Centene expects its ACA membership to fall nearly 40% by the end of 2026, company executives said March 11 at the Barclays 28th Annual Global Healthcare Conference.
CEO Sarah London said the company ended 2025 with 5.5 million members in the market, which dropped to 4.6 million in January and then 3.6 million in February. There are expected to be 3.5 million members by the end of the first quarter, followed by some additional attrition through the remainder of the year.
“Our view was that the market would shrink somewhere between the high teens and the mid-thirties,” she said. “We were pretty consistent in a view that we would be at the higher end of that and possibly higher than the top end of that, partly because of our FPL mix and partly because of the pricing actions that we took coming into the year and our focus on margin over membership.”
The company also flagged shifts in metal tier composition, with Bronze enrollment rising from the low 20% range to above 30% of its ACA business. Ms. London noted those members are not the traditionally younger and healthier Bronze enrollees seen in prior years, but instead individuals who are seeking more affordable coverage.
Centene also cited higher-than-expected specialty pharmacy utilization within its Silver tier, particularly with anti-inflammatory drugs for gastrointestinal and dermatological conditions.
Despite the membership headwinds, the insurer reaffirmed its adjusted EPS guidance of greater than $3 for 2026.
Within Medicaid, the company reported a mid-6% medical cost trend in 2025 and projected a net trend of approximately 4.5% for 2026, supported by cost management initiatives and 75 daily fraud detection algorithms to analyze millions of claims. Medicare Advantage margins remained negative in 2025 and are expected to be slightly below breakeven this year, with a target of breakeven by 2027.
