Anthem starts 2022 with lower expectations than Wall Street about how the year will play out.

The Blue Cross-Blue Shield health insurer on Wednesday reported earnings, revenue and enrollment forecasts that fell short of analysts’ average forecast, sending its shares lower while the broader index rose.

The health insurer expects enrollments to increase, especially in Medicare Advantage, the private version of Medicare. But it also expects to add some costs, at least initially, as new customers start using their coverage.

Anthem said it expects adjusted earnings of more than $28.25 per share this year on $152 billion in operating income, which excludes investment income.

The insurer also expects total enrollments of around 45.6 million to 46.2 million, or about 45.4 million, in the year after 2021.

Analysts expect an average of $28.59 in earnings per share next year on $153 billion in revenue and about 46.8 million signups, according to FactSet.

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The majority of Anthem’s customers have plans that they have purchased in the individual insurance market or through their employers. But the company’s government business, including the Medicare Advantage and Medicaid programs it administers for states, will grow 17% in 2021 to more than 15 million people.

In the fourth quarter, Anthem also missed consensus estimates by about $500 million with operating income of $36.02 billion.

The insurer posted adjusted earnings of $5.14 per share in the quarter, beating estimates by 3 cents, while Anthem’s profit doubled to $1.14 billion.

For the full year, Anthem’s operating income was $136.94 billion on revenue of $6.1 billion.

Shares of Indianapolis-based Anthem Inc. fell more than 1 percent, or $6.17, to $433.01 on Wednesday morning, while the S&P 500 rose more than 1 percent.

Shares of Anthem have risen about 40% over the past year.