economics just as competitors were exiting or downsizing their business. We’re seeing signs of another highly dynamic open enrollment as carrier strategies and relative attractiveness of their offerings continue to shift. We expect another wave of benefit changes, cancellations, and market exits. Carriers are also placing greater accountability on their distribution partners for enrollment quality, customer experience, and retention.

The gist of that, Pat, is that success will require scale in this market and the ability to deliver high-quality targeted enrollments. Again, we think eHealth is better positioned than most to take advantage of that environment, given our broad product portfolio and carrier relationships, our brand recognition, our quality of our sales organization, and our differentiated tech-driven enrollment channels. I would also point out that in the last few years, in fact, most recently, we’ve received from four top national carriers, eHealth has received both quality and retention awards for the quality of the book of the business that we continue to produce.

Great. As we go along here, I want to continue to weave in questions from the audience. One that we just got is as follows: How should we think about the operating cash generation potential of eHealth?

Yeah, John, I’m going to let John Dolan maybe take that one.

John Dolan, eHealth: Sure. Thanks, Pat, for that question. As we look into the future, obviously with the increase in the CMS rates, that’ll have a positive impact on our cash flows. We continue to look at our spend and our fixed costs and make sure we have that right balance between growing revenue and generating positive cash flows.

Excellent. Just to touch back on AEP, that’s always a big discussion for a company like yours. Beyond AEP, could you talk about the growth drivers outside of AEP that are key for the company?

Derek, CEO, eHealth: Yeah, I would love to do that. I do want to make maybe a follow-up point to John’s comments on cash generation. I would point back to a comment I made in the deck presentation around the investment that eHealth is making in our brand in terms of the way that we’re creating brand recognition, creating demand. We fully believe that that’s going to lead to higher retention in our book of business, which means more cash flow on a per policy basis that we sell over the life of the policy. Again, because of the uniqueness of the last open enrollment and what we’re going to experience again this year, we think we’ve yet to fully realize the opportunity that we’re going to see based on our brand recognition.

As it relates to our growth drivers, I would say that our growth strategy includes continuing to scale our Medicare Advantage business, where we see significant remaining potential. Diversification initiatives also include expanding our product portfolio, Medicare Supplement, our ancillary product business, such as hospital indemnity plans, which we’ve seen incredible growth year over year from 2024 to 2025. Those policies can be sold year-round. They address some of the challenges that we have as it relates to the open enrollment period and the fixed costs, obviously, that we carry during the remaining three quarters. We’ll continue to leverage our tech platform into the emerging ICRA opportunity that I mentioned. All of those initiatives will diversify our in-markets, reduce seasonality, and improve the cash flow profile of the company.

I would just say longer term, we’ll continue to look for opportunities and examine places in healthcare services and products that our installed membership base already purchases today, where we’ll take advantage long-term of the trusted relationship that we’re creating that’s being driven by our brand investment.

Excellent. Next, I wanted to touch on a key differentiator for you, which is that self-serve platform. I guess the question is, you know, when a consumer completes the process through the self-serve platform, what is the required final agent action to guarantee that they are the agent of record to receive credit for the sale? Are there varying degrees of agent involvement depending on the situation?

Yeah, that’s a great question, Pat. In our answer, I’ll just say I’m going to answer the question, but it’s important to note this is something that really differentiates eHealth from other people that we compete with. We have full back-office integrations with every major Medicare carrier. Those integrations date back to when we pioneered end-to-end online enrollments in the under 65 market, which was our legacy product. For eHealth, no agent action is necessary if customers want to complete the enrollment online. At the same time, as I covered during the presentation, we have a variety of hybrid solutions for customers who want to use self-service tools but need some degree of assistance along the way. That could be through our chat function, our co-browsing function as examples. Those are driven by customer preference versus need to confirm the broker of record. Again, a very important distinction.

During last year’s open enrollment, our online unassisted accounted for 26% of our total Medicare Advantage enrollments and partially assisted made up approximately 44% of our total enrollments. A high percentage of our consumers and our enrollments are becoming more and more comfortable with our online unassisted platform and the varying capabilities that we have, again, to interact with them when and where they want to be interacted with.

Again, could you piggyback on that just a bit in terms of the unit economics advantages that you may have by having that omni-channel and online unassisted sales channel?

Yeah, it’s a great question, Pat. Again, our digital capabilities allow for greater scalability. Maybe, again, what’s a bit unique about our capabilities at this point in time is that we can do that without causing our consumer experience to deteriorate. We can continue to provide superior consumer experience through those digital capabilities. We can lean into extra demand during open enrollment through channels that drive a high online unassisted %—channels like paid search and affiliate online. Others that we compete with are constrained by agent headcount. They have constraints around available cash to invest into the number of licensed seats that they have. Those constraints are much less for eHealth because of our digital capabilities. What we’ve referred to as CAC or customer acquisition cost is comprised of two elements. The first one is the marketing or demand generation expense. The second one is the agent cost.

For online unassisted, agent cost is zero, and that’s what really drives that scalability. One of the drivers of our most recent margin expansion has been greater online unassisted adoption. Enrollment margin went from 31% in Q4 of 2022 to 50% in Q4 of last year, 2024. Now, 26% of our Q4 apps were online unassisted, so there’s definitely continued room for expansion. In our under 65 business at its maturity, we were at 90+% online unassisted enrollments.

Great. I just want to weave in another question from the audience. Audience members are asking about free cash flow generation. Could you comment any on sort of what the path to that might look like for the company?

Sure. Again, I’m going to let John take it, and I’ll comment after.

John Dolan, eHealth: Yeah, similar to the prior question that was asked on operating cash flow, we are definitely looking at all things that generate cash flow. Obviously, diversification that we’ve touched upon. We’re looking at different products and services that are more cash positive on day one versus Medicare Advantage, which we all know takes time before the payback of the costs occur. The other thing is we continue, as we mentioned, the brand, we continue to execute on our brand strategy. That is making our process much more efficient between our marketing strategy as well as our agent strategy. We continue to roll out tools to our agents that make the process more efficient and obviously saves money. From a free cash flow perspective, the difference between the operating cash flow and the free cash flow is our CapEx and our software cap.

We continue to monitor our spending on those areas as well.

Derek, CEO, eHealth: Yeah, Pat, I would maybe add just a couple of things to that. First, I think it’s important to realize the progress that the company’s made over the last three to four years under Fran Soistman’s leadership, specifically addressing admin cost and taking a material amount of admin cost out of the system, if you will. We’re not where we want to be. We got a long way to go, but we’re keenly focused on that requirement, and our board is keenly focused on that as well. I’m confident that we’re going to continue to make progress through multiple ways. John mentioned through diversification, whether that’s product or markets. We’ll continue to see gains and efficiencies through our technology platform, and we’ll continue to be very mindful about our general admin expenses.

Excellent. That actually leads really well into my next question, which has to do with the seasonality of the business and steps you’re taking to mitigate that. Of course, that’s a big topic in this industry with the AEP-centric model. Could you just talk about what other opportunities that you’re pursuing might be?

I’ll maybe break those down into the way I think about it in terms of near term and maybe some things that we’re thinking about more longer term. In the near term, everything that we have in flight around diversification initiatives helps with this seasonality challenge that we have with Medicare Advantage. Medicare Supplement and ancillary products, as I mentioned earlier, such as hospital indemnity, final expense plans, and the life space can be sold year-round, and we can leverage our full-time agent force throughout the year to sell those products. Again, significant progress specifically in the hospital indemnity plan year over year in terms of the number of sales and the penetration that we’re realizing. Our newer market that I referenced, the Individual Coverage Health Reimbursement Arrangements (ICRA), also has enrollment periods that don’t fully overlap with AEP.

As that scales, it’ll help us absorb some of the fixed costs during the slow Medicare Advantage quarters. It’s important to note it does not utilize the same agent force as the Medicare Advantage business. Finally, we’ve implemented a more flexible structure in our telesales organization. This is important that it combines full-time licensed agents along with seasonal licensed benefit advisors. What we’ve seen and what we continue to develop is there’s a portion of our sales force that they don’t want to work year-round. They want to work during open enrollment. It benefits them. It benefits us from a cost structure perspective, and it allows us to adjust that capacity more efficiently to the seasonal pattern of the Medicare business. Pat, longer term, as I mentioned, we’re focused on identifying and expanding into, again, healthcare services or products that, quite frankly, our membership, our consumers buy today.

As we create that trusted advisor relationship through that brand investment, we believe it’s going to unlock the potential and opportunity for us to interact with that consumer in meaningful and different ways to help them meet the needs that they have on an everyday basis.

Great. If I might just squeeze in one more question, we’re running up on time here, could you comment on the liquidity position for the company and if there are any needs in order to, you know, for strategic needs or operational needs, anything you could say about liquidity?

Yeah, so quickly, I think it’s important for everyone to know we have ample liquidity today to support our strategic and operational plans. We finished the third quarter with over $100 million in cash on our balance sheet. As you know, we don’t have any significant debt on the balance sheet. The debt that we do have, we have a $70 million term loan. We just successfully completed and announced publicly that we’ve extended that maturity with our lender until Q1 of 2027. Previously, it was going to mature in the first quarter of 2026. We’ve sort of addressed that near-term potential demand for cash, and we’re grateful for the partnership that we have with our lender. In addition, we have a preferred equity instrument on the balance sheet with the first possible redemption date in 2027.

It’s important to know, it’s important for investors to understand that that is not a mandatory redemption. There’s nothing mandatory coming in 2027 that would require a cash outlay by the company. As we shared on our last earnings call, efforts are underway, and they continue to enhance our capital structure and to monetize our receivables. We have a very low appetite for diluting our common shareholders, and we’re working towards a transaction that will be acceptable for all key stakeholders: the company, our shareholders, and our preferred shareholder.

Great. Derek and John, I really want to appreciate you guys for being here today. It was an excellent presentation, and thanks to all the audience members for joining us.

Thanks, Pat. Again, we appreciate the opportunity, and again, thanks to the participants for taking time to learn about eHealth. We look forward to meeting you along the way.

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