10-K 0001071739-26-000049 (2026-02-17) vs 10-K 0001071739-25-000027 (2025-02-18)
| Section | Compared text | Words now | Changed |
| Risk Factors | Item 1A | 15,911 |
10.6% |
| MD&A | Item 7 | 12,062 |
31.9% |
| Legal Proceedings | Item 3, via Note 17 – Contingencies | 906 |
25.7% |
| Accounting Policies | Item 8, Note 2 – Summary of Significant Accounting Policies | 4,845 |
19.2% |
The redline: what was cut and what was added
In each section, the paragraph that changed most, marked against last year's 10-K:
cut words struck through, new words highlighted and underlined.
Risk Factors 294 words changed in this paragraph; it is 55% similar to last year's version.
From time to time, we are a defendant in lawsuits and regulatory actions and are subject to investigations relating to our business, including, without limitation, medical malpractice claims; claims that may have retroactive application and periodic compliance and other reviews and investigations by members various federal and providers alleging failure state regulatory agencies with respect to timely and accurately pay for or provide healthcare; claims requirements applicable to our business, including, without limitation, those related to non-payment or insufficient payments for out-of-network services; claims related to provider directory accuracy, claims related to network adequacy; claims alleging bad faith; payment of claims, compliance with the CMS Medicare and Marketplace regulations, including risk adjustment adjustment, prior authorizations and broker compensation; claims related to compensation, compliance with the False Claims Act, the calculation of minimum MLR and rebates related thereto; claims thereto, submissions to state agencies related to privacy, intellectual property payments or state false claims acts, pre-authorization penalties, timely review of grievances and vendor disputes; investigations regarding our submission appeals, timely and accurate payment of risk adjuster claims; putative securities class actions; protests and appeals related to Medicaid procurement awards; claims, provider directory accuracy, network adequacy, cybersecurity issues, including those related to our or our third-party vendors' information systems; employment-related disputes, including wage systems, HIPAA and hour claims; submissions to other federal and state agencies fraud, waste and abuse laws; litigation arising out of general business activities, such as tax matters, disputes related to payments healthcare benefits coverage or state false reimbursement, putative securities class actions and related derivative lawsuits, and medical malpractice, privacy, real estate, intellectual property, vendor disputes and employment-related claims; and disputes regarding reinsurance arrangements, claims acts, preauthorization penalties, timely review arising out of grievance the acquisition or divestiture of various assets, class actions and appeals; claims relating to the performance of contractual and non-contractual obligations to providers, members, employer groups, vendors and others, including, but not limited to, the alleged failure to properly pay claims and challenges to the manner in which we processes claims, claims related to the imposition of new taxes, including but not limited network adequacy and claims alleging that we have engaged in unfair business practices; and protests and appeals related to claims that may have retroactive application. Medicaid procurement awards. Although we maintain some third-party insurance coverage, including excess liability insurance with third-party insurance carriers, certain liabilities or types of damages, such as punitive damages, may not be covered by insurance, insurers may dispute coverage or the amount of insurance may be insufficient to cover the entire damages awarded. In addition, regardless of the outcome of any litigation or regulatory proceedings, such proceedings are costly and time-consuming and require significant attention from our management and could therefore have a material adverse effect on our business and financial condition, results of operations or cash flows.
Source: Item 1A, 10-K 0001071739-26-000049 vs Item 1A, 10-K 0001071739-25-000027
MD&A 231 words changed in this paragraph; it is 40% similar to last year's version.
The IRA significantly changes changed Medicare Part D, impacting stand-alone Medicare PDPs as well as the Part D benefit in many of our Medicare Advantage plans beginning in 2025, most notably by eliminating the coverage gap and capping members' annual out-of-pocket cost costs at $2,000 in order to provide more predictable and affordable prescription drug coverage for Medicare beneficiaries. The members' Part D annual out-of-pocket cap for 2026 is $2,100. The IRA changes effective for 2025 result resulted in a meaningful shift in cost-sharing responsibilities between members, drug companies, CMS, Centers for Medicare and Medicaid Services (CMS), and PDPs and will result have resulted in a significant increase in our premiums in consideration for our PDPs PDPs' responsibility for a larger portion of total Part D benefit costs. Starting in 2026, CMS created a Drug Subsidy to compensate plans for the loss of the Manufacturer Discount Program (MDP) for maximum fair price drugs. To help mitigate significant premium impacts and address these changes, CMS introduced the Medicare Part D Premium Stabilization Demonstration program. This program began in calendar year 2025 and was intended by CMS to exist for three years. The parameters of the program are expected to be different each year. For example, in 2025, participating PDPs operated under narrowed risk corridor thresholds as part of the supports CMS introduced to limit market volatility. For 2026, CMS eliminated these narrowed risk corridors entirely, shifting PDPs back toward standard program financial risk‑sharing. We continue to advocate for policies that promote cost-effective, high-quality care for our PDP enrolled members. We have receivables due to us from CMS for Part D risk-sharing programs attributable to the 2025 plan year that we expect to be paid by CMS within a year after the plan year closes. If the payments from CMS are delayed, our cash flows may be materially adversely affected.
Source: Item 7, 10-K 0001071739-26-000049 vs Item 7, 10-K 0001071739-25-000027
Accounting Policies 116 words changed in this paragraph; it is 34% similar to last year's version.
In December 2023, 2025, the FASB issued ASU 2023-09 - Income taxes: 2025-11 – Interim Reporting – Narrow-Scope Improvements which clarifies interim disclosure requirements and the applicability of Topic 270. The objective of the standard update is to Income Tax Disclosures which includes provide clarity about current interim requirements. The amendments in this standard update also include a disclosure principle that further enhance income tax disclosures, primarily through standardization and disaggregation requires entities to disclose events since the end of rate reconciliation categories and income taxes paid by jurisdiction. the last annual reporting period that have a material impact on the entity. The new standard is effective for interim periods within annual reporting periods beginning after December 15, 2024. 2027, with early adoption permitted. The Company early adopted is currently evaluating the new guidance in the fourth quarter impact of 2024, as permissible by the ASU. this standard update.
Source: Item 8, Note 2 – Summary of Significant Accounting Policies, 10-K 0001071739-26-000049 vs Item 8, Note 2 – Summary of Significant Accounting Policies, 10-K 0001071739-25-000027
Legal Proceedings 83 words changed in this paragraph; it is 58% similar to last year's version.
As of the date of this report, amounts accrued for legal proceedings and regulatory matters were not material. It Except for the matters discussed below, the Company believes that the ultimate outcome of any of the regulatory and legal proceedings that are currently pending against it should not have a material adverse effect on financial condition, results of operations, cash flow or liquidity. However, it is possible that in a particular quarter or annual period the Company's financial condition, results of operations, cash flow, and/or liquidity could be materially adversely affected by an ultimate unfavorable resolution of or development in legal and/or regulatory proceedings. The Company believes that the ultimate outcome of any of the regulatory and legal proceedings that are currently pending against it should not have a material adverse effect on financial condition, results of operations, cash flow, or liquidity.
Source: Item 3, via Note 17 – Contingencies, 10-K 0001071739-26-000049 vs Item 3, via Note 17 – Contingencies, 10-K 0001071739-25-000027
Every change, by type
Sentences and paragraphs of CNC's Risk Factors and MD&A, 10-K 2026-02-17 against 10-K 2025-02-18.
Each links to the text at sec.gov.
Quiet changes are sentences kept from last year with one to four words changed, at least one of them a hedge, a modal or a qualifier
(may, could, will, not, significant, material…). A year or date rolling forward is not counted.
The full word list
adverse, adversely, all, although, anticipate, anticipates, any, approximately, believe, believes, can, cannot, certain, could, expect, expects, generally, however, if, intend, intends, largely, likely, many, material, materially, may, might, most, must, never, no, not, possible, primarily, probable, should, significant, significantly, some, substantial, substantially, unlikely, will, would
AddedRisk Factors
The Final Rule was published in the Federal Register on June 25, 2025. The Final Rule makes changes to policies to strengthen program integrity measures in the Marketplace. For example, the Special Enrollment Period for those under 150% of the FPL has been repealed beginning August 25, 2025. Several of the provisions of the Final Rule have been stayed due to ongoing litigation. These include a requirement for certain consumers who automatically re-enroll into a fully subsidized Marketplace plan to be re-enrolled into the same plan with a $5 premium until the consumer updates their exchange application to confirm APTC eligibility. Additionally, exchanges may no longer accept a consumer's self-attestation of projected annual household income when the IRS cannot verify it due to lack of tax return data; rather, exchanges must verify household income using other trusted data sources.
Read it in 10-K 2026-02-17 at sec.gov ↗
AddedRisk Factors
Extended eligibility for the Enhanced APTC for Marketplace members expired on December 31, 2025. In July 2025, the OBBBA placed additional restrictions on APTC requirements. For example, beginning January 1, 2026, should individuals mis-estimate their projected income, the OBBBA requires them to reimburse the IRS for the full amount of excess tax credit received. In addition, as of January 1, 2026, the OBBBA prohibits individuals from receiving APTCs if they enroll in health coverage through a Special Enrollment Period associated with their income. We anticipate that the combined effect of the expiration of the Enhanced APTCs, the Final Rule, and the OBBBA will reduce 2026 Marketplace membership and continue to increase the overall morbidity of the Marketplace population.
Read it in 10-K 2026-02-17 at sec.gov ↗
AddedRisk Factors
Future levels of funding and premium rates may be affected by continuing government efforts to contain healthcare costs and may further be affected by state and federal budgetary constraints and spending initiatives or changes in control of the legislative or executive branches at the state and federal level. Governments periodically consider reducing or reallocating the amount of money they spend for Medicaid, Medicare, CHIP, LTSS, ABD and Foster Care. For example, the OBBBA includes requirements that may reduce the number of members eligible for state Medicaid Expansion programs by requiring work or community engagement by members and for state Medicaid agencies to redetermine member eligibility at more frequent intervals, along with adding a "Cost Sharing" or "Co-Pay" for certain medical services. These changes could have the effect of increasing the overall morbidity of the Medicaid Expansion population largely beginning in 2027, subject to state implementation plans. Several other provisions of the OBBBA, such as adjustments to provider taxes and state directed payments beginning in 2028, may have the effect of reducing the amount of federal funding for Medicaid, which could result in changes in the design of Medicaid programs, including coverage of benefits, eligibility, and/or provider payment rates. In particular, New York intends to terminate its Essentials Plan-5, which provided state-subsidized healthcare for individuals from 200% to 250% of the FPL by July 1, 2026.
Read it in 10-K 2026-02-17 at sec.gov ↗
AddedRisk Factors
In addition, the OBBBA includes requirements that may reduce the number of members eligible for state Medicaid Expansion programs by requiring work or community engagement by members and for state Medicaid agencies to redetermine member eligibility at more frequent intervals, along with adding a "Cost Sharing" or "Co-Pay" for certain medical services. These changes could have the effect of increasing the overall morbidity of the Medicaid Expansion population largely beginning in 2027, subject to state implementation plans. Several other provisions of the OBBBA, such as adjustments to provider taxes and state directed payments beginning in 2028, may have the effect of reducing the amount of federal funding for Medicaid, which could result in changes in the design of Medicaid programs, including coverage of benefits, eligibility, and/or provider payment rates. In particular, New York intends to terminate its Essentials Plan-5, which provided state-subsidized healthcare for individuals from 200% to 250% of the FPL by July 1, 2026.
Read it in 10-K 2026-02-17 at sec.gov ↗
AddedRisk Factors
The Final Rule was published in the Federal Register on June 25, 2025. The Final Rule makes changes to policies to strengthen program integrity measures in the Marketplace. For example, the Special Enrollment Period for those under 150% of the FPL has been repealed beginning August 25, 2025. Several of the provisions of the Final Rule have been stayed due to ongoing litigation. These include a requirement for certain consumers who automatically re-enroll into a fully subsidized Marketplace plan to be re-enrolled into the same plan with a $5 premium until the consumer updates their exchange application to confirm APTC eligibility. Additionally, exchanges may no longer accept a consumer's self-attestation of projected annual household income when the IRS cannot verify it due to lack of tax return data; rather, exchanges must verify household income using other trusted data sources.
Read it in 10-K 2026-02-17 at sec.gov ↗
AddedRisk Factors
Extended eligibility for the Enhanced APTC for Marketplace members expired on December 31, 2025. For example, beginning January 1, 2026, should individuals mis-estimate their projected income, the OBBBA requires them to reimburse the IRS for the full amount of excess tax credit received. In addition, as of January 1, 2026, the OBBBA prohibits individuals from receiving APTCs if they enroll in health coverage through a Special Enrollment Period associated with their income. We anticipate that the combined effect of the expiration of the Enhanced APTCs, the Final Rule, and the OBBBA will reduce 2026 Marketplace membership and continue to increase the overall morbidity of the Marketplace population.
Read it in 10-K 2026-02-17 at sec.gov ↗
RemovedRisk Factors
If eligibility for the enhanced advance premium tax credit for Marketplace members expires without renewal or the eligibility for the credit is modified or delayed, our results of operations, financial condition, and cash flows could be materially and adversely affected.
Read it in 10-K 2025-02-18 at sec.gov ↗
RemovedRisk Factors
In August 2022, the U.S. federal government enacted the Inflation Reduction Act, which, among other things, extended eligibility for the enhanced advance premium tax credit for Marketplace members. This enhanced credit expires on December 31, 2025, and if it is not renewed or extended, or if eligibility for this enhanced credit is limited, or if such renewal or extension is delayed, it could materially adversely impact our Marketplace membership. Submissions of the product design and pricing for the Marketplace product for the following calendar year is generally due to our state regulators in the summer. If the modifications or renewal of the credit is not known at that time, we may not be able to price our products appropriately or be able to change our product pricing or strategy in response to such modifications, which could materially adversely impact our Marketplace membership, financial condition and cash flows.
Read it in 10-K 2025-02-18 at sec.gov ↗
RemovedRisk Factors
Additionally, the U.S. Department of Labor issued a final rule on June 19, 2018, which expanded flexibility regarding the regulation and formation of association health plans (AHPs) provided by small employer groups and associations. On June 13, 2019, the HHS, the U.S. Department of Labor and the U.S. Treasury issued a final rule allowing employers of all sizes that do not offer a group coverage plan to fund a new kind of health reimbursement arrangement (HRA), known as an individual coverage HRA (ICHRA). Beginning January 1, 2020, employees became able to use employer-funded ICHRAs to buy individual-market insurance, including insurance purchased on the public exchanges formed under the ACA. It remains uncertain whether or when the current or future administrations will propose changes to these insurance plan options that are not required to meet ACA requirements, and what the impact of such potential changes may be.
Read it in 10-K 2025-02-18 at sec.gov ↗
RewordedRisk Factors
Also, member and provider behavior could continue to be influenced by the uncertainty surrounding the ACA, including potential changes in premium subsidies, availability, affordability, funding and access to health insurance, whether under Medicaid programs or the Affordable Care Act (ACA) or the OBBBA, including due to changes in the eligibility or amount expiration of enhanced advance premium tax credits the Enhanced Advance Premium Tax Credits (APTCs) and additional program integrity initiatives for Marketplace products.
Read it in 10-K 2026-02-17 at sec.gov ↗
RewordedRisk Factors
Changes in healthcare regulations and practices, including due to the OBBBA, the level of utilization of healthcare services, including due to eligibility changes, benefit design, provider or consumer behavior changes, out-of-network utilization and pricing, medical claim submission patterns, including due to the use of artificial intelligence, hospital and pharmaceutical costs, including new high-cost specialty drugs, unexpected events, such as natural disasters, the effects of climate change, acts of war or aggression, geopolitical instability, major epidemics, pandemics and their resurgence, or newly emergent diseases, new medical technologies, increases in provider fraud fraud, tariffs, unexpected increases in taxes and fees, including provider taxes, and other external factors, including general economic conditions such as interest rates, inflation and unemployment levels, are generally beyond our control and could reduce our ability to accurately predict and effectively control the costs of providing health benefits.
Read it in 10-K 2026-02-17 at sec.gov ↗
RewordedRisk Factors
Further, changes in the competitive market for both Health Insurance Marketplace and the Medicare Advantage products over time, unanticipated changes to member eligibility requirements or verification processes in the program design, including due to changes to the eligibility or amount expiration of the enhanced advanced premium tax credits Enhanced APTCs and the timing of those changes, additional program integrity initiatives that have the effect of reducing membership or causing the morbidity of the risk pool to rise, changes in consumer or provider behavior, or changes in the financial incentives of individuals, brokers and competitors to participate in such products may make pricing difficult to predict.
Read it in 10-K 2026-02-17 at sec.gov ↗
RewordedRisk Factors
Failure to accurately estimate timely and price our effectively identify and mitigate medical expenses or effectively manage our medical costs or related administrative costs cost trends and receive adequate rate adjustments to account for increased acuity could have a material adverse effect on our results of operations, financial condition and cash flows.
Read it in 10-K 2026-02-17 at sec.gov ↗
RewordedRisk Factors
Several states in which we operate have obtained Section 1115 waivers to implement the ACA's Medicaid expansion in ways that extend beyond the flexibility provided by the federal law, with additional states pursuing Section 1115 waivers regarding eligibility criteria, benefits, and cost-sharing, and provider payments across their Medicaid programs. law.
Read it in 10-K 2026-02-17 at sec.gov ↗
RewordedRisk Factors
Any significant variation from our expectations regarding acuity, acuity of our members, the Marketplace membership as a whole, enrollment levels, adverse selection, out-of-network costs or other increased costs, including due to tariffs or other assumptions utilized in setting adequate premium rates could have a material adverse effect on our results of operations, financial condition and cash flows for both our Health Insurance Marketplace and Medicare Advantage products.
Read it in 10-K 2026-02-17 at sec.gov ↗
RewordedRisk Factors
If we cannot comply are determined to be out of compliance with such accuracy requirements or other contractual operational requirements, we may be subject to penalties, sanctions, damages or other consequences resulting from regulatory audits and investigations, investigations and/or litigation and otherwise suffer competitive harm, which could have a material adverse impact on our business reputation, financial condition, cash flows or results of operations.
Read it in 10-K 2026-02-17 at sec.gov ↗
RewordedRisk Factors
Our 2026 PDP bids were below the benchmarks for all 34 CMS regions, compared to our 2025 PDP bids bids, which resulted in 33 of the 34 CMS regions for which we were below the benchmarks and one region for which we were above the benchmark.
Read it in 10-K 2026-02-17 at sec.gov ↗
RewordedRisk Factors
Additionally, when we commence operations in a new state or region or launch a new product, we have limited information with which to estimate our medical claims liability. liability and continuity of care requirements, which can affect our ability to accurately predict medical claims.
Read it in 10-K 2026-02-17 at sec.gov ↗
RewordedRisk Factors
Competitors may be more aggressive in the descriptions of their capabilities and the assumptions utilized in their bids. bids or more willing to accept the financial and other terms offered by the states.
Read it in 10-K 2026-02-17 at sec.gov ↗
RewordedRisk Factors
The In addition, the IRA is expected to has substantially increase increased PDP's risk exposure in 2025. exposure.
Read it in 10-K 2026-02-17 at sec.gov ↗
RewordedRisk Factors
Additionally, the taxes and fees paid to federal, state, and local and international governments may increase due to several factors, including: enactment of, changes to or interpretations of tax laws and regulations, audits by government authorities, and geographic expansions into higher taxing jurisdictions and the effect of expansions into international markets. jurisdictions.
Read it in 10-K 2026-02-17 at sec.gov ↗
Quiet changesRisk Factors
Under the IRA, PDP plan costs will increase increased significantly due to a reduction in members cost share (close of coverage gap, and the $2,000 cap on member out-of-pocket expenses) and a decrease in federal reinsurance (from 80% to 20%, while a greater portion of the plan drug costs will fall into the catastrophic phase).
Read it in 10-K 2026-02-17 at sec.gov ↗
Quiet changesRisk Factors
In addition, some cases, states may decide to reduce reimbursement or reduce benefits.
Read it in 10-K 2026-02-17 at sec.gov ↗
AddedMD&A
With our scale and expertise, we are not only improving lives but also shaping the future of healthcare. From leveraging data to drive better outcomes across the nation to creating innovative programs to address barriers to care, we hope to redefine the healthcare experience. Our data and insights give us a powerful opportunity to anticipate needs, personalize care, and build a more affordable and effective healthcare system for tomorrow.
Read it in 10-K 2026-02-17 at sec.gov ↗
AddedMD&A
Based on the most recent publicly available membership data, we are the nation's largest Medicaid and Marketplace insurer, as well as the largest stand-alone PDP provider. Our Medicare Advantage business includes one of the highest concentrations of D-SNP members among our peers, aligned with our focus on low-income, complex populations. As of December 31, 2025, we served 12.5 million Medicaid members in 30 states, 5.5 million Marketplace members across 29 states, 1.0 million Medicare Advantage members across 32 states and 8.1 million Medicare Prescription Drug Plan (PDP) members in 50 states and the District of Columbia.
Read it in 10-K 2026-02-17 at sec.gov ↗
AddedMD&A
In December 2025, we signed a definitive agreement to divest the remaining Magellan Health businesses. As a result, we recorded non-cash impairment charges associated with the pending divestiture totaling $513 million, or $389 million after-tax.
Read it in 10-K 2026-02-17 at sec.gov ↗
AddedMD&A
In 2025, we have experienced an accelerated increase in medical cost trend. The drivers of this trend include increasing medical demand, expanded access to care facilitated by program changes at the state level, and the rapid release and availability of new, high-cost pharmaceuticals. Increasingly, state healthcare policies are providing for expanded access through carve-ins for incremental coverage (for example, behavioral healthcare and home and community-based services).
Read it in 10-K 2026-02-17 at sec.gov ↗
AddedMD&A
The medical cost drivers are likely intensified by an environment where legislative changes to the United States healthcare model have been widely publicized (and with increasing intensity over the last year). Changes to the model include references to members in certain programs who may lose eligibility and certain provider reimbursement models that may be reduced in the future. Changes in Medicaid and Marketplace, including changes in the availability of Enhanced Advance Premium Tax Credits (APTCs) for Marketplace products coupled with the One Big Beautiful Bill Act (OBBBA), create member uncertainty surrounding the future availability, affordability, funding, and access to health insurance. This backdrop may be prompting members to seek care at an increased rate (given potential eligibility and subsidy funding shifts) and providers may be modifying operations and billing practices, all further exacerbating the medical cost trend.
Read it in 10-K 2026-02-17 at sec.gov ↗
AddedMD&A
We continue to work with our state partners to establish Medicaid premium rates that appropriately match the acuity of the population as well as reflect the most recent medical cost trend. We also provide states with data to help them analyze the implications of policy decisions as well as design effective risk adjustment programs. In Marketplace, we completed the process of refiling 2026 policy year rates during the third quarter of 2025 to reflect a higher projected baseline of Marketplace morbidity than previously expected. During the third quarter of 2025, we reacted to an evolving regulatory and market environment and took corrective pricing actions for 2026 in states covering 95% of Marketplace membership.
Read it in 10-K 2026-02-17 at sec.gov ↗
AddedMD&A
Additionally, we are committed to ensuring that the affordability of healthcare is maintained for our government partners and members and continue to address the cost trend through the implementation of new clinical initiatives and care management plans, thoughtful network design, and ongoing rigor and innovation to combat fraud, waste and abuse.
Read it in 10-K 2026-02-17 at sec.gov ↗
AddedMD&A
The OBBBA, passed in July 2025, includes requirements that may reduce the number of members eligible for state Medicaid Expansion programs by requiring work or community engagement by members and for state Medicaid agencies to redetermine member eligibility at more frequent intervals, along with adding a "Cost Sharing" or "Co-Pay" for certain medical services. These changes could have the effect of increasing the overall morbidity of the Medicaid Expansion population largely beginning in 2027, subject to state implementation plans. Several other provisions of the OBBBA, such as adjustments to provider taxes and state directed payments beginning in 2028, may have the effect of reducing the amount of federal funding for Medicaid, which could result in changes in the design of Medicaid programs, including coverage of benefits, eligibility, and/or provider payment rates. In particular, New York intends to terminate its Essentials Plan-5, which provided state-subsidized healthcare for individuals from 200% to 250% of the Federal Poverty Level (FPL). The OBBBA also includes a restriction against paying certain providers designated as "prohibited entities" as of October 1, 2025, which has the potential to create access to care issues and network gaps. The timing of regulatory guidance and other rulemaking changes will be critical to ensuring state and MCO implementation readiness.
Read it in 10-K 2026-02-17 at sec.gov ↗
AddedMD&A
The Marketplace Integrity and Affordability Final Rule (Final Rule) was published in the Federal Register on June 25, 2025. The Final Rule makes changes to policies to strengthen program integrity measures in the Marketplace. For example, the Special Enrollment Period for those under 150% of the FPL has been repealed beginning August 25, 2025. Several of the provisions of the Final Rule have been stayed due to ongoing litigation. These include a requirement for certain consumers who automatically re-enroll into a fully subsidized Marketplace plan to be re-enrolled into the same plan with a $5 premium until the consumer updates their exchange application to confirm APTC eligibility. Additionally, exchanges may no longer accept a consumer's self-attestation of projected annual household income when the Internal Revenue Service (IRS) cannot verify it due to lack of tax return data; rather, exchanges must verify household income using other trusted data sources.
Read it in 10-K 2026-02-17 at sec.gov ↗
AddedMD&A
In addition, the OBBBA placed additional restrictions on APTC requirements. For example, beginning January 1, 2026, should individuals mis-estimate their projected income, the OBBBA requires them to reimburse the IRS for the full amount of excess tax credit received. In addition, as of January 1, 2026, the OBBBA prohibits individuals from receiving APTCs if they enroll in health coverage through a Special Enrollment Period associated with their income. We anticipate that the combined effect of the expiration of the Enhanced APTCs, the Final Rule, and the OBBBA will reduce 2026 Marketplace membership and continue to increase the overall morbidity of the Marketplace population. During the third quarter of 2025, we reacted to an evolving regulatory and market environment and took corrective pricing actions for 2026 in states covering 95% of Marketplace membership. We continue to advocate for legislation and regulations aimed at leveraging Medicaid and the Health Insurance Marketplace to maintain health insurance coverage and affordability for consumers.
Read it in 10-K 2026-02-17 at sec.gov ↗
AddedMD&A
The IRA significantly changed Medicare Part D, impacting stand-alone Medicare PDPs as well as the Part D benefit in many of our Medicare Advantage plans beginning in 2025, most notably by eliminating the coverage gap and capping members' annual out-of-pocket costs at $2,000 in order to provide more predictable and affordable prescription drug coverage for Medicare beneficiaries. The members' Part D annual out-of-pocket cap for 2026 is $2,100. The IRA changes effective for 2025 resulted in a meaningful shift in cost-sharing responsibilities between members, drug companies, Centers for Medicare and Medicaid Services (CMS), and PDPs and have resulted in a significant increase in our premiums in consideration for our PDPs' responsibility for a larger portion of total Part D benefit costs. Starting in 2026, CMS created a Drug Subsidy to compensate plans for the loss of the Manufacturer Discount Program (MDP) for maximum fair price drugs. To help mitigate significant premium impacts and address these changes, CMS introduced the Medicare Part D Premium Stabilization Demonstration program. This program began in calendar year 2025 and was intended by CMS to exist for three years. The parameters of the program are expected to be different each year. For example, in 2025, participating PDPs operated under narrowed risk corridor thresholds as part of the supports CMS introduced to limit market volatility. For 2026, CMS eliminated these narrowed risk corridors entirely, shifting PDPs back toward standard program financial risk‑sharing. We continue to advocate for policies that promote cost-effective, high-quality care for our PDP enrolled members. We have receivables due to us from CMS for Part D risk-sharing programs attributable to the 2025 plan year that we expect to be paid by CMS within a year after the plan year closes. If the payments from CMS are delayed, our cash flows may be materially adversely affected.
Read it in 10-K 2026-02-17 at sec.gov ↗
AddedMD&A
•In October 2025, we completed our quantitative goodwill impairment analysis and recorded a non-cash goodwill impairment of $6.7 billion in the third quarter of 2025.
Read it in 10-K 2026-02-17 at sec.gov ↗
RemovedMD&A
Our record of organic growth and strategic acquisitions have given us the size, scale and privilege of providing local high-quality and affordable health care to more than 28.6 million Americans. As of December 31, 2024, we were the largest Medicaid health insurer in the country, serving more than 13 million Medicaid recipients in 30 states. We were the largest Marketplace carrier, serving 4.4 million members across 29 states, served 1.1 million Medicare Advantage members across 37 states and were the largest stand-alone Medicare Prescription Drug Plan (PDP) provider serving 6.9 million members in 50 states and the District of Columbia. Consistent with our strategy, we have reduced our Medicare Advantage footprint to 32 states as of January 1, 2025.
Read it in 10-K 2025-02-18 at sec.gov ↗
RemovedMD&A
The United States government, policymakers and healthcare experts continue to discuss and debate various elements of the United States healthcare model. We remain focused on the promise of delivering access to high-quality, affordable healthcare to all of our members and believe we are well positioned to meet the needs of the changing healthcare landscape.
Read it in 10-K 2025-02-18 at sec.gov ↗
RemovedMD&A
We also closely monitor state legislation across our markets and are advocating for and seeing adoption of coverage expansions for Medicaid populations (e.g., North Carolina), postpartum (now in effect for 48 states, the District of Columbia and the U.S. Virgin Islands), foster care children, among others, as well as mitigating adverse legislation addressing pharmacy, prior authorization and other issues. The Consolidated Appropriations Act, 2023 outlined key coverage expansion provisions, which went into effect in January 2024, requiring states to provide 12 months of continuous coverage for children under Medicaid and the Children's Health Insurance Program (CHIP).
Read it in 10-K 2025-02-18 at sec.gov ↗
RemovedMD&A
•In January 2024, our California health plan commenced direct Medicaid contracts in 10 counties (Los Angeles, Sacramento, Amador, Calaveras, Inyo, Mono, San Joaquin, Stanislaus, Tulare and Tuolumne). In Los Angeles, a portion of the membership is subcontracted. Prior to January 2024, our California health plan previously served the state's Medicaid Managed Care population with contracts in 13 counties, including San Diego.
Read it in 10-K 2025-02-18 at sec.gov ↗
RemovedMD&A
•In December 2023, our subsidiaries, Carolina Complete Health and WellCare of North Carolina, began providing coverage under North Carolina's new Medicaid Expansion program.
Read it in 10-K 2025-02-18 at sec.gov ↗
RemovedMD&A
•In April 2023, eligibility redeterminations related to the PHE began. States have substantially completed their unwinding processes as of December 2024. We continue to work with our state partners to match rates to acuity post-redeterminations.
Read it in 10-K 2025-02-18 at sec.gov ↗
RemovedMD&A
•In April 2023, the state of New York removed pharmacy services for certain of our managed care contracts in connection with the state's transition of pharmacy services to Medicaid fee-for-service.
Read it in 10-K 2025-02-18 at sec.gov ↗
RemovedMD&A
•Given our strong bid positioning, Medicare PDP membership increased 50% year-over-year.
Read it in 10-K 2025-02-18 at sec.gov ↗
RemovedMD&A
•The decrease in our Star quality ratings in the 2023 rating year, which CMS published in October 2022, adversely impacted our 2024 Medicare revenue. The decrease in Star quality ratings was driven by the expiration of certain disaster relief provisions as well as deterioration in select metrics. As a result of this impact, we recorded a premium deficiency reserve of $250 million in the fourth quarter of 2023. We anticipate that the 2025 Plan year will operate at a loss driven primarily by Star ratings; accordingly, we recorded a premium deficiency reserve of $92 million in the fourth quarter of 2024.
Read it in 10-K 2025-02-18 at sec.gov ↗
RemovedMD&A
•In December 2023 and January 2024, we completed the divestitures of Operose Health and Circle Health, respectively.
Read it in 10-K 2025-02-18 at sec.gov ↗
RemovedMD&A
•In June 2023, we completed the divestiture of Apixio. We maintain a close relationship with, and a minority interest in, the business.
Read it in 10-K 2025-02-18 at sec.gov ↗
RemovedMD&A
•In January 2023, we completed the divestitures of Magellan Specialty Health, Centurion and HealthSmart.
Read it in 10-K 2025-02-18 at sec.gov ↗
RewordedMD&A
Total revenues increased 6% 19% in the year ended December 31, 2024, 2025, over the corresponding period in 2023 2024 primarily driven by premium yield and membership growth in the Marketplace business due to strong product positioning as well as PDP business, overall market growth and outperformance in the Marketplace risk adjustment for the 2023 benefit year, along with Medicaid business, rate increases in the Medicaid business and increased premium tax revenue, partially offset by lower Medicaid membership and lower Marketplace estimated risk adjustment revenue.
Read it in 10-K 2026-02-17 at sec.gov ↗
RewordedMD&A
The benefits of successful execution implementation of our value creation third-party pharmacy benefits management (PBM) contract, which commenced in January 2024, along with SG&A initiatives have impacted our current results of operations and will continue to impact future results of operations, including the implementation of our new third-party pharmacy benefits management (PBM) contract, which commenced in January 2024. operations.
Read it in 10-K 2026-02-17 at sec.gov ↗
RewordedMD&A
Total revenues Gross margin increased 3% $388 million in the year ended December 31, 2024, 2025, compared to the corresponding period in 2023, 2024 primarily driven by increased program changes in the PDP business as a result of the IRA along with premium yield and membership of 50%, growth, partially offset by lower timing impacts of the Medicare Advantage membership. premium deficiency reserves.
Read it in 10-K 2026-02-17 at sec.gov ↗
RewordedMD&A
Based on the data as well as our successful appeal of the initial scoring of our TTY (Text-to-Voice teletypewriter services for the hearing impaired), data, we had approximately 55% 60% of our Medicare Advantage membership enrolled in plans rated 3.5 stars or higher – compared to higher, including approximately 23% 20% in the prior year. 4-star rated plans.
Read it in 10-K 2026-02-17 at sec.gov ↗
RewordedMD&A
The credit agreement underlying our Revolving Credit Facility Facility, in the principal amount of $4.0 billion, and Term Loan Facility Facility, in the principal amount of $2.0 billion, contains customary covenants, covenants as well as financial covenants, including, covenants including a minimum fixed charge coverage ratio and a maximum debt-to-EBITDA debt-to-capital ratio.
Read it in 10-K 2026-02-17 at sec.gov ↗
RewordedMD&A
Year Ended December 31, 2025 2024 2023 GAAP diluted EPS earnings (loss) per share attributable to Centene $ (13.53) $ 6.31 $ 4.95 Amortization of acquired intangible assets 1.32 1.39 1.32 Acquisition and divestiture related expenses 0.01 0.16 0.13 Other adjustments (1) 14.86 (0.22) 0.85 Income tax effects of adjustments (2) (0.64) (0.40) (0.57) Effect of basic to diluted shares (3) (0.01) — Adjusted diluted EPS $ 2.08 $ 7.17 $ 6.68
Read it in 10-K 2026-02-17 at sec.gov ↗
RewordedMD&A
Gross margin decreased $535 $130 million in the year ended December 31, 2024, 2025, compared to the corresponding period in 2023. 2024 driven by the Circle Health divestiture in the first quarter of 2024 along with the expiration of the TRICARE Managed Care Support Contract in December 2024.
Read it in 10-K 2026-02-17 at sec.gov ↗
RewordedMD&A
See "Risk Factors - Failure to accurately estimate timely and price our effectively identify and mitigate medical expenses or effectively manage our medical costs or related administrative costs cost trends and receive adequate rate adjustments to account for increased acuity could have a material adverse effect on our results of operations, financial condition and cash flows.
Read it in 10-K 2026-02-17 at sec.gov ↗
RewordedMD&A
December 31, 2025 2024 2023 Traditional Medicaid (1) 10,932,600 11,408,100 12,754,000 High Acuity Medicaid (2) 1,585,800 1,595,400 1,718,000 Total Medicaid 12,518,400 13,003,500 14,472,000 Commercial Marketplace 5,541,400 4,382,100 3,900,100 Individual and Commercial Group (3) 452,500 431,400 427,500 Total Commercial 5,993,900 4,813,500 4,327,600 Medicare (3) (4) 1,002,600 1,110,900 1,284,200 Medicare PDP 8,118,600 6,925,700 4,617,800 Total at-risk membership 27,633,500 25,853,600 24,701,600 TRICARE eligibles — 2,747,000 2,773,200 Total 27,633,500 28,600,600 27,474,800 (1) Membership includes Temporary Assistance for Needy Families (TANF), Medicaid Expansion, Children's Health Insurance Program (CHIP), Foster Care and Behavioral Health.
Read it in 10-K 2026-02-17 at sec.gov ↗
RewordedMD&A
During 2023, 2025, we recorded a reduction favorable adjustment to the previously reported gain on sale of $22 Magellan Rx of $2 million, or $10 $1 million after-tax, due to the finalization of working capital adjustments. after-tax.
Read it in 10-K 2026-02-17 at sec.gov ↗
RewordedMD&A
Year Ended December 31, 2025 2024 2023 Net cash provided by operating activities $ 5,088 $ 154 $ 8,053 Net cash used in provided by (used in) investing activities 472 (1,052) (1,191) Net cash used in (used in) financing activities (1,621) (2,406) (1,658) Effect of exchange rate changes on cash, cash equivalents and restricted cash — 8 (32) Net increase (decrease) in cash, cash equivalents, and restricted cash and cash equivalents $ 3,939 $ (3,296) $ 5,172
Read it in 10-K 2026-02-17 at sec.gov ↗
RewordedMD&A
Approximately nine to ten months one year subsequent to the end of the plan year, or later in the case of the coverage gap drug manufacturer discount subsidy, a settlement payment is made between CMS and our plans based on the difference between the earned premium, risk corridor, reinsurance and subsidies compared to monthly prospective payments and actual claims experience. payments.
Read it in 10-K 2026-02-17 at sec.gov ↗