Shares of UnitedHealth Group (UNH) tumbled 20% in premarket trading Thursday after the healthcare giant’s first-quarter results fell short of analysts’ estimates and it cut its profit forecasts for 2025.

UnitedHealth reported adjusted earnings per share (EPS) of $7.20 on revenue that rose 10% year-over-year to $109.58 billion. Analysts polled by Visible Alpha had expected $7.25 and $111.46 billion, respectively.

The Eden Prairie, Minn.-based company lowered its 2025 EPS outlook to a range of $24.65 to $25.15 and its adjusted EPS projection to $26 to $26.50. Last quarter, UnitedHealth said it expected to generate full-year EPS of $28.15 to $28.65 and adjusted EPS from $29.50 to $30.00.

UnitedHealth attributed the outlook cuts to “heightened care activity indications” in its Medicare Advantage business, and “unanticipated changes in the profile of Optum Health members impacting planned 2025 reimbursement.”

CEO Andrew Witty said the company “did not perform up to our expectations, and we are aggressively addressing those challenges to position us well for the years ahead.”

UnitedHealth shares entered the day up about 16% since the start of the year, recovering from a February slump following a report that the U.S. Department of Justice was investigating the company’s diagnosing practices.