Executive Summary

Q4 2024 delivered record total revenue ($315.2M, +27% y/y), record GAAP net income ($97.5M, +87% y/y), record adjusted EBITDA ($121.3M, +74% y/y), and diluted EPS of $2.51, driven by Medicare Advantage submissions (+42% y/y) and materially improved unit economics .
Medicare unit margin expanded 16% y/y as total acquisition cost per MA‑equivalent approved member fell 23% and MA constrained LTV increased 2% to $1,174; MA LTV/CAC improved to 2.0x vs 1.5x a year ago, with unit margins rising from 34% to 50% .
FY25 guidance is cautious: revenue $510–$550M, adjusted EBITDA $35–$60M, GAAP net income (loss) −$10M to +$15M, operating cash flow −$25M to +$10M; management expects Q1 to be the primary growth quarter, with lower volumes in Q2–Q3 due to D‑SNP rule changes; guidance includes $0–$20M positive net adjustment revenue .
Potential stock narrative catalysts: blockbuster Q4 execution vs a measured FY25 outlook; D‑SNP changes suppressing mid‑year switching; Amplify (carrier‑dedicated) growing as share of revenue but at lower margin than agency; continued capital structure work (term loan maturity extended) .

What Went Well and What Went Wrong

What Went Well

“eHealth delivered outstanding fourth quarter results materially exceeding our expectations for enrollment volumes, revenue, and earnings,” highlighting share gains in MA and margin expansion on a transformed omnichannel platform .
Direct branded channels outperformed: >100% growth in Q4 enrollments from branded direct channels; online unassisted applications rose 58% y/y; aided brand awareness up 23% y/y .
Record commissions receivable reached $1.0B (+9% y/y), underpinning future cash collections from a high‑quality cohort; Medicare segment gross profit rose 56% y/y to $159.9M .

What Went Wrong

Amplify volume came in below expectations as carriers prioritized margin protection and success fees were limited; management still expects margin improvement as the model scales .
Employer & Individual (E&I) revenue declined 33% y/y to $9.4M; segment gross profit fell to $4.0M in Q4 (from $9.3M a year ago), reflecting resource reallocation to MA .
Positive net adjustment (“tail”) revenue fell to $7.6M vs $15.6M in Q4 2023, reducing the tail contribution; management indicated D‑SNP rule changes will reduce Q2/Q3 switching activity .

Financial Results

Quarter and Year-over-Year Comparison

Metric	Q4 2023 (oldest)	Q3 2024	Q4 2024 (newest)
Total Revenue ($MM)	$247.7	$58.4	$315.2
GAAP Net Income (Loss) ($MM)	$52.2	$(42.5)	$97.5
Diluted EPS ($)	$1.27	$(1.83)	$2.51
Adjusted EBITDA ($MM)	$69.6	$(34.8)	$121.3
Adjusted EBITDA Margin (%)	28%	(60)%	38%
Net Income (Loss) Margin (%)	21%	(73)%	31%

Segment Breakdown (Q4 YoY)

Segment	Q4 2023 Revenue ($MM)	Q4 2024 Revenue ($MM)	Q4 2023 Segment Gross Profit ($MM)	Q4 2024 Segment Gross Profit ($MM)
Medicare	$233.7	$305.8	$102.4	$159.9
Employer & Individual (E&I)	$14.0	$9.4	$9.3	$4.0
Consolidated Total	$247.7	$315.2	$111.6	$163.9

Commission Revenue Mix (Q4 YoY)

Product	Q4 2023 ($MM)	Q4 2024 ($MM)	YoY
Medicare Advantage	$192.6	$251.3	+30%
Medicare Supplement	$6.0	$7.8	+29%
Medicare Part D	$6.5	$6.5	+1%
Individual & Family (Total)	$5.7	$3.2	−43%
Ancillary	$3.3	$3.5	+8%
Small Business	$5.1	$3.1	−39%
Commission Bonus & Other	$(0.7)	$0.2	+127%
Total Commission Revenue	$218.5	$275.7	+26%

KPIs (Q4 YoY)

KPI	Q4 2023	Q4 2024	Notes
Total Medicare Approved Members	186,567	248,440	+33%
MA Approved Members	159,595	222,631	+39%
MA Constrained LTV ($ per approved member)	$1,151	$1,174	+2%
Total Acquisition Cost per MA‑equiv Approved Member ($)	$763	$591	−23%
MA LTV/CAC Ratio (x)	1.5x	2.0x	Unit margins from 34%→50%
Positive Net Adjustment (“Tail”) Revenue ($MM)	$15.6	$7.6	Lower tail
Commissions Receivable ($MM, end of period)	$918.2	$1,000.0	+9%

Note: No Wall Street consensus estimates were available via S&P Global for Q4 2024 at time of this analysis (tool access limitation). Where estimate comparisons would normally appear, values are noted as unavailable.

Guidance Changes

Metric	Period	Previous Guidance	Current Guidance	Change
Total Revenue ($MM)	FY2024	$470–$495	$500–$520	Raised
GAAP Net Income (Loss) ($MM)	FY2024	$(36.5)–$(22.0)	$(12.0)–$3.0	Raised (improved)
Adjusted EBITDA ($MM)	FY2024	$7.5–$25.0	$40.0–$55.0	Raised
Operating Cash Flow ($MM)	FY2024	$(10.0)–$0.0	$(15.0)–$(5.0)	Lowered (more negative)
Total Revenue ($MM)	FY2025	—	$510–$550	New
GAAP Net Income (Loss) ($MM)	FY2025	—	$(10.0)–$15.0	New
Adjusted EBITDA ($MM)	FY2025	—	$35.0–$60.0	New
Operating Cash Flow ($MM)	FY2025	—	$(25.0)–$10.0	New
Net Adjustment Revenue ($MM)	FY2025	—	$0–$20 (included)	New
Implied Adjusted EBITDA Margin (%)	FY2025	—	~9% midpoint (management commentary)	New

Earnings Call Themes & Trends

Topic	Previous Mentions (Q-2 and Q-1)	Current Period (Q4 2024)	Trend
AI/technology initiatives	Live Advise pilot; personalization; mobile improvements (Q2)	Establishing AI Center of Excellence; gen‑AI to automate plan data, call screening; broader roll‑out of Live Advise	Accelerating digitization
Brand & direct channels	Year‑2 “Medicare Matchmaker” campaign; omnichannel differentiation (Q3)	23% aided awareness increase; >100% growth in branded direct enrollments; 58% increase in online unassisted apps	Strengthening
Regulatory/macro (rates, rules)	Advocacy to CMS for AEP extension; election-season crowding (Q2)	D‑SNP switching curtailed (no quarterly changes), reducing Q2/Q3 volumes; Q4 may absorb some D‑SNP demand; monitoring final MA rates/marketing rules	Mixed—near-term headwind mid‑year, watch rates
Amplify (carrier‑dedicated)	Scaling, BPO shift to fee‑based; HITRUST certification (Q2/Q3)	Volume below expectations given market favoring choice platform; margin below agency but expected to improve with scale; <10% of revenue	Mixed; building pipeline
Capital structure & liquidity	Target positive FCF by Mar’25; plan to refinance (Q2)	Extended $70M term loan to Feb’26; sufficient liquidity; Q1 cash collections to uplift cash	Improving flexibility
Retention strategy	Match Monitor; loyalty (ePerks); retention team build‑out (Q2)	Recapture rate tripled y/y; increased retention headcount planned in 2025	Positive trajectory

Management Commentary

CEO: “We gained share in the Medicare Advantage market while also meaningfully expanding our Medicare enrollment margins… these results reflect unique Medicare market dynamics, which made the value proposition of our carrier‑agnostic choice platform more relevant than ever” .
CFO: “We generated record high revenue and record high net income of any quarter in the company’s history… Acquisition cost per approved Medicare member improved 23%… MA LTV/CAC was 2x, exceeding our 1.7x target” .
CFO on FY25: “Adjusted EBITDA is expected to be $35–$60 million… Q1 is expected to be our primary enrollment growth quarter… we expect declines in Q2 and Q3 and a flattish Q4 versus 2024” .
On Amplify: “Amplify volume came in below expectations… carriers were more focused on margin protection than enrollment growth; we plan to continue scaling it with both new and existing customers” .

Q&A Highlights

Regulatory outlook and MA rates: Management is pragmatic given administration change; watching final MA rates and marketing rules; past tough rate environments drive shopping, while good rates also spur switching—AEP demand is hard to predict this early .
D‑SNP changes and cadence: Most D‑SNP beneficiaries will no longer switch quarterly; Q2/Q3 marketing spend to be reduced; Q4 assumptions include more D‑SNP opportunities .
Amplify outlook: Despite below‑plan volume, pipeline building via carrier word‑of‑mouth; margins should improve with scale; remains <10% of revenue today .
Brand extension beyond Medicare: Efforts underway to replicate MA brand success across Med Supp and E&I; 23% awareness increase cited as foundation .
Retention: Proactive outreach to disrupted members; recapture rate tripled; increased retention team expected to improve cash collections over time .

Estimates Context

Wall Street consensus estimates for Q4 2024 were unavailable via S&P Global at the time of this analysis due to access limitations; therefore, explicit revenue/EPS/EBITDA comparison vs consensus cannot be provided. Management did significantly exceed its own revised FY2024 guidance ranges (raised on Dec. 17) and reported record Q4 revenue and earnings .

Key Takeaways for Investors

Q4 was a standout execution quarter: revenue $315.2M (+27% y/y), GAAP net income $97.5M (+87% y/y), adjusted EBITDA $121.3M (+74% y/y), and EPS $2.51; MA volume and unit economics drove the beat .
2025 is a reset year on cadence: management guides flattish revenue vs 2024 and lower adjusted EBITDA (midpoint ~9% margin) as D‑SNP rules curb mid‑year activity and diversification investments ramp .
Mix matters: Agency choice platform is the growth/margin engine; Amplify will grow as share of revenue but currently carries lower margins; expect gradual margin improvement as Amplify scales .
Retention compounding: Recapture and retention initiatives (Match Monitor, expanded retention headcount) should support cash collections and lifetime economics, especially after a high‑quality Q4 cohort .
Capital structure improved at the margin: term loan maturity extended to Feb’26; strongest cash collections season (Q1) should bolster liquidity near‑term .
Tail normalization: Net adjustment revenue (“tail”) was lower y/y in Q4 ($7.6M vs $15.6M); FY25 guidance embeds $0–$20M tail—investors should focus on unit‑economics‑driven growth rather than tail variability .
Watchlist items into H1: final MA rates/marketing rules, D‑SNP impacts on Q2/Q3 volumes, brand‑driven direct mix, Amplify pipeline/margin trajectory, and retention progress—each materially influences enrollment cadence and margin profile .

eHealth, Inc. (EHTH)·Q4 2024 Earnings Summary