CI vs ELV: How The Cigna Group and Elevance Health Compare (2026)

Same yardstick, side by side (as of July 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: CI 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. CI and ELV 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 CI and ELV 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.

The Cigna Group is a large US health-services company built around two main engines. Its Evernorth health-services arm includes Express Scripts, one of the largest pharmacy benefit managers (PBMs) in the country, plus specialty pharmacy, care services, and pharmacy-related businesses; this is now the larger revenue and growth driver. Its Cigna Healthcare arm sells commercial health insurance, primarily to employers and individuals, along with international and supplemental coverage. Cigna makes money by collecting insurance premiums and managing medical costs, and by earning fees and spreads on managing drug benefits, negotiating with manufacturers, and dispensing specialty medications at scale. After exiting most of its Medicare businesses, Cigna is increasingly weighted toward commercial insurance and pharmacy services rather than government programs. It is headquartered in Bloomfield, Connecticut, and serves employers, health plans, government entities, and individuals.

Full CI guide

Elevance Health (formerly Anthem) is a diversified health insurer and healthcare services company that covers roughly 45.6 million medical members as of mid 2025. Its Health Benefits segment sells commercial, Medicare Advantage, Medicaid, and ACA marketplace plans, operating Blue Cross Blue Shield plans across 14 states, while its fast-growing Carelon segment houses pharmacy benefits (CarelonRx) and risk-based care services. Operating revenue reached roughly $197.6 billion in 2025, with Carelon revenue climbing about 33 percent on CarelonRx growth and the CareBridge acquisition.

Full ELV guide

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

• CI drivers: Evernorth and pharmacy services scale; Stable commercial insurance core.
• ELV drivers: Carelon services and pharmacy expansion; Government programs repricing.

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: Cigna faces significant regulatory and political risk: PBMs are under scrutiny from Congress, the FTC, and states over drug-pricing practices and rebate models, and potential reform could pressure the economics of Express Scripts. For ELV, the dominant risk is medical cost trend: the benefit expense ratio (medical loss ratio) ran near 86.8 percent in Q1 2026 and rising Medicaid and Medicare utilization can compress margins faster than premiums reprice.

Pick CI if you believe its drivers more; ELV 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 CI and ELV guides.

CI. Cigna trades at a low earnings multiple relative to the broad market, a discount that reflects PBM regulatory risk and the optically huge but low-margin pharmacy pass-through revenue. The bull case leans on steady adjusted EPS growth, heavy buybacks, and Evernorth's scale; the discounted valuation is the market pricing in policy and drug-pricing uncertainty.

ELV. Elevance trades at a low double-digit earnings multiple, reflecting investor caution on medical cost trend rather than doubt about scale. Q1 2026 operating revenue was roughly $49.5 billion with adjusted EPS of about $12.58, and management raised full-year guidance while reaffirming its benefit expense ratio target near 90.2 percent. These figures are approximate and as of April 2026; verify current numbers before acting.

Headline figures (approximate, early 2026): CI shows revenue (ttm) ~$250 billion (inflated by pharmacy pass-through revenue), operating margin thin on a revenue basis (PBM pass-through), measured better on adjusted EPS, adjusted eps double-digit growth targeted over time, dividend yield ~2%; ELV shows revenue (ttm) ~$200 billion, fy2025 operating revenue ~$197.6 billion, fy2025 net income ~$5.7 billion, fy2026 adjusted eps guidance at least ~$26.75.

CI and ELV 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 CI and ELV exposure against your real portfolio. It is not an investment adviser.