Centene Corporation reported a GAAP loss for 2025 despite strong top-line growth, as large non-cash charges overshadowed operating performance and cash generation.
The outcome leaves Centene at the more volatile end of the major US health insurers. Unlike more diversified peers such as UnitedHealth Group, Elevance Health and CVS Health’s Aetna unit - all of which remained profitable on a reported basis for the year - Centene’s heavier exposure to Medicaid, ACA marketplace and Medicare prescription drug plans amplified earnings volatility despite solid underlying operations.
Centene and UnitedHealth Group are the best health insurance companies by market share. Compare and identify strong partners for your broker business.
Total revenues for 2025 were $194.8 billion, up 20% from 2024. Premium and service revenues rose to $174.6 billion from $145.5 billion, with growth of 8% in Medicaid, 25% in commercial, 62% in Medicare and 4% in other revenue.
That growth rate clearly outpaced the high single-digit to low double-digit revenue increases reported by most large diversified rivals. UnitedHealth, Elevance and CVS/Aetna all delivered steadier, but slower, top-line expansion driven by employer, Medicare Advantage and services businesses. Centene’s faster growth reflects its greater weighting to ACA marketplace and Medicare PDP, segments that have been expanding rapidly across the industry but carry higher regulatory and earnings risk.
Centene recorded a diluted loss per share of $13.53 for the year and $2.24 in the fourth quarter, driven primarily by a $6.7 billion goodwill impairment in the third quarter of 2025, alongside a further $513 million of non-cash impairment charges linked to the planned divestiture of the remaining Magellan Health businesses.
By contrast, most large national peers did not take goodwill impairments on a comparable scale in 2025, allowing them to report positive GAAP earnings despite margin pressure. As a result, Centene’s reported results diverged more sharply from peers than its underlying operating trends alone would suggest.
On an adjusted basis, diluted EPS was $2.08 for the full year, while Q4 showed an adjusted diluted loss per share of $1.19. Cash flow from operations remained robust at $5.1 billion for 2025 and $437 million in the fourth quarter. This places Centene broadly in line with peers in terms of cash generation, with management echoing a common industry theme: resilient cash flows even as underwriting margins came under pressure.
The health benefits ratio (HBR) deteriorated to 91.9% for 2025 from 88.3% in 2024, and to 94.3% in Q4 from 89.6% a year earlier. Centene cited lower estimated marketplace risk-adjustment revenue versus an unusually strong 2024, higher marketplace medical costs, Medicare PDP changes under the Inflation Reduction Act and rising Medicaid costs for behavioral health, home health and high-cost drugs.
Peers have reported similar pressures in Medicare and exchange business, particularly at Humana and CVS/Aetna, but the impact on consolidated margins has been more muted at companies with larger employer and services operations. Centene’s heavier concentration in government programs meant these headwinds flowed more directly through to group-level results.
The SG&A expense ratio improved to 7.4% for 2025 from 8.5% in 2024, reflecting cost discipline and operating leverage. This compares favorably with peers, although gains were partly offset by continued expansion in the higher-SG&A marketplace segment - again highlighting the trade-off between growth and stability in Centene’s portfolio.
Total at-risk membership rose to 27.6 million at year-end 2025 from 25.9 million. Medicaid lives declined amid redeterminations, while marketplace membership climbed to 5.54 million and Medicare PDP to 8.12 million.
Those increases place Centene toward the upper end of peer growth in ACA marketplace and Medicare drug plans, where UnitedHealth, Elevance and CVS/Aetna have generally prioritized pricing discipline over volume expansion. The result is faster growth for Centene, but with greater earnings sensitivity to regulatory and utilization swings.
Chief executive Sarah London said Centene exits “a challenging year” with “positive momentum” from actions to restore marketplace profitability and stabilize Medicaid.
For 2026, Centene is guiding to GAAP diluted EPS of more than $1.98, adjusted diluted EPS above $3.00, an HBR of 90.9%–91.7% and an SG&A ratio of 7.1%–7.7%. That outlook implies a margin recovery broadly in line with repair efforts underway across the large US health insurers - though Centene’s trajectory remains more dependent than peers on improvement in government and exchange books.
