Centene Corporation

Overview

• Centene is a nationwide managed care company focused on underserved populations. Its mission is to transform the health of the communities it serves through affordable, high-quality health plans and related services.
• The company operates as a diversified, value-based health care organization with a local, community-oriented model and an emphasis on partnerships with providers, policymakers, and community organizations.
• Centene serves four primary business segments and provides a broad spectrum of health solutions beyond traditional coverage, including alignment with social determinants of health, transportation, and housing support.

Business segments and scale (as of 2025)

• Operating segments: Medicaid, Medicare, Commercial, and Other.
  • Segment mix of external revenues (2025): Medicaid 57%, Commercial 21%, Medicare 19%, Other 3%.
• Membership and customers (as of December 31, 2025):
  • Total membership: 27.6 million.
  • Medicaid membership: 12.5 million across 30 states.
  • Marketplace (Ambetter Health) membership: 5.5 million across 29 states.
  • Stand-alone Medicare Part D (PDP) membership: 8.1 million (12/31/2025); PDP membership grew to over 8.7 million by January 1, 2026.
  • Medicare Advantage membership: 1.0 million across 32 states.
• Corporate action: Signed a definitive agreement to divest the remaining Magellan Health businesses in December 2025.

Financial highlights (year ended December 31, 2025)

• Total revenues: $194.8 billion.
• Cash flow from operations: $5.1 billion.
• Non-cash goodwill impairment charge: $6.7 billion recorded in Q3 2025.
• Employee base: Approximately 61,100 team members (as of December 31, 2025).

Business model and capabilities

• Core products and programs:
  • Medicaid: Managed care plans and related programs (TANF, Medicaid Expansion, ABD, CHIP, LTSS, foster care, dual-eligible support via MMPs, etc.).
  • Medicare: Medicare Advantage, Dual Eligible Special Needs Plans (D-SNPs), and Medicare Part D PDPs; emphasis on risk-sharing and increasing dual-eligible alignment.
  • Commercial/Marketplace: ACA Marketplace plans (Ambetter) and employer-based products, including off-exchange offerings and ICHRA-compatible options.
  • Other: Specialty pharmacy (AcariaHealth), behavioral health (Magellan Health, divested in 2025), vision and dental, clinical healthcare (CMG/Denova Collaborative Health), and centralized services.
• Customer access model:
  • Local brands and regional teams operate in communities to improve access, affordability, and quality.
  • Broad provider networks that include primary and specialty care, hospitals, behavioral health providers, and other clinicians.
• Provider relationships and payment models:
  • Contract types include fee-for-service, capitation, and a range of value-based arrangements such as pay-for-performance, shared savings, shared risk, and full risk.
  • Integrated care and care management programs (for example, an Integrated Care Model with a single care manager per member) supported by provider portals and analytics.
• Data and quality:
  • Extensive use of data analytics to monitor utilization, identify health disparities, and improve outcomes.
  • Focus on quality accreditations (e.g., NCQA) and state/federal quality measures (Medicare Star, Medicaid HPR, Marketplace QRS).
  • Governance around AI/ML use with human-in-the-loop oversight to mitigate bias and ensure appropriate application.
• Risk and regulatory environment:
  • Operates under federal and state regulation, with contracts with CMS and state Medicaid agencies and ongoing audits and performance reviews.
  • Pricing and rate setting are tied to eligibility, actuarial soundness, risk adjustment, and regulatory changes (including ACA, IRA, and OBBBA dynamics).

Operations and infrastructure

• Geographic footprint:
  • Medicaid operations in 30 states (12.5 million members).
  • Marketplace operations in 29 states (Ambetter) with 5.5 million members.
  • PDP operations across all 50 states and DC (8.1 million members, with further growth into 2026).
  • Medicare Advantage presence in 32 states (1.0 million members).
• People and culture:
  • Workforce of about 61,100 team members as of end of 2025.
  • Emphasis on talent development (Centene University), succession planning, and a flexible work environment (remote/hybrid).

Competitive positioning

• Largest Medicaid and Marketplace insurer in the United States.
• One of the largest stand-alone PDP providers.
• Strong focus on dual-eligible populations with overlapping Medicaid/Medicare footprints that support D-SNP offerings.
• Localized, community-based approach combined with national scale and data-driven care management.

Public disclosures and reporting

• Reports on governance, sustainability, ethics/compliance, and risk factors, with commitments to data security, privacy, and regulatory compliance.
• Disclosures cover risks related to medical cost trends, regulatory changes, contract renewals, and partnership dynamics.