UnitedHealth Group Inc.'s fourth-quarter net income slipped 1 percent, as a rise in costs from medical claims and other expenses countered revenue gains for the nation's largest health insurer.

The Minnetonka, Minn., company also said Thursday it was reaffirming a forecast for 2013 earnings it made in November. UnitedHealth shares then fell before markets opened for trading.

UnitedHealth earned $1.24 billion, or $1.20 per share, in the three months that ended Dec. 31. That compares with $1.26 billion, or $1.17 per share, in the last quarter of 2011, when the company had more shares outstanding.

Total revenue climbed 11 percent to $28.77 billion, but medical costs grew 12 percent to $20.8 billion.

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