Centene lost 2.4 million ACA members in a year

Centene had 3,403,300 Affordable Care Act marketplace members on Sept. 30, 2026, down from 5,828,100 a year earlier, the company said in its third quarter results on Oct. 27. That is 2,424,800 fewer people in one year. By our math, the marketplace book shrank 42%.

The insurer still raised its outlook. Centene now expects adjusted earnings of more than $5.20 a share for 2026, up $0.40 from its last forecast. It posted a GAAP loss of $0.14 a share for the quarter and adjusted earnings of $0.58 a share.

Where Centene’s members are now

Centene covered 25.7 million people at the end of September, down from 28 million a year earlier. The marketplace lost more people than the company did overall, because its drug plans grew. Here is the count by business, from the company’s release:

• Marketplace: 3.40 million, down from 5.83 million.
• Medicaid: 11.90 million, down from 12.71 million.
• Medicare Advantage and other Medicare plans: 954,400, down from 1.01 million.
• Standalone Part D drug plans: 8.95 million, up from 7.97 million.

Revenue moved the same way. Commercial revenue fell 21% to $8.7 billion in the quarter. Medicare revenue rose 20% to $11.3 billion. Total revenue was $50.6 billion.

Why the marketplace shrank

Centene’s release does not say why members left. It credits “rate increases in Marketplace” for part of its revenue and says that was “partially offset by lower Marketplace and Medicaid membership.”

The timing matches one big change. The enhanced premium tax credits that lowered marketplace premiums expired at the end of 2025, KFF reported on Aug. 3. Insurers named that expiration in their 2027 rate filings, along with a sicker group of people left in the market, KFF found.

Why fewer members meant more profit

Centene’s health benefits ratio, the share of premium dollars it spends on medical care, was 92.7% in the quarter. That matched a year earlier. The company said its marketplace ratio improved because of “improved pricing and risk transfer reflecting the acuity of the Marketplace membership.” In plain terms, it charged more for the people who stayed and got paid through the program that moves money between insurers based on how sick their members are.

Centene also cut its full year ratio forecast to a range of 90.4% to 91.1%. CEO Sarah M. London said the company’s “core businesses have powered a faster recovery to our earnings trajectory than previously anticipated.”

For Centene, a smaller marketplace book costs less to run. The release says marketplace membership “operates at a meaningfully higher SG&A expense ratio,” the share of revenue that goes to overhead.

What this means if you buy your own coverage

Open enrollment for 2027 marketplace plans starts Nov. 1, according to HealthCare.gov, which lets you preview plans and prices before you apply. KFF found insurers proposed a median premium increase of 15% for 2027.

If you have a Centene plan, look at your renewal notice when it arrives. Compare the 2027 premium and the doctor network against other plans in your county before you let it renew. We covered Centene’s 2027 marketplace plans earlier this month. Centene’s Medicare business is in a separate fight with CMS over its 2027 star ratings.

Why it matters: The largest drop in Centene’s book came from people buying their own insurance. The company’s earnings went up while 2.4 million of those people left its plans.