Centene's marketplace membership falls to 3.4 million from 5.8 million a year earlier
The insurer lost about 2.4 million exchange members after enhanced federal tax credits expired, and it credited higher prices for improving margins on the people who stayed.
Centene reported Oct. 27 that it covered 3,403,300 people in Affordable Care Act (ACA) marketplace plans on Sept. 30, down from 5,828,100 a year earlier, according to its third-quarter earnings release1. That is a decline of about 42% in one year.
The drop shows how the marketplace changed in 2026. The enhanced premium tax credits that had lowered marketplace premiums expired after 2025, and enrollees faced an average premium payment increase of 114% to keep the same plan, KFF reported3 June 29. The members who left Centene were largely subsidy-driven enrollees who tended to be healthier and more sensitive to price, according to Insurance Business5.
Centene said its marketplace business became more profitable even as it shrank. The company said its marketplace health benefits ratio (HBR), the share of premium revenue spent on members' medical care, came down because of improved pricing and risk transfer, the payments that shift money among marketplace insurers. A lower ratio means the insurer kept more of each premium dollar. The release did not give a separate marketplace figure. Centene's commercial ratio was 89.0%, down from 89.9% a year earlier.
Price increases also held up revenue. Centene said premium and service revenues rose 0.5% to $45.1 billion, as growth in its Medicare prescription drug plan business and rate increases in its marketplace and Medicaid plans outweighed lower enrollment in those two lines. Commercial premium and service revenues fell 21% to $8.7 billion, from $10.99 billion a year earlier.
Overall, the company posted a net loss of $71 million for the quarter, compared with a loss of $6.6 billion a year earlier, when Centene recorded a large goodwill writedown, Insurance Business reported. Adjusted earnings were 58 cents a share, up from 50 cents. Centene raised its 2026 adjusted earnings forecast by 40 cents to more than $5.20 a share. Chief Executive Sarah London said the core businesses had powered a "faster recovery to our earnings trajectory than previously anticipated."
Total at-risk membership fell to about 25.7 million from 28.0 million. Medicaid enrollment dropped to 11.9 million from 12.7 million, while enrollment in its Medicare prescription drug plans grew to 8.9 million from 8.0 million, the company reported.
Molina Healthcare, which reported Oct. 21, showed the same trade-off on a smaller scale. Its marketplace membership fell to 267,000 from 713,000 a year earlier, while its marketplace medical care ratio improved to 92.5% from 95.6%, according to its earnings release2. Molina said lower premium revenue reflected fewer Medicaid and marketplace members, partly offset by rate increases.
Open enrollment for 2027 marketplace coverage began Nov. 1 and runs through Jan. 15, according to HealthCare.gov4. Centene's release gave no 2027 marketplace pricing or enrollment forecast. London said only that the company is focused on finishing 2026 strongly and building on its progress in 2027.
Centene's Medicaid business faces its own change soon. Medicaid work requirements under last year's federal budget law take effect in January 2027, Insurance Business reported, and Medicaid is Centene's largest segment. The company is also narrowing its Medicare Advantage footprint for 2027 to focus on people eligible for both Medicare and Medicaid, according to the same report.
