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Centene on Friday reported mixed fourth-quarter and full 2025 results.
Despite a $1.1 billion loss in Q4, revenue and earnings reportedly beat Wall Street expectations.
The fundamental fourth-quarter 2025 trend was consistent with expectations in Medicaid and Medicare Advantage, Centene said, while the trends for the Affordable Care Act marketplace and Medicare prescription drug program were “slightly favorable.”
Centene’s main line of business is in government programs Medicaid, Medicare and the ACA.
Medicaid profitability has improved, CEO Sarah London said on Friday’s earnings call. While the year has been challenging, it has been better than expectations. The company expects year-over-year growth and to break even in the Medicare Advantage market.
“2025 [was] a strong finish to a rough year,” said CFO Andrew Asher.
With the loss of the enhanced premium tax credits at the end of 2025, Centene’s ACA membership has dropped to 3.5 million members compared to 5.5 million, but the loss was expected, Centene said.
Also, more members are now enrolled in bronze plans, rather than the higher-tiered silver plans.
Centene also expects to end the quarter with a decline in Medicare Advantage membership due in large part to its decreasing MA footprint. In 2025, the insurer left MA in six states: Alabama, Massachusetts, New Hampshire, Rhode Island, New Mexico and Vermont.
MA rates announced in an Advance Notice earlier this month are expected to be finalized in early April.
Behavioral health is a big driver of spending. The company is looking at therapy in which people are spending years in long-term therapy.
Centene is also looking at potential fraud and waste. In December 2025, Centene filed a multimillion-dollar lawsuit over fraudulent claims in the state Supreme Court in New York.
Centene Corporation v. Jal Equity Corporation names defendants JAL Equity and its owner Eran Salu in a lawsuit over the alleged misappropriation of over $5 million in escrow funds, according to Law.com.
Heading into 2026, artificial intelligence will continue to be an important lever that is incorporated into operations, prior authorization approvals and call centers, the company said.
The financial estimates mark a rare beat across the managed-care industry, which has been grappling with rising medical costs and weakening reimbursement from government programs, Seeking Alpha said. Shares of Molina Healthcare plunged 33% on Thursday after the insurer forecast 2026 profit at less than half of analyst expectations, the report said.
"As we look to 2026, we are positioned to deliver meaningful margin improvement and renewed adjusted diluted EPS growth," London said. "We expect full year 2026 adjusted diluted EPS to be greater than $3.00, marking important progress toward restoring the enterprise's embedded earnings power all while continuing to work to provide access to affordable, high-quality care for our members."
Email the writer: SMorse@himss.org