ASTH vs UNH: Which Is the Better Buy in 2026?

Same yardstick, side by side (as of August 2026). Valuation lined up like this is most meaningful for two names in the same corner of the market, which these are. Figures are approximate; verify before investing.

Reading it: ASTH is the cheaper of the two on forward earnings, but cheaper is not the same as better. Pair the valuation with growth (how far the forward P/E sits below the trailing P/E) and risk (beta) before you decide.

The metrics above tell you which is the marginally better business. The bigger risk for most people is not picking the slightly worse stock, it is over-concentrating. ASTH and UNH share themes, so owning both, or adding either to what you already hold, can quietly push a large share of your portfolio into one bet.

This is the part a generic comparison page cannot answer, because it depends on what you own. Connect your brokerage and Walnut shows your real, combined ASTH and UNH exposure, flags overlap with your existing positions, and tells you if adding one would tip you past a concentration you are comfortable with, read-only by default, with your login staying at your broker. Walnut is not an investment adviser.

Astrana Health trades on Nasdaq under ASTH and was known as Apollo Medical Holdings (AMEH) until the 2024 rebrand. The company organizes independent physicians into risk-bearing networks and then contracts with health plans on a capitated basis, meaning it accepts a fixed per-member payment and keeps the difference if it can manage care for less. The business reports in three segments: Care Partners, the risk-bearing network arm that produces the large majority of revenue; Care Delivery, the owned and affiliated clinics; and Care Enablement, the technology and management-services platform that the networks run on. The membership base skews heavily toward Medicare Advantage, with Medicaid, commercial and ACO REACH or Medicare Shared Savings lives filling out the rest, and the geographic footprint is still concentrated in California even after expansion into Nevada, Texas and other states.

Full ASTH guide

UnitedHealth Group is the largest US health insurer and one of the largest healthcare companies in the world. It runs through two main engines. UnitedHealthcare is the insurance arm, providing employer, individual, Medicare Advantage, and Medicaid health plans to tens of millions of members. Optum is the faster-growing health-services arm: Optum Health (physician groups and care delivery, including value-based care), Optum Insight (healthcare data, analytics, and technology), and Optum Rx (one of the largest pharmacy benefit managers in the country). The combination lets UnitedHealth manage both the financing and the delivery of care, capturing margin across the system and using vast claims data to manage costs. Headquartered in Minnetonka, Minnesota, UnitedHealth is a Dow component and one of the largest companies in the S&P 500 by revenue. Its scale, vertical integration, and Medicare Advantage leadership define its competitive position.

Full UNH guide

Both fit overlapping themes, but they are not interchangeable. The useful comparison is which set of drivers and risks you want exposure to.

• ASTH drivers: The shift toward full-risk contracts; Membership growth through acquisition and network additions.
• UNH drivers: Optum growth engine; Medicare Advantage scale.

A faster-growing, richer-valued name usually swings harder, so it suits a longer horizon and a higher tolerance for volatility; a steadier, more cash-generative business suits a more conservative or income-minded investor. The honest test is which set of risks you could hold through a drawdown: The core risk is structural: with operating margin under 3%, a modest increase in medical cost trend or utilization can erase profitability across the capitated book, and 2023 through 2025 already showed net income falling from ~$60.7 million to ~$22.5 million even as revenue more than doubled. For UNH, unitedHealth faces a difficult medical-cost environment: rising utilization (especially in Medicare Advantage) can spike the medical loss ratio and compress margins, as the company has experienced.

Growth-minded investors who believe the theme has years to run tend to accept the richer multiple for more upside; value-minded investors lean toward the cheaper forward earnings and steadier profile. Pick ASTH if you believe its drivers more; UNH if you believe its. Many investors hold both, but since they share themes, that is a concentrated bet, not diversification. Decide deliberately and check overlap. For the full detail, see the ASTH and UNH guides.

ASTH. The valuation gap between a ~44x trailing multiple and a ~22x forward multiple is the whole debate in one number: it prices in the raised full-year 2026 adjusted EBITDA guidance of ~$255 million to ~$280 million actually landing. Note also that market cap of ~$1.76 billion sits at less than half of trailing revenue, which is normal for capitated healthcare because the company books the full premium dollar as revenue while keeping only a thin slice. Comparing ASTH on price-to-sales against a software or device company is therefore misleading; margin and cash conversion are the relevant lenses.

UNH. UnitedHealth's revenue is enormous but its insurance margins are thin by design, so earnings hinge on the medical loss ratio and Optum's higher-margin growth. The valuation reflects scale and integration but has been pressured by cost inflation, regulatory uncertainty, and reputational headwinds. The market weighs Optum's durable growth against insurance-cycle and political risk.

Headline figures (approximate, August 2026): ASTH shows market cap ~$1.76B, revenue (ttm) ~$3.84B, up ~59% year over year, net income (ttm) ~$40.6M, EPS ~$0.82, trailing p/e ~44x, forward P/E ~22x; UNH shows revenue (ttm) ~$400 billion, operating margin ~6-8%, net income (ttm) ~$15-22 billion (sensitive to medical costs), medical loss ratio ~85-89%.

ASTH and UNH are related but distinct: same themes, different businesses and risks. Neither wins in the abstract; the right pick is whichever thesis you actually believe, sized so you are not over-concentrated in one theme. Walnut can show your combined ASTH and UNH exposure against your real portfolio. It is not an investment adviser.