UnitedHealth’s fourth-quarter earnings tumbled as costs from COVID-19 hit the health insurance provider, but results still easily beat expectations.

Health care use rebounded in the final quarter of 2020 after the global pandemic kept people away from doctor offices and surgery centers when it first spread earlier last year.

UnitedHealth also said Wednesday that its insurance business spent more in the quarter covering claims for COVID-19 testing and treatment. They accounted for 11 percent of all care activity, not counting prescriptions. That’s up from 6 percent in the third quarter.

Medical costs, by far the company’s largest expense, jumped 7 percent to more than $42 billion in the fourth quarter.

Overall net income for UnitedHealth Group Inc. fell more than 37 percent in the fourth quarter to $2.21 billion, and adjusted earnings totaled $2.52 per share.

That topped the average analyst forecast for earnings of $2.39 per share, according to a survey of analysts by Zacks Investment Research.

Total revenue climbed more than 7 percent to $65.47 billion, also surpassing analyst forecasts.

The results generated little surprise on Wall Street after UnitedHealth gave analysts an update on its business last month. The quarter turned out “slightly better” than the guidance it provided then, Jefferies analyst David Windley said in a research note.

UnitedHealth had said it expected care use to rebound in the final quarter of 2020, and the company also set aside reserves in the quarter to pay rebates from the lower utilization earlier in the year, which contributed to huge insurer profits.

UnitedHealth runs UnitedHealthcare, a health insurance business that covers more than 48 million people mostly in the United States. Its Optum segment also runs one of the nation’s largest pharmacy benefit management operations as well as a growing number of clinics and urgent care and surgery centers.

Operating earnings from that segment climbed 3 percent to $3.1 billion in the fourth quarter.

UnitedHealth also reaffirmed on Wednesday its forecast for 2021 adjusted earnings of between $17.75 and $18.25 per share. That includes a per-share hit of about $1.80 due to rising COVID-19 costs as well as procedures that are being put off due to the pandemic. The company’s commercial health insurance enrollment also has been hit by high unemployment during the pandemic.

Analysts expect, on average, adjusted earnings to total $18.20 per share, according to FactSet.