GoHealth, Inc. (GOCO): Business Model Canvas [Dec-2025 Updated]

You're looking at GoHealth, Inc. right in the teeth of a tough Medicare Advantage cycle, and honestly, their recent performance shows a deliberate, almost painful pivot away from pure acquisition. After years of growth, the strategy is clearly about protecting that high-quality member back-book and managing capital, which is why they secured that new term loan facility and are pushing a retention-first model, aiming to keep their Direct Operating Cost per Submission below the $522 seen in Q1 2025. To see exactly how they are retooling their entire operation-from their agent force to their tech spend-you need to break down the nine blocks of their Business Model Canvas below.

GoHealth, Inc. (GOCO) - Canvas Business Model: Key Partnerships

You're looking at the relationships GoHealth, Inc. (GOCO) relies on to operate its marketplace, especially after the significant capital restructuring in mid-2025. These partnerships are the backbone for both distribution and operational stability.

The core of the distribution network involves relationships with health insurance carriers. GoHealth, Inc. maintains contractual agency relationships with major national and regional health insurance carriers. The scale of this network is substantial, with the company serving 300+ as of early 2025.

Key carriers mentioned in recent filings for the twelve months ended December 31, 2024, included United, Humana, Elevance, Aetna, and Centene. These relationships are typically non-exclusive and can be terminated by either party on short notice.

The operational and strategic flexibility heading into the critical Medicare annual enrollment period was bolstered by new financing secured in August 2025. This involved a new senior secured superpriority term loan facility.

Here's the quick math on that August 2025 capital action:

• The total facility was $115 million.
• This included $80.0 million in new-money term loans.
• An additional $35.0 million came from roll-up loans.
• The facility created debt basket capacity of up to $250.0 million for potential transformative transactions.
• Lenders received 4,766,219 shares of Class A common stock.

The financing package was structured to waive near-term principal payments through 2026 and reset financial covenants, providing runway to fund operations for at least the next 12 months.

The following table breaks down the key components of the August 2025 financing, which directly involved financial institutions and strategic lenders:

GoHealth, Inc.'s proprietary technology platform is a key resource, heavily dependent on data providers. This platform leverages modern machine-learning algorithms. The foundation for these algorithms is powered by over two decades of insurance purchasing behavior data.

You should note the structure of the new debt; the super-priority loan carries a high rate, Term SOFR + 5.50% (with a 3% floor) or ABR + 4.50% (with a 4% floor), plus a cash MOIC premium of up to 2.0x. That's expensive capital, but it bought time. Finance: draft 13-week cash view by Friday.

GoHealth, Inc. (GOCO) - Canvas Business Model: Key Activities

Developing and maintaining the proprietary technology platform

• Leverages modern machine-learning algorithms, powered by over two decades of insurance purchasing behavior.
• Deployed PlanFit technology and the PlanGPT AI assistant to improve plan comparisons.
• AI tools cut average call time by 10 minutes in 2024.
• Continued investment in AI and automation to improve agent effectiveness.

Executing a retention-first strategy for the existing member base

• Intentionally reduced Medicare Advantage volume to prioritize renewal stability and member quality.
• Reinforcing objective guidance to members, confirming a member's current plan when appropriate.
• The GoHealth Protect product suite generated approximately $8 million in Q2 2025 revenue.
• Focus on the retention and engagement model.

Managing a large, internal network of licensed insurance agents

• The ability to sell Medicare-related health insurance plans is largely dependent on licensed health insurance agents.
• Agents offer unbiased advice to help customers navigate plan selection.
• The company maintains necessary agent/broker licenses in each respective state requiring insurance transactions through a licensed agent/broker.
• A contact number associated with speaking to a licensed insurance agent has a review rating of 4.8 out of 5 based on 42,976 reviews.

Strategic capital management and industry consolidation assessment

GoHealth, Inc. executed strategic capital actions in mid-2025 to enhance financial flexibility and position for consolidation. The company has 2,746 employees as of late 2025.

GoHealth, Inc. (GOCO) - Canvas Business Model: Key Resources

You're analyzing the core assets GoHealth, Inc. (GOCO) relies on to operate and pursue its strategy in the consolidating Medicare market as of late 2025. These resources are what the company is actively preserving while pivoting toward retention and stability.

Proprietary technology platform leveraging machine-learning

The technology is central, using modern machine-learning algorithms. This system is powered by data spanning over two decades of insurance purchasing behavior to match consumers with plans. Following the strategic pullback in Q3 2025, GoHealth explicitly stated it is sustaining this core infrastructure, including its agent enablement technology, to be ready when market conditions stabilize.

• Technology powered by over two decades of insurance purchasing behavior data.
• Core infrastructure, including agent enablement technology, is being preserved.
• Platform is designed to offer personalized plan recommendations.

High-quality member 'back-book' (existing policyholders)

The current strategy heavily emphasizes a 'retention-first' stance. This means protecting the quality and durability of the existing member base, which is the value inherent in the 'back-book.' The company is reinforcing guidance to confirm a member's current plan when appropriate to safeguard this asset. While specific size metrics aren't current for late 2025, the strategic intent is to preserve this back-book value.

• Strategic focus on retention to protect member quality and durability.
• Preserving core retention operations is a stated priority.
• The company is maintaining a leading position in Special Needs Plans (SNP) categories.

Licensed, captive agent workforce for enrollment and retention

The licensed agent workforce remains a key channel, evidenced by their strong contribution to Q1 2025 Submissions. While the company is streamlining operations, the agent enablement capabilities are being sustained as a core resource. The total employee count provides a proxy for the scale of this workforce, though not all employees are licensed agents.

Liquidity and financial flexibility from the new term loan facility

To enhance financial flexibility heading into the Medicare Annual Enrollment Period, GoHealth, Inc. executed significant capital actions in August 2025. This provided immediate cash and capacity for future strategic moves. You need to see the scale of this financing to understand the current liquidity position.

The company's Q3 2025 performance reflected this pivot, with Net Revenues at $34.2 million and an Adjusted EBITDA of $(47.1) million, underscoring the focus on conserving cash while maintaining these key resources. Finance: draft 13-week cash view by Friday.

GoHealth, Inc. (GOCO) - Canvas Business Model: Value Propositions

You're looking at the core value GoHealth, Inc. (GOCO) delivers to its customers-the Medicare-eligible population-as of late 2025. It's about cutting through the noise in a complex market.

Simplifying complex Medicare plan selection via technology and agents

GoHealth, Inc. positions its technology, like the PlanFit technology, alongside licensed agents to make plan selection less of a headache. The focus on agent effectiveness is clear from their operational metrics, showing a drive to make each interaction count. For instance, in the first quarter of 2025, the company saw its Submissions (completed and approved applications) jump by 40.2% year-over-year, reaching 303,026. This growth was heavily driven by their internal captive agents.

The company is actively working to lower the cost associated with acquiring a new member, which directly impacts the efficiency of their agent-supported model. The Direct Operating Cost per Submission in Q1 2025 was $522, marking an 18.4% improvement compared to $640 in the prior year period. This efficiency gain suggests technology and agent enablement are key value drivers.

Here's a quick look at some of those operational efficiency points from the first quarter of 2025:

Objective, retention-focused guidance, even confirming a member's current plan

Following market rationalization in 2025, GoHealth, Inc. explicitly shifted its operating stance to prioritize member retention and quality over raw volume. Management signaled this 'retention-first strategy' involves reinforcing objective guidance, which includes confirming a member's current plan when that is the most suitable option for protecting the quality and durability of the member base. This commitment to objective guidance is a direct value proposition against high-pressure sales tactics common in the industry.

This strategic pivot was evident in the third quarter of 2025, where net revenues fell 71% year-over-year to $34.2 million, reflecting an intentional reduction in Medicare Advantage volume aligned with carrier priorities for stability and unit economics. The company is focusing on its 'back-book value' and retention operations, preserving capabilities required to lead when market conditions stabilize.

Access to a curated marketplace of diverse health and ancillary plans

GoHealth, Inc. offers access to a marketplace of health plans, and as of 2025, they are actively diversifying this offering. Beyond core Medicare, the company launched GoHealth Protect, which includes expansion into guaranteed acceptance life insurance to extend customer relationships. This shows a move to offer a broader suite of coverage options to existing and new customers.

The company's valuation metrics as of late 2025 reflect the market's view of its sales potential relative to its size. The Price-to-Sales (PS) Ratio was reported at 0.1x, which is considered good value compared to the US Insurance industry average of 1.1x. As of December 2025, the market capitalization stood at $87.86 Million USD.

Specialized expertise in Special Needs Plans (SNP) enrollment

GoHealth, Inc. maintains a stated leadership position in Special Needs Plans (SNP) enrollment, a segment where health plans continue to allocate resources. This specialization addresses the needs of a specific, complex subset of the Medicare population. Nationally in 2025, SNPs accounted for 21% of total Medicare Advantage enrollees, totaling nearly 7.3 million beneficiaries.

The company's focus aligns with the fastest-growing SNP categories. Specifically, Chronic Condition SNPs (C-SNPs) saw their enrollment increase to 1.2 million enrollees in 2025, representing 16% of all SNPs. Furthermore, the largest segment, Dual Eligible SNPs (D-SNPs), comprised 83% of all SNP enrollees in 2025. GoHealth, Inc. is investing in technology, such as PlanGPT and targeted routing, to enhance its capabilities in this specialized area.

Key SNP market statistics for 2025:

• Total Medicare Advantage (MA) enrollment: 34.1 million beneficiaries.
• Share of MA enrollees in SNPs: 21%.
• Total SNP enrollment: Nearly 7.3 million beneficiaries.
• D-SNP enrollees as a percentage of total SNPs: 83%.
• C-SNP enrollees as a percentage of total SNPs: 16%.

Finance: review Q3 2025 cash burn rate against the stated liquidity of approximately $32 million cash on hand plus access to a $40 million super-priority facility by Monday.

GoHealth, Inc. (GOCO) - Canvas Business Model: Customer Relationships

You're looking at how GoHealth, Inc. manages the people who buy their insurance. It's a mix of human guidance and digital tools, which makes sense in the complex Medicare space.

High-touch, personalized service through licensed agents

GoHealth, Inc. relies heavily on its internal licensed agents to drive new business. This high-touch approach is key to navigating plan selection for consumers.

For the first quarter of 2025, Submissions (completed and approved applications) hit 303,026, which was a 40.2% increase compared to the 216,148 Submissions in the first quarter of 2024. This growth was primarily driven by strong contributions from GoHealth's internal captive agents. The company's proprietary technology platform is designed to work alongside these agents, using machine-learning algorithms powered by over two decades of insurance purchasing behavior to better match a plan to a consumer's specific needs. This unbiased, technology-driven marketplace is coupled with these highly skilled licensed agents.

The focus on agency-driven volume is clear in the revenue mix shift. Non-agency revenue, which covers services where GoHealth is not the agent of record, fell from 46.4% of total Medicare revenue in the first quarter of 2024 down to just 14.5% in the first quarter of 2025. This shift impacts how performance is measured, as Sales per Submission decreased by 15.4% to $724 in the first quarter of 2025 from $856 in the same period in 2024, largely because non-agency revenue typically carries a higher Sales per Submission value.

Retention-first engagement model to protect member quality

The market dynamic in late 2025 forced GoHealth, Inc. to double down on keeping existing members, which health plans value for margin integrity and stability. The company explicitly reinforced a Retention-First Strategy.

This strategy involves reinforcing objective guidance-confirming a member's current plan when it is appropriate-to protect the quality and durability of the member base. This focus is a direct response to health plans emphasizing renewal stability and long-term member value over raw enrollment growth. During the last Annual Enrollment Period (AEP), GoHealth reported nearly 30,000 PlanFit confirmations, indicating successful use of their tools to validate the best plan for existing members.

The company's operational focus in Q3 2025 included preserving the core capabilities required to scale when market conditions stabilize, which specifically includes the retention and engagement model.

Ongoing post-enrollment support and engagement services

Customer relationship management extends beyond the initial enrollment. GoHealth, Inc. supports its members throughout the year, which is crucial for retention and future cross-selling opportunities.

In 2024, GoHealth supported nearly 3 million Medicare consumers in assessing their benefit options. Furthermore, the company is diversifying its product offerings to cover unexpected life events, evidenced by the launch of the GoHealth Protect suite, with guaranteed acceptance life insurance as the inaugural product. This expansion aims to enhance customer value beyond core health insurance.

The use of technology also directly supports ongoing service efficiency:

• AI tools cut average call time by 10 minutes in 2024.
• Proprietary tools like PlanGPT are deployed to support licensed agents and improve plan comparisons.

Technology-driven self-service options via the marketplace

While agents are central, the marketplace itself is a technology-driven platform designed to simplify plan selection. This technology underpins both agent effectiveness and potential self-service pathways.

The platform leverages modern machine-learning algorithms to reimagine plan matching. The company's PlanFit technology, backed by analytics from nearly 30 million consumer touch points, is designed to match every consumer with the best plan based on their profile and priorities. This technology is central to improving the consumer journey, even as the company intentionally reduced Medicare Advantage volume in response to market shifts.

Here is a look at key operational metrics that reflect the efficiency of the agent-technology interaction as of the first half of 2025:

The improvement in Direct Operating Cost per Submission to $522 in the first quarter of 2025, an 18.4% improvement from $640 in the prior year period, shows that technology and training programs are driving agent productivity gains.

GoHealth, Inc. (GOCO) - Canvas Business Model: Channels

You're looking at how GoHealth, Inc. gets its business done, specifically how they connect with the millions of consumers needing Medicare and other insurance plans. The channel strategy is clearly bifurcated, moving toward a higher-quality, agent-driven model as of late 2025.

Direct-to-Consumer (DTC) digital marketplace and web properties

The digital marketplace is the front door, powered by proprietary technology and machine-learning algorithms designed to match consumers to plans. This channel feeds both the internal agents and, historically, non-agency contracts. The shift in focus in late 2025 suggests a recalibration of this channel's role, prioritizing quality leads over sheer volume.

The company's technology platform supports over 10,000 unique insurance plan variations across multiple states.

• Digital conversion rate was cited at 22.5% for fiscal year 2022, though this specific metric for late 2025 isn't public.
• The company launched GoHealth Protect, expanding into guaranteed acceptance life insurance, which contributed to 'Other Revenue' growth in Q3 2025.

Internal captive agents operating via call centers

This is where GoHealth, Inc. is placing its primary bet for quality volume, as evidenced by the Q1 2025 results. The internal captive agents use technology tools like PlanFit CheckUp and Customer 360 to enhance their service delivery. The focus here is on driving submissions through this high-touch channel.

Submissions driven by internal captive agents were the primary driver of growth in the first quarter of 2025. Here's the quick math on that period:

The improvement in Direct Operating Cost per Submission to $522 from $640 in the prior year period shows better capital efficiency within this core channel.

Partner marketing channels (reduced volume in late 2025)

This channel, often associated with non-agency revenue streams, saw a significant strategic pullback as the company prioritized retention and quality member base preservation through the 2025 Annual Enrollment Period (AEP). The results from the third quarter of 2025 clearly reflect this intentional reduction in volume from these sources.

The shift is evident when comparing revenue breakdowns from earlier in the year to the Q3 2025 results. For instance, in Q1 2025, Partner Marketing and Other Revenue was $20,524 (in thousands), while Non-Agency Revenue was $31,771 (in thousands). By Q3 2025, net revenues overall declined to $34.2M, with management noting meaningful declines in non-agency activity.

This channel dynamic is summarized below based on the Q1 2025 data, which precedes the reported late-year pullback:

If onboarding takes 14+ days, churn risk rises, which is a key reason for focusing on the captive agent model over potentially lower-quality partner flows.

GoHealth, Inc. (GOCO) - Canvas Business Model: Customer Segments

Seniors eligible for Medicare (Medicare Advantage, Supplement, PDP)

GoHealth, Inc. serves consumers navigating Medicare coverage options through its technology-driven marketplace and licensed agents.

• Consumers trusting GoHealth, Inc. as of a recent report: 10 million.
• Total Medicare Beneficiaries (Parts A & B) in the US market in 2025: approximately 62.8 million.
• Medicare Advantage (MA) enrollees in the US market in 2025: 34.1 million, representing 54% of eligible beneficiaries.

The company's revenue streams are disaggregated based on the Medicare product sales model for the three months ended March 31, 2025:

For the first quarter of 2025, GoHealth, Inc. reported 303,026 Submissions. The Direct Operating Cost per Submission for Q1 2025 was $522.

Individuals qualifying for Special Needs Plans (SNP)

This group is a subset of the broader Medicare Advantage segment, focusing on beneficiaries with specific needs.

• In the US market in 2025, 21% of Medicare Advantage enrollees are in Special Needs Plans (SNPs).
• Total C-SNP (Chronic SNP) enrollment in the US market in 2025 was approximately 1.2 million people.

Consumers seeking ancillary products like guaranteed acceptance life insurance

GoHealth, Inc. has expanded its offerings beyond core health insurance products.

• The company launched GoHealth Protect, with guaranteed acceptance life insurance as the inaugural product.
• Other Revenue for GoHealth, Inc. in Q1 2025 was $1,568 thousand.

The overall financial performance for the three months ended September 30, 2025, included a Net Loss of $313.9 million and Adjusted EBITDA of $(47.1) million. Net revenues for that period were $34.2 million.

GoHealth, Inc. (GOCO) - Canvas Business Model: Cost Structure

The Cost Structure for GoHealth, Inc. (GOCO) is heavily weighted toward variable costs directly tied to generating insurance Submissions, though fixed costs for technology and overhead remain a focus for reduction as of late 2025.

Direct Operating Cost per Submission is a critical metric management uses to gauge efficiency, and it showed significant improvement in the first quarter of 2025.

This reduction to $522 per Submission in Q1 2025, down from $640 in the prior year period, is a testament to targeted marketing strategies and efficient agent performance.

Variable costs for customer acquisition (marketing and advertising) are a major component of the Direct Operating Cost of Submission. These costs are explicitly described as direct and variable with Submissions, driven by expenses for direct, online advertising, and marketing partner channels.

Agent compensation and consumer care/enrollment expenses are also embedded within the Direct Operating Cost of Submission, meaning they scale directly with the volume of applications processed. Consumer care and enrollment expenses primarily cover compensation and benefits for enrollment personnel assisting consumers through the application process, which is generally variable with Submissions.

• Variable costs included in Direct Operating Cost of Submission:
  • Revenue share (for external agents).
  • Marketing and advertising expense.
  • Consumer care and enrollment expenses.

Fixed costs for technology development and corporate overhead are actively being managed. You've heard CEO Vijay Kotte state that the company has significantly reduced overhead while continuing to invest in AI and automation. Technology expense, which is a key fixed/investment area, primarily consists of compensation and benefits for personnel developing and enhancing the technology platform, data analytics, and business intelligence systems. Corporate overhead would include general and administrative expenses, which also include compensation and benefits costs. The strategic focus is on reducing these fixed components while maintaining core technology investments that improve agent effectiveness and consumer experience.

Finance: draft 13-week cash view by Friday.

GoHealth, Inc. (GOCO) - Canvas Business Model: Revenue Streams

You're looking at how GoHealth, Inc. brings in money, and as of late 2025, the story is one of strategic realignment following a strong start to the year. The revenue picture clearly shows the impact of the company's decision to pull back from certain Medicare Advantage volumes.

The baseline for the year was strong. Q1 2025 Net Revenues were $221.0 million before the strategic pullback. That figure represented a 19.1% increase compared to the prior year period. This early performance was driven by solid execution in the core agency model.

The primary engine remains the Medicare agency business, which generates revenue through initial and renewal commissions from health plan enrollments. Looking at the second quarter, which reflects the initial impact of the strategic shift, the Medicare Agency Revenue component was substantial.

• Medicare Agency Revenue (Q2 2025): $81.17 million.
• Commission Revenue component within that (Q2 2025): $73.32 million.

This indicates that the core commission-based business, which you'd expect from an agency model, still forms the bulk of the recognized revenue, even as total revenue contracted later in the year.

Non-agency revenues from enrollment and engagement services saw a significant contraction as GoHealth, Inc. executed its strategic pullback from the Medicare Advantage space starting in May 2025 due to health plan uncertainties. This segment took a major hit, which is clear when you look at the Q2 figures.

• Non-agency revenue declined by 79.4% year-over-year in Q2 2025.
• Other Non-Agency Revenue for Q2 2025 was reported at $8.42 million.

To counter seasonality and diversify the top line, GoHealth, Inc. launched the new GoHealth Protect product suite. This suite, which includes guaranteed acceptance life insurance, is designed to be a scalable, cash-flow supportive complement to the core business. This new stream showed early traction.

The revenue contribution from this new product was a bright spot in the second quarter. Specifically, the GoHealth Protect initiative generated $8.7 million in revenue in Q2 2025, meeting performance expectations for its ramp-up phase.

The sequential decline in overall revenue through the third quarter highlights the effect of the strategic adjustments made mid-year. Here's a quick look at the top-line trend across the first three reported quarters of 2025:

For context on the trailing twelve months as of September 30, 2025, GoHealth, Inc.'s revenue was $738.34 million USD.