Centene (CNC) 10-Q 25 Oct 21 2021 Q3 Quarterly report Financial data

Cover

Cover - shares	9 Months Ended
	Sep. 30, 2021	Oct. 15, 2021
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Sep. 30, 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		583,502,932
Entity Central Index Key	0001071739
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2021
Document Fiscal Period Focus	Q3
Amendment Flag	false

CONSOLIDATED BALANCE SHEETS

CONSOLIDATED BALANCE SHEETS - USD ($) $ in Millions	Sep. 30, 2021	Dec. 31, 2020
Current assets:
Cash and cash equivalents	$ 13,423	$ 10,800
Premium and trade receivables	11,516	9,696
Short-term investments	1,517	1,580
Other current assets	1,600	1,317
Total current assets	28,056	23,393
Long-term investments	13,561	12,853
Restricted deposits	1,114	1,060
Property, software and equipment, net	3,302	2,774
Goodwill	19,699	18,652
Intangible assets, net	8,143	8,388
Other long-term assets	3,868	1,599
Total assets	77,743	68,719
Current liabilities:
Medical claims liability	14,099	12,438
Accounts payable and accrued expenses	8,089	7,069
Return of premium payable	2,238	1,458
Unearned revenue	371	523
Current portion of long-term debt	245	97
Total current liabilities	25,042	21,585
Long-term debt	18,594	16,682
Deferred tax liability	1,440	1,534
Other long-term liabilities	5,993	2,956
Total liabilities	51,069	42,757
Commitments and contingencies
Redeemable noncontrolling interests	84	77
Stockholders’ equity:
Preferred stock, $0.001 par value; authorized 10,000 shares; no shares issued or outstanding at September 30, 2021 and December 31, 2020	0	0
Common stock, $0.001 par value; authorized 800,000 shares; 600,708 issued and 583,500 outstanding at September 30, 2021, and 598,249 issued and 581,479 outstanding at December 31, 2020	1	1
Additional paid-in capital	19,594	19,459
Accumulated other comprehensive earnings	176	337
Retained earnings	7,540	6,792
Treasury stock, at cost (17,208 and 16,770 shares, respectively)	(845)	(816)
Total Centene stockholders’ equity	26,466	25,773
Nonredeemable noncontrolling interest	124	112
Total stockholders’ equity	26,590	25,885
Total liabilities, redeemable noncontrolling interests and stockholders’ equity	$ 77,743	$ 68,719

CONSOLIDATED BALANCE SHEETS (Pa

CONSOLIDATED BALANCE SHEETS (Parenthetical) - $ / shares	Sep. 30, 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)	600,708,000	598,249,000
Common stock, shares outstanding (in shares)	583,500,000	581,479,000
Treasury stock (in shares)	17,208,000	16,770,000

CONSOLIDATED STATEMENTS OF OPER

CONSOLIDATED STATEMENTS OF OPERATIONS - USD ($) shares in Thousands, $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Revenues:
Premium and service revenues	$ 30,514	$ 27,459	$ 87,490	$ 77,355
Premium tax and health insurer fee	1,892	1,631	5,924	5,472
Total revenues	32,406	29,090	93,414	82,827
Expenses:
Medical costs	25,430	22,932	73,210	63,659
Cost of services	1,355	861	3,510	2,519
Selling, general and administrative expenses	2,684	2,507	7,324	7,146
Amortization of acquired intangible assets	198	164	581	527
Premium tax expense	1,965	1,389	6,129	4,737
Health insurer fee expense	0	376	0	1,100
Impairment	229	0	229	72
Legal settlement	0	0	1,250	0
Total operating expenses	31,861	28,229	92,233	79,760
Earnings from operations	545	861	1,181	3,067
Other income (expense):
Investment and other income	424	95	566	375
Debt extinguishment costs	(79)	0	(125)	(44)
Interest expense	(170)	(184)	(503)	(551)
Earnings before income tax expense	720	772	1,119	2,847
Income tax expense	139	207	376	1,034
Net earnings	581	565	743	1,813
Loss attributable to noncontrolling interests	3	3	5	7
Net earnings attributable to Centene Corporation	$ 584	$ 568	$ 748	$ 1,820
Net earnings per common share attributable to Centene Corporation:
Basic earnings per common share (in dollars per share)	$ 1	$ 0.98	$ 1.28	$ 3.21
Diluted earnings per common share (in dollars per share)	$ 0.99	$ 0.97	$ 1.27	$ 3.16
Weighted average number of common shares outstanding:
Basic (in shares)	583,244	579,510	582,636	567,586
Diluted (in shares)	590,702	587,971	590,154	575,732
Premium
Revenues:
Premium and service revenues	$ 28,876	$ 26,537	$ 83,436	$ 74,496
Service
Revenues:
Premium and service revenues	$ 1,638	$ 922	$ 4,054	$ 2,859

CONSOLIDATED STATEMENTS OF COMP

CONSOLIDATED STATEMENTS OF COMPREHENSIVE EARNINGS - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Statement of Comprehensive Income [Abstract]
Net earnings	$ 581	$ 565	$ 743	$ 1,813
Reclassification adjustment, net of tax	1	0	(16)	1
Change in unrealized gain (loss) on investments, net of tax	(47)	38	(125)	152
Defined benefit pension plan net gain, net of tax	0	0	0	2
Foreign currency translation adjustments	(17)	10	(20)	4
Other comprehensive earnings (loss)	(63)	48	(161)	159
Comprehensive earnings	518	613	582	1,972
Comprehensive loss attributable to noncontrolling interests	3	3	5	7
Comprehensive earnings attributable to Centene Corporation	$ 521	$ 616	$ 587	$ 1,979

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, 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]
Other comprehensive loss , net of tax	159
Balance (in shares) at Sep. 30, 2020		595,622
Balance at Sep. 30, 2020	25,843	$ 0	19,390	293	6,804	$ (762)	118
Treasury stock (in shares) at Sep. 30, 2020						15,896
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
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net earnings (loss)	1,200				1,206		(6)
Other comprehensive loss , net of tax	250			250
Common stock issued for employee benefit plans (in shares)		269
Common stock issued for employee benefit plans	7		7
Common stock repurchases (in shares)		1				(47)
Common stock repurchases	(3)					$ (3)
Stock compensation expense	47		47
Contribution from noncontrolling interest	15						15
Balance (in shares) at Jun. 30, 2020		595,160
Balance at Jun. 30, 2020	25,172	$ 0	19,333	245	6,236	$ (758)	116
Treasury stock (in shares) at Jun. 30, 2020						15,815
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net earnings (loss)	562				568		(6)
Other comprehensive loss , net of tax	48			48
Common stock issued for employee benefit plans (in shares)		531
Common stock issued for employee benefit plans	8		8
Common stock repurchases (in shares)		(69)				(81)
Common stock repurchases	(9)		(5)			$ (4)
Stock compensation expense	54		54
Contribution from noncontrolling interest	8						8
Balance (in shares) at Sep. 30, 2020		595,622
Balance at Sep. 30, 2020	$ 25,843	$ 0	19,390	293	6,804	$ (762)	118
Treasury stock (in shares) at Sep. 30, 2020						15,896
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		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
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]
Other comprehensive loss , net of tax	$ (161)
Balance (in shares) at Sep. 30, 2021	583,500	600,708
Balance at Sep. 30, 2021	$ 26,590	$ 1	19,594	176	7,540	$ (845)	124
Treasury stock (in shares) at Sep. 30, 2021	17,208					17,208
Balance (in shares) at Mar. 31, 2021		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
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net earnings (loss)	(538)				(535)		(3)
Other comprehensive loss , net of tax	63			63
Common stock issued for employee benefit plans (in shares)		390
Common stock issued for employee benefit plans	9		9
Common stock repurchases (in shares)		(10)				(60)
Common stock repurchases	(4)					$ (4)
Stock compensation expense	36		36
Contribution from noncontrolling interest	21						21
Balance (in shares) at Jun. 30, 2021		599,988
Balance at Jun. 30, 2021	26,045	$ 1	19,545	239	6,956	$ (830)	134
Treasury stock (in shares) at Jun. 30, 2021						16,986
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net earnings (loss)	576				584		(8)
Other comprehensive loss , net of tax	(63)			(63)
Common stock issued for employee benefit plans (in shares)		720
Common stock issued for employee benefit plans	9		9
Common stock repurchases (in shares)		0				(222)
Common stock repurchases	(15)		0			$ (15)
Stock compensation expense	40		40
Contribution from noncontrolling interest	5						5
Divestiture of noncontrolling interest	(10)						(10)
Acquisition resulting in noncontrolling interest	$ 3						3
Balance (in shares) at Sep. 30, 2021	583,500	600,708
Balance at Sep. 30, 2021	$ 26,590	$ 1	$ 19,594	$ 176	$ 7,540	$ (845)	$ 124
Treasury stock (in shares) at Sep. 30, 2021	17,208					17,208

CONSOLIDATED STATEMENTS OF ST_2

CONSOLIDATED STATEMENTS OF STOCKHOLDERS' EQUITY (Parenthetical) - USD ($) $ in Millions	3 Months Ended
	Sep. 30, 2021	Jun. 30, 2021	Mar. 31, 2021	Sep. 30, 2020	Jun. 30, 2020	Mar. 31, 2020	Dec. 31, 2020	Dec. 31, 2019
Par value (in dollars per share)	$ 0.001						$ 0.001
Other comprehensive loss, tax	$ (15)	$ 19	$ (49)	$ 13	$ 76	$ (40)
Common Stock
Par value (in dollars per share)	$ 0.001	$ 0.001	$ 0.001	$ 0.001	$ 0.001	$ 0.001	0.001	$ 0.001
Treasury Stock
Par value (in dollars per share)	$ 0.001	$ 0.001	$ 0.001	$ 0.001	$ 0.001	$ 0.001	$ 0.001	$ 0.001

CONSOLIDATED STATEMENTS OF CASH

CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Millions	9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020
Cash flows from operating activities:
Net earnings	$ 743	$ 1,813
Adjustments to reconcile net earnings to net cash provided by operating activities
Depreciation and amortization	1,098	916
Stock compensation expense	127	218
Impairment	229	72
Loss on debt extinguishment	125	44
Gain on acquisition	(309)	0
Deferred income taxes	(143)	(154)
Gain on divestiture	62	(104)
Other adjustments, net	(6)	0
Changes in assets and liabilities
Premium and trade receivables	(1,723)	(1,640)
Other assets	(124)	185
Medical claims liabilities	1,661	1,563
Unearned revenue	(169)	(212)
Accounts payable and accrued expenses	993	(861)
Other long-term liabilities	964	663
Other operating activities, net	2	19
Net cash provided by operating activities	3,530	2,522
Cash flows from investing activities:
Capital expenditures	(662)	(663)
Purchases of investments	(5,253)	(2,911)
Sales and maturities of investments	4,069	3,408
Acquisitions, net of cash acquired	(534)	(3,000)
Divestiture proceeds, net of divested cash	(62)	466
Net cash used in investing activities	(2,442)	(2,700)
Cash flows from financing activities:
Proceeds from long-term debt	9,247	2,687
Payments of long-term debt	(7,411)	(1,654)
Common stock repurchases	(49)	(570)
Payments for debt extinguishment	(157)	(21)
Debt issuance costs	(72)	(94)
Other financing activities, net	39	35
Net cash provided by financing activities	1,597	383
Effect of exchange rate changes on cash, cash equivalents, and restricted cash	(8)	8
Net increase in cash, cash equivalents and restricted cash and cash equivalents	2,677	213
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	13,634	12,344
Supplemental disclosures of cash flow information:
Interest paid	479	479
Income taxes paid	477	920
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	13,423	12,198
Restricted cash and cash equivalents, included in restricted deposits	211	146
Total cash, cash equivalents, and restricted cash and cash equivalents	$ 13,634	$ 12,344

Organization and Operations

Organization and Operations	9 Months Ended
	Sep. 30, 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	9 Months Ended
	Sep. 30, 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): September 30, 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 $ 656 $ — $ — $ 656 $ 907 $ 4 $ — $ 911 Corporate securities 7,686 178 (37) 7,827 6,560 262 (8) 6,814 Restricted certificates of deposit 4 — — 4 105 — — 105 Restricted cash equivalents 211 — — 211 157 — — 157 Short-term time deposits 78 — — 78 53 — — 53 Municipal securities 3,381 97 (8) 3,470 2,970 129 (2) 3,097 Asset-backed securities 1,141 8 (1) 1,148 1,154 13 (3) 1,164 Residential mortgage-backed securities 902 15 (6) 911 1,068 27 — 1,095 Commercial mortgage-backed securities 818 18 (6) 830 748 30 (5) 773 Equity securities (1) 317 — — 317 318 — — 318 Private equity investments 561 — — 561 838 — — 838 Life insurance contracts 179 — — 179 168 — — 168 Total $ 15,934 $ 316 $ (58) $ 16,192 $ 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 September 30, 2021, 98% of the Company’s investments in rated securities carry an investment grade rating by nationally recognized statistical rating organizations. At September 30, 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 $92 million and $86 million at September 30, 2021 and December 31, 2020, respectively, and is included in other current assets on the Consolidated Balance Sheets. The Company’s residential mortgage-backed securities are primarily issued by the Federal National Mortgage Association, Government National Mortgage Association or Federal Home Loan Mortgage Corporation, which carry implicit or explicit guarantees of the U.S. government. The Company’s commercial mortgage-backed securities are primarily senior tranches with a weighted average rating of AA and a weighted average duration of 4 years at September 30, 2021. The fair value of available-for-sale debt securities with gross unrealized losses by investment type and length of time that individual securities have been in a continuous unrealized loss position were as follows ($ in millions): September 30, 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 $ (35) $ 3,089 $ (2) $ 75 $ (7) $ 953 $ (1) $ 24 Municipal securities (7) 929 (1) 26 (2) 238 — — Asset-backed securities (1) 334 — 36 (2) 302 (1) 105 Residential mortgage-backed securities (6) 428 — 1 — 59 — 2 Commercial mortgage-backed securities (4) 272 (2) 33 (5) 147 — 13 Total $ (53) $ 5,052 $ (5) $ 171 $ (16) $ 1,699 $ (2) $ 144 As of September 30, 2021, the gross unrealized losses were generated from 1,887 positions out of a total of 6,468 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. In June 2019, the Company acquired 40% of Circle Health, one of the U.K.’s largest independent operators of hospitals. The initial 40% investment was accounted for as an equity method investment. In July 2021, the Company acquired the remaining 60% interest of Circle Health for $705 million. As a result of the acquisition, the Company recorded a non-cash gain of $309 million on its original investment in the three months ended September 30, 2021. The gain was included in investment and other income on the Consolidated Statement of Operations. Beginning in July 2021, the Company consolidates 100% of Circle Health. In September 2021, the Company recorded a $229 million impairment of its equity method investment in RxAdvance, a pharmacy benefit manager. During the third quarter, the Company made a strategic decision to transition from using the RxAdvance platform and consolidate its business on an alternative external platform as a result of the Company's focus on simplification of its pharmacy operations. The impairment was based on the Company’s estimate of RxAdvance’s future cash flows and other market indicators of fair value. The contractual maturities of short-term and long-term debt securities and restricted deposits are as follows ($ in millions): September 30, 2021 December 31, 2020 Investments Restricted Deposits Investments Restricted Deposits Amortized Fair Amortized Fair Amortized Fair Amortized Fair One year or less $ 1,355 $ 1,361 $ 507 $ 508 $ 1,407 $ 1,414 $ 817 $ 818 One year through five years 5,701 5,845 355 355 4,748 4,937 221 223 Five years through ten years 3,791 3,865 243 243 3,460 3,639 18 19 Greater than ten years 56 61 8 8 81 87 — — Asset-backed securities 2,861 2,889 — — 2,970 3,032 — — Total $ 13,764 $ 14,021 $ 1,113 $ 1,114 $ 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	9 Months Ended
	Sep. 30, 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 September 30, 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 $ 13,423 $ — $ — $ 13,423 Investments: U.S. Treasury securities and obligations of U.S. government corporations and agencies $ 216 $ — $ — $ 216 Corporate securities — 7,796 — 7,796 Municipal securities — 3,042 — 3,042 Short-term time deposits — 78 — 78 Asset-backed securities — 1,148 — 1,148 Residential mortgage-backed securities — 911 — 911 Commercial mortgage-backed securities — 830 — 830 Equity securities 315 2 — 317 Total investments $ 531 $ 13,807 $ — $ 14,338 Restricted deposits: Cash and cash equivalents $ 211 $ — $ — $ 211 Certificates of deposit — 4 — 4 Corporate securities — 31 — 31 Municipal securities — 428 — 428 U.S. Treasury securities and obligations of U.S. government corporations and agencies 440 — — 440 Total restricted deposits $ 651 $ 463 $ — $ 1,114 Other current assets: Foreign currency swap agreement $ — $ 18 $ — $ 18 Total assets at fair value $ 14,605 $ 14,288 $ — $ 28,893 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 $740 million and $1,006 million as of September 30, 2021 and December 31, 2020, respectively.

Medical Claims Liability

Medical Claims Liability	9 Months Ended
	Sep. 30, 2021
Insurance [Abstract]
Medical Claims Liability	Medical Claims Liability The following table summarizes the change in medical claims liability ($ in millions): Nine Months Ended September 30, 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 — 3,872 Incurred related to: Current year 74,736 64,105 Prior years (1,526) (446) Total incurred 73,210 63,659 Paid related to: Current year 62,205 56,074 Prior years 9,344 6,032 Total paid 71,549 62,106 Balance at September 30, net 14,076 12,878 Plus: Reinsurance recoverable 23 21 Balance, September 30 $ 14,099 $ 12,899 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 $438 million and $97 million as a reduction to premium revenue in the nine months ended September 30, 2021 and 2020, respectively. Incurred but not reported (IBNR) plus expected development on reported claims as of September 30, 2021 was $9,346 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	9 Months Ended
	Sep. 30, 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. In June 2021, the Centers for Medicare and Medicaid Services (CMS) announced the final risk adjustment transfers for the 2020 benefit year. As a result of the announcement, the Company increased its risk adjustment net payables by $83 million from December 31, 2020. After consideration of minimum MLR and other related impacts, the net pre-tax expense recognized was approximately $80 million in the second quarter of 2021. The Company's net receivables (payables) for each of the programs are as follows ($ in millions): September 30, 2021 December 31, 2020 Risk adjustment receivable $ 463 $ 340 Risk adjustment payable (472) (1,224) Minimum medical loss ratio (65) (238) Cost sharing reduction receivable 92 101 Cost sharing reduction payable (12) (1)

Debt

Debt	9 Months Ended
	Sep. 30, 2021
Debt Disclosure [Abstract]
Debt	Debt Debt consists of the following ($ in millions): September 30, 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 $750 million 5.375% Senior Notes due August 15, 2026 — 794 $2,500 million 4.25% Senior Notes due December 15, 2027 2,484 2,482 $2,300 million 2.45% Senior Notes due July 15, 2028 2,304 — $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 — $1,300 million 2.625% Senior Notes due August 1, 2031 1,300 — Total senior notes 15,988 15,006 Term loan facility 2,195 1,450 Revolving credit agreement 150 97 Mortgage notes payable — 50 Construction loan payable 188 180 Finance leases and other 495 153 Debt issuance costs (177) (157) Total debt 18,839 16,779 Less current portion (245) (97) Long-term debt $ 18,594 $ 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, the write-off of the unamortized premium and debt issuance costs, and expenses related to the redemption. In July 2021, the Company issued $1,800 million 2.45% Senior Notes due 2028 (the 2028 Notes). The Company intends to use the net proceeds from the offering of the 2028 Notes to finance a portion of the cash consideration payable in connection with its previously announced acquisition of Magellan Health Inc. and to pay related fees and expenses. If the Magellan Acquisition is not completed, the Company expects to use the net proceeds of the offering for debt repayment and general corporate purposes. In August 2021, the Company issued $1,800 million aggregate principal amount of Senior Notes which included $500 million aggregate principal amount of additional 2028 Notes at a premium to yield 2.31% and $1,300 million aggregate principal amount of new 2.625% Senior Notes due 2031. The Company used the net proceeds of the offering, together with cash on hand and term loan facility borrowings, to redeem all of its outstanding 5.375% Senior Notes due 2026 and WellCare Health Plans, Inc.'s outstanding 5.375% Senior Notes due 2026 (together the 2026 Notes), including all premiums, accrued interest and costs and expenses. The Company recognized a pre-tax loss on extinguishment of $79 million on the redemptions of the 2026 Notes, including the call premium, the write-off of the unamortized premium and debt issuance costs, and expenses related to the redemptions. Foreign Currency Swap In connection with the July 2021 acquisition of the remaining 60% interest of Circle Health, the Company funded an intercompany note receivable with an international subsidiary, which is denominated in Great British Pounds and remeasured through earnings each period. In order to manage the resulting foreign exchange risk associated with the note receivable, the Company entered into a foreign currency swap agreement for a notional amount of $705 million, to purchase £509 million. The swap agreement is formally designated and qualifies as a fair value hedge. Gains and losses due to changes in the fair value of the foreign currency swap completely offset changes in the remeasurement of the intercompany note receivable within investment and other income in the Consolidated Statement of Operations. Therefore, there is no net impact to the Consolidated Statement of Operations. The swap expires on March 1, 2022. The fair value of the swap agreement as of September 30, 2021, was $18 million, which was recorded in other current assets in the Consolidated Balance Sheet. Based on the current fair value of the swap, the Company expects an immaterial impact to its cash flows upon concurrent settlement of the swap and intercompany note receivable. The offsetting changes in fair value of the foreign currency swap and the remeasurement on the underlying intercompany note receivable were both recognized in investment and other income in the Consolidated Statements of Operations. The Company does not hold or issue any derivative instruments for trading or speculative purposes. The fair value of the swap contract excludes accrued interest and considers the swap counterparty’s credit risk and the current likelihood of the counterparty’s compliance with its contractual obligations. Revolving Credit Agreement and Term Loan Credit Facility In August 2021, the Company amended and restated its existing credit agreement to, among other things, (i) extend the various maturities under the Existing Credit Agreement until 2026, (ii) increase the aggregate principal amount of the U.S. dollar unsecured term loan facility under the Existing Credit Agreement from $1,450 million to $2,200 million, (iii) increase the maximum total net leverage ratio permitted under the total debt to EBITDA financial covenant from 3.50:1.00 to 4.00:1.00, (iv) reduce the applicable margin with respect to borrowings to between 1.50% to 1.125%, based on the total debt to EBITDA ratio and type of borrowing and (v) include scheduled amortization payments with respect to the term loan facility equal to 0.0% for the first year following closing, 2.5% for the second year following closing and 5% thereafter until maturity. 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. Until final completion of the construction project, which occurred in July 2021, the loan bore interest based on one month LIBOR plus 2.70%, which reduced to LIBOR plus 2.00% at the time construction was completed. The agreement contains financial and non-financial covenants similar to those contained in the Company Credit Facility. The Company 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 September 30, 2021, the Company had $188 million in borrowings outstanding under the loan, which is included in the current portion of long-term debt. 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	9 Months Ended
	Sep. 30, 2021
Leases [Abstract]
Leases	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 $123 million and $68 million for the three months ended September 30, 2021 and 2020, respectively, and $257 million and $202 million for the nine months ended September 30, 2021 and 2020, respectively. The increase in operating lease expense is primarily due to the acquisition of the remaining 60% interest of Circle Health, one of the U.K.’s largest independent operators of hospitals, in July 2021, which leases its hospitals and facilities. The following table sets forth the ROU assets and lease liabilities ($ in millions): September 30, 2021 December 31, 2020 Assets ROU assets (recorded within other long-term assets) $ 3,637 $ 1,311 Liabilities Short-term (recorded within accounts payable and accrued expenses) $ 200 $ 204 Long-term (recorded within other long-term liabilities) 3,660 1,334 Total lease liabilities $ 3,860 $ 1,538 During the three and nine months ended September 30, 2021, the Company reduced its lease liabilities by $136 million and $274 million, respectively, for cash paid. In addition, new operating leases commenced or were acquired resulting in the recognition of ROU assets and lease liabilities of $2,396 million and $2,504 million, during the three and nine months ended September 30, 2021, respective ly. Of the newly commenced operating leases, $2,351 million of the increase in ROU assets and lease liabilities is due to the Company’s acquisition of the remaining 60% interest in its investment in Circle Health that occurred in July 2021. As of September 30, 2021, the Company had additional operating leases that have not yet commenced of $43 million. These operating leases will commence in 2021 and 2022 with lease terms ranging from two nine Prior to the acquisition of the remaining Circle Health portfolio, the average remaining lease term of the Company’s operating lease population was 9.2 years. The average remaining lease term of the Circle Health portfolio is 28.9 years resulting in a weighted average remaining lease term for the Company of 21.4 years as of September 30, 2021. The lease liabilities as of September 30, 2021 reflect a weighted average discount rate of 5.7%. Lease payments over the next five years and thereafter are as follows ($ in millions): September 30, 2021 2021 $ 86 2022 409 2023 388 2024 370 2025 337 2026 316 Thereafter 5,546 Total lease payments 7,452 Less: imputed interest (3,592) Total lease liabilities $ 3,860

Earnings Per Share

Earnings Per Share	9 Months Ended
	Sep. 30, 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 September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Earnings attributable to Centene Corporation $ 584 $ 568 $ 748 $ 1,820 Shares used in computing per share amounts: Weighted average number of common shares outstanding 583,244 579,510 582,636 567,586 Common stock equivalents (as determined by applying the treasury stock method) 7,458 8,461 7,518 8,146 Weighted average number of common shares and potential dilutive common shares outstanding 590,702 587,971 590,154 575,732 Net earnings per common share attributable to Centene Corporation: Basic earnings per common share $ 1.00 $ 0.98 $ 1.28 $ 3.21 Diluted earnings per common share $ 0.99 $ 0.97 $ 1.27 $ 3.16 The calculation of diluted earnings per common share for the three months ended September 30, 2021 and 2020 excludes the impact of 111 thousand and 64 thousand shares, respectively, related to anti-dilutive stock options, restricted stock and restricted stock units. The calculation of diluted earnings per common share for the nine months ended September 30, 2021 and 2020 excludes the impact of 57 thousand and 75 thousand shares, respectively, related to anti-dilutive stock options, restricted stock and restricted stock units.

Segment Information

Segment Information	9 Months Ended
	Sep. 30, 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 and nine months ended September 30, 2020 has been conformed to the 2021 presentation of segment eliminations. Segment information for the three months ended September 30, 2021, is as follows ($ in millions): Managed Care Specialty Eliminations Consolidated Total revenues from external customers $ 30,888 $ 1,518 $ — $ 32,406 Total revenues from internal customers 1 3,209 (3,210) — Total revenues $ 30,889 $ 4,727 $ (3,210) $ 32,406 Earnings from operations $ 699 $ (154) $ — $ 545 Segment information for the three months ended September 30, 2020, is as follows ($ in millions): Managed Care Specialty Eliminations Consolidated Total revenues from external customers $ 28,014 $ 1,076 $ — $ 29,090 Total revenues from internal customers 2 2,698 (2,700) — Total revenues $ 28,016 $ 3,774 $ (2,700) $ 29,090 Earnings from operations $ 888 $ (27) $ — $ 861 Segment information for the nine months ended September 30, 2021, is as follows ($ in millions): Managed Care Specialty Eliminations Consolidated Total revenues from external customers $ 89,078 $ 4,336 $ — $ 93,414 Total revenues from internal customers 4 9,217 (9,221) — Total revenues $ 89,082 $ 13,553 $ (9,221) $ 93,414 Earnings from operations $ 1,240 $ (59) $ — $ 1,181 Segment information for the nine months ended September 30, 2020, is as follows ($ in millions): Managed Care Specialty Eliminations Consolidated Total revenues from external customers $ 79,573 $ 3,254 $ — $ 82,827 Total revenues from internal customers 4 7,949 (7,953) — Total revenues $ 79,577 $ 11,203 $ (7,953) $ 82,827 Earnings from operations $ 3,014 $ 53 $ — $ 3,067

Contingencies

Contingencies	9 Months Ended
	Sep. 30, 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, claims related to network adequacy 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, except for the reserve estimate as described below with respect to claims or potential claims involving services provided by Envolve Pharmacy Solutions, Inc. (Envolve), as the Company’s pharmacy benefits manager subsidiary. 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. Beginning in April 2021, several lawsuits have been filed against the Company and its subsidiaries, alleging 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 Company denies any wrongdoing and intends to vigorously defend against the claims in these lawsuits. In addition, claims related to these lawsuits are anticipated to be covered in part by the Company’s insurance carrier. As a result, while these matters are subject to many uncertainties, the Company does not believe that an adverse outcome in these matters is likely to have a materially adverse impact on the Company’s financial position, results of operations and cash flows. Ohio, Mississippi and Other States 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, in Franklin County Court of Common Pleas, captioned as Ohio Department of Medicaid, et al. v. Centene Corporation, et al. The complaint alleged breaches of contract with the Ohio Department of Medicaid relating to the provision of pharmacy benefits 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 sought an undisclosed sum of money in damages, penalties, and possible termination of the contract with Buckeye Health Plan. In June 2021, the Company reached no-fault agreements with the Attorney General of Ohio and with the Attorney General and State Auditor of Mississippi to resolve claims and/or allegations made by the states related to services provided by Envolve. The Company will pay $88 million to Ohio and $55 million to Mississippi. As a result of the settlement, the Ohio Attorney General’s litigation against the Company was dismissed. In addition, in September 2021, the Company reached no-fault agreements with the Attorney General of Arkansas and the Attorney General of Illinois to resolve claims related to services provided by Envolve. The Company will pay $15 million to Arkansas and $57 million to Illinois. Additionally, the Company is in discussions with a plaintiff’s group in an effort to bring final resolution to similar concerns in other affected states. Consistent with those discussions, the Company recorded a reserve estimate of $1,250 million in the second quarter of 2021 related to this issue, inclusive of the above settlements. Additional claims, reviews or investigations relating to the Company’s PBM business may be brought by other states, the federal government or shareholder litigants, and there is no guarantee the Company will have the ability to settle such claims with other states within the reserve estimate the Company has recorded and on other acceptable terms, or at all. This matter is subject to many uncertainties, and an adverse outcome in this matter could have an adverse impact on the Company’s financial position, results of operations and cash flows.

Organization and Operations (Po

Organization and Operations (Policies)	9 Months Ended
	Sep. 30, 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	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)	9 Months Ended
	Sep. 30, 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): September 30, 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 $ 656 $ — $ — $ 656 $ 907 $ 4 $ — $ 911 Corporate securities 7,686 178 (37) 7,827 6,560 262 (8) 6,814 Restricted certificates of deposit 4 — — 4 105 — — 105 Restricted cash equivalents 211 — — 211 157 — — 157 Short-term time deposits 78 — — 78 53 — — 53 Municipal securities 3,381 97 (8) 3,470 2,970 129 (2) 3,097 Asset-backed securities 1,141 8 (1) 1,148 1,154 13 (3) 1,164 Residential mortgage-backed securities 902 15 (6) 911 1,068 27 — 1,095 Commercial mortgage-backed securities 818 18 (6) 830 748 30 (5) 773 Equity securities (1) 317 — — 317 318 — — 318 Private equity investments 561 — — 561 838 — — 838 Life insurance contracts 179 — — 179 168 — — 168 Total $ 15,934 $ 316 $ (58) $ 16,192 $ 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): September 30, 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 $ (35) $ 3,089 $ (2) $ 75 $ (7) $ 953 $ (1) $ 24 Municipal securities (7) 929 (1) 26 (2) 238 — — Asset-backed securities (1) 334 — 36 (2) 302 (1) 105 Residential mortgage-backed securities (6) 428 — 1 — 59 — 2 Commercial mortgage-backed securities (4) 272 (2) 33 (5) 147 — 13 Total $ (53) $ 5,052 $ (5) $ 171 $ (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): September 30, 2021 December 31, 2020 Investments Restricted Deposits Investments Restricted Deposits Amortized Fair Amortized Fair Amortized Fair Amortized Fair One year or less $ 1,355 $ 1,361 $ 507 $ 508 $ 1,407 $ 1,414 $ 817 $ 818 One year through five years 5,701 5,845 355 355 4,748 4,937 221 223 Five years through ten years 3,791 3,865 243 243 3,460 3,639 18 19 Greater than ten years 56 61 8 8 81 87 — — Asset-backed securities 2,861 2,889 — — 2,970 3,032 — — Total $ 13,764 $ 14,021 $ 1,113 $ 1,114 $ 12,666 $ 13,109 $ 1,056 $ 1,060

Fair Value Measurements (Tables

Fair Value Measurements (Tables)	9 Months Ended
	Sep. 30, 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 September 30, 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 $ 13,423 $ — $ — $ 13,423 Investments: U.S. Treasury securities and obligations of U.S. government corporations and agencies $ 216 $ — $ — $ 216 Corporate securities — 7,796 — 7,796 Municipal securities — 3,042 — 3,042 Short-term time deposits — 78 — 78 Asset-backed securities — 1,148 — 1,148 Residential mortgage-backed securities — 911 — 911 Commercial mortgage-backed securities — 830 — 830 Equity securities 315 2 — 317 Total investments $ 531 $ 13,807 $ — $ 14,338 Restricted deposits: Cash and cash equivalents $ 211 $ — $ — $ 211 Certificates of deposit — 4 — 4 Corporate securities — 31 — 31 Municipal securities — 428 — 428 U.S. Treasury securities and obligations of U.S. government corporations and agencies 440 — — 440 Total restricted deposits $ 651 $ 463 $ — $ 1,114 Other current assets: Foreign currency swap agreement $ — $ 18 $ — $ 18 Total assets at fair value $ 14,605 $ 14,288 $ — $ 28,893 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)	9 Months Ended
	Sep. 30, 2021
Insurance [Abstract]
Schedule of change in medical claims liability	The following table summarizes the change in medical claims liability ($ in millions): Nine Months Ended September 30, 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 — 3,872 Incurred related to: Current year 74,736 64,105 Prior years (1,526) (446) Total incurred 73,210 63,659 Paid related to: Current year 62,205 56,074 Prior years 9,344 6,032 Total paid 71,549 62,106 Balance at September 30, net 14,076 12,878 Plus: Reinsurance recoverable 23 21 Balance, September 30 $ 14,099 $ 12,899

Affordable Care Act (Tables)

Affordable Care Act (Tables)	9 Months Ended
	Sep. 30, 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): September 30, 2021 December 31, 2020 Risk adjustment receivable $ 463 $ 340 Risk adjustment payable (472) (1,224) Minimum medical loss ratio (65) (238) Cost sharing reduction receivable 92 101 Cost sharing reduction payable (12) (1)

Debt (Tables)

Debt (Tables)	9 Months Ended
	Sep. 30, 2021
Debt Disclosure [Abstract]
Schedule of Debt	Debt consists of the following ($ in millions): September 30, 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 $750 million 5.375% Senior Notes due August 15, 2026 — 794 $2,500 million 4.25% Senior Notes due December 15, 2027 2,484 2,482 $2,300 million 2.45% Senior Notes due July 15, 2028 2,304 — $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 — $1,300 million 2.625% Senior Notes due August 1, 2031 1,300 — Total senior notes 15,988 15,006 Term loan facility 2,195 1,450 Revolving credit agreement 150 97 Mortgage notes payable — 50 Construction loan payable 188 180 Finance leases and other 495 153 Debt issuance costs (177) (157) Total debt 18,839 16,779 Less current portion (245) (97) Long-term debt $ 18,594 $ 16,682

Leases (Tables)

Leases (Tables)	9 Months Ended
	Sep. 30, 2021
Leases [Abstract]
ROU Assets and Liabilities	The following table sets forth the ROU assets and lease liabilities ($ in millions): September 30, 2021 December 31, 2020 Assets ROU assets (recorded within other long-term assets) $ 3,637 $ 1,311 Liabilities Short-term (recorded within accounts payable and accrued expenses) $ 200 $ 204 Long-term (recorded within other long-term liabilities) 3,660 1,334 Total lease liabilities $ 3,860 $ 1,538
Maturity of Operating Lease Liabilities	Lease payments over the next five years and thereafter are as follows ($ in millions): September 30, 2021 2021 $ 86 2022 409 2023 388 2024 370 2025 337 2026 316 Thereafter 5,546 Total lease payments 7,452 Less: imputed interest (3,592) Total lease liabilities $ 3,860

Earnings Per Share (Tables)

Earnings Per Share (Tables)	9 Months Ended
	Sep. 30, 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 September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Earnings attributable to Centene Corporation $ 584 $ 568 $ 748 $ 1,820 Shares used in computing per share amounts: Weighted average number of common shares outstanding 583,244 579,510 582,636 567,586 Common stock equivalents (as determined by applying the treasury stock method) 7,458 8,461 7,518 8,146 Weighted average number of common shares and potential dilutive common shares outstanding 590,702 587,971 590,154 575,732 Net earnings per common share attributable to Centene Corporation: Basic earnings per common share $ 1.00 $ 0.98 $ 1.28 $ 3.21 Diluted earnings per common share $ 0.99 $ 0.97 $ 1.27 $ 3.16

Segment Information (Tables)

Segment Information (Tables)	9 Months Ended
	Sep. 30, 2021
Segment Reporting [Abstract]
Segment Information	Segment information for the three months ended September 30, 2021, is as follows ($ in millions): Managed Care Specialty Eliminations Consolidated Total revenues from external customers $ 30,888 $ 1,518 $ — $ 32,406 Total revenues from internal customers 1 3,209 (3,210) — Total revenues $ 30,889 $ 4,727 $ (3,210) $ 32,406 Earnings from operations $ 699 $ (154) $ — $ 545 Segment information for the three months ended September 30, 2020, is as follows ($ in millions): Managed Care Specialty Eliminations Consolidated Total revenues from external customers $ 28,014 $ 1,076 $ — $ 29,090 Total revenues from internal customers 2 2,698 (2,700) — Total revenues $ 28,016 $ 3,774 $ (2,700) $ 29,090 Earnings from operations $ 888 $ (27) $ — $ 861 Segment information for the nine months ended September 30, 2021, is as follows ($ in millions): Managed Care Specialty Eliminations Consolidated Total revenues from external customers $ 89,078 $ 4,336 $ — $ 93,414 Total revenues from internal customers 4 9,217 (9,221) — Total revenues $ 89,082 $ 13,553 $ (9,221) $ 93,414 Earnings from operations $ 1,240 $ (59) $ — $ 1,181 Segment information for the nine months ended September 30, 2020, is as follows ($ in millions): Managed Care Specialty Eliminations Consolidated Total revenues from external customers $ 79,573 $ 3,254 $ — $ 82,827 Total revenues from internal customers 4 7,949 (7,953) — Total revenues $ 79,577 $ 11,203 $ (7,953) $ 82,827 Earnings from operations $ 3,014 $ 53 $ — $ 3,067

Short-term and Long-term Inve_3

Short-term and Long-term Investments, Restricted Deposits - By Investment Type (Details) - USD ($) $ in Millions	Sep. 30, 2021	Dec. 31, 2020
Debt Securities
Gross Unrealized Gains	$ 316	$ 465
Gross Unrealized Losses	(58)	(18)
Equity securities	317	318
Private equity investments	561	838
Life insurance contracts	179	168
Total, Amortized Cost	15,934	15,046
Total, Fair Value	16,192	15,493
U.S. Treasury securities and obligations of U.S. government corporations and agencies
Debt Securities
Amortized Cost	656	907
Gross Unrealized Gains	0	4
Gross Unrealized Losses	0	0
Fair Value	656	911
Corporate securities
Debt Securities
Amortized Cost	7,686	6,560
Gross Unrealized Gains	178	262
Gross Unrealized Losses	(37)	(8)
Fair Value	7,827	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	211	157
Gross Unrealized Gains	0	0
Gross Unrealized Losses	0	0
Fair Value	211	157
Short-term time deposits
Debt Securities
Amortized Cost	78	53
Gross Unrealized Gains	0	0
Gross Unrealized Losses	0	0
Fair Value	78	53
Municipal securities
Debt Securities
Amortized Cost	3,381	2,970
Gross Unrealized Gains	97	129
Gross Unrealized Losses	(8)	(2)
Fair Value	3,470	3,097
Asset-backed securities
Debt Securities
Amortized Cost	1,141	1,154
Gross Unrealized Gains	8	13
Gross Unrealized Losses	(1)	(3)
Fair Value	1,148	1,164
Residential mortgage-backed securities
Debt Securities
Amortized Cost	902	1,068
Gross Unrealized Gains	15	27
Gross Unrealized Losses	(6)	0
Fair Value	911	1,095
Commercial mortgage-backed securities
Debt Securities
Amortized Cost	818	748
Gross Unrealized Gains	18	30
Gross Unrealized Losses	(6)	(5)
Fair Value	$ 830	$ 773

Short-term and Long-term Inve_4

Short-term and Long-term Investments, Restricted Deposits - Narrative (Details) $ in Millions	1 Months Ended		3 Months Ended	9 Months Ended
	Sep. 30, 2021USD ($)position	Jul. 31, 2021USD ($)	Sep. 30, 2021USD ($)position	Sep. 30, 2021USD ($)position	Sep. 30, 2020USD ($)	Dec. 31, 2020USD ($)	Jun. 30, 2019
Schedule Of Investments And Restricted Deposits By Type [Line Items]
Accrued interest income	$ 92		$ 92	$ 92		$ 86
Positions from which gross unrealized losses were generated | position	1,887		1,887	1,887
Total unrealized investment positions | position	6,468		6,468	6,468
Step acquisition, gain on investment				$ 309	$ 0
Circle Health
Schedule Of Investments And Restricted Deposits By Type [Line Items]
Acquisition, interests acquired		60.00%
Business combination, ownership percentage		100.00%
Circle Health
Schedule Of Investments And Restricted Deposits By Type [Line Items]
Equity method investment, ownership percentage							40.00%
Cash paid		$ 705
Step acquisition, gain on investment			$ 309
RxAdvance
Schedule Of Investments And Restricted Deposits By Type [Line Items]
Impairment of equity method investment	$ 229
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 | Investment Securities
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				98.00%

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	Sep. 30, 2021	Dec. 31, 2020
Unrealized Losses
Less Than 12 Months	$ (53)	$ (16)
12 Months or More	(5)	(2)
Fair Value
Fair Value, Less Than 12 Months	5,052	1,699
Fair Value, 12 Months or More	171	144
Corporate securities
Unrealized Losses
Less Than 12 Months	(35)	(7)
12 Months or More	(2)	(1)
Fair Value
Fair Value, Less Than 12 Months	3,089	953
Fair Value, 12 Months or More	75	24
Municipal securities
Unrealized Losses
Less Than 12 Months	(7)	(2)
12 Months or More	(1)	0
Fair Value
Fair Value, Less Than 12 Months	929	238
Fair Value, 12 Months or More	26	0
Asset-backed securities
Unrealized Losses
Less Than 12 Months	(1)	(2)
12 Months or More	0	(1)
Fair Value
Fair Value, Less Than 12 Months	334	302
Fair Value, 12 Months or More	36	105
Residential mortgage-backed securities
Unrealized Losses
Less Than 12 Months	(6)	0
12 Months or More	0	0
Fair Value
Fair Value, Less Than 12 Months	428	59
Fair Value, 12 Months or More	1	2
Commercial mortgage-backed securities
Unrealized Losses
Less Than 12 Months	(4)	(5)
12 Months or More	(2)	0
Fair Value
Fair Value, Less Than 12 Months	272	147
Fair Value, 12 Months or More	$ 33	$ 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	Sep. 30, 2021	Dec. 31, 2020
Investments
Amortized Cost
One year or less	$ 1,355	$ 1,407
One year through five years	5,701	4,748
Five years through ten years	3,791	3,460
Greater than ten years	56	81
Asset-backed securities	2,861	2,970
Amortized Cost	13,764	12,666
Fair Value
One year or less	1,361	1,414
One year through five years	5,845	4,937
Five years through ten years	3,865	3,639
Greater than ten years	61	87
Asset-backed securities	2,889	3,032
Fair Value	14,021	13,109
Restricted Deposits
Amortized Cost
One year or less	507	817
One year through five years	355	221
Five years through ten years	243	18
Greater than ten years	8	0
Asset-backed securities	0	0
Amortized Cost	1,113	1,056
Fair Value
One year or less	508	818
One year through five years	355	223
Five years through ten years	243	19
Greater than ten years	8	0
Asset-backed securities	0	0
Fair Value	$ 1,114	$ 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	Sep. 30, 2021	Dec. 31, 2020
Assets
Cash and cash equivalents	$ 13,423	$ 10,800
Investments:
Equity securities	317	318
Other current assets:
Total assets at fair value	28,893	25,287
U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Assets measured at fair value	656	911
Corporate securities
Investments:
Assets measured at fair value	7,827	6,814
Municipal securities
Investments:
Assets measured at fair value	3,470	3,097
Short-term time deposits
Investments:
Assets measured at fair value	78	53
Asset-backed securities
Investments:
Assets measured at fair value	1,148	1,164
Residential mortgage-backed securities
Investments:
Assets measured at fair value	911	1,095
Commercial mortgage-backed securities
Investments:
Assets measured at fair value	830	773
Investments available-for-sale
Investments:
Assets measured at fair value	14,338	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	216	165
Investments available-for-sale | Corporate securities
Investments:
Assets measured at fair value	7,796	6,789
Investments available-for-sale | Municipal securities
Investments:
Assets measured at fair value	3,042	3,070
Investments available-for-sale | Short-term time deposits
Investments:
Assets measured at fair value	78	53
Investments available-for-sale | Asset-backed securities
Investments:
Assets measured at fair value	1,148	1,164
Investments available-for-sale | Residential mortgage-backed securities
Investments:
Assets measured at fair value	911	1,095
Investments available-for-sale | Commercial mortgage-backed securities
Investments:
Assets measured at fair value	830	773
Restricted deposits
Investments:
Assets measured at fair value	1,114	1,060
Restricted deposits | U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Assets measured at fair value	440	746
Restricted deposits | Corporate securities
Investments:
Assets measured at fair value	31	25
Restricted deposits | Municipal securities
Investments:
Assets measured at fair value	428	27
Restricted deposits | Cash and cash equivalents
Investments:
Assets measured at fair value	211	157
Restricted deposits | Certificates of deposit
Investments:
Assets measured at fair value	4	105
Other current assets | Foreign currency swap agreement
Other current assets:
Foreign currency swap agreement	18
Level I
Assets
Cash and cash equivalents	13,423	10,800
Investments:
Equity securities	315	316
Other current assets:
Total assets at fair value	14,605	12,184
Level I | Investments available-for-sale
Investments:
Assets measured at fair value	531	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	216	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	651	903
Level I | Restricted deposits | U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Assets measured at fair value	440	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	211	157
Level I | Restricted deposits | Certificates of deposit
Investments:
Assets measured at fair value	0	0
Level I | Other current assets | Foreign currency swap agreement
Other current assets:
Foreign currency swap agreement	0
Level II
Assets
Cash and cash equivalents	0	0
Investments:
Equity securities	2	2
Other current assets:
Total assets at fair value	14,288	13,103
Level II | Investments available-for-sale
Investments:
Assets measured at fair value	13,807	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	7,796	6,789
Level II | Investments available-for-sale | Municipal securities
Investments:
Assets measured at fair value	3,042	3,070
Level II | Investments available-for-sale | Short-term time deposits
Investments:
Assets measured at fair value	78	53
Level II | Investments available-for-sale | Asset-backed securities
Investments:
Assets measured at fair value	1,148	1,164
Level II | Investments available-for-sale | Residential mortgage-backed securities
Investments:
Assets measured at fair value	911	1,095
Level II | Investments available-for-sale | Commercial mortgage-backed securities
Investments:
Assets measured at fair value	830	773
Level II | Restricted deposits
Investments:
Assets measured at fair value	463	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	31	25
Level II | Restricted deposits | Municipal securities
Investments:
Assets measured at fair value	428	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 II | Other current assets | Foreign currency swap agreement
Other current assets:
Foreign currency swap agreement	18
Level III
Assets
Cash and cash equivalents	0	0
Investments:
Equity securities	0	0
Other current assets:
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
Level III | Other current assets | Foreign currency swap agreement
Other current assets:
Foreign currency swap agreement	$ 0

Fair Value Measurements - Narra

Fair Value Measurements - Narrative (Details) - USD ($) $ in Millions	Sep. 30, 2021	Dec. 31, 2020
Fair Value Disclosures [Abstract]
Aggregate carrying amount of life insurance contracts and equity investments, fair value	$ 740	$ 1,006

Medical Claims Liability - Sche

Medical Claims Liability - Schedule of Change in Medical Claims Liability (Details) - USD ($) $ in Millions	9 Months Ended
	Sep. 30, 2021	Sep. 30, 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	3,872
Incurred related to:
Current year	74,736	64,105
Prior years	(1,526)	(446)
Total incurred	73,210	63,659
Paid related to:
Current year	62,205	56,074
Prior years	9,344	6,032
Total paid	71,549	62,106
Balance at September 30, net	14,076	12,878
Plus: Reinsurance recoverable	23	21
Balance, September 30	$ 14,099	$ 12,899

Medical Claims Liability - Narr

Medical Claims Liability - Narrative (Details) - USD ($) $ in Millions	9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020
Insurance [Abstract]
Amounts recorded as an adjustment to premium revenues related to minimum HBR and return of premium programs	$ 438	$ 97
Short-duration insurance contracts, Incurred but not reported and expected development on reported claims	$ 9,346

Affordable Care Act - Additiona

Affordable Care Act - Additional information (Details) $ in Millions	6 Months Ended
	Jun. 30, 2021USD ($)
Affordable Care Act [Abstract]
Risk adjustment increase to net payables	$ 83
Risk adjustment and reinsurance pre-tax expense	$ 80

Affordable Care Act - Net Recei

Affordable Care Act - Net Receivables (Payables) for Each of the Ongoing Programs (Details) - USD ($) $ in Millions	Sep. 30, 2021	Dec. 31, 2020
Affordable Care Act [Abstract]
Risk adjustment receivable	$ 463	$ 340
Risk adjustment payable	(472)	(1,224)
Minimum medical loss ratio	(65)	(238)
Cost sharing reduction receivable	92	101
Cost sharing reduction payable	$ (12)	$ (1)

Debt - Schedule of Debt (Detail

Debt - Schedule of Debt (Details) - USD ($)	Sep. 30, 2021	Aug. 31, 2021	Feb. 28, 2021	Dec. 31, 2020
Debt Instrument [Line Items]
Total senior notes	$ 15,988,000,000			$ 15,006,000,000
Mortgage notes payable	0			50,000,000
Construction loan payable	188,000,000			180,000,000
Finance leases and other	495,000,000			153,000,000
Debt issuance costs	(177,000,000)			(157,000,000)
Total debt	18,839,000,000			16,779,000,000
Less current portion	(245,000,000)			(97,000,000)
Long-term debt	18,594,000,000			16,682,000,000
Revolving credit agreement
Debt Instrument [Line Items]
Credit facility	150,000,000			97,000,000
Senior Notes
Debt Instrument [Line Items]
Debt, face amount		$ 1,800,000,000
Term loan facility
Debt Instrument [Line Items]
Credit facility	2,195,000,000			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%	5.375%
Senior notes	$ 0			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	$ 0			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	$ 2,484,000,000			2,482,000,000
$2,300 million 2.45% Senior Notes due July 15, 2028 | Senior Notes
Debt Instrument [Line Items]
Debt, face amount	$ 2,300,000,000
Interest rate	2.45%
Senior notes	$ 2,304,000,000			0
$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
$1,300 million 2.625% Senior Notes due August 1, 2031 | Senior Notes
Debt Instrument [Line Items]
Debt, face amount	$ 1,300,000,000	$ 1,300,000,000
Interest rate	2.625%	2.625%
Senior notes	$ 1,300,000,000			$ 0

Debt - Narrative (Details)

Debt - Narrative (Details) £ in Millions	1 Months Ended						6 Months Ended	9 Months Ended
	Aug. 31, 2021USD ($)	Jul. 31, 2021GBP (£)	Apr. 30, 2021	Feb. 28, 2021USD ($)	Jan. 31, 2021USD ($)	Oct. 31, 2017USD ($)	Jun. 30, 2021USD ($)	Sep. 30, 2021USD ($)	Sep. 30, 2020USD ($)	Jul. 31, 2021USD ($)	Dec. 31, 2020USD ($)
Debt Instrument [Line Items]
Loss on extinguishment of debt	$ 79,000,000			$ 46,000,000				$ (125,000,000)	$ (44,000,000)
Payments for foreign currency hedge | £		£ 509
Extension term			1 year
Construction loan payable								188,000,000			$ 180,000,000
Repayment of mortgage note					$ 50,000,000
Debt Instrument, Payment Period, One
Debt Instrument [Line Items]
Interest rate	0.00%
Debt Instrument, Payment Period, Two
Debt Instrument [Line Items]
Interest rate	2.50%
Debt Instrument, Payment Period, Three
Debt Instrument [Line Items]
Interest rate	5.00%
Foreign currency swap agreement
Debt Instrument [Line Items]
Derivative agreement										$ 705,000,000
Fair value, swap agreement								18,000,000
Circle Health
Debt Instrument [Line Items]
Acquisition, interests acquired										60.00%
Senior Notes
Debt Instrument [Line Items]
Debt, face amount	$ 1,800,000,000
Construction Loan Payable
Debt Instrument [Line Items]
Debt, face amount						$ 200,000,000
Construction Loan Payable | Maximum | LIBOR
Debt Instrument [Line Items]
Basis spread on variable rate						2.70%
Construction Loan Payable | Minimum | LIBOR
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%
$1,800 Million 2.45% Senior Notes due March 2028 | Senior Notes
Debt Instrument [Line Items]
Debt, face amount	$ 500,000,000									$ 1,800,000,000
Interest rate										2.45%
Yield, percentage	2.31%
$1,300 million 2.625% Senior Notes due August 1, 2031 | Senior Notes
Debt Instrument [Line Items]
Debt, face amount	$ 1,300,000,000							$ 1,300,000,000
Interest rate	2.625%							2.625%
$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%							5.375%
Term loan facility
Debt Instrument [Line Items]
Credit facility, maximum borrowing capacity	$ 2,200,000,000						$ 1,450,000,000
Covenant, maximum net leverage ratio,	4						3.50
Term loan facility | Maximum
Debt Instrument [Line Items]
Basis spread on variable rate	1.50%
Term loan facility | Minimum
Debt Instrument [Line Items]
Basis spread on variable rate	1.125%

Leases - Narrative (Details)

Leases - Narrative (Details) - USD ($) $ in Millions	1 Months Ended	3 Months Ended		9 Months Ended
	Jul. 31, 2021	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020	Jun. 30, 2021
Lessee, Lease, Description [Line Items]
Operating lease expense		$ 123	$ 68	$ 257	$ 202
Lease liabilities reduced by cash paid		136		274
ROU assets from new operating leases in exchange for lease liability		2,396		2,504
Increase in operating lease liabilities		$ 2,396		2,504
Operating leases not yet commenced				$ 43
Weighted average remaining lease term		21 years 4 months 24 days		21 years 4 months 24 days		9 years 2 months 12 days
Weighted-average discount rate for operating leases		5.70%		5.70%
Minimum
Lessee, Lease, Description [Line Items]
Operating leases, not yet commenced, lease term		2 years		2 years
Maximum
Lessee, Lease, Description [Line Items]
Operating leases, not yet commenced, lease term		9 years		9 years
Circle Health
Lessee, Lease, Description [Line Items]
Acquisition, interests acquired	60.00%
ROU assets from new operating leases in exchange for lease liability	$ 2,351
Increase in operating lease liabilities	$ 2,351
Weighted average remaining lease term		28 years 10 months 24 days		28 years 10 months 24 days

Leases - ROU Assets and Liabili

Leases - ROU Assets and Liabilities (Details) - USD ($) $ in Millions	Sep. 30, 2021	Dec. 31, 2020
Assets
ROU assets (recorded within other long-term assets)	$ 3,637	$ 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)	$ 200	$ 204
Long-term (recorded within other long-term liabilities)	3,660	1,334
Total lease liabilities	$ 3,860	$ 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	Sep. 30, 2021	Dec. 31, 2020
Leases [Abstract]
2021	$ 86
2022	409
2023	388
2024	370
2025	337
2026	316
Thereafter	5,546
Total lease payments	7,452
Less: imputed interest	(3,592)
Total lease liabilities	$ 3,860	$ 1,538

Earnings Per Share (Details)

Earnings Per Share (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Earnings attributable to Centene Corporation
Earnings attributable to Centene Corporation	$ 584	$ 568	$ 748	$ 1,820
Shares used in computing per share amounts:
Weighted average number of common shares outstanding (in shares)	583,244	579,510	582,636	567,586
Common stock equivalents (as determined by applying the treasury stock method) (in shares)	7,458	8,461	7,518	8,146
Weighted average number of common shares and potential dilutive common shares outstanding (in shares)	590,702	587,971	590,154	575,732
Net earnings per common share attributable to Centene Corporation:
Basic earnings per common share (in dollars per share)	$ 1	$ 0.98	$ 1.28	$ 3.21
Diluted earnings per common share (in dollars per share)	$ 0.99	$ 0.97	$ 1.27	$ 3.16
Anti-dilutive restricted stock and restricted stock units excluded from the calculation of diluted earnings (loss) per common share (in shares)	111	64	57	75

Segment Information (Details)

Segment Information (Details) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2021USD ($)	Sep. 30, 2020USD ($)	Sep. 30, 2021USD ($)segment	Sep. 30, 2020USD ($)
Segment Reporting [Abstract]
Number of operating segments | segment			2
Segment Reporting Information [Line Items]
Total revenues	$ 32,406	$ 29,090	$ 93,414	$ 82,827
Earnings from operations	545	861	1,181	3,067
Eliminations
Segment Reporting Information [Line Items]
Total revenues	(3,210)	(2,700)	(9,221)	(7,953)
Managed Care
Segment Reporting Information [Line Items]
Total revenues	30,889	28,016	89,082	79,577
Earnings from operations	699	888	1,240	3,014
Managed Care | Operating Segments
Segment Reporting Information [Line Items]
Total revenues	30,888	28,014	89,078	79,573
Managed Care | Eliminations
Segment Reporting Information [Line Items]
Total revenues	1	2	4	4
Specialty Services
Segment Reporting Information [Line Items]
Total revenues	4,727	3,774	13,553	11,203
Earnings from operations	(154)	(27)	(59)	53
Specialty Services | Operating Segments
Segment Reporting Information [Line Items]
Total revenues	1,518	1,076	4,336	3,254
Specialty Services | Eliminations
Segment Reporting Information [Line Items]
Total revenues	$ 3,209	$ 2,698	$ 9,217	$ 7,949

Contingencies (Details)

Contingencies (Details) - USD ($) $ in Millions	1 Months Ended
	Sep. 30, 2021	Jun. 30, 2021
Pending Litigation
Loss Contingencies [Line Items]
Reserve estimate		$ 1,250
Ohio Department of Medicaid, et al. v. Centene Corporation | Settled Litigation
Loss Contingencies [Line Items]
Litigation settlement, amount awarded to other party		88
Mississippi Department of Medicaid, et al. v. Envolve | Settled Litigation
Loss Contingencies [Line Items]
Litigation settlement, amount awarded to other party		$ 55
Arkansas Department of Medicaid, et al. v. Centene Corporation | Settled Litigation
Loss Contingencies [Line Items]
Litigation settlement, amount awarded to other party	$ 15
Illinois Department of Medicaid, et al. v. Centene Corporation | Settled Litigation
Loss Contingencies [Line Items]
Litigation settlement, amount awarded to other party	$ 57