Centene (CNC) 10-Q 26 Apr 21 2021 Q1 Quarterly report Financial data

Cover

Cover - shares	3 Months Ended
	Mar. 31, 2021	Apr. 16, 2021
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Mar. 31, 2021
Document Transition Report	false
Entity File Number	001-31826
Entity Registrant Name	CENTENE CORPORATION
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	42-1406317
Entity Address, Address Line One	7700 Forsyth Boulevard
Entity Address, City or Town	St. Louis,
Entity Address, State or Province	MO
Entity Address, Postal Zip Code	63105
City Area Code	314
Local Phone Number	725-4477
Title of 12(b) Security	Common Stock $0.001 Par Value
Trading Symbol	CNC
Security Exchange Name	NYSE
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		582,734,777
Entity Central Index Key	0001071739
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2021
Document Fiscal Period Focus	Q1
Amendment Flag	false

CONSOLIDATED BALANCE SHEETS

CONSOLIDATED BALANCE SHEETS - USD ($) $ in Millions	Mar. 31, 2021	Dec. 31, 2020
Current assets:
Cash and cash equivalents	$ 9,627	$ 10,800
Premium and trade receivables	11,601	9,696
Short-term investments	1,662	1,580
Other current assets	1,550	1,317
Total current assets	24,440	23,393
Long-term investments	13,245	12,853
Restricted deposits	1,113	1,060
Property, software and equipment, net	2,822	2,774
Goodwill	18,788	18,652
Intangible assets, net	8,235	8,388
Other long-term assets	1,642	1,599
Total assets	70,285	68,719
Current liabilities:
Medical claims liability	12,842	12,438
Accounts payable and accrued expenses	6,866	7,069
Return of premium payable	1,935	1,458
Unearned revenue	574	523
Current portion of long-term debt	62	97
Total current liabilities	22,279	21,585
Long-term debt	16,695	16,682
Deferred tax liability	1,641	1,534
Other long-term liabilities	3,134	2,956
Total liabilities	43,749	42,757
Commitments and contingencies
Redeemable noncontrolling interests	78	77
Stockholders’ equity:
Preferred stock, $0.001 par value; authorized 10,000 shares; no shares issued or outstanding at March 31, 2021 and December 31, 2020	0	0
Common stock, $0.001 par value; authorized 800,000 shares; 599,608 issued and 582,682 outstanding at March 31, 2021, and 598,249 issued and 581,479 outstanding at December 31, 2020	1	1
Additional paid-in capital	19,500	19,459
Accumulated other comprehensive earnings	176	337
Retained earnings	7,491	6,792
Treasury stock, at cost (16,926 and 16,770 shares, respectively)	(826)	(816)
Total Centene stockholders’ equity	26,342	25,773
Nonredeemable noncontrolling interest	116	112
Total stockholders’ equity	26,458	25,885
Total liabilities, redeemable noncontrolling interests and stockholders’ equity	$ 70,285	$ 68,719

CONSOLIDATED BALANCE SHEETS (Pa

CONSOLIDATED BALANCE SHEETS (Parenthetical) - $ / shares	Mar. 31, 2021	Dec. 31, 2020
Stockholders' equity
Preferred stock, par value (in dollars per share)	$ 0.001	$ 0.001
Preferred stock, shares authorized (in shares)	10,000,000	10,000,000
Preferred stock, shares issued (in shares)	0	0
Preferred stock, shares outstanding (in shares)	0	0
Common stock, par value (in dollars per share)	$ 0.001	$ 0.001
Common stock, shares authorized (in shares)	800,000,000	800,000,000
Common stock, shares issued (in shares)	599,608,000	598,249,000
Common stock, shares outstanding (in shares)	582,682,000	581,479,000
Treasury stock (in shares)	16,926,000	16,770,000

CONSOLIDATED STATEMENTS OF OPER

CONSOLIDATED STATEMENTS OF OPERATIONS - USD ($) shares in Thousands, $ in Millions	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Revenues:
Premium and service revenues	$ 28,114	$ 24,172
Premium tax and health insurer fee	1,869	1,853
Total revenues	29,983	26,025
Expenses:
Medical costs	23,391	20,420
Cost of services	1,048	825
Selling, general and administrative expenses	2,367	2,384
Amortization of acquired intangible assets	195	166
Premium tax expense	1,928	1,625
Health insurer fee expense	0	345
Impairment	0	72
Total operating expenses	28,929	25,837
Earnings from operations	1,054	188
Other income (expense):
Investment and other income	103	167
Debt extinguishment costs	(46)	(44)
Interest expense	(170)	(180)
Earnings before income tax expense	941	131
Income tax expense	244	85
Net earnings	697	46
Loss attributable to noncontrolling interests	2	0
Net earnings attributable to Centene Corporation	$ 699	$ 46
Net earnings per common share attributable to Centene Corporation:
Basic earnings per common share (in dollars per share)	$ 1.20	$ 0.08
Diluted earnings per common share (in dollars per share)	$ 1.19	$ 0.08
Weighted average number of common shares outstanding:
Basic (in shares)	581,869	544,436
Diluted (in shares)	589,343	552,062
Premium
Revenues:
Premium and service revenues	$ 26,933	$ 23,214
Service
Revenues:
Premium and service revenues	$ 1,181	$ 958

CONSOLIDATED STATEMENTS OF COMP

CONSOLIDATED STATEMENTS OF COMPREHENSIVE EARNINGS (LOSS) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Statement of Comprehensive Income [Abstract]
Net earnings	$ 697	$ 46
Reclassification adjustment, net of tax	(2)	0
Change in unrealized gain (loss) on investments, net of tax	(154)	(134)
Defined benefit pension plan net gain, net of tax	0	2
Foreign currency translation adjustments	(5)	(7)
Other comprehensive earnings (loss)	(161)	(139)
Comprehensive earnings (loss)	536	(93)
Comprehensive loss attributable to noncontrolling interests	2	0
Comprehensive earnings (loss) attributable to Centene Corporation	$ 538	$ (93)

CONSOLIDATED STATEMENTS OF STOC

CONSOLIDATED STATEMENTS OF STOCKHOLDERS' EQUITY - USD ($) shares in Thousands, $ in Millions	Total	Common Stock	Additional Paid-in Capital	Accumulated Other Comprehensive Earnings (Loss)	Retained Earnings	Treasury Stock	Non-redeemable Non- controlling Interest
Balance (in shares) at Dec. 31, 2019		421,508
Balance at Dec. 31, 2019	$ 12,659	$ 0	$ 7,647	$ 134	$ 4,984	$ (214)	$ 108
Treasury stock (in shares) at Dec. 31, 2019						6,460
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net earnings (loss)	43				46		(3)
Other comprehensive loss , net of tax	(139)			(139)
Common stock issued for acquisitions (in shares)		171,225
Common stock issued for acquisitions	11,526		11,526
Common stock issued for employee benefit plans (in shares)		2,448
Common stock issued for employee benefit plans	5		5
Common stock repurchases (in shares)		(291)				(9,308)
Common stock repurchases	(558)		(17)			$ (541)
Stock compensation expense	117		117
Contribution from noncontrolling interest	2						2
Other	1		1
Balance (in shares) at Mar. 31, 2020		594,890
Balance at Mar. 31, 2020	$ 23,656	$ 0	19,279	(5)	5,030	$ (755)	107
Treasury stock (in shares) at Mar. 31, 2020						15,768
Balance (in shares) at Dec. 31, 2020	581,479	598,249
Balance at Dec. 31, 2020	$ 25,885	$ 1	19,459	337	6,792	$ (816)	112
Treasury stock (in shares) at Dec. 31, 2020	16,770					16,770
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net earnings (loss)	$ 694				699		(5)
Other comprehensive loss , net of tax	(161)			(161)
Common stock issued for employee benefit plans (in shares)		1,675
Common stock issued for employee benefit plans	9		9
Common stock repurchases (in shares)		(316)				(156)
Common stock repurchases	(29)		(19)			$ (10)
Stock compensation expense	51		51
Contribution from noncontrolling interest	$ 9						9
Balance (in shares) at Mar. 31, 2021	582,682	599,608
Balance at Mar. 31, 2021	$ 26,458	$ 1	$ 19,500	$ 176	$ 7,491	$ (826)	$ 116
Treasury stock (in shares) at Mar. 31, 2021	16,926					16,926

CONSOLIDATED STATEMENTS OF ST_2

CONSOLIDATED STATEMENTS OF STOCKHOLDERS' EQUITY (Parenthetical) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020	Dec. 31, 2020	Dec. 31, 2019
Par value (in dollars per share)	$ 0.001		$ 0.001
Other comprehensive loss, tax	$ (49)	$ (40)
Common Stock
Par value (in dollars per share)	$ 0.001	$ 0.001	0.001	$ 0.001
Treasury Stock
Par value (in dollars per share)	$ 0.001	$ 0.001	$ 0.001	$ 0.001

CONSOLIDATED STATEMENTS OF CASH

CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Cash flows from operating activities:
Net earnings	$ 697	$ 46
Adjustments to reconcile net earnings to net cash provided by (used in) operating activities
Depreciation and amortization	361	288
Stock compensation expense	51	117
Impairment	0	72
Loss on debt extinguishment	46	44
Deferred income taxes	156	112
Gain on divestiture	0	(93)
Other adjustments, net	2	24
Changes in assets and liabilities
Premium and trade receivables	(1,891)	(2,182)
Other assets	(287)	97
Medical claims liabilities	405	252
Unearned revenue	48	(88)
Accounts payable and accrued expenses	32	704
Other long-term liabilities	423	361
Other operating activities, net	0	6
Net cash provided by (used in) operating activities	43	(240)
Cash flows from investing activities:
Capital expenditures	(187)	(177)
Purchases of investments	(1,653)	(1,400)
Sales and maturities of investments	1,391	902
Acquisitions, net of cash acquired	(158)	(3,048)
Divestiture proceeds, net of divested cash	0	456
Other investing activities, net	0	(5)
Net cash used in investing activities	(607)	(3,272)
Cash flows from financing activities:
Proceeds from long-term debt	2,317	2,542
Payments of long-term debt	(2,295)	(1,039)
Common stock repurchases	(29)	(558)
Payments for debt extinguishment	(54)	(21)
Debt issuance costs	(27)	(92)
Other financing activities, net	15	7
Net cash provided by (used in) financing activities	(73)	839
Effect of exchange rate changes on cash, cash equivalents, and restricted cash	(16)	(1)
Net decrease in cash, cash equivalents and restricted cash and cash equivalents	(653)	(2,674)
Cash, cash equivalents, and restricted cash and cash equivalents, beginning of period	10,957	12,131
Cash, cash equivalents, and restricted cash and cash equivalents, end of period	10,304	9,457
Supplemental disclosures of cash flow information:
Interest paid	130	104
Income taxes paid	20	3
Equity issued in connection with acquisitions	0	11,526
The following table provides a reconciliation of cash, cash equivalents, and restricted cash and cash equivalents reported within the Consolidated Balance Sheets to the totals above:
Cash and cash equivalents	9,627	9,308
Restricted cash and cash equivalents, included in restricted deposits	677	149
Total cash, cash equivalents, and restricted cash and cash equivalents	$ 10,304	$ 9,457

Organization and Operations

Organization and Operations	3 Months Ended
	Mar. 31, 2021
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Organization and Operations	Organization and Operations Basis of Presentation The accompanying interim financial statements have been prepared under the presumption that users of the interim financial information have either read or have access to the audited financial statements included in the Form 10-K for the fiscal year ended December 31, 2020. The unaudited interim financial statements herein have been prepared pursuant to the rules and regulations of the Securities and Exchange Commission. Accordingly, footnote disclosures that would substantially duplicate the disclosures contained in the December 31, 2020 audited financial statements have been omitted from these interim financial statements, where appropriate. In the opinion of management, these financial statements reflect all adjustments, consisting only of normal recurring adjustments, which are necessary for a fair presentation of the results of the interim periods presented. Certain 2020 amounts in the consolidated financial statements and notes to the consolidated financial statements have been reclassified to conform to the 2021 presentation. These reclassifications have no effect on net earnings or stockholders’ equity as previously reported. Recently Adopted Accounting Guidance In December 2019, the Financial Accounting Standards Board issued an Accounting Standards Update which simplifies the accounting for income taxes. The guidance is effective for annual and interim periods beginning after December 15, 2020. The Company adopted the new guidance in the first quarter of 2021. The new guidance did not have a material impact on the Company's consolidated financial position, results of operations and cash flows.

Short-term and Long-term Invest

Short-term and Long-term Investments, Restricted Deposits	3 Months Ended
	Mar. 31, 2021
Investments, Debt and Equity Securities [Abstract]
Short-term and Long-term Investments, Restricted Deposits	Short-term and Long-term Investments, Restricted Deposits Short-term and long-term investments and restricted deposits by investment type consist of the following ($ in millions): March 31, 2021 December 31, 2020 Amortized Gross Gross Fair Amortized Gross Gross Fair Debt securities: U.S. Treasury securities and obligations of U.S. government corporations and agencies $ 515 $ 2 $ — $ 517 $ 907 $ 4 $ — $ 911 Corporate securities 6,944 182 (64) 7,062 6,560 262 (8) 6,814 Restricted certificates of deposit 4 — — 4 105 — — 105 Restricted cash equivalents 677 — — 677 157 — — 157 Short-term time deposits 82 — — 82 53 — — 53 Municipal securities 3,118 101 (14) 3,205 2,970 129 (2) 3,097 Asset-backed securities 1,197 12 (2) 1,207 1,154 13 (3) 1,164 Residential mortgage-backed securities 1,066 20 (8) 1,078 1,068 27 — 1,095 Commercial mortgage-backed securities 793 19 (11) 801 748 30 (5) 773 Equity securities (1) 319 — — 319 318 — — 318 Private equity investments 896 — — 896 838 — — 838 Life insurance contracts 172 — — 172 168 — — 168 Total $ 15,783 $ 336 $ (99) $ 16,020 $ 15,046 $ 465 $ (18) $ 15,493 (1) Investments in equity securities primarily consists of exchange traded funds in fixed income securities. The Company’s investments are debt securities classified as available-for-sale with the exception of equity securities, certain private equity investments and life insurance contracts. The Company’s investment policies are designed to provide liquidity, preserve capital and maximize total return on invested assets with the focus on high credit quality securities. The Company limits the size of investment in any single issuer other than U.S. treasury securities and obligations of U.S. government corporations and agencies. As of March 31, 2021, 97% of the Company’s investments in rated securities carry an investment grade rating by nationally recognized statistical rating organizations. At March 31, 2021, the Company held certificates of deposit, equity securities, private equity investments and life insurance contracts, which did not carry a credit rating. Accrued interest income on available-for-sale debt securities was $91 million and $86 million at March 31, 2021 and December 31, 2020, respectively, and is included in other current assets on the Consolidated Balance Sheets. The Company’s residential mortgage-backed securities are primarily issued by the Federal National Mortgage Association, Government National Mortgage Association or Federal Home Loan Mortgage Corporation, which carry implicit or explicit guarantees of the U.S. government. The Company’s commercial mortgage-backed securities are primarily senior tranches with a weighted average rating of AA and a weighted average duration of 4 years at March 31, 2021. The fair value of available-for-sale debt securities with gross unrealized losses by investment type and length of time that individual securities have been in a continuous unrealized loss position were as follows ($ in millions): March 31, 2021 December 31, 2020 Less Than 12 Months 12 Months or More Less Than 12 Months 12 Months or More Unrealized Losses Fair Unrealized Losses Fair Unrealized Losses Fair Unrealized Losses Fair Corporate securities $ (61) $ 2,711 $ (3) $ 100 $ (7) $ 953 $ (1) $ 24 Municipal securities (13) 759 (1) 13 (2) 238 — — Asset-backed securities (1) 296 (1) 58 (2) 302 (1) 105 Residential mortgage-backed securities (8) 442 — 2 — 59 — 2 Commercial mortgage-backed securities (10) 245 (1) 53 (5) 147 — 13 Total $ (93) $ 4,453 $ (6) $ 226 $ (16) $ 1,699 $ (2) $ 144 As of March 31, 2021, the gross unrealized losses were generated from 1,829 positions out of a total of 6,470 positions. The change in fair value of fixed income securities is primarily a result of movement in interest rates subsequent to the purchase of the security. For each security in an unrealized loss position, the Company assesses whether it intends to sell the security or if it is more likely than not the Company will be required to sell the security before recovery of the amortized cost basis for reasons such as liquidity, contractual or regulatory purposes. If the security meets this criterion, the decline in fair value is recorded in earnings. The Company does not intend to sell these securities prior to maturity and it is not likely that the Company will be required to sell these securities prior to maturity; therefore, the Company did not record the unrealized loss in earnings for these securities. In addition, the Company continuously monitors available-for-sale debt securities for credit losses. Certain investments have experienced a decline in fair value due to changes in credit quality, market interest rates and/or general economic conditions. The Company recognizes an allowance when evidence demonstrates that it is credit related. Evidence of a credit related loss may include rating agency actions, adverse conditions specifically related to the security, or failure of the issuer of the security to make scheduled payments. The contractual maturities of short-term and long-term debt securities and restricted deposits are as follows ($ in millions): March 31, 2021 December 31, 2020 Investments Restricted Deposits Investments Restricted Deposits Amortized Fair Amortized Fair Amortized Fair Amortized Fair One year or less $ 1,488 $ 1,497 $ 845 $ 846 $ 1,407 $ 1,414 $ 817 $ 818 One year through five years 5,082 5,227 240 241 4,748 4,937 221 223 Five years through ten years 3,589 3,637 26 26 3,460 3,639 18 19 Greater than ten years 70 73 — — 81 87 — — Asset-backed securities 3,056 3,086 — — 2,970 3,032 — — Total $ 13,285 $ 13,520 $ 1,111 $ 1,113 $ 12,666 $ 13,109 $ 1,056 $ 1,060 Actual maturities may differ from contractual maturities due to call or prepayment options. Equity securities, private equity investments and life insurance contracts are excluded from the table above because they do not have a contractual maturity. The Company has an option to redeem at amortized cost substantially all of the securities included in the greater than ten years category listed above.

Fair Value Measurements

Fair Value Measurements	3 Months Ended
	Mar. 31, 2021
Fair Value Disclosures [Abstract]
Fair Value Measurements	Fair Value Measurements Assets and liabilities recorded at fair value in the Consolidated Balance Sheets are categorized based upon observable or unobservable inputs used to estimate fair value. Level inputs are as follows: Level Input: Input Definition: Level I Inputs are unadjusted, quoted prices for identical assets or liabilities in active markets at the measurement date. Level II Inputs other than quoted prices included in Level I that are observable for the asset or liability through corroboration with market data at the measurement date. Level III Unobservable inputs that reflect management’s best estimate of what market participants would use in pricing the asset or liability at the measurement date. The following table summarizes fair value measurements by level at March 31, 2021, for assets and liabilities measured at fair value on a recurring basis ($ in millions): Level I Level II Level III Total Assets Cash and cash equivalents $ 9,627 $ — $ — $ 9,627 Investments: U.S. Treasury securities and obligations of U.S. government corporations and agencies $ 145 $ — $ — $ 145 Corporate securities — 7,035 — 7,035 Municipal securities — 3,172 — 3,172 Short-term time deposits — 82 — 82 Asset-backed securities — 1,207 — 1,207 Residential mortgage-backed securities — 1,078 — 1,078 Commercial mortgage-backed securities — 801 — 801 Equity securities 317 2 — 319 Total investments $ 462 $ 13,377 $ — $ 13,839 Restricted deposits: Cash and cash equivalents $ 677 $ — $ — $ 677 Certificates of deposit — 4 — 4 Corporate securities — 27 — 27 Municipal securities — 33 — 33 U.S. Treasury securities and obligations of U.S. government corporations and agencies 372 — — 372 Total restricted deposits $ 1,049 $ 64 $ — $ 1,113 Total assets at fair value $ 11,138 $ 13,441 $ — $ 24,579 The following table summarizes fair value measurements by level at December 31, 2020, for assets and liabilities measured at fair value on a recurring basis ($ in millions): Level I Level II Level III Total Assets Cash and cash equivalents $ 10,800 $ — $ — $ 10,800 Investments: U.S. Treasury securities and obligations of U.S. government corporations and agencies $ 165 $ — $ — $ 165 Corporate securities — 6,789 — 6,789 Municipal securities — 3,070 — 3,070 Short-term time deposits — 53 — 53 Asset backed securities — 1,164 — 1,164 Residential mortgage backed securities — 1,095 — 1,095 Commercial mortgage backed securities — 773 — 773 Equity securities 316 2 — 318 Total investments $ 481 $ 12,946 $ — $ 13,427 Restricted deposits: Cash and cash equivalents $ 157 $ — $ — $ 157 Certificates of deposit — 105 — 105 Corporate securities — 25 — 25 Municipal securities — 27 — 27 U.S. Treasury securities and obligations of U.S. government corporations and agencies 746 — — 746 Total restricted deposits $ 903 $ 157 $ — $ 1,060 Total assets at fair value $ 12,184 $ 13,103 $ — $ 25,287 The Company utilizes matrix-pricing services to estimate fair value for securities which are not actively traded on the measurement date. The Company designates these securities as Level II fair value measurements. In addition, the aggregate carrying amount of the Company’s private equity investments and life insurance contracts, which approximates fair value, was $1,068 million and $1,006 million as of March 31, 2021 and December 31, 2020, respectively.

Medical Claims Liability

Medical Claims Liability	3 Months Ended
	Mar. 31, 2021
Insurance [Abstract]
Medical Claims Liability	Medical Claims Liability The following table summarizes the change in medical claims liability ($ in millions): Three Months Ended March 31, 2021 2020 Balance, January 1 $ 12,438 $ 7,473 Less: Reinsurance recoverable 23 20 Balance, January 1, net 12,415 7,453 Acquisitions and divestitures — 3,697 Incurred related to: Current year 24,255 20,866 Prior years (864) (446) Total incurred 23,391 20,420 Paid related to: Current year 15,161 15,147 Prior years 7,828 5,031 Total paid 22,989 20,178 Balance at March 31, net 12,817 11,392 Plus: Reinsurance recoverable 25 21 Balance, March 31 $ 12,842 $ 11,413 Reinsurance recoverables related to medical claims are included in premium and trade receivables. Changes in estimates of incurred claims for prior years are primarily attributable to reserving under moderately adverse conditions. Additionally, as a result of minimum health benefits ratio (HBR) and other return of premium programs, the Company recorded $202 million and $31 million as a reduction to premium revenue in the three months ended March 31, 2021 and 2020, respectively. Incurred but not reported (IBNR) plus expected development on reported claims as of March 31, 2021 was $8,630 million. Total IBNR plus expected development on reported claims represents estimates for claims incurred but not reported, development on reported claims, and estimates for the costs necessary to process unpaid claims at the end of each period. The Company estimates its liability using actuarial methods that are commonly used by health insurance actuaries and meet Actuarial Standards of Practice. These actuarial methods consider factors such as historical data for payment patterns, cost trends, product mix, seasonality, utilization of healthcare services and other relevant factors.

Affordable Care Act

Affordable Care Act	3 Months Ended
	Mar. 31, 2021
Affordable Care Act [Abstract]
Affordable Care Act	Affordable Care Act The Affordable Care Act established risk spreading premium stabilization programs as well as a minimum annual medical loss ratio (MLR) and cost sharing reductions. The Company's net receivables (payables) for each of the programs are as follows ($ in millions): March 31, 2021 December 31, 2020 Risk adjustment receivable $ 377 $ 340 Risk adjustment payable (1,341) (1,224) Minimum medical loss ratio (235) (238) Cost sharing reduction receivable 120 101 Cost sharing reduction payable (1) (1)

Debt

Debt	3 Months Ended
	Mar. 31, 2021
Debt Disclosure [Abstract]
Debt	Debt Debt consists of the following ($ in millions): March 31, 2021 December 31, 2020 $2,200 million 4.75% Senior Notes, due January 15, 2025 $ — $ 2,230 $1,800 million 5.375% Senior Notes, due June 1, 2026 1,800 1,800 $750 million 5.375% Senior Notes due August 15, 2026 792 794 $2,500 million 4.25% Senior Notes due December 15, 2027 2,483 2,482 $3,500 million 4.625% Senior Notes due December 15, 2029 3,500 3,500 $2,000 million 3.375% Senior Notes due February 15, 2030 2,000 2,000 $2,200 million 3.00% Senior Notes due October 15, 2030 2,200 2,200 $2,200 million 2.50% Senior Notes due March 1, 2031 2,200 — Total senior notes 14,975 15,006 Term loan facility 1,450 1,450 Revolving credit agreement 152 97 Mortgage notes payable — 50 Construction loan payable 184 180 Finance leases and other 156 153 Debt issuance costs (160) (157) Total debt 16,757 16,779 Less current portion (62) (97) Long-term debt $ 16,695 $ 16,682 Senior Notes In February 2021, the Company issued $2,200 million 2.50% Senior Notes due 2031 (the 2031 Notes). In conjunction with the 2031 Notes offering, the Company completed a tender offer (the Tender Offer) to purchase for cash, subject to certain conditions, any and all of the outstanding aggregate principal amount of the $2,200 million 4.75% Senior Notes due 2025 (the 2025 Notes). The Company used the net proceeds from the 2031 Notes, together with available cash on hand, to fund the purchase price for the 2025 Notes accepted for purchase in the Tender Offer (approximately 36% of the aggregate principal amount outstanding) and used the remaining proceeds to redeem any of the 2025 Notes that remained outstanding following the Tender Offer, including all premiums, accrued interest and costs and expenses related to the redemption. The Company recognized a pre-tax loss on extinguishment of $46 million on the redemption of the 2025 Notes, including the call premium and write-off of unamortized debt issuance costs. Construction Loan In October 2017, the Company executed a $200 million non-recourse construction loan to fund the expansion of the Company's corporate headquarters. The loan bears interest based on one month LIBOR plus 2.70%, which will reduce to LIBOR plus 2.00% at the time construction has been completed. The agreement contains financial and non-financial covenants similar to those contained in the Company Credit Facility. The Company has guaranteed completion of the construction project associated with the loan. In April 2021, the Company finalized the one year extension of the construction loan maturing in April 2022. As of March 31, 2021, the Company had $184 million in borrowings outstanding under the loan. Mortgage Notes Payable The Company paid its non-recourse mortgage note of $50 million in January 2021. The mortgage note was collateralized by its corporate headquarters building and bore a 5.14% interest rate.

Leases

Leases	3 Months Ended
	Mar. 31, 2021
Leases [Abstract]
Leases	The Company records right of use (ROU) assets and lease liabilities for non-cancelable operating leases primarily for real estate and equipment. Leases with an initial term of 12 months or less are not recorded on the balance sheet. Expense related to leases is recorded on a straight-line basis over the lease term, including rent holidays. The Company recognized operating lease expense of $66 million and $62 million for the three months ended March 31, 2021 and 2020, respectively. The following table sets forth the ROU assets and lease liabilities ($ in millions): March 31, 2021 December 31, 2020 Assets ROU assets (recorded within other long-term assets) $ 1,339 $ 1,311 Liabilities Short-term (recorded within accounts payable and accrued expenses) $ 204 $ 204 Long-term (recorded within other long-term liabilities) 1,367 1,334 Total lease liabilities $ 1,571 $ 1,538 During the three months ended March 31, 2021, the Company reduced its lease liabilities by $67 million for cash paid. In addition, during the three months ended March 31, 2021, new operating leases commenced resulting in the recognition of ROU assets and lease liabilities of $96 million. As of March 31, 2021, the Company had additional operating leases that have not yet commenced of $31 million. These operating leases will commence in 2021 and 2022 with lease terms ranging from seven nine As of March 31, 2021, the weighted average remaining lease term of the Company’s operating leases was 9.5 years. The lease liabilities as of March 31, 2021 reflect a weighted average discount rate of 3.2%. Lease payments over the next five years and thereafter are as follows ($ in millions): March 31, 2021 2021 $ 186 2022 243 2023 219 2024 197 2025 160 2026 136 Thereafter 692 Total lease payments 1,833 Less: imputed interest (262) Total lease liabilities $ 1,571

Earnings Per Share

Earnings Per Share	3 Months Ended
	Mar. 31, 2021
Earnings Per Share [Abstract]
Earnings Per Share	Earnings Per Share The following table sets forth the calculation of basic and diluted net earnings per common share ($ in millions, except per share data in dollars and shares in thousands): Three Months Ended March 31, 2021 2020 Earnings attributable to Centene Corporation $ 699 $ 46 Shares used in computing per share amounts: Weighted average number of common shares outstanding 581,869 544,436 Common stock equivalents (as determined by applying the treasury stock method) 7,474 7,626 Weighted average number of common shares and potential dilutive common shares outstanding 589,343 552,062 Net earnings per common share attributable to Centene Corporation: Basic earnings per common share $ 1.20 $ 0.08 Diluted earnings per common share $ 1.19 $ 0.08

Segment Information

Segment Information	3 Months Ended
	Mar. 31, 2021
Segment Reporting [Abstract]
Segment Information	Segment Information Centene operates in two segments: Managed Care and Specialty Services. The Managed Care segment consists of Centene’s health plans, including all of the functions needed to operate them. The Specialty Services segment consists of Centene’s specialty companies offering auxiliary healthcare services and products. Factors used in determining the reportable business segments include the nature of operating activities, the existence of separate senior management teams, and the type of information presented to the Company’s chief operating decision-maker to evaluate all results of operations. Segment information for the three months ended March 31, 2020 has been conformed to the 2021 presentation of segment eliminations. Segment information for the three months ended March 31, 2021, is as follows ($ in millions): Managed Care Specialty Eliminations Consolidated Total revenues from external customers $ 28,602 $ 1,381 $ — $ 29,983 Total revenues from internal customers 1 2,886 (2,887) — Total revenues $ 28,603 $ 4,267 $ (2,887) $ 29,983 Earnings from operations $ 956 $ 98 $ — $ 1,054 Segment information for the three months ended March 31, 2020, is as follows ($ in millions): Managed Care Specialty Eliminations Consolidated Total revenues from external customers $ 24,936 $ 1,089 $ — $ 26,025 Total revenues from internal customers 1 2,537 (2,538) — Total revenues $ 24,937 $ 3,626 $ (2,538) $ 26,025 Earnings from operations $ 217 $ (29) $ — $ 188

Contingencies

Contingencies	3 Months Ended
	Mar. 31, 2021
Commitments and Contingencies Disclosure [Abstract]
Contingencies	Contingencies Overview The Company is routinely subjected to legal and regulatory proceedings in the normal course of business. These matters can include, without limitation: • periodic compliance and other reviews and investigations by various federal and state regulatory agencies with respect to requirements applicable to the Company’s business, including, without limitation, those related to payment of out-of-network claims, submissions to CMS for risk adjustment payments or the False Claims Act, submissions to state agencies related to payments or state false claims acts, pre-authorization penalties, timely review of grievances and appeals, timely and accurate payment of claims, and the Health Insurance Portability and Accountability Act of 1996 and other federal and state fraud, waste and abuse laws; • litigation arising out of general business activities, such as tax matters, disputes related to healthcare benefits coverage or reimbursement, putative securities class actions and medical malpractice, privacy, real estate, intellectual property and employment-related claims; and • disputes regarding reinsurance arrangements, claims arising out of the acquisition or divestiture of various assets, class actions and claims relating to the performance of contractual and non-contractual obligations to providers, members, employer groups and others, including, but not limited to, the alleged failure to properly pay claims and challenges to the manner in which the Company processes claims and claims alleging that the Company has engaged in unfair business practices. Among other things, these matters may result in awards of damages, fines or penalties, which could be substantial, and/or could require changes to the Company’s business. The Company intends to vigorously defend itself against legal and regulatory proceedings to which it is currently a party; however, these proceedings are subject to many uncertainties. In some of the cases pending against the Company, substantial non-economic or punitive damages are being sought. The Company records reserves and accrues costs for certain legal proceedings and regulatory matters to the extent that it determines an unfavorable outcome is probable and the amount of the loss can be reasonably estimated. While such reserves and accrued costs reflect the Company’s best estimate of the probable loss for such matters, the recorded amounts may differ materially from the actual amount of any such losses. In some cases, no estimate of the possible loss or range of loss in excess of amounts accrued, if any, can be made because of the inherently unpredictable nature of legal and regulatory proceedings, which may be exacerbated by various factors, including but not limited to, they may involve indeterminate claims for monetary damages or may involve fines, penalties or punitive damages; present novel legal theories or legal uncertainties; involve disputed facts; represent a shift in regulatory policy; involve a large number of parties, claimants or regulatory bodies; are in the early stages of the proceedings; involve a number of separate proceedings and/or a wide range of potential outcomes; or result in a change of business practices. As of the date of this report, amounts accrued for legal proceedings and regulatory matters were not material. However, it is possible that in a particular quarter or annual period the Company’s financial condition, results of operations, cash flow and/or liquidity could be materially adversely affected by an ultimate unfavorable resolution of, or development in, legal and/or regulatory proceedings, including as described below. Except for the proceedings discussed below, the Company believes that the ultimate outcome of any of the regulatory and legal proceedings that are currently pending against it should not have a material adverse effect on financial condition, results of operations, cash flow or liquidity. California On October 20, 2015, the Company’s California subsidiary, Health Net of California, Inc. (Health Net California), was named as a defendant in a California taxpayer action filed in Los Angeles County Superior Court, captioned as Michael D. Myers v. State Board of Equalization, Dave Jones, Insurance Commissioner of the State of California, Betty T. Yee, Controller of the State of California, et al., Los Angeles Superior Court Case No. BS158655. This action is brought under a California statute that permits an individual taxpayer to sue a governmental agency when the taxpayer believes the agency has failed to enforce governing law. Plaintiff contends that Health Net California, a California licensed Health Care Service Plan (HCSP), is an “insurer” for purposes of taxation despite acknowledging it is not an “insurer” under regulatory law. Under California law, “insurers” must pay a gross premiums tax (GPT), calculated as 2.35% on gross premiums. As a licensed HCSP, Health Net California has paid the California Corporate Franchise Tax (CFT), the tax generally paid by California businesses. Plaintiff contends that Health Net California must pay the GPT rather than the CFT. Plaintiff seeks a writ of mandate directing the California taxing agencies to collect the GPT, and seeks an order requiring Health Net California to pay GPT, interest and penalties for a period dating to eight years prior to the October 2015 filing of the complaint. This lawsuit is being coordinated with similar lawsuits filed against other entities (collectively, “Related Actions”). In March 2018, the Court overruled the Company’s demurrer seeking to dismiss the complaint and denied the Company’s motion to strike allegations seeking retroactive relief. In August 2018, the trial court stayed all the Related Actions pending determination of a writ of mandate by the California Court of Appeals in two of the Related Actions. In March 2019, the California Court of Appeals denied the writ of mandate. The defendants in those Related Actions sought review by the California Supreme Court, which declined to review the matter. Upon the return of the matter to the Los Angeles County Superior Court, motions for summary judgment were scheduled. Health Net California’s motion for summary judgment was heard by the Court in March 2020. In March 2020, the Court granted Health Net California’s motion for summary judgment. In September 2020, the plaintiff appealed the Court’s decision. The Company intends to continue its vigorous defense against these claims; however, this matter is subject to many uncertainties, and an adverse outcome in this matter could potentially have a materially adverse impact on the Company’s financial position, results of operations and cash flows. On April 6, 2021, a putative California class action, Vunisa v. Health Net, LLC et al., was filed in Santa Clara County Superior Court against the Company and its subsidiaries, Health Net, LLC, Health Net of California, Inc., Health Net Life Insurance Company, Health Net Community Solutions, Inc., and California Health & Wellness (collectively, Health Net), and third-party vendor Accellion, Inc. On April 23, 2021, a putative nationwide class action, Doe v. Health Net of California, Inc. et al., was filed in federal district court in the Northern District of California against Health Net of California, Health Net, LLC, and Accellion. The complaints in those lawsuits allege that the defendants failed to prevent Health Net members' personal and health data from being exposed in connection with a data breach involving Accellion's File Transfer Appliance. The putative classes seek unspecified damages and injunctive relief. The Company denies any wrongdoing and intends to vigorously defend against the claims in both lawsuits. The Company also maintains that Accellion is required to indemnify it and its subsidiaries against any claims arising out of the data breach. While these matters are subject to many uncertainties, the Company does not believe that an adverse outcome in either of these matters is likely to have a materially adverse impact on the Company’s financial position, results of operations and cash flows. Ohio On March 11, 2021, the State of Ohio filed a civil action against the Company and the Company’s subsidiaries, Buckeye Health Plan Community Solutions, Inc. and Envolve Pharmacy Solutions, Inc., in Franklin County Court of Common Pleas, captioned as Ohio Department of Medicaid, et al. v. Centene Corporation, et al. The complaint alleges breaches of contract with the Ohio Department of Medicaid relating to the provision of pharmacy benefit management (PBM) services and violations of Ohio law relating to such contracts, including among other things, by (i) seeking payment for services already reimbursed, (ii) not accurately disclosing to the Ohio Department of Medicaid the true cost of the PBM services and (iii) inflating dispensing fees for prescription drugs. The plaintiffs seek an undisclosed sum of money in damages, penalties, and possible termination of the contract with Buckeye Health Plan. The Company maintains these claims are unfounded and intends to vigorously defend against them; however, this matter is subject to many uncertainties, and an adverse outcome in this matter could potentially have a materially adverse impact on the Company’s financial position, results of operations and cash flows.

Organization and Operations (Po

Organization and Operations (Policies)	3 Months Ended
	Mar. 31, 2021
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Basis of Presentation	Basis of Presentation The accompanying interim financial statements have been prepared under the presumption that users of the interim financial information have either read or have access to the audited financial statements included in the Form 10-K for the fiscal year ended December 31, 2020. The unaudited interim financial statements herein have been prepared pursuant to the rules and regulations of the Securities and Exchange Commission. Accordingly, footnote disclosures that would substantially duplicate the disclosures contained in the December 31, 2020 audited financial statements have been omitted from these interim financial statements, where appropriate. In the opinion of management, these financial statements reflect all adjustments, consisting only of normal recurring adjustments, which are necessary for a fair presentation of the results of the interim periods presented. Certain 2020 amounts in the consolidated financial statements and notes to the consolidated financial statements have been reclassified to conform to the 2021 presentation. These reclassifications have no effect on net earnings or stockholders’ equity as previously reported.
Recently Adopted Accounting Guidance and Accounting Guidance Not Yet Adopted	Recently Adopted Accounting Guidance In December 2019, the Financial Accounting Standards Board issued an Accounting Standards Update which simplifies the accounting for income taxes. The guidance is effective for annual and interim periods beginning after December 15, 2020. The Company adopted the new guidance in the first quarter of 2021. The new guidance did not have a material impact on the Company's consolidated financial position, results of operations and cash flows.

Short-term and Long-term Inve_2

Short-term and Long-term Investments, Restricted Deposits (Tables)	3 Months Ended
	Mar. 31, 2021
Investments, Debt and Equity Securities [Abstract]
Short-term and long-term investments and restricted deposits by investment type	Short-term and long-term investments and restricted deposits by investment type consist of the following ($ in millions): March 31, 2021 December 31, 2020 Amortized Gross Gross Fair Amortized Gross Gross Fair Debt securities: U.S. Treasury securities and obligations of U.S. government corporations and agencies $ 515 $ 2 $ — $ 517 $ 907 $ 4 $ — $ 911 Corporate securities 6,944 182 (64) 7,062 6,560 262 (8) 6,814 Restricted certificates of deposit 4 — — 4 105 — — 105 Restricted cash equivalents 677 — — 677 157 — — 157 Short-term time deposits 82 — — 82 53 — — 53 Municipal securities 3,118 101 (14) 3,205 2,970 129 (2) 3,097 Asset-backed securities 1,197 12 (2) 1,207 1,154 13 (3) 1,164 Residential mortgage-backed securities 1,066 20 (8) 1,078 1,068 27 — 1,095 Commercial mortgage-backed securities 793 19 (11) 801 748 30 (5) 773 Equity securities (1) 319 — — 319 318 — — 318 Private equity investments 896 — — 896 838 — — 838 Life insurance contracts 172 — — 172 168 — — 168 Total $ 15,783 $ 336 $ (99) $ 16,020 $ 15,046 $ 465 $ (18) $ 15,493 (1) Investments in equity securities primarily consists of exchange traded funds in fixed income securities.
Fair value of available-for-sale investments with gross unrealized losses by investment type and length of time	The fair value of available-for-sale debt securities with gross unrealized losses by investment type and length of time that individual securities have been in a continuous unrealized loss position were as follows ($ in millions): March 31, 2021 December 31, 2020 Less Than 12 Months 12 Months or More Less Than 12 Months 12 Months or More Unrealized Losses Fair Unrealized Losses Fair Unrealized Losses Fair Unrealized Losses Fair Corporate securities $ (61) $ 2,711 $ (3) $ 100 $ (7) $ 953 $ (1) $ 24 Municipal securities (13) 759 (1) 13 (2) 238 — — Asset-backed securities (1) 296 (1) 58 (2) 302 (1) 105 Residential mortgage-backed securities (8) 442 — 2 — 59 — 2 Commercial mortgage-backed securities (10) 245 (1) 53 (5) 147 — 13 Total $ (93) $ 4,453 $ (6) $ 226 $ (16) $ 1,699 $ (2) $ 144
Contractual maturities of short-term and long-term investments and restricted deposits	The contractual maturities of short-term and long-term debt securities and restricted deposits are as follows ($ in millions): March 31, 2021 December 31, 2020 Investments Restricted Deposits Investments Restricted Deposits Amortized Fair Amortized Fair Amortized Fair Amortized Fair One year or less $ 1,488 $ 1,497 $ 845 $ 846 $ 1,407 $ 1,414 $ 817 $ 818 One year through five years 5,082 5,227 240 241 4,748 4,937 221 223 Five years through ten years 3,589 3,637 26 26 3,460 3,639 18 19 Greater than ten years 70 73 — — 81 87 — — Asset-backed securities 3,056 3,086 — — 2,970 3,032 — — Total $ 13,285 $ 13,520 $ 1,111 $ 1,113 $ 12,666 $ 13,109 $ 1,056 $ 1,060

Fair Value Measurements (Tables

Fair Value Measurements (Tables)	3 Months Ended
	Mar. 31, 2021
Fair Value Disclosures [Abstract]
Assets and Liabilities, Based Upon Observable or Unobservable Inputs, Level Input Definitions	Assets and liabilities recorded at fair value in the Consolidated Balance Sheets are categorized based upon observable or unobservable inputs used to estimate fair value. Level inputs are as follows: Level Input: Input Definition: Level I Inputs are unadjusted, quoted prices for identical assets or liabilities in active markets at the measurement date. Level II Inputs other than quoted prices included in Level I that are observable for the asset or liability through corroboration with market data at the measurement date. Level III Unobservable inputs that reflect management’s best estimate of what market participants would use in pricing the asset or liability at the measurement date.
Fair Value Measurements by Level for Assets and Liabilities Measured at Fair Value on a Recurring Basis	The following table summarizes fair value measurements by level at March 31, 2021, for assets and liabilities measured at fair value on a recurring basis ($ in millions): Level I Level II Level III Total Assets Cash and cash equivalents $ 9,627 $ — $ — $ 9,627 Investments: U.S. Treasury securities and obligations of U.S. government corporations and agencies $ 145 $ — $ — $ 145 Corporate securities — 7,035 — 7,035 Municipal securities — 3,172 — 3,172 Short-term time deposits — 82 — 82 Asset-backed securities — 1,207 — 1,207 Residential mortgage-backed securities — 1,078 — 1,078 Commercial mortgage-backed securities — 801 — 801 Equity securities 317 2 — 319 Total investments $ 462 $ 13,377 $ — $ 13,839 Restricted deposits: Cash and cash equivalents $ 677 $ — $ — $ 677 Certificates of deposit — 4 — 4 Corporate securities — 27 — 27 Municipal securities — 33 — 33 U.S. Treasury securities and obligations of U.S. government corporations and agencies 372 — — 372 Total restricted deposits $ 1,049 $ 64 $ — $ 1,113 Total assets at fair value $ 11,138 $ 13,441 $ — $ 24,579 The following table summarizes fair value measurements by level at December 31, 2020, for assets and liabilities measured at fair value on a recurring basis ($ in millions): Level I Level II Level III Total Assets Cash and cash equivalents $ 10,800 $ — $ — $ 10,800 Investments: U.S. Treasury securities and obligations of U.S. government corporations and agencies $ 165 $ — $ — $ 165 Corporate securities — 6,789 — 6,789 Municipal securities — 3,070 — 3,070 Short-term time deposits — 53 — 53 Asset backed securities — 1,164 — 1,164 Residential mortgage backed securities — 1,095 — 1,095 Commercial mortgage backed securities — 773 — 773 Equity securities 316 2 — 318 Total investments $ 481 $ 12,946 $ — $ 13,427 Restricted deposits: Cash and cash equivalents $ 157 $ — $ — $ 157 Certificates of deposit — 105 — 105 Corporate securities — 25 — 25 Municipal securities — 27 — 27 U.S. Treasury securities and obligations of U.S. government corporations and agencies 746 — — 746 Total restricted deposits $ 903 $ 157 $ — $ 1,060 Total assets at fair value $ 12,184 $ 13,103 $ — $ 25,287

Medical Claims Liability (Table

Medical Claims Liability (Tables)	3 Months Ended
	Mar. 31, 2021
Insurance [Abstract]
Schedule of change in medical claims liability	The following table summarizes the change in medical claims liability ($ in millions): Three Months Ended March 31, 2021 2020 Balance, January 1 $ 12,438 $ 7,473 Less: Reinsurance recoverable 23 20 Balance, January 1, net 12,415 7,453 Acquisitions and divestitures — 3,697 Incurred related to: Current year 24,255 20,866 Prior years (864) (446) Total incurred 23,391 20,420 Paid related to: Current year 15,161 15,147 Prior years 7,828 5,031 Total paid 22,989 20,178 Balance at March 31, net 12,817 11,392 Plus: Reinsurance recoverable 25 21 Balance, March 31 $ 12,842 $ 11,413

Affordable Care Act (Tables)

Affordable Care Act (Tables)	3 Months Ended
	Mar. 31, 2021
Affordable Care Act [Abstract]
Schedule of net receivables (payables) related to the Affordable Care Act Programs	The Company's net receivables (payables) for each of the programs are as follows ($ in millions): March 31, 2021 December 31, 2020 Risk adjustment receivable $ 377 $ 340 Risk adjustment payable (1,341) (1,224) Minimum medical loss ratio (235) (238) Cost sharing reduction receivable 120 101 Cost sharing reduction payable (1) (1)

Debt (Tables)

Debt (Tables)	3 Months Ended
	Mar. 31, 2021
Debt Disclosure [Abstract]
Schedule of Debt	Debt consists of the following ($ in millions): March 31, 2021 December 31, 2020 $2,200 million 4.75% Senior Notes, due January 15, 2025 $ — $ 2,230 $1,800 million 5.375% Senior Notes, due June 1, 2026 1,800 1,800 $750 million 5.375% Senior Notes due August 15, 2026 792 794 $2,500 million 4.25% Senior Notes due December 15, 2027 2,483 2,482 $3,500 million 4.625% Senior Notes due December 15, 2029 3,500 3,500 $2,000 million 3.375% Senior Notes due February 15, 2030 2,000 2,000 $2,200 million 3.00% Senior Notes due October 15, 2030 2,200 2,200 $2,200 million 2.50% Senior Notes due March 1, 2031 2,200 — Total senior notes 14,975 15,006 Term loan facility 1,450 1,450 Revolving credit agreement 152 97 Mortgage notes payable — 50 Construction loan payable 184 180 Finance leases and other 156 153 Debt issuance costs (160) (157) Total debt 16,757 16,779 Less current portion (62) (97) Long-term debt $ 16,695 $ 16,682

Leases (Tables)

Leases (Tables)	3 Months Ended
	Mar. 31, 2021
Leases [Abstract]
ROU Assets and Liabilities	The following table sets forth the ROU assets and lease liabilities ($ in millions): March 31, 2021 December 31, 2020 Assets ROU assets (recorded within other long-term assets) $ 1,339 $ 1,311 Liabilities Short-term (recorded within accounts payable and accrued expenses) $ 204 $ 204 Long-term (recorded within other long-term liabilities) 1,367 1,334 Total lease liabilities $ 1,571 $ 1,538
Maturity of Operating Lease Liabilities	Lease payments over the next five years and thereafter are as follows ($ in millions): March 31, 2021 2021 $ 186 2022 243 2023 219 2024 197 2025 160 2026 136 Thereafter 692 Total lease payments 1,833 Less: imputed interest (262) Total lease liabilities $ 1,571

Earnings Per Share (Tables)

Earnings Per Share (Tables)	3 Months Ended
	Mar. 31, 2021
Earnings Per Share [Abstract]
Calculation of Basic and Diluted Net Earnings Per Common Share	The following table sets forth the calculation of basic and diluted net earnings per common share ($ in millions, except per share data in dollars and shares in thousands): Three Months Ended March 31, 2021 2020 Earnings attributable to Centene Corporation $ 699 $ 46 Shares used in computing per share amounts: Weighted average number of common shares outstanding 581,869 544,436 Common stock equivalents (as determined by applying the treasury stock method) 7,474 7,626 Weighted average number of common shares and potential dilutive common shares outstanding 589,343 552,062 Net earnings per common share attributable to Centene Corporation: Basic earnings per common share $ 1.20 $ 0.08 Diluted earnings per common share $ 1.19 $ 0.08

Segment Information (Tables)

Segment Information (Tables)	3 Months Ended
	Mar. 31, 2021
Segment Reporting [Abstract]
Segment Information	Segment information for the three months ended March 31, 2021, is as follows ($ in millions): Managed Care Specialty Eliminations Consolidated Total revenues from external customers $ 28,602 $ 1,381 $ — $ 29,983 Total revenues from internal customers 1 2,886 (2,887) — Total revenues $ 28,603 $ 4,267 $ (2,887) $ 29,983 Earnings from operations $ 956 $ 98 $ — $ 1,054 Segment information for the three months ended March 31, 2020, is as follows ($ in millions): Managed Care Specialty Eliminations Consolidated Total revenues from external customers $ 24,936 $ 1,089 $ — $ 26,025 Total revenues from internal customers 1 2,537 (2,538) — Total revenues $ 24,937 $ 3,626 $ (2,538) $ 26,025 Earnings from operations $ 217 $ (29) $ — $ 188

Short-term and Long-term Inve_3

Short-term and Long-term Investments, Restricted Deposits - By Investment Type (Details) - USD ($) $ in Millions	Mar. 31, 2021	Dec. 31, 2020
Debt Securities
Gross Unrealized Gains	$ 336	$ 465
Gross Unrealized Losses	(99)	(18)
Equity securities	319	318
Private equity investments	896	838
Life insurance contracts	172	168
Total, Amortized Cost	15,783	15,046
Total, Fair Value	16,020	15,493
U.S. Treasury securities and obligations of U.S. government corporations and agencies
Debt Securities
Amortized Cost	515	907
Gross Unrealized Gains	2	4
Gross Unrealized Losses	0	0
Fair Value	517	911
Corporate securities
Debt Securities
Amortized Cost	6,944	6,560
Gross Unrealized Gains	182	262
Gross Unrealized Losses	(64)	(8)
Fair Value	7,062	6,814
Restricted certificates of deposit
Debt Securities
Amortized Cost	4	105
Gross Unrealized Gains	0	0
Gross Unrealized Losses	0	0
Fair Value	4	105
Restricted cash equivalents
Debt Securities
Amortized Cost	677	157
Gross Unrealized Gains	0	0
Gross Unrealized Losses	0	0
Fair Value	677	157
Short-term time deposits
Debt Securities
Amortized Cost	82	53
Gross Unrealized Gains	0	0
Gross Unrealized Losses	0	0
Fair Value	82	53
Municipal securities
Debt Securities
Amortized Cost	3,118	2,970
Gross Unrealized Gains	101	129
Gross Unrealized Losses	(14)	(2)
Fair Value	3,205	3,097
Asset-backed securities
Debt Securities
Amortized Cost	1,197	1,154
Gross Unrealized Gains	12	13
Gross Unrealized Losses	(2)	(3)
Fair Value	1,207	1,164
Residential mortgage-backed securities
Debt Securities
Amortized Cost	1,066	1,068
Gross Unrealized Gains	20	27
Gross Unrealized Losses	(8)	0
Fair Value	1,078	1,095
Commercial mortgage-backed securities
Debt Securities
Amortized Cost	793	748
Gross Unrealized Gains	19	30
Gross Unrealized Losses	(11)	(5)
Fair Value	$ 801	$ 773

Short-term and Long-term Inve_4

Short-term and Long-term Investments, Restricted Deposits - Narrative (Details) $ in Millions	3 Months Ended
	Mar. 31, 2021USD ($)position	Dec. 31, 2020USD ($)
Schedule Of Investments And Restricted Deposits By Type [Line Items]
Accrued interest income | $	$ 91	$ 86
Positions from which gross unrealized losses were generated	1,829
Total unrealized investment positions	6,470
Commercial mortgage-backed securities
Schedule Of Investments And Restricted Deposits By Type [Line Items]
Investments recorded at fair value that carry rating of AA Plus, weighted average (in years)	4 years
Rated Securities | External Credit Rating, Investment Grade
Schedule Of Investments And Restricted Deposits By Type [Line Items]
Percentage of investments in rated securities carry an investment grade rating by nationally recognized statistical rating organizations	97.00%

Short-term and Long-term Inve_5

Short-term and Long-term Investments, Restricted Deposits - Fair Value of Available-For-Sale Investments with Gross Unrealized Losses by Investment Type and Length of Time (Details) - USD ($) $ in Millions	Mar. 31, 2021	Dec. 31, 2020
Unrealized Losses
Less Than 12 Months	$ (93)	$ (16)
12 Months or More	(6)	(2)
Fair Value
Fair Value, Less Than 12 Months	4,453	1,699
Fair Value, 12 Months or More	226	144
Corporate securities
Unrealized Losses
Less Than 12 Months	(61)	(7)
12 Months or More	(3)	(1)
Fair Value
Fair Value, Less Than 12 Months	2,711	953
Fair Value, 12 Months or More	100	24
Municipal securities
Unrealized Losses
Less Than 12 Months	(13)	(2)
12 Months or More	(1)	0
Fair Value
Fair Value, Less Than 12 Months	759	238
Fair Value, 12 Months or More	13	0
Asset-backed securities
Unrealized Losses
Less Than 12 Months	(1)	(2)
12 Months or More	(1)	(1)
Fair Value
Fair Value, Less Than 12 Months	296	302
Fair Value, 12 Months or More	58	105
Residential mortgage-backed securities
Unrealized Losses
Less Than 12 Months	(8)	0
12 Months or More	0	0
Fair Value
Fair Value, Less Than 12 Months	442	59
Fair Value, 12 Months or More	2	2
Commercial mortgage-backed securities
Unrealized Losses
Less Than 12 Months	(10)	(5)
12 Months or More	(1)	0
Fair Value
Fair Value, Less Than 12 Months	245	147
Fair Value, 12 Months or More	$ 53	$ 13

Short-term and Long-term Inve_6

Short-term and Long-term Investments, Restricted Deposits - Contractual Maturities of Short-Term and Long-Term Investments and Restricted Deposits (Details) - USD ($) $ in Millions	Mar. 31, 2021	Dec. 31, 2020
Investments
Amortized Cost
One year or less	$ 1,488	$ 1,407
One year through five years	5,082	4,748
Five years through ten years	3,589	3,460
Greater than ten years	70	81
Asset-backed securities	3,056	2,970
Amortized Cost	13,285	12,666
Fair Value
One year or less	1,497	1,414
One year through five years	5,227	4,937
Five years through ten years	3,637	3,639
Greater than ten years	73	87
Asset-backed securities	3,086	3,032
Fair Value	13,520	13,109
Restricted Deposits
Amortized Cost
One year or less	845	817
One year through five years	240	221
Five years through ten years	26	18
Greater than ten years	0	0
Asset-backed securities	0	0
Amortized Cost	1,111	1,056
Fair Value
One year or less	846	818
One year through five years	241	223
Five years through ten years	26	19
Greater than ten years	0	0
Asset-backed securities	0	0
Fair Value	$ 1,113	$ 1,060

Fair Value Measurements - Fair

Fair Value Measurements - Fair Value Measurements by Level for Assets and Liabilities Measured at Fair Value on a Recurring Basis (Details) - USD ($) $ in Millions	Mar. 31, 2021	Dec. 31, 2020
Assets
Cash and cash equivalents	$ 9,627	$ 10,800
Investments:
Equity securities	319	318
Total assets at fair value	24,579	25,287
U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Assets measured at fair value	517	911
Corporate securities
Investments:
Assets measured at fair value	7,062	6,814
Municipal securities
Investments:
Assets measured at fair value	3,205	3,097
Short-term time deposits
Investments:
Assets measured at fair value	82	53
Asset-backed securities
Investments:
Assets measured at fair value	1,207	1,164
Residential mortgage-backed securities
Investments:
Assets measured at fair value	1,078	1,095
Commercial mortgage-backed securities
Investments:
Assets measured at fair value	801	773
Investments available-for-sale
Investments:
Assets measured at fair value	13,839	13,427
Investments available-for-sale | U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Assets measured at fair value	145	165
Investments available-for-sale | Corporate securities
Investments:
Assets measured at fair value	7,035	6,789
Investments available-for-sale | Municipal securities
Investments:
Assets measured at fair value	3,172	3,070
Investments available-for-sale | Short-term time deposits
Investments:
Assets measured at fair value	82	53
Investments available-for-sale | Asset-backed securities
Investments:
Assets measured at fair value	1,207	1,164
Investments available-for-sale | Residential mortgage-backed securities
Investments:
Assets measured at fair value	1,078	1,095
Investments available-for-sale | Commercial mortgage-backed securities
Investments:
Assets measured at fair value	801	773
Restricted deposits
Investments:
Assets measured at fair value	1,113	1,060
Restricted deposits | U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Assets measured at fair value	372	746
Restricted deposits | Corporate securities
Investments:
Assets measured at fair value	27	25
Restricted deposits | Municipal securities
Investments:
Assets measured at fair value	33	27
Restricted deposits | Cash and cash equivalents
Investments:
Assets measured at fair value	677	157
Restricted deposits | Certificates of deposit
Investments:
Assets measured at fair value	4	105
Level I
Assets
Cash and cash equivalents	9,627	10,800
Investments:
Equity securities	317	316
Total assets at fair value	11,138	12,184
Level I | Investments available-for-sale
Investments:
Assets measured at fair value	462	481
Level I | Investments available-for-sale | U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Assets measured at fair value	145	165
Level I | Investments available-for-sale | Corporate securities
Investments:
Assets measured at fair value	0	0
Level I | Investments available-for-sale | Municipal securities
Investments:
Assets measured at fair value	0	0
Level I | Investments available-for-sale | Short-term time deposits
Investments:
Assets measured at fair value	0	0
Level I | Investments available-for-sale | Asset-backed securities
Investments:
Assets measured at fair value	0	0
Level I | Investments available-for-sale | Residential mortgage-backed securities
Investments:
Assets measured at fair value	0	0
Level I | Investments available-for-sale | Commercial mortgage-backed securities
Investments:
Assets measured at fair value	0	0
Level I | Restricted deposits
Investments:
Assets measured at fair value	1,049	903
Level I | Restricted deposits | U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Assets measured at fair value	372	746
Level I | Restricted deposits | Corporate securities
Investments:
Assets measured at fair value	0	0
Level I | Restricted deposits | Municipal securities
Investments:
Assets measured at fair value	0	0
Level I | Restricted deposits | Cash and cash equivalents
Investments:
Assets measured at fair value	677	157
Level I | Restricted deposits | Certificates of deposit
Investments:
Assets measured at fair value	0	0
Level II
Assets
Cash and cash equivalents	0	0
Investments:
Equity securities	2	2
Total assets at fair value	13,441	13,103
Level II | Investments available-for-sale
Investments:
Assets measured at fair value	13,377	12,946
Level II | Investments available-for-sale | U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Assets measured at fair value	0	0
Level II | Investments available-for-sale | Corporate securities
Investments:
Assets measured at fair value	7,035	6,789
Level II | Investments available-for-sale | Municipal securities
Investments:
Assets measured at fair value	3,172	3,070
Level II | Investments available-for-sale | Short-term time deposits
Investments:
Assets measured at fair value	82	53
Level II | Investments available-for-sale | Asset-backed securities
Investments:
Assets measured at fair value	1,207	1,164
Level II | Investments available-for-sale | Residential mortgage-backed securities
Investments:
Assets measured at fair value	1,078	1,095
Level II | Investments available-for-sale | Commercial mortgage-backed securities
Investments:
Assets measured at fair value	801	773
Level II | Restricted deposits
Investments:
Assets measured at fair value	64	157
Level II | Restricted deposits | U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Assets measured at fair value	0	0
Level II | Restricted deposits | Corporate securities
Investments:
Assets measured at fair value	27	25
Level II | Restricted deposits | Municipal securities
Investments:
Assets measured at fair value	33	27
Level II | Restricted deposits | Cash and cash equivalents
Investments:
Assets measured at fair value	0	0
Level II | Restricted deposits | Certificates of deposit
Investments:
Assets measured at fair value	4	105
Level III
Assets
Cash and cash equivalents	0	0
Investments:
Equity securities	0	0
Total assets at fair value	0	0
Level III | Investments available-for-sale
Investments:
Assets measured at fair value	0	0
Level III | Investments available-for-sale | U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Assets measured at fair value	0	0
Level III | Investments available-for-sale | Corporate securities
Investments:
Assets measured at fair value	0	0
Level III | Investments available-for-sale | Municipal securities
Investments:
Assets measured at fair value	0	0
Level III | Investments available-for-sale | Short-term time deposits
Investments:
Assets measured at fair value	0	0
Level III | Investments available-for-sale | Asset-backed securities
Investments:
Assets measured at fair value	0	0
Level III | Investments available-for-sale | Residential mortgage-backed securities
Investments:
Assets measured at fair value	0	0
Level III | Investments available-for-sale | Commercial mortgage-backed securities
Investments:
Assets measured at fair value	0	0
Level III | Restricted deposits
Investments:
Assets measured at fair value	0	0
Level III | Restricted deposits | U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Assets measured at fair value	0	0
Level III | Restricted deposits | Corporate securities
Investments:
Assets measured at fair value	0	0
Level III | Restricted deposits | Municipal securities
Investments:
Assets measured at fair value	0	0
Level III | Restricted deposits | Cash and cash equivalents
Investments:
Assets measured at fair value	0	0
Level III | Restricted deposits | Certificates of deposit
Investments:
Assets measured at fair value	$ 0	$ 0

Fair Value Measurements - Narra

Fair Value Measurements - Narrative (Details) - USD ($) $ in Millions	Mar. 31, 2021	Dec. 31, 2020
Fair Value Disclosures [Abstract]
Aggregate carrying amount of life insurance contracts and equity investments, fair value	$ 1,068	$ 1,006

Medical Claims Liability - Sche

Medical Claims Liability - Schedule of Change in Medical Claims Liability (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Liability for Unpaid Claims and Claims Adjustment Expense [Roll Forward]
Balance, January 1	$ 12,438	$ 7,473
Less: Reinsurance recoverable	23	20
Balance, January 1, net	12,415	7,453
Acquisitions and divestitures	0	3,697
Incurred related to:
Current year	24,255	20,866
Prior years	(864)	(446)
Total incurred	23,391	20,420
Paid related to:
Current year	15,161	15,147
Prior years	7,828	5,031
Total paid	22,989	20,178
Balance at March 31, net	12,817	11,392
Plus: Reinsurance recoverable	25	21
Balance, March 31	$ 12,842	$ 11,413

Medical Claims Liability - Narr

Medical Claims Liability - Narrative (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Insurance [Abstract]
Amounts recorded as an adjustment to premium revenues related to minimum HBR and return of premium programs	$ 202	$ 31
Short-duration insurance contracts, Incurred but not reported and expected development on reported claims	$ 8,630

Affordable Care Act - Net Recei

Affordable Care Act - Net Receivables (Payables) for Each of the Ongoing Programs (Details) - USD ($) $ in Millions	Mar. 31, 2021	Dec. 31, 2020
Affordable Care Act [Abstract]
Risk adjustment receivable	$ 377	$ 340
Risk adjustment payable	(1,341)	(1,224)
Minimum medical loss ratio	(235)	(238)
Cost sharing reduction receivable	120	101
Cost sharing reduction payable	$ (1)	$ (1)

Debt - Schedule of Debt (Detail

Debt - Schedule of Debt (Details) - USD ($)	Mar. 31, 2021	Feb. 28, 2021	Dec. 31, 2020
Debt Instrument [Line Items]
Total senior notes	$ 14,975,000,000		$ 15,006,000,000
Mortgage notes payable	0		50,000,000
Construction loan payable	184,000,000		180,000,000
Finance leases and other	156,000,000		153,000,000
Debt issuance costs	(160,000,000)		(157,000,000)
Total debt	16,757,000,000		16,779,000,000
Less current portion	(62,000,000)		(97,000,000)
Long-term debt	16,695,000,000		16,682,000,000
Revolving credit agreement
Debt Instrument [Line Items]
Credit facility	152,000,000		97,000,000
Term loan facility
Debt Instrument [Line Items]
Credit facility	1,450,000,000		1,450,000,000
$2,200 million 4.75% Senior Notes, due January 15, 2025 | Senior Notes
Debt Instrument [Line Items]
Debt, face amount	$ 2,200,000,000	$ 2,200,000,000
Interest rate	4.75%	4.75%
Senior notes	$ 0		2,230,000,000
$1,800 million 5.375% Senior Notes, due June 1, 2026 | Senior Notes
Debt Instrument [Line Items]
Debt, face amount	$ 1,800,000,000
Interest rate	5.375%
Senior notes	$ 1,800,000,000		1,800,000,000
$750 million 5.375% Senior Notes due August 15, 2026 | Senior Notes
Debt Instrument [Line Items]
Debt, face amount	$ 750,000,000
Interest rate	5.375%
Senior notes	$ 792,000,000		794,000,000
$2,500 million 4.25% Senior Notes due December 15, 2027 | Senior Notes
Debt Instrument [Line Items]
Debt, face amount	$ 2,500,000,000
Interest rate	4.25%
Senior notes	$ 2,483,000,000		2,482,000,000
$3,500 million 4.625% Senior Notes due December 15, 2029 | Senior Notes
Debt Instrument [Line Items]
Debt, face amount	$ 3,500,000,000
Interest rate	4.625%
Senior notes	$ 3,500,000,000		3,500,000,000
$2,000 million 3.375% Senior Notes due February 15, 2030 | Senior Notes
Debt Instrument [Line Items]
Debt, face amount	$ 2,000,000,000
Interest rate	3.375%
Senior notes	$ 2,000,000,000		2,000,000,000
$2,200 million 3.00% Senior Notes due October 15, 2030 | Senior Notes
Debt Instrument [Line Items]
Debt, face amount	$ 2,200,000,000
Interest rate	3.00%
Senior notes	$ 2,200,000,000		2,200,000,000
$2,200 million 2.50% Senior Notes due March 1, 2031 | Senior Notes
Debt Instrument [Line Items]
Debt, face amount	$ 2,200,000,000	$ 2,200,000,000
Interest rate	2.50%	2.50%
Senior notes	$ 2,200,000,000		$ 0

Debt - Narrative (Details)

Debt - Narrative (Details) - USD ($)	Jan. 01, 2021	Apr. 30, 2021	Feb. 28, 2021	Oct. 31, 2017	Mar. 31, 2021	Mar. 31, 2020	Dec. 31, 2020
Debt Instrument [Line Items]
Loss on extinguishment of debt			$ 46,000,000		$ (46,000,000)	$ (44,000,000)
Construction loan payable					184,000,000		$ 180,000,000
Repayment of mortgage note	$ 50,000,000
Subsequent Event
Debt Instrument [Line Items]
Extension term		1 year
Construction Loan Payable
Debt Instrument [Line Items]
Debt, face amount				$ 200,000,000
Construction Loan Payable | LIBOR | Maximum
Debt Instrument [Line Items]
Basis spread on variable rate				2.70%
Construction Loan Payable | LIBOR | Minimum
Debt Instrument [Line Items]
Basis spread on variable rate				2.00%
Mortgage Notes Payable
Debt Instrument [Line Items]
Interest rate							5.14%
$2,200 million 2.50% Senior Notes due March 1, 2031 | Senior Notes
Debt Instrument [Line Items]
Debt, face amount			$ 2,200,000,000		$ 2,200,000,000
Interest rate			2.50%		2.50%
$2,200 million 4.75% Senior Notes, due 2025 | Senior Notes
Debt Instrument [Line Items]
Debt, face amount			$ 2,200,000,000		$ 2,200,000,000
Interest rate			4.75%		4.75%
Notes accepted for Tender Offer, principal outstanding, percentage			36.00%

Leases - Narrative (Details)

Leases - Narrative (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Lessee, Lease, Description [Line Items]
Operating lease expense	$ 66	$ 62
Lease liabilities reduced by cash paid	67
ROU assets from new operating leases in exchange for lease liability	96
Operating leases not yet commenced	$ 31
Weighted average remaining lease term	9 years 6 months
Weighted-average discount rate for operating leases	3.20%
Minimum
Lessee, Lease, Description [Line Items]
Operating leases, not yet commenced, lease term	7 years
Maximum
Lessee, Lease, Description [Line Items]
Operating leases, not yet commenced, lease term	9 years

Leases - ROU Assets and Liabili

Leases - ROU Assets and Liabilities (Details) - USD ($) $ in Millions	Mar. 31, 2021	Dec. 31, 2020
Assets
Operating Lease, Right-of-Use Asset	$ 1,339	$ 1,311
Operating Lease, Right-of-Use Asset, Statement of Financial Position [Extensible List]	Other long-term assets	Other long-term assets
Liabilities
Short-term (recorded within accounts payable and accrued expenses)	$ 204	$ 204
Long-term (recorded within other long-term liabilities)	1,367	1,334
Total lease liabilities	$ 1,571	$ 1,538
Operating Lease, Liability, Current, Statement of Financial Position [Extensible List]	Accounts payable and accrued expenses	Accounts payable and accrued expenses
Operating Lease, Liability, Noncurrent, Statement of Financial Position [Extensible List]	Other long-term liabilities	Other long-term liabilities

Leases - Operating Lease Paymen

Leases - Operating Lease Payments Over Next Five Years (Details) - USD ($) $ in Millions	Mar. 31, 2021	Dec. 31, 2020
Leases [Abstract]
2021	$ 186
2022	243
2023	219
2024	197
2025	160
2026	136
Thereafter	692
Total lease payments	1,833
Less: imputed interest	(262)
Total lease liabilities	$ 1,571	$ 1,538

Earnings Per Share (Details)

Earnings Per Share (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Millions	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Earnings attributable to Centene Corporation
Earnings attributable to Centene Corporation	$ 699	$ 46
Shares used in computing per share amounts:
Weighted average number of common shares outstanding (in shares)	581,869	544,436
Common stock equivalents (as determined by applying the treasury stock method) (in shares)	7,474	7,626
Weighted average number of common shares and potential dilutive common shares outstanding (in shares)	589,343	552,062
Net earnings per common share attributable to Centene Corporation:
Basic earnings per common share (in dollars per share)	$ 1.20	$ 0.08
Diluted earnings per common share (in dollars per share)	$ 1.19	$ 0.08
Anti-dilutive restricted stock and restricted stock units excluded from the calculation of diluted earnings per common share (in shares)	533	400

Segment Information (Details)

Segment Information (Details) $ in Millions	3 Months Ended
	Mar. 31, 2021USD ($)segment	Mar. 31, 2020USD ($)
Segment Reporting [Abstract]
Number of operating segments | segment	2
Segment Reporting Information [Line Items]
Total revenues	$ 29,983	$ 26,025
Earnings from operations	1,054	188
Eliminations
Segment Reporting Information [Line Items]
Total revenues	(2,887)	(2,538)
Managed Care
Segment Reporting Information [Line Items]
Total revenues	28,603	24,937
Earnings from operations	956	217
Managed Care | Operating Segments
Segment Reporting Information [Line Items]
Total revenues	28,602	24,936
Managed Care | Eliminations
Segment Reporting Information [Line Items]
Total revenues	1	1
Specialty Services
Segment Reporting Information [Line Items]
Total revenues	4,267	3,626
Earnings from operations	98	(29)
Specialty Services | Operating Segments
Segment Reporting Information [Line Items]
Total revenues	1,381	1,089
Specialty Services | Eliminations
Segment Reporting Information [Line Items]
Total revenues	$ 2,886	$ 2,537