Centene (CNC) Q1 2026 earnings summary

Executive summary

• Adjusted diluted EPS for Q1 2026 was $3.37, exceeding expectations, with GAAP diluted EPS at $3.11; full-year adjusted EPS guidance was raised to greater than $3.40.

• Total revenues for Q1 2026 were $49.9 billion, up 7% year-over-year, driven by premium yield, PDP membership growth, and Medicaid rate increases, despite lower Marketplace and Medicaid membership.

• Strong operational improvements and disciplined execution drove outperformance, especially in Medicaid and Medicare segments.

• Managed care membership declined by 1.7 million, or 6%, year-over-year, mainly due to Medicaid eligibility redeterminations and Marketplace contraction.

• Leadership changes were announced to further strengthen business performance and support sustainable growth.

Financial highlights

• Premium and service revenues grew 5% to $44.7 billion; premium tax revenue rose 28% to $5.3 billion.

• Health benefits ratio (HBR) was 87.3%, down from 87.5% in Q1 2025; Medicaid HBR improved to 93.1%, Medicare HBR to 84.9%, and Commercial HBR to 75.3%.

• Cash flow from operations was $4.4 billion in Q1, with $437 million in cash available for corporate use.

• Debt-to-capital ratio improved to 43.2% from 46.5% at year-end after repurchasing $1 billion in senior notes.

• Net earnings attributable to shareholders were $1.54 billion, up 18% year-over-year.

Outlook and guidance

• Full-year 2026 adjusted EPS guidance raised to greater than $3.40; GAAP diluted EPS guidance floor increased to greater than $2.37.

• 2026 premium and service revenue guidance raised by $1.0 billion to $171.0–$175.0 billion.

• Medicaid composite rate yield expected around 4.5%; overall Medicaid membership projected to decline 6% year-over-year.

• Marketplace pre-tax margin guidance set at 3%, with potential upside pending June Wakely data.

• No change to full-year HBR range of 90.9%-91.7%; SG&A expense ratio expected between 7.0% and 7.6%.