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Call sheet · Q4'25

Centene (CNC)

Q4'25 earnings call · held February 6, 2026 · compared with the Q3'25 call · management-credibility review
9/12
Disclosure score
1 high, 4 medium, 3 low flags
Financial quality
Bottom line
The sleeper story is Medicaid rate relief: Two years of elevated trend data is now baked into the actuarial process, setting up structural rate increases that peers may not have positioned for. The obvious headline is marketplace recovery, but the real constraint is NSA cost escalation - management admits it's been 'weaponized' and they're resorting to lawsuits rather than operational solutions. Sarah London's most telling quote: 'If all we do is deliver a 93.7 in Medicaid, I will be very disappointed' - suggesting internal targets are more aggressive than guidance. My view changes if NSA disputes continue accelerating or if 1/1/26 Medicaid rate decisions come in below the mid-4% assumption.

The 30-second version

  • THE SLEEPER STORY: Medicaid acuity windfall is coming - rates are about to catch up to two years of trend data
  • ACA exchanges: From disaster to goldmine - the mid-30s rate increases are already locked and loaded
  • Red flag: No Surprises Act costs are spiraling and they're playing defense with lawsuits

What changed this quarter

MetricQ3'25Q4'25Change
Adjusted EPS Q4$0.50 Q3 2025-$1.19 Q4 2025169 basis point decline quarter over quarter
Full Year Adjusted EPS$1.75 guidance$2.08 actual33 cent beat vs guidance
2026 Adjusted EPS GuidanceNo prior guidance>$3.0044% growth target vs 2025
Medicaid HBR Q493.4% Q3 202593.0% Q4 202540 bps sequential improvement
Marketplace HBR Q489.9% Q3 2025Higher by 100 bps vs expectations100 bps deterioration vs plan
Medicare HBR Q494.3% Q3 2025Slightly elevated vs expectationsProvider contract write-offs
Premium Revenue Guidance 2026$174.6B actual 2025$170-174B guidanceFlat to down $4.6B midpoint
Medicaid Membership12.7M Q3 202512.5M Q4 2025200K member decline
Marketplace Membership5.8M Q3 20255.0M Dec 2025, 3.5M Q1 2026E30% expected decline
PDP Membership8.1M8.7M600K member growth

Accountability tracked

8 new promises made4 narrative shifts flagged6 prior promises scored
Inside the full report
The complete write-up covers the full promise ledger with kept/missed calls, disclosure-quality scoring, the metrics-vanished check, verification items, and the questions to ask next quarter.
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Scores, kept-promise rates, and flags on this site reflect the author's opinion, applying a stated methodology to statements management made on public earnings calls. Informational and educational purposes only - not investment advice, a recommendation, or an offer to buy or sell any security. Sources believed reliable but not guaranteed; the author may hold positions in the securities discussed.

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