CNC
Updated: 24/09/2026, 16:38:16
Centene Corporation operates as a managed care company that provides programs and services to under-insured families, and commercial organizations in the United States. It operates through four segments: Medicaid, Medicare, Commercial, and Other. The Medicaid segment offers the temporary assistance for needy families; medicaid expansion; aged, blind, or disabled; and children's health insurance programs, as well as long-term services and supports; foster care; and medicare-medicaid plans. This segment also provides healthcare products and services. The Medicare segment offers special needs and medicare supplement, and prescription drug plans. The Commercial segment provides health insurance marketplace product for individual and commercial group. The Other segment operates clinical healthcare and pharmacies, as well as offers vision and dental, behavioral health, and centralized services. It provides services through primary and specialty care physicians, hospitals, behavioral health practitioners, and ancillary providers. The company was founded in 1984 and is headquartered in Saint Louis, Missouri.
No summaries found.
Reported and calculated KPIs plus operational exposure disclosed in the FY 2025 filing.
Revenue
$174.6B
FY 2025 · Reported
Net income
$-6.7B
FY 2025 · Reported
Gross margin
98.5%
FY 2025 · Calculated
Free cash flow
$4.3B
FY 2025 · Calculated
R&D intensity
N/A
FY — · Reported
Share repurchases
$0.5B
FY 2025 · Reported
Other offerings mentioned without separate sales
Area-level product sales are displayed only when the filing reports a product × geography breakdown. Regional totals are not allocated across products by estimation.
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Only locations and quantities explicitly supported by the filing are displayed. A country-level manufacturing percentage or product allocation is shown only when the source discloses it; materiality scores are never presented as production shares.
Company overview
Nation's largest managed care company focused on underserved populations; >1 in 15 individuals served; NYSE: CNC
“As the nation's largest managed care company focused on underserved populations, Centene is committed to helping people live healthier lives.”
Operating segments
Four segments in 2025: Medicaid, Medicare, Commercial, Other
“During 2025, we operated in four segments: Medicaid, Medicare, Commercial and Other.”
Medicaid product lines
Medicaid products: TANF, Expansion, ABD, CHIP, LTSS, Foster Care, MMP (ended 12/31/2025)
“We operated MMPs, which ended on December 31, 2025, as CMS transitioned to D-SNP-based integration.”
Provider engagement and integrated care model
Integrated Care Model (one care manager per member) plus Provider Portal for claims/eligibility/analytics drive provider engagement
“Our Integrated Care Model is member-centric and managed by one care manager assigned to a member who looks at the care for the member in a holistic manner.”
FY2025 segment revenue mix
Medicaid 57%, Commercial 21%, Medicare 19%, Other 3% of total external revenues (FY2025)
“our Medicaid, Commercial, Medicare and Other segments accounted for 57%, 21%, 19% and 3%, respectively, of our total external revenues”
Segment results table FY2025 vs FY2024
FY2025 revenues: Medicaid $110,434M (+9%), Medicare $37,210M (+62%), Commercial $42,003M (+25%), Other $5,130M (+4%), Total $194,777M (+19%); gross margin $14,209M (-17%)
“Medicaid$110,434 $101,417 9 % Medicare37,210 23,032 62 % Commercial42,003 33,702 25 % Other5,130 4,920 4 % Consolidated Total$194,777 $163,071 19 %”
Specialty pharmacy (AcariaHealth) supplier dependency
Specialty pharmacy business depends on favorable contracting with pharmaceutical manufacturers; AcariaHealth is a key owned pharmacy with broader network
“Our specialty pharmacy business would be materially and adversely affected by an inability to contract on favorable terms with pharmaceutical manufacturers and other suppliers, though we use a network of specialty pharmacies beyond AcariaHealth.”
Capital expenditures
Capex $767M (2025) vs $644M (2024), primarily system enhancements and computer hardware
“We spent $767 million and $644 million in the years ended December 31, 2025 and 2024, respectively, on capital expenditures primarily for system enhancements and computer hardware.”
Medicaid market growth
CMS estimates Medicaid spending growth of 7% annually to $1.5 trillion by 2031; ~12M dual-eligibles in 2025
“CMS estimates Medicaid spending will grow at an average annual rate of 7% to $1.5 trillion by 2031.”
Prior divestitures
Divestitures: Magellan Rx ($1.3B, 2022), Magellan Specialty Health ($646M, 2023), Circle Health ($931M, 2024); TRICARE contract expired Dec 2024
“In January 2024, we completed the divestiture of Circle Health Group (Circle Health) for $931 million.”
Magellan Health divestiture agreement
Definitive agreement signed December 2025 to divest remaining Magellan Health businesses
“We signed a definitive agreement to divest the remaining Magellan Health businesses in December 2025.”
Market leadership positions
Largest Medicaid and Marketplace insurer, largest stand-alone PDP provider; 12.5M Medicaid members in 30 states; 5.5M Marketplace in 29 states; 1.0M MA in 32 states; 8.1M PDP in 50 states + DC
“we are the nation's largest Medicaid and Marketplace insurer, as well as the largest stand-alone PDP provider.”
AI, machine learning and predictive modeling use
Uses AI/ML/predictive modeling for cost reduction and value-based care with 'Humans in the Loop' governance; does not use AI to deny prior authorizations
“we do not use AI to deny requests for prior authorization.”
Segment cost and revenue drivers
Key drivers: Medicaid rate increases vs. redeterminations; Medicare PDP yield/IRA changes; Commercial 26% Marketplace growth but -$2.6B gross margin; TRICARE contract expiry
“Gross margin decreased $2.6 billion in the year ended December 31, 2025, compared to the corresponding period in 2024 due to lower estimated risk adjustment revenue and increased Marketplace medical costs.”
Debt and capital resources
$15.5B senior notes outstanding; $1.8B remaining on $10B buyback authorization (6.7M shares/$400M repurchased in 2025); interest expense $678M
“As of December 31, 2025, we had an aggregate principal amount of $15.5 billion of senior notes issued and outstanding.”
Liquidity and cash flows
2025 operating cash flow $5.1B (vs $154M in 2024); unregulated cash $1.5B ($400M for general corporate use); portfolio duration 3.3 years
“Cash flows provided by operations in 2025 were primarily driven by net earnings, improved pharmacy rebate timing and higher medical claims liabilities primarily driven by higher membership.”
CMS Star ratings economics
Star ratings drive Medicare bonus revenue and enrollment eligibility; <3 stars for 3 years risks contract termination
“plans with Star ratings of fewer than three stars for three consecutive years are denoted as "low performing" plans”
FY2025 key financials
Total revenues $194.8B; operating cash flow $5.1B; membership 27.6M (Dec 31, 2025); pre-tax loss $6.7B
“Our membership totaled 27.6 million as of December 31, 2025. For the year ended December 31, 2025, our total revenues were $194.8 billion and our total cash flow from operations was $5.1 billion.”
One Big Beautiful Bill Act (OBBBA)
OBBBA (July 2025) may reduce Medicaid Expansion eligibility via work requirements and more frequent redeterminations
“The One Big Beautiful Bill Act (OBBBA), passed in July 2025, includes requirements that may reduce the number of members eligible for state Medicaid Expansion programs by requiring work or community engagement by members”
Enhanced APTC expiration and Marketplace program integrity risk
Expiration of Enhanced APTCs and program integrity initiatives may cut Marketplace membership or raise morbidity
“member and provider behavior could continue to be influenced by the uncertainty surrounding the availability, affordability, funding and access to health insurance... including due to the expiration of the Enhanced Advance Premium Tax Credits (APTCs) and additional program integrity initiatives for Marketplace products.”
Medical cost trend and pricing risk
Medical cost trend risk: 2025 Marketplace morbidity worse than expected (risk adjustment revenue cut); Medicaid costs up in behavioral health, home health, high-cost drugs
“late in the second quarter of 2025, data from an independent actuarial firm suggested a materially higher implied aggregate morbidity of the Marketplace membership as a whole than anticipated, resulting in a significant reduction of our expected net risk adjustment revenue for 2025.”
Medicaid redetermination acuity risk
Higher HBR from remaining Medicaid members post-redeterminations; rate adjustments may lag or be insufficient
“such rate adjustments may be delayed or insufficient to offset the increased acuity.”
Forward-looking risk factor summary
Broad risk factors: pricing/actuarial, medical cost trends, rate cuts, ACA/APTC policy changes, tariffs/inflation, Star ratings, competition, cyber, contracts with governments, litigation, financing availability
“the expiration, suspension, or termination of our contracts with federal or state governments (including, but not limited to, Medicaid, Medicare or other customers)”
Litigation and regulatory proceedings risk
Exposed to costly litigation/regulatory proceedings spanning FCA, CMS risk adjustment, broker compensation, network adequacy, cybersecurity, procurement protests
“compliance with the CMS Medicare and Marketplace regulations, including risk adjustment, prior authorizations and broker compensation, compliance with the False Claims Act”
Data privacy and security regulatory risk
Subject to HIPAA, HITECH, GLBA, CCPA, PCI-DSS, 50-state breach notification laws and emerging AI/automation regulation
“including HIPAA, the HITECH Act, the Gramm-Leach-Bliley Act, which require us to protect the privacy of medical records and safeguard personal health information”
57% of external revenues come from the Medicaid segment; state contracts (esp. Florida and New York ~10%+ each of Medicaid premium revenues) fund the majority of revenue, with rate setting by state actuaries.
“Our Medicaid contracts with the states of Florida and New York accounted for approximately 10% or more of our consolidated Medicaid premium revenues individually in the year ended December 31, 2025.”
CMS-estimated 7% average annual Medicaid spending growth to $1.5 trillion by 2031 and states' adoption of managed care drive demand for Centene's MCO services.
“CMS estimates Medicaid spending will grow at an average annual rate of 7% to $1.5 trillion by 2031.”
ACA risk adjustment provisions, Enhanced APTC expiration, and program integrity initiatives materially affect Marketplace membership, morbidity and profitability.
“the risk adjustment provisions of the ACA established to apportion risk amongst insurers may not be effective in appropriately mitigating the financial risks related to the Health Insurance Marketplace product”
OBBBA work requirements and more frequent eligibility redeterminations may reduce Medicaid Expansion membership; also cited as a change in healthcare regulations affecting medical cost predictability.
“includes requirements that may reduce the number of members eligible for state Medicaid Expansion programs by requiring work or community engagement by members and for state Medicaid agencies to redetermine member eligibility at more frequent intervals”
Star ratings determine bonus revenue, enrollment eligibility and potential contract termination; maintaining/improving ratings is a disclosed risk and quality objective.
“Plans receive additional Medicare revenue related to the achievement of higher Star ratings that can be used to offer more attractive benefit packages to members and/or achieve higher profit margins.”
HIPAA, HITECH, GLBA, CCPA, PCI-DSS and state breach laws plus emerging AI regulation govern processing of member data; non-compliance could raise costs or constrain the business model.
“Compliance with existing or new data privacy and security laws, regulations and requirements may result in increased operating costs, and may constrain or require us to alter our business model or operations.”
Specialty pharmacy business (AcariaHealth) depends on favorable contracting with pharmaceutical manufacturers; rebate receipt and drug pricing benchmarks affect results.
“Our specialty pharmacy business would be materially and adversely affected by an inability to contract on favorable terms with pharmaceutical manufacturers and other suppliers”
AI/ML and predictive modeling are used to lower costs and advance value-based care with human-in-the-loop governance; ethical/legal use of AI is both an operational tool and a cited risk factor; AI-driven claim submission patterns affect cost predictability.
“we have utilized artificial intelligence (AI), Machine Learning (ML), and predictive modeling in ways that lower costs, advance access to value-based care and increase operational efficiencies”
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