Centene Corporation is the largest Medicaid managed care organization in the United States. It was founded in 1984 in Milwaukee as a single nonprofit Medicaid plan by former hospital bookkeeper Elizabeth "Betty" Brinn, and grew under Michael Neidorff into a St. Louis-based Fortune 500 company that reported $194.8 billion in revenue in 2025.
How Centene Makes Money
Centene collects premiums from state Medicaid agencies, from the federal government for Medicare Advantage and Part D plans, and from members of its Ambetter ACA Marketplace plans, whose premiums are largely subsidized by federal tax credits. It pays doctors, hospitals and pharmacies from those premiums and keeps what remains after medical and administrative costs. In Q2 2026, medical costs consumed 89.6% of premiums and SG&A another 7.0%.
Medicaid Scale
At June 30, 2026, Centene served about 12.1 million Medicaid members across 30 states through local plans such as Superior HealthPlan in Texas, Sunshine Health in Florida and Fidelis Care in New York. State contracts are won through competitive procurements, so local networks, quality scores and regulatory track record matter.
Acquisitions That Built Centene
Centene bought Health Net in 2016, Fidelis Care in 2018, WellCare for about $17.3 billion in 2020 and Magellan Health in 2022. WellCare made Centene a major Medicare insurer; it had about 8.8 million Part D members by mid-2026.
The 2025 Shock
On July 1, 2025, Centene withdrew its 2025 guidance after actuarial data showed its Marketplace members were sicker than expected, and its stock fell about 40% in one day. A $6.7 billion goodwill impairment followed in the third quarter, and FY2025 ended with a $6.674 billion GAAP net loss.
2026 Recovery and Outlook
Under CEO Sarah M. London, Centene repriced Ambetter plans and cut costs. Marketplace membership dropped from 5.86 million to 3.49 million year over year, but Q2 2026 net income reached about $1.1 billion and 2026 adjusted EPS guidance rose to above $4.80. The main risks ahead are Medicaid cost trend, federal Medicaid changes and Marketplace subsidy policy.
