2026 adjusted EPS guided above $3, over 40% growth
Centene's Q4 2025 call focused on stabilizing Medicaid after a difficult year, with sequential HBR improvement into Q4. Management provided a 2026 EPS guide of greater than $3, implying more than 40% growth, driven by Marketplace margin recovery and continued Medicaid stability, while flagging policy-related costs like the No Surprises Act and a decline in Marketplace membership due to APTC expiration. Medicaid HBR improved to 93.0% in Q4, a 40bp sequential improvement, with management expecting a flat HBR in 2026.
Buzzberg read2026 adjusted EPS guided above $3, over 40% growthCentene's Q4 2025 call focused on stabilizing Medicaid after a difficult year, with sequential HBR improvement into Q4. Management provided a 2026 EPS guide of greater than $3, implying more than 40% growth, driven by Marketplace margin recovery and continued Medicaid stability, while flagging policy-related costs like the No Surprises Act and a decline in Marketplace membership due to APTC expiration. Medicaid HBR improved to 93.0% in Q4, a 40bp sequential improvement, with management expecting a flat HBR in 2026.Read full analysisCollapse analysis
Centene's Q4 2025 call focused on stabilizing Medicaid after a difficult year, with sequential HBR improvement into Q4. Management provided a 2026 EPS guide of greater than $3, implying more than 40% growth, driven by Marketplace margin recovery and continued Medicaid stability, while flagging policy-related costs like the No Surprises Act and a decline in Marketplace membership due to APTC expiration. Medicaid HBR improved to 93.0% in Q4, a 40bp sequential improvement, with management expecting a flat HBR in 2026.
2026 adjusted EPS guide is 'greater than $3', representing over 40% growth year-over-year.
Marketplace membership is expected to be around 3.5 million by end of Q1 2026, down from 5.5 million in December 2025, due to enhanced APTC expiration.
Centene is taking a more aggressive legal stance against provider abuse of the No Surprises Act IDR process, including a new multimillion-dollar lawsuit.
Revenue$49.725B
reported
EPS$-1.19
reported
Gross margin15.18%
reported
MEDICAID op margin93%
reported
What changed this quarter
01
Guidance
2026 adjusted EPS guided above $3, over 40% growth
Guidance · revenue to $172B
02
Membership
Marketplace membership expected to drop to 3.5 million by Q1 end
Medicaid HBR improved to 93.0% in Q4, a 40bp sequential improvement, with management expecting a flat HBR in 2026.
03
Margins
Medicaid HBR improving to 93.0% in Q4 2025
Reported gross margin was 15.18%, reinforcing the quarter's better-than-guided profitability.
04
Legal/Regulatory
No Surprises Act costs and fraud lawsuits pressure Marketplace
Marketplace membership is expected to be around 3.5 million by end of Q1 2026, down from 5.5 million in December 2025, due to enhanced APTC expiration.
AI, capex & demand read
AI
Platform & monetization
Management discussed integrating AI into operations, citing proof points in prior authorization, call centers, member engagement, and analytics for fraud detection, with plans to accelerate GenAI integration in 2026.
Demand
Bookings & conversion
Management frames 2026 as a recovery year, with EPS expected to grow more than 40% driven by Medicaid stabilization, Marketplace margin recovery, and progress toward Medicare Advantage break-even. This is a cautiously long tone, acknowledging 2025 as a rough base but pointing to specific levers for improvement.
Tone · Measured
Management acknowledged 2025 challenges but expressed confidence in 2026 guidance and margin improvement, with a cautious but forward-looking stance.
Supply-chain alpha
A1
Centene is taking a more aggressive, litigious posture against providers exploiting the No Surprises Act (NSA) independent dispute resolution (IDR) process, including filing a multimillion-dollar lawsuit against a New York provider for fraudulent claims manipulation.
“we'll be taking a more proactive, litigious posture as necessary. As an example, earlier this week, we filed a multimillion-dollar lawsuit against a New York provider alleging fraudulent manipulation of in-network and out-of-network claims.”
Centene is collaborating with actuarial firm Wakely to publish a new industry-wide report on paid membership metallic tier distribution and statewide average premiums, aiming to improve transparency and inform risk adjustment assumptions for the individual market.
“we are pleased to have worked closely with Wakely, the independent actuarial firm, to support publication of a new report reflecting market-wide paid membership metallic tier distribution, and statewide average premium set to be released t…”
Centene's Medicaid trend is being significantly driven by behavioral health (roughly half of excess trend), with ABA (applied behavioral analysis) therapy as a primary component, prompting the company to establish a task force to crack down on provider outliers prescribing excessive treatment hours.
“We found children who had been in therapy for 5 to 10 years, where clinical evidence suggests the optimal duration is 2 to 3 years, as well as those enrolled in 40 hours per week of therapy instead of balanced school integrated care.”
Centene's reported quarterly results include a one-time, non-cash write-off of older provider receivables in its Medicare Advantage segment, signaling a tougher stance on collections and potentially reflecting broader industry issues with provider billing practices.
“we completed a review of our provider contract portfolio in the quarter and adjusted certain receivables accordingly, which drove the slightly elevated HBR compared to expectations.”