Centene (CNC) 10-Q 25 Apr 22 2022 Q1 Quarterly report Financial data

Cover

Cover - shares	3 Months Ended
	Mar. 31, 2022	Apr. 15, 2022
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Mar. 31, 2022
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		584,886,987
Entity Central Index Key	0001071739
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2022
Document Fiscal Period Focus	Q1
Amendment Flag	false

CONSOLIDATED BALANCE SHEETS

CONSOLIDATED BALANCE SHEETS - USD ($) $ in Millions	Mar. 31, 2022	Dec. 31, 2021
Current assets:
Cash and cash equivalents	$ 11,237	$ 13,118
Premium and trade receivables	16,169	12,238
Short-term investments	1,668	1,539
Other current assets	2,036	1,602
Total current assets	31,110	28,497
Long-term investments	14,129	14,043
Restricted deposits	1,210	1,068
Property, software and equipment, net	3,583	3,391
Goodwill	20,903	19,771
Intangible assets, net	8,138	7,824
Other long-term assets	3,828	3,781
Total assets	82,901	78,375
Current liabilities:
Medical claims liability	16,259	14,243
Accounts payable and accrued expenses	9,980	8,493
Return of premium payable	2,628	2,328
Unearned revenue	526	434
Current portion of long-term debt	292	267
Total current liabilities	29,685	25,765
Long-term debt	18,640	18,571
Deferred tax liability	1,292	1,407
Other long-term liabilities	5,854	5,610
Total liabilities	55,471	51,353
Commitments and contingencies
Redeemable noncontrolling interests	117	82
Stockholders’ equity:
Preferred stock, $0.001 par value; authorized 10,000 shares; no shares issued or outstanding at March 31, 2022 and December 31, 2021	0	0
Common stock, $0.001 par value; authorized 800,000 shares; 605,925 issued and 584,854 outstanding at March 31, 2022, and 602,704 issued and 582,479 outstanding at December 31, 2021	1	1
Additional paid-in capital	19,830	19,672
Accumulated other comprehensive earnings	(485)	77
Retained earnings	8,988	8,139
Treasury stock, at cost (21,071 and 20,225 shares, respectively)	(1,165)	(1,094)
Total Centene stockholders’ equity	27,169	26,795
Nonredeemable noncontrolling interest	144	145
Total stockholders’ equity	27,313	26,940
Total liabilities, redeemable noncontrolling interests and stockholders’ equity	$ 82,901	$ 78,375

CONSOLIDATED BALANCE SHEETS (Pa

CONSOLIDATED BALANCE SHEETS (Parenthetical) - $ / shares	Mar. 31, 2022	Dec. 31, 2021
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)	605,925,000	602,704,000
Common stock, shares outstanding (in shares)	584,854,000	582,479,000
Treasury stock (in shares)	21,071,000	20,225,000

CONSOLIDATED STATEMENTS OF OPER

CONSOLIDATED STATEMENTS OF OPERATIONS - USD ($) shares in Thousands, $ in Millions	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Revenues:
Premium and service revenues	$ 34,232	$ 28,114
Premium tax	2,953	1,869
Total revenues	37,185	29,983
Expenses:
Medical costs	27,838	23,391
Cost of services	1,988	1,048
Selling, general and administrative expenses	2,745	2,234
Depreciation expense	156	133
Amortization of acquired intangible assets	199	195
Premium tax expense	3,006	1,928
Total operating expenses	35,932	28,929
Earnings from operations	1,253	1,054
Other income (expense):
Investment and other income	52	103
Debt extinguishment	3	(46)
Interest expense	(160)	(170)
Earnings before income tax expense	1,148	941
Income tax expense	296	244
Net earnings	852	697
(Earnings) loss attributable to noncontrolling interests	(3)	2
Net earnings attributable to Centene Corporation	$ 849	$ 699
Net earnings per common share attributable to Centene Corporation:
Basic earnings per common share (in dollars per share)	$ 1.46	$ 1.20
Diluted earnings per common share (in dollars per share)	$ 1.44	$ 1.19
Weighted average number of common shares outstanding:
Basic (in shares)	583,230	581,869
Diluted (in shares)	590,658	589,343
Premium
Revenues:
Premium and service revenues	$ 31,889	$ 26,933
Service
Revenues:
Premium and service revenues	$ 2,343	$ 1,181

CONSOLIDATED STATEMENTS OF COMP

CONSOLIDATED STATEMENTS OF COMPREHENSIVE EARNINGS - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Statement of Comprehensive Income [Abstract]
Net earnings	$ 852	$ 697
Reclassification adjustment, net of tax	2	(2)
Change in unrealized gain (loss) on investments, net of tax	(544)	(154)
Foreign currency translation adjustments	(20)	(5)
Other comprehensive loss	(562)	(161)
Comprehensive earnings	290	536
Comprehensive (earnings) loss attributable to noncontrolling interests	(3)	2
Comprehensive earnings attributable to Centene Corporation	$ 287	$ 538

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, 2020		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
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, 2021	582,479	602,704
Balance at Dec. 31, 2021	$ 26,940	$ 1	19,672	77	8,139	$ (1,094)	145
Treasury stock (in shares) at Dec. 31, 2021	20,225					20,225
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net earnings (loss)	$ 848				849		(1)
Other comprehensive loss , net of tax	(562)			(562)
Common stock issued for employee benefit plans (in shares)		3,221
Common stock issued for employee benefit plans	28		28
Fair value of unvested equity awards in connection with acquisition	60		60
Common stock repurchases (in shares)						(846)
Common stock repurchases	(71)					$ (71)
Stock compensation expense	$ 70		70
Balance (in shares) at Mar. 31, 2022	584,854	605,925
Balance at Mar. 31, 2022	$ 27,313	$ 1	$ 19,830	$ (485)	$ 8,988	$ (1,165)	$ 144
Treasury stock (in shares) at Mar. 31, 2022	21,071					21,071

CONSOLIDATED STATEMENTS OF ST_2

CONSOLIDATED STATEMENTS OF STOCKHOLDERS' EQUITY (Parenthetical) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021	Dec. 31, 2021	Dec. 31, 2020
Par value (in dollars per share)	$ 0.001		$ 0.001
Other comprehensive loss, tax expense (benefit)	$ (171)	$ (49)
Common Stock
Par value (in dollars per share)	$ 0.001	$ 0.001	0.001	$ 0.001
Treasury Stock
Par value (in dollars per share)	$ 0.001	$ 0.001	$ 0.001	$ 0.001

CONSOLIDATED STATEMENTS OF CASH

CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Cash flows from operating activities:
Net earnings	$ 852	$ 697
Adjustments to reconcile net earnings to net cash provided by operating activities
Depreciation and amortization	390	361
Stock compensation expense	70	51
(Gain) loss on debt extinguishment	(3)	46
Deferred income taxes	12	156
Other adjustments, net	22	2
Changes in assets and liabilities
Premium and trade receivables	(3,099)	(1,891)
Other assets	(299)	(287)
Medical claims liabilities	1,767	405
Unearned revenue	81	48
Accounts payable and accrued expenses	957	32
Other long-term liabilities	401	423
Net cash provided by operating activities	1,151	43
Cash flows from investing activities:
Capital expenditures	(242)	(187)
Purchases of investments	(1,700)	(1,653)
Sales and maturities of investments	1,047	1,391
Acquisitions, net of cash acquired	(1,504)	(158)
Other investing activities, net	(2)	0
Net cash used in investing activities	(2,401)	(607)
Cash flows from financing activities:
Proceeds from long-term debt	100	2,317
Payments of long-term debt	(526)	(2,295)
Common stock repurchases	(71)	(29)
Payments for debt extinguishment	(27)	(54)
Debt issuance costs	0	(27)
Other financing activities, net	26	15
Net cash used in financing activities	(498)	(73)
Effect of exchange rate changes on cash, cash equivalents, and restricted cash	33	(16)
Net decrease in cash, cash equivalents and restricted cash and cash equivalents	(1,715)	(653)
Cash, cash equivalents, and restricted cash and cash equivalents, beginning of period	13,214	10,957
Cash, cash equivalents, and restricted cash and cash equivalents, end of period	11,499	10,304
Supplemental disclosures of cash flow information:
Interest paid	139	130
Income taxes paid	11	20
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	11,237	9,627
Restricted cash and cash equivalents, included in restricted deposits	262	677
Total cash, cash equivalents, and restricted cash and cash equivalents	$ 11,499	$ 10,304

Organization and Operations

Organization and Operations	3 Months Ended
	Mar. 31, 2022
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, 2021. 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, 2021 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 2021 amounts in the consolidated financial statements and notes to the consolidated financial statements have been reclassified to conform to the 2022 presentation. Beginning in 2022, the Company has included a separate line item for depreciation expense on the Consolidated Statement of Operations, which was previously included in selling, general and administrative (SG&A) expenses. Prior period SG&A expense ratios have also been conformed to the current presentation. These reclassifications have no effect on net earnings or stockholders’ equity as previously reported. On January 4, 2022, the Company acquired all of the issued and outstanding shares of Magellan Health, Inc. (Magellan) (the Magellan Acquisition). The acquisition was accounted for as a business combination. See Note 2. Acquisitions for further details. Accounting Guidance Not Yet Adopted The Company has determined that there are no recently issued accounting pronouncements that will have a material impact on its consolidated financial position, results of operations, or cash flows.

Acquisitions

Acquisitions	3 Months Ended
	Mar. 31, 2022
Business Combinations [Abstract]
Acquisitions	Acquisitions Magellan Acquisition On January 4, 2022, the Company acquired all of the issued and outstanding shares of Magellan. The Magellan Acquisition enables Centene to provide whole-health, integrated healthcare solutions to deliver better health outcomes at lower costs for complex, high-cost populations. Total consideration for the acquisition was $2,561 million, consisting of $2,501 million in cash and $60 million related to the fair value of replacement equity awards associated with pre-combination service. The Company recognized $97 million of acquisition related expenses, primarily related to Magellan, that were in the Consolidated Statement of Operations for the three months ended March 31, 2022. The Magellan Acquisition was accounted for as a business combination using the acquisition method of accounting that requires assets acquired and liabilities assumed to be recognized at fair value as of the acquisition date. Due to the timing of the acquisition, the valuation of assets acquired and liabilities assumed has not yet been finalized, and as a result, the preliminary estimates have been recorded and are subject to change. Any necessary adjustments from the preliminary estimates will be finalized within one year from the date of acquisition. Measurement period adjustments will be recorded in the period in which they are determined, as if they had been completed at the acquisition date. The Company's preliminary allocation of the fair value of assets acquired and liabilities assumed as of the acquisition date of January 4, 2022 is as follows ($ in millions): Assets acquired and liabilities assumed Cash and cash equivalents $ 997 Premium and related receivables 855 Short-term investments 144 Other current assets 225 Long-term investments 43 Restricted deposits 7 Property, software and equipment 91 Intangible assets (a) 600 Other long-term assets 50 Total assets acquired 3,012 Medical claims liability 249 Accounts payable and accrued expenses 476 Return of premium payable 75 Unearned revenue 8 Current portion of long-term debt 5 Long-term debt (b) 542 Deferred tax liabilities (c) 81 Other long-term liabilities 82 Total liabilities assumed 1,518 Mezzanine equity 32 Total identifiable net assets 1,462 Goodwill (d) 1,099 Total assets acquired and liabilities assumed $ 2,561 The Company has made the following preliminary fair value adjustments based on information reviewed through March 31, 2022. Significant fair value adjustments are noted as follows: (a) The identifiable intangible assets acquired are to be measured at fair value as of the completion of the acquisition. The fair value of intangible assets will be determined primarily using variations of the income approach, which is based on the present value of the future after tax cash flows attributable to each identified intangible asset. Other valuation methods, including the market approach and cost approach, will be considered in estimating the fair value. The identifiable intangible assets include purchased contract rights, trade names, provider contracts and developed technologies. (b) Debt is required to be measured at fair value under the acquisition method of accounting. The fair value of Magellan's Senior Notes and Credit Agreement assumed in the acquisition was $535 million. In January 2022, the Company paid off Magellan's debt acquired in the transaction using Magellan's cash on hand. (c) The preliminary deferred tax liabilities are presented net of $117 million of deferred tax assets. (d) Goodwill is estimated at $1,099 million and primarily relates to synergies expected from the acquisition and the assembled workforce of Magellan. The assignment of goodwill to the Company’s respective segments has not been completed at this time, but the majority of goodwill is expected to be allocated to the Specialty segment. The majority of the goodwill is not deductible for income tax purposes.

Short-term and Long-term Invest

Short-term and Long-term Investments, Restricted Deposits	3 Months Ended
	Mar. 31, 2022
Investments, Debt and Equity Securities [Abstract]
Short-term and Long-term Investments, Restricted Deposits	Short-term and Long-term Investments, Restricted Deposits Short-term and long-term investments and restricted deposits by investment type consist of the following ($ in millions): March 31, 2022 December 31, 2021 Amortized Gross Gross Fair Amortized Gross Gross Fair Debt securities: U.S. Treasury securities and obligations of U.S. government corporations and agencies $ 552 $ — $ (9) $ 543 $ 642 $ — $ (2) $ 640 Corporate securities 8,752 26 (368) 8,410 8,145 130 (75) 8,200 Restricted certificates of deposit 4 — — 4 4 — — 4 Restricted cash equivalents 262 — — 262 96 — — 96 Short-term time deposits 130 — — 130 109 — — 109 Municipal securities 3,607 13 (136) 3,484 3,398 85 (15) 3,468 Asset-backed securities 1,308 — (29) 1,279 1,308 5 (5) 1,308 Residential mortgage-backed securities 919 1 (45) 875 850 10 (7) 853 Commercial mortgage-backed securities 939 1 (43) 897 870 13 (10) 873 Equity securities (1) 301 — — 301 326 — — 326 Private equity investments 626 — — 626 587 — — 587 Life insurance contracts 196 — — 196 186 — — 186 Total $ 17,596 $ 41 $ (630) $ 17,007 $ 16,521 $ 243 $ (114) $ 16,650 (1) Investments in equity securities primarily consist of exchange traded funds in fixed income securities. The Company's investments are debt securities classified as available-for-sale with the exception of equity securities, certain private equity investments and life insurance contracts. The Company's investment policies are designed to provide liquidity, preserve capital and maximize total return on invested assets with the focus on high credit quality securities. The Company limits the size of investment in any single issuer other than U.S. treasury securities and obligations of U.S. government corporations and agencies. As of March 31, 2022, 98% of the Company's investments in rated securities carry an investment grade rating by nationally recognized statistical rating organizations. At March 31, 2022, 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 $101 million and $96 million at March 31, 2022 and December 31, 2021, respectively, and is included in other current assets on the Consolidated Balance Sheets. The Company's residential mortgage-backed securities are primarily issued by the Federal National Mortgage Association, Government National Mortgage Association or Federal Home Loan Mortgage Corporation, which carry implicit or explicit guarantees of the U.S. government. The Company's commercial mortgage-backed securities are primarily senior tranches with a weighted average rating of AA and a weighted average duration of 4 years at March 31, 2022. The fair value of available-for-sale debt securities with gross unrealized losses by investment type and length of time that individual securities have been in a continuous unrealized loss position were as follows ($ in millions): March 31, 2022 December 31, 2021 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 U.S. Treasury securities and obligations of U.S. government corporations and agencies $ (7) $ 495 $ (2) $ 33 $ (2) $ 598 $ — $ 3 Corporate securities (271) 5,653 (97) 1,024 (66) 4,209 (9) 209 Municipal securities (125) 2,336 (11) 121 (14) 1,173 (1) 39 Asset-backed securities (28) 1,097 (1) 65 (5) 770 — 33 Residential mortgage-backed securities (29) 629 (16) 172 (7) 472 — 15 Commercial mortgage-backed securities (27) 680 (16) 139 (8) 380 (2) 32 Total $ (487) $ 10,890 $ (143) $ 1,554 $ (102) $ 7,602 $ (12) $ 331 As of March 31, 2022, the gross unrealized losses were generated from 5,048 positions out of a total of 6,748 positions. The change in fair value of available-for-sale debt 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 an impairment for these securities. In addition, the Company 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 the decline in fair value is credit related. Evidence of a credit related loss may include rating agency actions, adverse conditions specifically related to the security, or failure of the issuer of the security to make scheduled payments. The contractual maturities of short-term and long-term debt securities and restricted deposits are as follows ($ in millions): March 31, 2022 December 31, 2021 Investments Restricted Deposits Investments Restricted Deposits Amortized Fair Amortized Fair Amortized Fair Amortized Fair One year or less $ 1,543 $ 1,540 $ 611 $ 609 $ 1,390 $ 1,396 $ 368 $ 368 One year through five years 6,519 6,327 400 382 6,212 6,294 460 457 Five years through ten years 3,903 3,665 238 219 3,647 3,681 244 243 Greater than ten years 93 91 — — 73 78 — — Asset-backed securities 3,166 3,051 — — 3,028 3,034 — — Total $ 15,224 $ 14,674 $ 1,249 $ 1,210 $ 14,350 $ 14,483 $ 1,072 $ 1,068 Actual maturities may differ from contractual maturities due to call or prepayment options. Equity securities, private equity investments and life insurance contracts are excluded from the table above because they do not have a contractual maturity. The Company has an option to redeem at amortized cost substantially all of the securities included in the greater than ten years category listed above.

Fair Value Measurements

Fair Value Measurements	3 Months Ended
	Mar. 31, 2022
Fair Value Disclosures [Abstract]
Fair Value Measurements	Fair Value Measurements Assets and liabilities recorded at fair value in the Consolidated Balance Sheets are categorized based upon observable or unobservable inputs used to estimate fair value. Level inputs are as follows: Level Input: Input Definition: Level I Inputs are unadjusted, quoted prices for identical assets or liabilities in active markets at the measurement date. Level II Inputs other than quoted prices included in Level I that are observable for the asset or liability through corroboration with market data at the measurement date. Level III Unobservable inputs that reflect management's best estimate of what market participants would use in pricing the asset or liability at the measurement date. The following table summarizes fair value measurements by level at March 31, 2022, 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 $ 11,237 $ — $ — $ 11,237 Investments: U.S. Treasury securities and obligations of U.S. government corporations and agencies $ 154 $ — $ — $ 154 Corporate securities — 8,380 — 8,380 Municipal securities — 2,959 — 2,959 Short-term time deposits — 130 — 130 Asset-backed securities — 1,279 — 1,279 Residential mortgage-backed securities — 875 — 875 Commercial mortgage-backed securities — 897 — 897 Equity securities 299 2 — 301 Total investments $ 453 $ 14,522 $ — $ 14,975 Restricted deposits: Cash and cash equivalents $ 262 $ — $ — $ 262 Certificates of deposit — 4 — 4 Corporate securities — 30 — 30 Municipal securities — 525 — 525 U.S. Treasury securities and obligations of U.S. government corporations and agencies 389 — — 389 Total restricted deposits $ 651 $ 559 $ — $ 1,210 Total assets at fair value $ 12,341 $ 15,081 $ — $ 27,422 The following table summarizes fair value measurements by level at December 31, 2021, for assets and liabilities measured at fair value on a recurring basis ($ in millions): Level I Level II Level III Total Assets Cash and cash equivalents $ 13,118 $ — $ — $ 13,118 Investments: U.S. Treasury securities and obligations of U.S. government corporations and agencies $ 171 $ — $ — $ 171 Corporate securities — 8,170 — 8,170 Municipal securities — 2,999 — 2,999 Short-term time deposits — 109 — 109 Asset backed securities — 1,308 — 1,308 Residential mortgage backed securities — 853 — 853 Commercial mortgage backed securities — 873 — 873 Equity securities 324 2 — 326 Total investments $ 495 $ 14,314 $ — $ 14,809 Restricted deposits: Cash and cash equivalents $ 96 $ — $ — $ 96 Certificates of deposit — 4 — 4 Corporate securities — 30 — 30 Municipal securities — 469 — 469 U.S. Treasury securities and obligations of U.S. government corporations and agencies 469 — — 469 Total restricted deposits $ 565 $ 503 $ — $ 1,068 Other long-term assets: Interest rate swap agreements $ — $ 15 $ — $ 15 Total assets at fair value $ 14,178 $ 14,832 $ — $ 29,010 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 $822 million and $773 million as of March 31, 2022 and December 31, 2021, respectively.

Medical Claims Liability

Medical Claims Liability	3 Months Ended
	Mar. 31, 2022
Insurance [Abstract]
Medical Claims Liability	Medical Claims Liability The following table summarizes the change in medical claims liability ($ in millions): Three Months Ended March 31, 2022 2021 Balance, January 1 $ 14,243 $ 12,438 Less: Reinsurance recoverable 23 23 Balance, January 1, net 14,220 12,415 Acquisitions and divestitures 249 — Incurred related to: Current year 28,561 24,255 Prior years (723) (864) Total incurred 27,838 23,391 Paid related to: Current year 17,398 15,161 Prior years 8,662 7,828 Total paid 26,060 22,989 Balance at March 31, net 16,247 12,817 Plus: Reinsurance recoverable 12 25 Balance, March 31 $ 16,259 $ 12,842 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. The impact from COVID-19 on healthcare utilization and medical claims submission patterns continues to provide increased estimation uncertainty on the incurred but not reported liability. Additionally, as a result of minimum health benefits ratio (HBR) and other return of premium programs, the Company recorded $67 million and $202 million as a reduction to premium revenue in the three months ended March 31, 2022 and 2021, respectively. Incurred but not reported (IBNR) plus expected development on reported claims as of March 31, 2022 was $10,480 million. Total IBNR plus expected development on reported claims represents estimates for claims incurred but not reported, development on reported claims, and estimates for the costs necessary to process unpaid claims at the end of each period. The Company estimates its liability using actuarial methods that are commonly used by health insurance actuaries and meet Actuarial Standards of Practice. These actuarial methods consider factors such as historical data for payment patterns, cost trends, product mix, seasonality, utilization of healthcare services and other relevant factors.

Affordable Care Act

Affordable Care Act	3 Months Ended
	Mar. 31, 2022
Affordable Care Act [Abstract]
Affordable Care Act	Affordable Care Act The Affordable Care Act established risk spreading premium stabilization programs as well as a minimum annual medical loss ratio (MLR) and cost sharing reductions. The Company's net receivables (payables) for each of the programs are as follows ($ in millions): March 31, 2022 December 31, 2021 Risk adjustment receivable $ 643 $ 522 Risk adjustment payable (735) (536) Minimum medical loss ratio (186) (196) Cost sharing reduction receivable 27 69 Cost sharing reduction payable (58) (42)

Debt

Debt	3 Months Ended
	Mar. 31, 2022
Debt Disclosure [Abstract]
Debt	Debt Debt consists of the following ($ in millions): March 31, 2022 December 31, 2021 $2,500 million 4.25% Senior Notes due December 15, 2027 $ 2,485 $ 2,484 $2,300 million 2.45% Senior Notes due July 15, 2028 2,304 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 2,200 $1,300 million 2.625% Senior Notes due August 1, 2031 1,300 1,300 Total senior notes 15,989 15,988 Term loan facility 2,196 2,195 Revolving credit agreement 213 149 Construction loan payable 182 184 Finance leases and other 518 493 Debt issuance costs (166) (171) Total debt 18,932 18,838 Less current portion (292) (267) Long-term debt $ 18,640 $ 18,571 Of the Company's total debt, approximately 15% is variable rate debt tied to London Interbank Offered Rate (LIBOR). The debt agreements that may be impacted by the discontinuation of LIBOR include provisions that the Company believes are sufficient for the Company to transition from the existing LIBOR rates to the prevailing successor market rates as necessary. Senior Notes In connection with the Magellan Acquisition in January 2022, the Company redeemed Magellan’s existing outstanding 4.4% Senior Notes due 2024 and paid off the existing Credit Agreement using Magellan’s cash on hand. The Company recognized an immaterial net pre-tax gain on extinguishment including related fees and expenses and the write-off of the unamortized premium. Foreign Currency Swap In order to manage the foreign exchange risk associated with an intercompany note receivable related to the Circle Health acquisition, the Company entered into a foreign currency swap agreement for a notional amount of $705 million, to purchase £509 million. The swap agreement was formally designated and qualified as a fair value hedge. All 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, resulting in no net impact to the Consolidated Statement of Operations. On March 31, 2022, the interest rate swap settled in connection with its expiration, and the Company received cash proceeds of $35 million. The Company does not hold or issue any derivative instruments for trading or speculative purposes. 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. As of March 31, 2022, the Company had $182 million in borrowings outstanding under the loan, which is included in the current portion of long-term debt. In April 2022, the Company extended the term of the loan for an additional one year. The extension reduced interest on the loan to SOFR plus 1.85% and matures in April 2023.

Leases

Leases	3 Months Ended
	Mar. 31, 2022
Leases [Abstract]
Leases	Leases The following table sets forth the ROU assets and lease liabilities ($ in millions): March 31, 2022 December 31, 2021 Assets ROU assets (recorded within other long-term assets) $ 3,490 $ 3,566 Liabilities Short-term (recorded within accounts payable and accrued expenses) $ 210 $ 204 Long-term (recorded within other long-term liabilities) 3,527 3,619 Total lease liabilities $ 3,737 $ 3,823 As of March 31, 2022, the weighted average remaining lease term for the Company was 20.7 years. The lease liabilities as of March 31, 2022 reflect a weighted average discount rate of 5.7%.

Earnings Per Share

Earnings Per Share	3 Months Ended
	Mar. 31, 2022
Earnings Per Share [Abstract]
Earnings Per Share	Earnings Per Share The following table sets forth the calculation of basic and diluted net earnings per common share ($ in millions, except per share data in dollars and shares in thousands): Three Months Ended March 31, 2022 2021 Earnings attributable to Centene Corporation $ 849 $ 699 Shares used in computing per share amounts: Weighted average number of common shares outstanding 583,230 581,869 Common stock equivalents (as determined by applying the treasury stock method) 7,428 7,474 Weighted average number of common shares and potential dilutive common shares outstanding 590,658 589,343 Net earnings per common share attributable to Centene Corporation: Basic earnings per common share $ 1.46 $ 1.20 Diluted earnings per common share $ 1.44 $ 1.19 The calculation of diluted earnings per common share for the three months ended March 31, 2022 and 2021 excludes the impact of 923 thousand and 533 thousand shares, respectively, related to anti-dilutive stock options, restricted stock and restricted stock units.

Segment Information

Segment Information	3 Months Ended
	Mar. 31, 2022
Segment Reporting [Abstract]
Segment Information	Segment Information Centene operates in two segments: Managed Care and Specialty Services. The Managed Care segment consists of Centene's health plans, including all of the functions needed to operate them. The Specialty Services segment consists of Centene's specialty companies offering auxiliary healthcare services and products. Factors used in determining the reportable business segments include the nature of operating activities, the existence of separate senior management teams, and the type of information presented to the Company's chief operating decision-maker to evaluate all results of operations. Segment information for the three months ended March 31, 2022, is as follows ($ in millions): Managed Specialty Eliminations Consolidated Total revenues from external customers $ 34,519 $ 2,666 $ — $ 37,185 Total revenues from internal customers 2 3,449 (3,451) — Total revenues $ 34,521 $ 6,115 $ (3,451) $ 37,185 Earnings from operations $ 1,237 $ 16 $ — $ 1,253 Segment information for the three months ended March 31, 2021, is as follows ($ in millions): Managed Specialty Eliminations Consolidated Total revenues from external customers $ 28,602 $ 1,381 $ — $ 29,983 Total revenues from internal customers 1 2,886 (2,887) — Total revenues $ 28,603 $ 4,267 $ (2,887) $ 29,983 Earnings from operations $ 956 $ 98 $ — $ 1,054

Contingencies

Contingencies	3 Months Ended
	Mar. 31, 2022
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 Centers for Medicare and Medicaid Services (CMS) for risk adjustment payments or the False Claims Act, the calculation of minimum medical loss ratios and rebates related thereto, 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 is seeking indemnification from Accellion for these claims. In December 2021, the plaintiffs in three of the pending actions filed a motion for preliminary approval of a settlement with the Company and its subsidiaries, which, if approved by the court, should resolve most or all of the pending litigation. 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. Pharmacy Benefits Management Matters 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. The Company has reached no-fault agreements with the Attorney Generals in nine states, including Ohio, to resolve claims and/or allegations made by the states related to services provided by Envolve. As a result of the settlement, the Ohio Attorney General’s litigation against the Company was dismissed. Additionally, the Company is in discussions 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 and rebates that the Company determined in the course of the matter are payable across products. Additional claims, reviews or investigations relating to the Company's PBM business across products 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)	3 Months Ended
	Mar. 31, 2022
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, 2021. 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, 2021 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 2021 amounts in the consolidated financial statements and notes to the consolidated financial statements have been reclassified to conform to the 2022 presentation. Beginning in 2022, the Company has included a separate line item for depreciation expense on the Consolidated Statement of Operations, which was previously included in selling, general and administrative (SG&A) expenses. Prior period SG&A expense ratios have also been conformed to the current presentation. These reclassifications have no effect on net earnings or stockholders’ equity as previously reported. On January 4, 2022, the Company acquired all of the issued and outstanding shares of Magellan Health, Inc. (Magellan) (the Magellan Acquisition). The acquisition was accounted for as a business combination. See Note 2. Acquisitions
Recently Accounting Guidance Not Yet Adopted	Accounting Guidance Not Yet Adopted The Company has determined that there are no recently issued accounting pronouncements that will have a material impact on its consolidated financial position, results of operations, or cash flows.

Acquisitions (Tables)

Acquisitions (Tables)	3 Months Ended
	Mar. 31, 2022
Business Combinations [Abstract]
Schedule of Allocation of the Fair Value of Assets Acquired and Liabilities Assumed	The Company's preliminary allocation of the fair value of assets acquired and liabilities assumed as of the acquisition date of January 4, 2022 is as follows ($ in millions): Assets acquired and liabilities assumed Cash and cash equivalents $ 997 Premium and related receivables 855 Short-term investments 144 Other current assets 225 Long-term investments 43 Restricted deposits 7 Property, software and equipment 91 Intangible assets (a) 600 Other long-term assets 50 Total assets acquired 3,012 Medical claims liability 249 Accounts payable and accrued expenses 476 Return of premium payable 75 Unearned revenue 8 Current portion of long-term debt 5 Long-term debt (b) 542 Deferred tax liabilities (c) 81 Other long-term liabilities 82 Total liabilities assumed 1,518 Mezzanine equity 32 Total identifiable net assets 1,462 Goodwill (d) 1,099 Total assets acquired and liabilities assumed $ 2,561

Short-term and Long-term Inve_2

Short-term and Long-term Investments, Restricted Deposits (Tables)	3 Months Ended
	Mar. 31, 2022
Investments, Debt and Equity Securities [Abstract]
Short-term and long-term investments and restricted deposits by investment type	Short-term and long-term investments and restricted deposits by investment type consist of the following ($ in millions): March 31, 2022 December 31, 2021 Amortized Gross Gross Fair Amortized Gross Gross Fair Debt securities: U.S. Treasury securities and obligations of U.S. government corporations and agencies $ 552 $ — $ (9) $ 543 $ 642 $ — $ (2) $ 640 Corporate securities 8,752 26 (368) 8,410 8,145 130 (75) 8,200 Restricted certificates of deposit 4 — — 4 4 — — 4 Restricted cash equivalents 262 — — 262 96 — — 96 Short-term time deposits 130 — — 130 109 — — 109 Municipal securities 3,607 13 (136) 3,484 3,398 85 (15) 3,468 Asset-backed securities 1,308 — (29) 1,279 1,308 5 (5) 1,308 Residential mortgage-backed securities 919 1 (45) 875 850 10 (7) 853 Commercial mortgage-backed securities 939 1 (43) 897 870 13 (10) 873 Equity securities (1) 301 — — 301 326 — — 326 Private equity investments 626 — — 626 587 — — 587 Life insurance contracts 196 — — 196 186 — — 186 Total $ 17,596 $ 41 $ (630) $ 17,007 $ 16,521 $ 243 $ (114) $ 16,650 (1) Investments in equity securities primarily consist of exchange traded funds in fixed income securities.
Fair value of available-for-sale investments with gross unrealized losses by investment type and length of time	The fair value of available-for-sale debt securities with gross unrealized losses by investment type and length of time that individual securities have been in a continuous unrealized loss position were as follows ($ in millions): March 31, 2022 December 31, 2021 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 U.S. Treasury securities and obligations of U.S. government corporations and agencies $ (7) $ 495 $ (2) $ 33 $ (2) $ 598 $ — $ 3 Corporate securities (271) 5,653 (97) 1,024 (66) 4,209 (9) 209 Municipal securities (125) 2,336 (11) 121 (14) 1,173 (1) 39 Asset-backed securities (28) 1,097 (1) 65 (5) 770 — 33 Residential mortgage-backed securities (29) 629 (16) 172 (7) 472 — 15 Commercial mortgage-backed securities (27) 680 (16) 139 (8) 380 (2) 32 Total $ (487) $ 10,890 $ (143) $ 1,554 $ (102) $ 7,602 $ (12) $ 331
Contractual maturities of short-term and long-term investments and restricted deposits	The contractual maturities of short-term and long-term debt securities and restricted deposits are as follows ($ in millions): March 31, 2022 December 31, 2021 Investments Restricted Deposits Investments Restricted Deposits Amortized Fair Amortized Fair Amortized Fair Amortized Fair One year or less $ 1,543 $ 1,540 $ 611 $ 609 $ 1,390 $ 1,396 $ 368 $ 368 One year through five years 6,519 6,327 400 382 6,212 6,294 460 457 Five years through ten years 3,903 3,665 238 219 3,647 3,681 244 243 Greater than ten years 93 91 — — 73 78 — — Asset-backed securities 3,166 3,051 — — 3,028 3,034 — — Total $ 15,224 $ 14,674 $ 1,249 $ 1,210 $ 14,350 $ 14,483 $ 1,072 $ 1,068

Fair Value Measurements (Tables

Fair Value Measurements (Tables)	3 Months Ended
	Mar. 31, 2022
Fair Value Disclosures [Abstract]
Assets and Liabilities, Based Upon Observable or Unobservable Inputs, Level Input Definitions	Assets and liabilities recorded at fair value in the Consolidated Balance Sheets are categorized based upon observable or unobservable inputs used to estimate fair value. Level inputs are as follows: Level Input: Input Definition: Level I Inputs are unadjusted, quoted prices for identical assets or liabilities in active markets at the measurement date. Level II Inputs other than quoted prices included in Level I that are observable for the asset or liability through corroboration with market data at the measurement date. Level III Unobservable inputs that reflect management's best estimate of what market participants would use in pricing the asset or liability at the measurement date.
Fair Value Measurements by Level for Assets and Liabilities Measured at Fair Value on a Recurring Basis	The following table summarizes fair value measurements by level at March 31, 2022, 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 $ 11,237 $ — $ — $ 11,237 Investments: U.S. Treasury securities and obligations of U.S. government corporations and agencies $ 154 $ — $ — $ 154 Corporate securities — 8,380 — 8,380 Municipal securities — 2,959 — 2,959 Short-term time deposits — 130 — 130 Asset-backed securities — 1,279 — 1,279 Residential mortgage-backed securities — 875 — 875 Commercial mortgage-backed securities — 897 — 897 Equity securities 299 2 — 301 Total investments $ 453 $ 14,522 $ — $ 14,975 Restricted deposits: Cash and cash equivalents $ 262 $ — $ — $ 262 Certificates of deposit — 4 — 4 Corporate securities — 30 — 30 Municipal securities — 525 — 525 U.S. Treasury securities and obligations of U.S. government corporations and agencies 389 — — 389 Total restricted deposits $ 651 $ 559 $ — $ 1,210 Total assets at fair value $ 12,341 $ 15,081 $ — $ 27,422 The following table summarizes fair value measurements by level at December 31, 2021, for assets and liabilities measured at fair value on a recurring basis ($ in millions): Level I Level II Level III Total Assets Cash and cash equivalents $ 13,118 $ — $ — $ 13,118 Investments: U.S. Treasury securities and obligations of U.S. government corporations and agencies $ 171 $ — $ — $ 171 Corporate securities — 8,170 — 8,170 Municipal securities — 2,999 — 2,999 Short-term time deposits — 109 — 109 Asset backed securities — 1,308 — 1,308 Residential mortgage backed securities — 853 — 853 Commercial mortgage backed securities — 873 — 873 Equity securities 324 2 — 326 Total investments $ 495 $ 14,314 $ — $ 14,809 Restricted deposits: Cash and cash equivalents $ 96 $ — $ — $ 96 Certificates of deposit — 4 — 4 Corporate securities — 30 — 30 Municipal securities — 469 — 469 U.S. Treasury securities and obligations of U.S. government corporations and agencies 469 — — 469 Total restricted deposits $ 565 $ 503 $ — $ 1,068 Other long-term assets: Interest rate swap agreements $ — $ 15 $ — $ 15 Total assets at fair value $ 14,178 $ 14,832 $ — $ 29,010

Medical Claims Liability (Table

Medical Claims Liability (Tables)	3 Months Ended
	Mar. 31, 2022
Insurance [Abstract]
Schedule of change in medical claims liability	The following table summarizes the change in medical claims liability ($ in millions): Three Months Ended March 31, 2022 2021 Balance, January 1 $ 14,243 $ 12,438 Less: Reinsurance recoverable 23 23 Balance, January 1, net 14,220 12,415 Acquisitions and divestitures 249 — Incurred related to: Current year 28,561 24,255 Prior years (723) (864) Total incurred 27,838 23,391 Paid related to: Current year 17,398 15,161 Prior years 8,662 7,828 Total paid 26,060 22,989 Balance at March 31, net 16,247 12,817 Plus: Reinsurance recoverable 12 25 Balance, March 31 $ 16,259 $ 12,842

Affordable Care Act (Tables)

Affordable Care Act (Tables)	3 Months Ended
	Mar. 31, 2022
Affordable Care Act [Abstract]
Schedule of net receivables (payables) related to the Affordable Care Act Programs	The Company's net receivables (payables) for each of the programs are as follows ($ in millions): March 31, 2022 December 31, 2021 Risk adjustment receivable $ 643 $ 522 Risk adjustment payable (735) (536) Minimum medical loss ratio (186) (196) Cost sharing reduction receivable 27 69 Cost sharing reduction payable (58) (42)

Debt (Tables)

Debt (Tables)	3 Months Ended
	Mar. 31, 2022
Debt Disclosure [Abstract]
Schedule of Debt	Debt consists of the following ($ in millions): March 31, 2022 December 31, 2021 $2,500 million 4.25% Senior Notes due December 15, 2027 $ 2,485 $ 2,484 $2,300 million 2.45% Senior Notes due July 15, 2028 2,304 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 2,200 $1,300 million 2.625% Senior Notes due August 1, 2031 1,300 1,300 Total senior notes 15,989 15,988 Term loan facility 2,196 2,195 Revolving credit agreement 213 149 Construction loan payable 182 184 Finance leases and other 518 493 Debt issuance costs (166) (171) Total debt 18,932 18,838 Less current portion (292) (267) Long-term debt $ 18,640 $ 18,571

Leases (Tables)

Leases (Tables)	3 Months Ended
	Mar. 31, 2022
Leases [Abstract]
ROU Assets and Liabilities	The following table sets forth the ROU assets and lease liabilities ($ in millions): March 31, 2022 December 31, 2021 Assets ROU assets (recorded within other long-term assets) $ 3,490 $ 3,566 Liabilities Short-term (recorded within accounts payable and accrued expenses) $ 210 $ 204 Long-term (recorded within other long-term liabilities) 3,527 3,619 Total lease liabilities $ 3,737 $ 3,823

Earnings Per Share (Tables)

Earnings Per Share (Tables)	3 Months Ended
	Mar. 31, 2022
Earnings Per Share [Abstract]
Calculation of Basic and Diluted Net Earnings Per Common Share	The following table sets forth the calculation of basic and diluted net earnings per common share ($ in millions, except per share data in dollars and shares in thousands): Three Months Ended March 31, 2022 2021 Earnings attributable to Centene Corporation $ 849 $ 699 Shares used in computing per share amounts: Weighted average number of common shares outstanding 583,230 581,869 Common stock equivalents (as determined by applying the treasury stock method) 7,428 7,474 Weighted average number of common shares and potential dilutive common shares outstanding 590,658 589,343 Net earnings per common share attributable to Centene Corporation: Basic earnings per common share $ 1.46 $ 1.20 Diluted earnings per common share $ 1.44 $ 1.19

Segment Information (Tables)

Segment Information (Tables)	3 Months Ended
	Mar. 31, 2022
Segment Reporting [Abstract]
Segment Information	Segment information for the three months ended March 31, 2022, is as follows ($ in millions): Managed Specialty Eliminations Consolidated Total revenues from external customers $ 34,519 $ 2,666 $ — $ 37,185 Total revenues from internal customers 2 3,449 (3,451) — Total revenues $ 34,521 $ 6,115 $ (3,451) $ 37,185 Earnings from operations $ 1,237 $ 16 $ — $ 1,253 Segment information for the three months ended March 31, 2021, is as follows ($ in millions): Managed Specialty Eliminations Consolidated Total revenues from external customers $ 28,602 $ 1,381 $ — $ 29,983 Total revenues from internal customers 1 2,886 (2,887) — Total revenues $ 28,603 $ 4,267 $ (2,887) $ 29,983 Earnings from operations $ 956 $ 98 $ — $ 1,054

Acquisitions - Narrative (Detai

Acquisitions - Narrative (Details) - Magellan Acquisition - USD ($) $ in Millions	Jan. 04, 2022	Mar. 31, 2022
Business Acquisition [Line Items]
Consideration transferred	$ 2,561
Cash paid	2,501
Consideration transferred related to fair value of replacement equity awards associated with pre-combination service	$ 60
Acquisition related expenses		$ 97

Acquisitions - Schedule of Fair

Acquisitions - Schedule of Fair Value of Assets Acquired and Liabilities Assumed (Details) - USD ($) $ in Millions	Mar. 31, 2022	Jan. 04, 2022	Dec. 31, 2021
Assets acquired and liabilities assumed
Goodwill	$ 20,903		$ 19,771
Goodwill	$ 20,903		$ 19,771
Magellan Acquisition
Assets acquired and liabilities assumed
Cash and cash equivalents		$ 997
Premium and related receivables		855
Short-term investments		144
Other current assets		225
Long-term investments		43
Restricted deposits		7
Property, software and equipment		91
Intangible assets		600
Other long-term assets		50
Total assets acquired		3,012
Medical claims liability		249
Accounts payable and accrued expenses		476
Return of premium payable		75
Unearned revenue		8
Current portion of long-term debt		5
Long-term debt		542
Deferred tax liabilities		81
Other long-term liabilities		82
Total liabilities assumed		1,518
Mezzanine equity		32
Total identifiable net assets		1,462
Goodwill		1,099
Total assets acquired and liabilities assumed		2,561
Debt assumed, aggregate principal		535
Deferred tax assets		117
Goodwill		$ 1,099

Short-term and Long-term Inve_3

Short-term and Long-term Investments, Restricted Deposits - By Investment Type (Details) - USD ($) $ in Millions	Mar. 31, 2022	Dec. 31, 2021
Debt Securities
Gross Unrealized Gains	$ 41	$ 243
Gross Unrealized Losses	(630)	(114)
Equity securities	301	326
Private equity investments	626	587
Life insurance contracts	196	186
Total, Amortized Cost	17,596	16,521
Total, Fair Value	17,007	16,650
U.S. Treasury securities and obligations of U.S. government corporations and agencies
Debt Securities
Amortized Cost	552	642
Gross Unrealized Gains	0	0
Gross Unrealized Losses	(9)	(2)
Fair Value	543	640
Corporate securities
Debt Securities
Amortized Cost	8,752	8,145
Gross Unrealized Gains	26	130
Gross Unrealized Losses	(368)	(75)
Fair Value	8,410	8,200
Restricted certificates of deposit
Debt Securities
Amortized Cost	4	4
Gross Unrealized Gains	0	0
Gross Unrealized Losses	0	0
Fair Value	4	4
Restricted cash equivalents
Debt Securities
Amortized Cost	262	96
Gross Unrealized Gains	0	0
Gross Unrealized Losses	0	0
Fair Value	262	96
Short-term time deposits
Debt Securities
Amortized Cost	130	109
Gross Unrealized Gains	0	0
Gross Unrealized Losses	0	0
Fair Value	130	109
Municipal securities
Debt Securities
Amortized Cost	3,607	3,398
Gross Unrealized Gains	13	85
Gross Unrealized Losses	(136)	(15)
Fair Value	3,484	3,468
Asset-backed securities
Debt Securities
Amortized Cost	1,308	1,308
Gross Unrealized Gains	0	5
Gross Unrealized Losses	(29)	(5)
Fair Value	1,279	1,308
Residential mortgage-backed securities
Debt Securities
Amortized Cost	919	850
Gross Unrealized Gains	1	10
Gross Unrealized Losses	(45)	(7)
Fair Value	875	853
Commercial mortgage-backed securities
Debt Securities
Amortized Cost	939	870
Gross Unrealized Gains	1	13
Gross Unrealized Losses	(43)	(10)
Fair Value	$ 897	$ 873

Short-term and Long-term Inve_4

Short-term and Long-term Investments, Restricted Deposits - Narrative (Details) $ in Millions	3 Months Ended
	Mar. 31, 2022USD ($)position	Dec. 31, 2021USD ($)
Schedule Of Investments And Restricted Deposits By Type [Line Items]
Accrued interest income | $	$ 101	$ 96
Positions from which gross unrealized losses were generated	5,048
Total unrealized investment positions	6,748
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	Mar. 31, 2022	Dec. 31, 2021
Unrealized Losses
Less Than 12 Months	$ (487)	$ (102)
12 Months or More	(143)	(12)
Fair Value
Fair Value, Less Than 12 Months	10,890	7,602
Fair Value, 12 Months or More	1,554	331
U.S. Treasury securities and obligations of U.S. government corporations and agencies
Unrealized Losses
Less Than 12 Months	(7)	(2)
12 Months or More	(2)	0
Fair Value
Fair Value, Less Than 12 Months	495	598
Fair Value, 12 Months or More	33	3
Corporate securities
Unrealized Losses
Less Than 12 Months	(271)	(66)
12 Months or More	(97)	(9)
Fair Value
Fair Value, Less Than 12 Months	5,653	4,209
Fair Value, 12 Months or More	1,024	209
Municipal securities
Unrealized Losses
Less Than 12 Months	(125)	(14)
12 Months or More	(11)	(1)
Fair Value
Fair Value, Less Than 12 Months	2,336	1,173
Fair Value, 12 Months or More	121	39
Asset-backed securities
Unrealized Losses
Less Than 12 Months	(28)	(5)
12 Months or More	(1)	0
Fair Value
Fair Value, Less Than 12 Months	1,097	770
Fair Value, 12 Months or More	65	33
Residential mortgage-backed securities
Unrealized Losses
Less Than 12 Months	(29)	(7)
12 Months or More	(16)	0
Fair Value
Fair Value, Less Than 12 Months	629	472
Fair Value, 12 Months or More	172	15
Commercial mortgage-backed securities
Unrealized Losses
Less Than 12 Months	(27)	(8)
12 Months or More	(16)	(2)
Fair Value
Fair Value, Less Than 12 Months	680	380
Fair Value, 12 Months or More	$ 139	$ 32

Short-term and Long-term Inve_6

Short-term and Long-term Investments, Restricted Deposits - Contractual Maturities of Short-Term and Long-Term Investments and Restricted Deposits (Details) - USD ($) $ in Millions	Mar. 31, 2022	Dec. 31, 2021
Investments
Amortized Cost
One year or less	$ 1,543	$ 1,390
One year through five years	6,519	6,212
Five years through ten years	3,903	3,647
Greater than ten years	93	73
Asset-backed securities	3,166	3,028
Amortized Cost	15,224	14,350
Fair Value
One year or less	1,540	1,396
One year through five years	6,327	6,294
Five years through ten years	3,665	3,681
Greater than ten years	91	78
Asset-backed securities	3,051	3,034
Fair Value	14,674	14,483
Restricted Deposits
Amortized Cost
One year or less	611	368
One year through five years	400	460
Five years through ten years	238	244
Greater than ten years	0	0
Asset-backed securities	0	0
Amortized Cost	1,249	1,072
Fair Value
One year or less	609	368
One year through five years	382	457
Five years through ten years	219	243
Greater than ten years	0	0
Asset-backed securities	0	0
Fair Value	$ 1,210	$ 1,068

Fair Value Measurements - Fair

Fair Value Measurements - Fair Value Measurements by Level for Assets and Liabilities Measured at Fair Value on a Recurring Basis (Details) - USD ($) $ in Millions	Mar. 31, 2022	Dec. 31, 2021
Assets
Cash and cash equivalents	$ 11,237	$ 13,118
Investments:
Equity securities	301	326
Total assets at fair value	27,422	29,010
U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Assets measured at fair value	543	640
Corporate securities
Investments:
Assets measured at fair value	8,410	8,200
Municipal securities
Investments:
Assets measured at fair value	3,484	3,468
Short-term time deposits
Investments:
Assets measured at fair value	130	109
Asset-backed securities
Investments:
Assets measured at fair value	1,279	1,308
Residential mortgage-backed securities
Investments:
Assets measured at fair value	875	853
Commercial mortgage-backed securities
Investments:
Assets measured at fair value	897	873
Investments available-for-sale
Investments:
Assets measured at fair value	14,975	14,809
Investments available-for-sale | U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Assets measured at fair value	154	171
Investments available-for-sale | Corporate securities
Investments:
Assets measured at fair value	8,380	8,170
Investments available-for-sale | Municipal securities
Investments:
Assets measured at fair value	2,959	2,999
Investments available-for-sale | Short-term time deposits
Investments:
Assets measured at fair value	130	109
Investments available-for-sale | Asset-backed securities
Investments:
Assets measured at fair value	1,279	1,308
Investments available-for-sale | Residential mortgage-backed securities
Investments:
Assets measured at fair value	875	853
Investments available-for-sale | Commercial mortgage-backed securities
Investments:
Assets measured at fair value	897	873
Restricted deposits
Investments:
Assets measured at fair value	1,210	1,068
Restricted deposits | U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Assets measured at fair value	389	469
Restricted deposits | Corporate securities
Investments:
Assets measured at fair value	30	30
Restricted deposits | Municipal securities
Investments:
Assets measured at fair value	525	469
Restricted deposits | Cash and cash equivalents
Investments:
Assets measured at fair value	262	96
Restricted deposits | Certificates of deposit
Investments:
Assets measured at fair value	4	4
Other long-term assets: | Interest rate swap agreements
Investments:
Derivative asset		15
Level I
Assets
Cash and cash equivalents	11,237	13,118
Investments:
Equity securities	299	324
Total assets at fair value	12,341	14,178
Level I | Investments available-for-sale
Investments:
Assets measured at fair value	453	495
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	154	171
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	565
Level I | Restricted deposits | U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Assets measured at fair value	389	469
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	262	96
Level I | Restricted deposits | Certificates of deposit
Investments:
Assets measured at fair value	0	0
Level I | Other long-term assets: | Interest rate swap agreements
Investments:
Derivative asset		0
Level II
Assets
Cash and cash equivalents	0	0
Investments:
Equity securities	2	2
Total assets at fair value	15,081	14,832
Level II | Investments available-for-sale
Investments:
Assets measured at fair value	14,522	14,314
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	8,380	8,170
Level II | Investments available-for-sale | Municipal securities
Investments:
Assets measured at fair value	2,959	2,999
Level II | Investments available-for-sale | Short-term time deposits
Investments:
Assets measured at fair value	130	109
Level II | Investments available-for-sale | Asset-backed securities
Investments:
Assets measured at fair value	1,279	1,308
Level II | Investments available-for-sale | Residential mortgage-backed securities
Investments:
Assets measured at fair value	875	853
Level II | Investments available-for-sale | Commercial mortgage-backed securities
Investments:
Assets measured at fair value	897	873
Level II | Restricted deposits
Investments:
Assets measured at fair value	559	503
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	30	30
Level II | Restricted deposits | Municipal securities
Investments:
Assets measured at fair value	525	469
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	4
Level II | Other long-term assets: | Interest rate swap agreements
Investments:
Derivative asset		15
Level III
Assets
Cash and cash equivalents	0	0
Investments:
Equity securities	0	0
Total assets at fair value	0	0
Level III | Investments available-for-sale
Investments:
Assets measured at fair value	0	0
Level III | Investments available-for-sale | U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Assets measured at fair value	0	0
Level III | Investments available-for-sale | Corporate securities
Investments:
Assets measured at fair value	0	0
Level III | Investments available-for-sale | Municipal securities
Investments:
Assets measured at fair value	0	0
Level III | Investments available-for-sale | Short-term time deposits
Investments:
Assets measured at fair value	0	0
Level III | Investments available-for-sale | Asset-backed securities
Investments:
Assets measured at fair value	0	0
Level III | Investments available-for-sale | Residential mortgage-backed securities
Investments:
Assets measured at fair value	0	0
Level III | Investments available-for-sale | Commercial mortgage-backed securities
Investments:
Assets measured at fair value	0	0
Level III | Restricted deposits
Investments:
Assets measured at fair value	0	0
Level III | Restricted deposits | U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Assets measured at fair value	0	0
Level III | Restricted deposits | Corporate securities
Investments:
Assets measured at fair value	0	0
Level III | Restricted deposits | Municipal securities
Investments:
Assets measured at fair value	0	0
Level III | Restricted deposits | Cash and cash equivalents
Investments:
Assets measured at fair value	0	0
Level III | Restricted deposits | Certificates of deposit
Investments:
Assets measured at fair value	$ 0	0
Level III | Other long-term assets: | Interest rate swap agreements
Investments:
Derivative asset		$ 0

Fair Value Measurements - Narra

Fair Value Measurements - Narrative (Details) - USD ($) $ in Millions	Mar. 31, 2022	Dec. 31, 2021
Fair Value Disclosures [Abstract]
Aggregate carrying amount of life insurance contracts and equity investments, fair value	$ 822	$ 773

Medical Claims Liability - Sche

Medical Claims Liability - Schedule of Change in Medical Claims Liability (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Liability for Unpaid Claims and Claims Adjustment Expense [Roll Forward]
Balance, January 1	$ 14,243	$ 12,438
Less: Reinsurance recoverable	23	23
Balance, January 1, net	14,220	12,415
Acquisitions and divestitures	249	0
Incurred related to:
Current year	28,561	24,255
Prior years	(723)	(864)
Total incurred	27,838	23,391
Paid related to:
Current year	17,398	15,161
Prior years	8,662	7,828
Total paid	26,060	22,989
Balance at March 31, net	16,247	12,817
Plus: Reinsurance recoverable	12	25
Balance, March 31	$ 16,259	$ 12,842

Medical Claims Liability - Narr

Medical Claims Liability - Narrative (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Insurance [Abstract]
Amounts recorded as an adjustment to premium revenues related to minimum HBR and return of premium programs	$ 67	$ 202
Short-duration insurance contracts, Incurred but not reported and expected development on reported claims	$ 10,480

Affordable Care Act - Net Recei

Affordable Care Act - Net Receivables (Payables) for Each of the Ongoing Programs (Details) - USD ($) $ in Millions	Mar. 31, 2022	Dec. 31, 2021
Affordable Care Act [Abstract]
Risk adjustment receivable	$ 643	$ 522
Risk adjustment payable	(735)	(536)
Minimum medical loss ratio	(186)	(196)
Cost sharing reduction receivable	27	69
Cost sharing reduction payable	$ (58)	$ (42)

Debt - Schedule of Debt (Detail

Debt - Schedule of Debt (Details) - USD ($)	Mar. 31, 2022	Dec. 31, 2021
Debt Instrument [Line Items]
Total senior notes	$ 15,989,000,000	$ 15,988,000,000
Construction loan payable	182,000,000	184,000,000
Finance leases and other	518,000,000	493,000,000
Debt issuance costs	(166,000,000)	(171,000,000)
Total debt	18,932,000,000	18,838,000,000
Less current portion	(292,000,000)	(267,000,000)
Long-term debt	18,640,000,000	18,571,000,000
Revolving credit agreement
Debt Instrument [Line Items]
Credit facility	213,000,000	149,000,000
Term loan facility
Debt Instrument [Line Items]
Credit facility	2,196,000,000	2,195,000,000
$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	$ 2,485,000,000	2,484,000,000
$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	2,304,000,000
$3,500 million 4.625% Senior Notes due December 15, 2029 | Senior Notes
Debt Instrument [Line Items]
Debt, face amount	$ 3,500,000,000
Interest rate	4.625%
Senior notes	$ 3,500,000,000	3,500,000,000
$2,000 million 3.375% Senior Notes due February 15, 2030 | Senior Notes
Debt Instrument [Line Items]
Debt, face amount	$ 2,000,000,000
Interest rate	3.375%
Senior notes	$ 2,000,000,000	2,000,000,000
$2,200 million 3.00% Senior Notes due October 15, 2030 | Senior Notes
Debt Instrument [Line Items]
Debt, face amount	$ 2,200,000,000
Interest rate	3.00%
Senior notes	$ 2,200,000,000	2,200,000,000
$2,200 million 2.50% Senior Notes due March 1, 2031 | Senior Notes
Debt Instrument [Line Items]
Debt, face amount	$ 2,200,000,000
Interest rate	2.50%
Senior notes	$ 2,200,000,000	2,200,000,000
$1,300 million 2.625% Senior Notes due August 1, 2031 | Senior Notes
Debt Instrument [Line Items]
Debt, face amount	$ 1,300,000,000
Interest rate	2.625%
Senior notes	$ 1,300,000,000	$ 1,300,000,000

Debt - Narrative (Details)

Debt - Narrative (Details) £ in Millions	Mar. 31, 2022USD ($)	Apr. 26, 2022	Jul. 31, 2021GBP (£)	Oct. 31, 2017USD ($)	Mar. 31, 2022USD ($)	Jan. 04, 2022	Dec. 31, 2021USD ($)	Jul. 31, 2021USD ($)
Debt Instrument [Line Items]
Payments for foreign currency hedge | £			£ 509
Construction loan payable	$ 182,000,000				$ 182,000,000		$ 184,000,000
Magellan Acquisition
Debt Instrument [Line Items]
Interest rate						4.40%
Construction Loan Payable
Debt Instrument [Line Items]
Debt, face amount				$ 200,000,000
Construction Loan Payable | Subsequent Event
Debt Instrument [Line Items]
Extension term		1 year
LIBOR | Construction Loan Payable | Maximum
Debt Instrument [Line Items]
Basis spread on variable rate				2.70%
LIBOR | Construction Loan Payable | Minimum
Debt Instrument [Line Items]
Basis spread on variable rate			2.00%
SOFR | Construction Loan Payable | Subsequent Event
Debt Instrument [Line Items]
Basis spread on variable rate		1.85%
Currency Swap
Debt Instrument [Line Items]
Derivative agreement								$ 705,000,000
Proceeds from termination of interest rate swaps	$ 35,000,000
Debt Total | Credit Availability Concentration Risk | LIBOR
Debt Instrument [Line Items]
Percentage of investments in rated securities carry an investment grade rating by nationally recognized statistical rating organizations					15.00%

Leases - Narrative (Details)

Leases - Narrative (Details)	Mar. 31, 2022
Lessee, Lease, Description [Line Items]
Weighted average remaining lease term	20 years 8 months 12 days
Weighted-average discount rate for operating leases	5.70%

Leases - ROU Assets and Liabili

Leases - ROU Assets and Liabilities (Details) - USD ($) $ in Millions	Mar. 31, 2022	Dec. 31, 2021
Assets
ROU assets (recorded within other long-term assets)	$ 3,490	$ 3,566
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)	$ 210	$ 204
Long-term (recorded within other long-term liabilities)	3,527	3,619
Total lease liabilities	$ 3,737	$ 3,823
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

Earnings Per Share (Details)

Earnings Per Share (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Millions	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Earnings attributable to Centene Corporation
Earnings attributable to Centene Corporation	$ 849	$ 699
Shares used in computing per share amounts:
Weighted average number of common shares outstanding (in shares)	583,230	581,869
Common stock equivalents (as determined by applying the treasury stock method) (in shares)	7,428	7,474
Weighted average number of common shares and potential dilutive common shares outstanding (in shares)	590,658	589,343
Net earnings per common share attributable to Centene Corporation:
Basic earnings per common share (in dollars per share)	$ 1.46	$ 1.20
Diluted earnings per common share (in dollars per share)	$ 1.44	$ 1.19
Anti-dilutive restricted stock and restricted stock units excluded from the calculation of diluted earnings (loss) per common share (in shares)	923	533

Segment Information (Details)

Segment Information (Details) $ in Millions	3 Months Ended
	Mar. 31, 2022USD ($)segment	Mar. 31, 2021USD ($)
Segment Reporting [Abstract]
Number of operating segments | segment	2
Segment Reporting Information [Line Items]
Total revenues	$ 37,185	$ 29,983
Earnings from operations	1,253	1,054
Eliminations
Segment Reporting Information [Line Items]
Total revenues	(3,451)	(2,887)
Managed  Care
Segment Reporting Information [Line Items]
Total revenues	34,521	28,603
Earnings from operations	1,237	956
Managed  Care | Operating Segments
Segment Reporting Information [Line Items]
Total revenues	34,519	28,602
Managed  Care | Eliminations
Segment Reporting Information [Line Items]
Total revenues	2	1
Specialty Services
Segment Reporting Information [Line Items]
Total revenues	6,115	4,267
Earnings from operations	16	98
Specialty Services | Operating Segments
Segment Reporting Information [Line Items]
Total revenues	2,666	1,381
Specialty Services | Eliminations
Segment Reporting Information [Line Items]
Total revenues	$ 3,449	$ 2,886

Contingencies (Details)

Contingencies (Details) $ in Millions	Mar. 31, 2022state	Dec. 31, 2021claim	Jun. 30, 2021USD ($)
Pending Litigation
Loss Contingencies [Line Items]
Pending claims | claim		3
Reserve estimate | $			$ 1,250
Settled Litigation
Loss Contingencies [Line Items]
Number of states where no fault agreements were reached with attorney generals | state	9