Macquarie's Hospital Claims Index, which monitors private hospital admission volumes and outlays, shows claims outlays growth was comfortably above the pre-COVID-19 trend during the second half of 2025 to date.
In a note to investors, Macquarie revealed positive unadjusted figures for the volume of procedures, cost per procedure, and total claims cost (outlays).
Source: Medicare, Macquarie Research, June 2025
Outlays growth over the period was +5.2% versus a +4.7% claims growth for the three months leading into COVID-19 (February 2020), the investor note said.
Using these trends, Macquarie forecasts industry net margins (as disclosed by APRA) to be lower in the second half of 2025 (versus H1 2025), albeit only slightly.
According to the note, this outlook includes the following assumptions:
- With the implementation of new accounting standards, DCLs (deferred claim liabilities) no longer exist. As a result, reported and underlying margins should be very close, except for cash-backs which are expected to conclude in the second half of 2025.
- A +230bps policyholder growth (+1.3% for ancillary and +2.5% for Hospital).
- A -120bps of net downgrading (compared with long-term averages of -1.4% downgrading) reflecting impacts of the Adult Dependent Reforms and higher conversion of immigration into private health insurance.
Overall, the results are positive, but what does it mean for stocks in the sector?
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ASX 200 health insurance stock outlook
According to Macquarie, the unadjusted figures underwrite a good H2 2025 for ASX-listed health insurance stocks Medibank Private Ltd (ASX: MPL) and NIB Holdings Ltd (ASX: NHF).
"Coming into results, PHIs [private health insurers] should serve as a relative safe haven in a tougher economic environment," Macquarie told investors.
This is "particularly due to the weak claims volumes this half".
As a result, the broker maintains its neutral recommendation and $4.25 target price on Medibank Private shares. This represents a 15.08% decrease from the $5.005 per share trading price at the time of writing.
Medibank Private's share price has enjoyed consistent growth over the past 6 months, increasing 12.1% throughout the 2025 calendar year so far and up 34.18% for the year.
The broker also maintains its underperform rating and $5.55 target price on NIB Holdings shares. This represents a small 0.09% increase from the $5.55 per share trading price at the time of writing.
NIB's share price has also risen since early January, up 2.77%. But the private health insurer suffered a sharp 17.74% drop in late August last year after following its full-year results announcement. Over the year, shares are 10.83% lower.
