Centene (CNC) 10-Q 23 Oct 23 2023 Q3 Quarterly report Financial data

Cover

Cover - shares shares in Thousands	9 Months Ended
	Sep. 30, 2023	Oct. 20, 2023
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Sep. 30, 2023
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		534,201
Entity Central Index Key	0001071739
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2023
Document Fiscal Period Focus	Q3
Amendment Flag	false

CONSOLIDATED BALANCE SHEETS

CONSOLIDATED BALANCE SHEETS - USD ($) $ in Millions	Sep. 30, 2023	Dec. 31, 2022
Assets, Current [Abstract]
Cash and cash equivalents	$ 18,190	$ 12,074
Premium and trade receivables	15,503	13,272
Short-term investments	2,241	2,321
Other current assets	5,471	2,461
Total current assets	41,405	30,128
Long-term investments	15,234	14,684
Restricted deposits	1,343	1,217
Property, software and equipment, net	2,004	2,432
Goodwill	17,558	18,812
Intangible assets, net	6,277	6,911
Other long-term assets	560	2,686
Total assets	84,381	76,870
Liabilities, Current [Abstract]
Medical claims liability	17,141	16,745
Accounts payable and accrued expenses	15,081	9,525
Return of premium payable	2,160	1,634
Unearned revenue	2,356	478
Current portion of long-term debt	113	82
Total current liabilities	36,851	28,464
Long-term debt	17,888	17,938
Deferred tax liability	577	615
Other long-term liabilities	3,649	5,616
Total liabilities	58,965	52,633
Commitments and contingencies
Redeemable noncontrolling interests	21	56
Stockholders' equity:
Preferred stock, $0.001 par value; authorized 10,000 shares; no shares issued or outstanding at September 30, 2023 and December 31, 2022	0	0
Common stock, $0.001 par value; authorized 800,000 shares; 614,956 issued and 534,596 outstanding at September 30, 2023, and 607,847 issued and 550,754 outstanding at December 31, 2022	1	1
Additional paid-in capital	20,243	20,060
Accumulated other comprehensive (loss)	(1,122)	(1,132)
Retained earnings	11,998	9,341
Treasury stock, at cost (80,360 and 57,093 shares, respectively)	(5,825)	(4,213)
Total Centene stockholders' equity	25,295	24,057
Nonredeemable noncontrolling interest	100	124
Total stockholders' equity	25,395	24,181
Total liabilities, redeemable noncontrolling interests and stockholders' equity	$ 84,381	$ 76,870

CONSOLIDATED BALANCE SHEETS (Pa

CONSOLIDATED BALANCE SHEETS (Parenthetical) - $ / shares	Sep. 30, 2023	Dec. 31, 2022
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)	614,956,000	607,847,000
Common stock, shares outstanding (in shares)	534,596,000	550,754,000
Treasury stock (in shares)	80,360,000	57,093,000

CONSOLIDATED STATEMENTS OF OPER

CONSOLIDATED STATEMENTS OF OPERATIONS - USD ($) shares in Thousands, $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Revenues:
Premium and service revenues	$ 34,967	$ 33,726	$ 104,757	$ 101,926
Premium tax	3,075	2,139	9,782	7,060
Total revenues	38,042	35,865	114,539	108,986
Expenses:
Medical costs	29,479	28,111	88,260	83,261
Cost of services	856	1,571	2,603	5,658
Selling, general and administrative expenses	3,048	2,846	9,075	8,391
Depreciation expense	148	150	436	470
Amortization of acquired intangible assets	180	211	542	609
Premium tax expense	3,156	2,211	10,021	7,258
Impairment	440	289	478	1,739
Total operating expenses	37,307	35,389	111,415	107,386
Earnings from operations	735	476	3,124	1,600
Other income (expense):
Investment and other income	214	692	992	786
Debt extinguishment	0	10	0	26
Interest expense	(181)	(169)	(542)	(491)
Earnings before income tax	768	1,009	3,574	1,921
Income tax expense	293	269	914	500
Net earnings	475	740	2,660	1,421
(Earnings) attributable to noncontrolling interests	(6)	(2)	(3)	(6)
Net earnings attributable to Centene Corporation	$ 469	$ 738	$ 2,657	$ 1,415
Net earnings per common share attributable to Centene Corporation:
Basic earnings per common share (in dollars per share)	$ 0.87	$ 1.29	$ 4.86	$ 2.44
Diluted earnings per common share (in dollars per share)	$ 0.87	$ 1.27	$ 4.85	$ 2.41
Weighted average number of common shares outstanding:
Basic (in shares)	539,535	573,961	546,374	580,277
Diluted (in shares)	541,270	580,607	548,412	587,084
Premium
Revenues:
Premium and service revenues	$ 33,866	$ 31,848	$ 101,404	$ 95,247
Service
Revenues:
Premium and service revenues	$ 1,101	$ 1,878	$ 3,353	$ 6,679

CONSOLIDATED STATEMENTS OF COMP

CONSOLIDATED STATEMENTS OF COMPREHENSIVE EARNINGS (LOSS) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Statement of Comprehensive Income [Abstract]
Net earnings	$ 475	$ 740	$ 2,660	$ 1,421
Change in unrealized gain (loss) on investments	(235)	(503)	(124)	(1,664)
Change in unrealized gain (loss) on investments, tax effect	56	120	29	397
Change in unrealized gain (loss) on investments, net of tax	(179)	(383)	(95)	(1,267)
Reclassification adjustment, net of tax	57	3	61	12
Foreign currency translation adjustments, net of tax	(22)	(101)	24	(216)
Net unrealized gain on cash flow hedge, net of tax	20	0	20	0
Other comprehensive earnings (loss)	(124)	(481)	10	(1,471)
Comprehensive earnings (loss)	351	259	2,670	(50)
Comprehensive (earnings) attributable to noncontrolling interests	(6)	(2)	(3)	(6)
Comprehensive earnings (loss) attributable to Centene Corporation	$ 345	$ 257	$ 2,667	$ (56)

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	Noncontrolling Interest
Balance (in shares) at Dec. 31, 2021		602,704
Treasury stock (in shares) at Dec. 31, 2021						20,225
Balance at Dec. 31, 2021	$ 26,940	$ 1	$ 19,672	$ 77	$ 8,139	$ (1,094)	$ 145
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net earnings (loss)	848				849		(1)
Other comprehensive earnings (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		605,925
Treasury stock (in shares) at Mar. 31, 2022						21,071
Balance at Mar. 31, 2022	27,313	$ 1	19,830	(485)	8,988	$ (1,165)	144
Balance (in shares) at Dec. 31, 2021		602,704
Treasury stock (in shares) at Dec. 31, 2021						20,225
Balance at Dec. 31, 2021	26,940	$ 1	19,672	77	8,139	$ (1,094)	145
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Other comprehensive earnings (loss), net of tax	(1,471)
Balance (in shares) at Sep. 30, 2022		606,931
Treasury stock (in shares) at Sep. 30, 2022						36,840
Balance at Sep. 30, 2022	25,534	$ 1	19,774	(1,394)	9,554	$ (2,557)	156
Balance (in shares) at Mar. 31, 2022		605,925
Treasury stock (in shares) at Mar. 31, 2022						21,071
Balance at Mar. 31, 2022	27,313	$ 1	19,830	(485)	8,988	$ (1,165)	144
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net earnings (loss)	(175)				(172)		(3)
Other comprehensive earnings (loss), net of tax	(428)			(428)
Common stock issued for employee benefit plans (in shares)		519
Common stock issued for employee benefit plans	10		10
Common stock repurchases (in shares)						4,249
Common stock repurchases	(349)					$ (349)
Stock compensation expense	59		59
Balance (in shares) at Jun. 30, 2022		606,444
Treasury stock (in shares) at Jun. 30, 2022						25,320
Balance at Jun. 30, 2022	26,430	$ 1	19,899	(913)	8,816	$ (1,514)	141
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net earnings (loss)	736				738		(2)
Other comprehensive earnings (loss), net of tax	(481)			(481)
Common stock issued for employee benefit plans (in shares)		487
Common stock issued for employee benefit plans	24		24
Common stock repurchases (in shares)						11,520
Common stock repurchases	(1,243)		(200)			$ (1,043)
Stock compensation expense	51		51
Reclassification to redeemable	17						17
Balance (in shares) at Sep. 30, 2022		606,931
Treasury stock (in shares) at Sep. 30, 2022						36,840
Balance at Sep. 30, 2022	$ 25,534	$ 1	19,774	(1,394)	9,554	$ (2,557)	156
Balance (in shares) at Dec. 31, 2022	550,754	607,847
Treasury stock (in shares) at Dec. 31, 2022	57,093					57,093
Balance at Dec. 31, 2022	$ 24,181	$ 1	20,060	(1,132)	9,341	$ (4,213)	124
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net earnings (loss)	1,130				1,130
Other comprehensive earnings (loss), net of tax	217			217
Common stock issued for employee benefit plans (in shares)		6,508
Common stock issued for employee benefit plans	12		12
Common stock repurchases (in shares)						5,548
Common stock repurchases	(423)					$ (423)
Stock compensation expense	61		61
Purchase of redeemable and non-redeemable noncontrolling interest	(12)		(12)
Balance (in shares) at Mar. 31, 2023		614,355
Treasury stock (in shares) at Mar. 31, 2023						62,641
Balance at Mar. 31, 2023	$ 25,166	$ 1	20,121	(915)	10,471	$ (4,636)	124
Balance (in shares) at Dec. 31, 2022	550,754	607,847
Treasury stock (in shares) at Dec. 31, 2022	57,093					57,093
Balance at Dec. 31, 2022	$ 24,181	$ 1	20,060	(1,132)	9,341	$ (4,213)	124
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Other comprehensive earnings (loss), net of tax	$ 10
Balance (in shares) at Sep. 30, 2023	534,596	614,956
Treasury stock (in shares) at Sep. 30, 2023	80,360					80,360
Balance at Sep. 30, 2023	$ 25,395	$ 1	20,243	(1,122)	11,998	$ (5,825)	100
Balance (in shares) at Mar. 31, 2023		614,355
Treasury stock (in shares) at Mar. 31, 2023						62,641
Balance at Mar. 31, 2023	25,166	$ 1	20,121	(915)	10,471	$ (4,636)	124
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net earnings (loss)	1,055				1,058		(3)
Other comprehensive earnings (loss), net of tax	(83)			(83)
Common stock issued for employee benefit plans (in shares)		388
Common stock issued for employee benefit plans	9		9
Common stock repurchases (in shares)						6,099
Common stock repurchases	(408)					$ (408)
Stock compensation expense	56		56
Purchase of redeemable and non-redeemable noncontrolling interest	(27)		(3)				(24)
Balance (in shares) at Jun. 30, 2023		614,743
Treasury stock (in shares) at Jun. 30, 2023						68,740
Balance at Jun. 30, 2023	25,768	$ 1	20,183	(998)	11,529	$ (5,044)	97
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net earnings (loss)	472				469		3
Other comprehensive earnings (loss), net of tax	(124)			(124)
Common stock issued for employee benefit plans (in shares)		213
Common stock issued for employee benefit plans	11		11
Common stock repurchases (in shares)						11,620
Common stock repurchases	(781)					$ (781)
Stock compensation expense	50		50
Purchase of redeemable and non-redeemable noncontrolling interest	$ (1)		(1)
Balance (in shares) at Sep. 30, 2023	534,596	614,956
Treasury stock (in shares) at Sep. 30, 2023	80,360					80,360
Balance at Sep. 30, 2023	$ 25,395	$ 1	$ 20,243	$ (1,122)	$ 11,998	$ (5,825)	$ 100

CONSOLIDATED STATEMENTS OF ST_2

CONSOLIDATED STATEMENTS OF STOCKHOLDERS' EQUITY (Parenthetical) - USD ($) $ in Millions	3 Months Ended
	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023	Sep. 30, 2022	Jun. 30, 2022	Mar. 31, 2022	Dec. 31, 2022	Dec. 31, 2021
Par value (in dollars per share)	$ 0.001						$ 0.001
Other comprehensive earning (loss), tax	$ (34)	$ (34)	$ 61	$ (120)	$ (106)	$ (171)
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	3 Months Ended		9 Months Ended		12 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022	Dec. 31, 2022
Cash flows from operating activities:
Net earnings	$ 475	$ 740	$ 2,660	$ 1,421
Adjustments to reconcile net earnings to net cash provided by operating activities
Depreciation and amortization			978	1,079
Stock compensation expense			167	180
Impairment	440	289	478	1,739
(Gain) loss on debt extinguishment			0	(26)
Deferred income taxes			14	(682)
(Gain) loss on divestitures			(172)	(503)
Other adjustments, net			158	164
Changes in assets and liabilities
Premium and trade receivables			(2,329)	(1,274)
Other assets			(103)	152
Medical claims liabilities			401	1,976
Unearned revenue			1,878	1,964
Accounts payable and accrued expenses			3,127	686
Other long-term liabilities			583	863
Other operating activities, net			(4)	98
Net cash provided by operating activities			7,836	7,837
Cash flows from investing activities:
Capital expenditures			(576)	(771)
Purchases of investments			(4,729)	(5,118)
Sales and maturities of investments			4,373	2,842
Acquisitions, net of cash acquired			0	(1,457)
Divestiture proceeds, net of divested cash			690	1,362
Net cash (used in) investing activities			(242)	(3,142)
Cash flows from financing activities:
Proceeds from long-term debt			2,170	357
Payments and repurchases of long-term debt			(1,970)	(1,202)
Common stock repurchases			(1,602)	(1,663)
Proceeds from common stock issuances			32	62
Payments for debt extinguishment			0	(14)
Purchase of noncontrolling interest			(87)	0
Other financing activities, net			0	(5)
Net cash (used in) financing activities			(1,457)	(2,465)
Effect of exchange rate changes on cash, cash equivalents, and restricted cash			19	(37)
Net increase in cash, cash equivalents, and restricted cash and cash equivalents			6,156	2,193
Cash and cash equivalents reclassified from (to) held for sale	(36)	(192)	(36)	(192)
Cash, cash equivalents, and restricted cash and cash equivalents, beginning of period			12,330	13,214	$ 13,214
Cash, cash equivalents, and restricted cash and cash equivalents, end of period	18,450	15,215	18,450	15,215	12,330
Supplemental disclosures of cash flow information:
Interest paid			496	462
Income taxes paid			759	448
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	18,190	14,987	18,190	14,987	12,074
Restricted cash and cash equivalents, included in restricted deposits	260	228	260	228
Total cash, cash equivalents, and restricted cash and cash equivalents	$ 18,450	$ 15,215	$ 18,450	$ 15,215	$ 12,330

Organization and Operations

Organization and Operations	9 Months Ended
	Sep. 30, 2023
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, 2022. 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, 2022 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 2022 amounts in the consolidated financial statements and notes to the consolidated financial statements have been reclassified to conform to the 2023 presentation, including reclassifications related to the Company's new segment reporting structure as outlined below. These reclassifications have no effect on net earnings or stockholders' equity as previously reported. Segment Reporting In the first quarter of 2023, and in conjunction with the Company's updated strategic plan, executive leadership realignment, and corresponding 2023 divestitures, the Company revised the way it manages the business, evaluates performance, and allocates resources, resulting in an updated segment structure comprised of (1) a Medicaid segment, (2) a Medicare segment, (3) a Commercial segment, and (4) an Other segment. The Medicaid, Medicare, and Commercial segments represent the government-sponsored or subsidized programs under which the Company offers managed healthcare services. Specifically, the Medicaid segment includes the Temporary Assistance for Needy Families (TANF) program, Medicaid Expansion programs, the Aged, Blind, or Disabled (ABD) program, the Children's Health Insurance Program (CHIP), Long-Term Services and Supports (LTSS), Foster Care, Medicare-Medicaid Plans (MMP), which cover beneficiaries who are dually eligible for Medicaid and Medicare, and other state-based programs. The Medicare segment includes Medicare Advantage, Medicare Supplement, Dual Eligible Special Needs Plans (D-SNPs), and Medicare Prescription Drug Plans (PDPs), also known as Medicare Part D. The Commercial segment includes the Health Insurance Marketplace product along with individual, small group, and large group commercial health insurance products. The Other segment includes the Company's pharmacy operations, vision and dental services, clinical healthcare, behavioral health, international operations, and corporate management companies, among others. 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 and Divestitures

Acquisitions and Divestitures	9 Months Ended
	Sep. 30, 2023
Business Combination and Asset Acquisition [Abstract]
Acquisitions and Divestitures	Acquisitions and Divestitures On January 5, 2023, the Company completed the divestiture of HealthSmart, its third-party health plan administration business. On January 10, 2023, the Company signed and closed on a definitive agreement to divest Centurion, its prison healthcare business. During 2022, the Company recorded impairment charges related to goodwill and other current assets associated with the divestiture. During the second quarter of 2023, the Company recognized a $15 million gain on the divestiture of the Centurion business reflecting additional proceeds for contingent consideration, partially offset by net working capital adjustments. The gain is included in investment and other income in the Consolidated Statements of Operations. On January 20, 2023, the Company completed the divestiture of Magellan Specialty Health for approximately $646 million in cash and stock, including an estimated working capital adjustment, and recognized a pre-tax gain of $79 million. The stock consideration was subsequently sold in April 2023 for cash proceeds of $245 million. The Company could also receive up to an additional $150 million in cash and stock in 2024 based on certain 2023 performance metrics. The Company will recognize the appropriate amount of contingent consideration related to the additional $150 million when realized or realizable. On June 13, 2023, the Company completed the divestiture of its majority stake in Apixio. The Company recognized a pre-tax gain of $91 million, or $63 million after-tax, which is included in investment and other income in the Consolidated Statements of Operations. During the second quarter of 2023, the Company recognized an additional $13 million expense related to the divestiture of its Spanish and Central European businesses, in addition to the previously recorded impairment charge of $163 million, or $140 million after-tax. The expense is included in investment and other income in the Consolidated Statements of Operations. Circle Health Group Divestiture On August 28, 2023, the Company signed a definitive agreement to sell Circle Health Group (Circle Health), one of the U.K.'s largest independent hospital operators, which is included in the Other segment. As of September 30, 2023, the assets and liabilities of Circle Health were considered held for sale resulting in $3,744 million of assets held for sale in other current assets and $2,947 million of liabilities held for sale in accounts payable and accrued expenses in the Consolidated Balance Sheet. The majority of the held for sale assets were previously reported as other long-term assets, goodwill and property, software and equipment. The majority of the liabilities were previously reported as debt and other long-term liabilities. During the third quarter of 2023, the Company recorded an impairment charge related to goodwill associated with the pending divestiture of $251 million, or $269 million after-tax. In order to manage the foreign exchange risk on the sale price associated with the pending divestiture of Circle Health, in August 2023 the Company entered into a foreign currency swap agreement for a notional amount of $931 million, to sell £740 million. The swap agreement was formally designated and qualified as a cash flow hedge. The swap expires on March 28, 2024. The gain or loss due to changes in the fair value of the foreign currency swap is recorded in other comprehensive income until the Circle Health divestiture closes, at which time the gain or loss will be recorded in earnings to the same line in the Consolidated Statement of Operations as the gain or loss on sale. The fair value of the swap agreement as of September 30, 2023 was $27 million, which was recorded in other current assets in the Consolidated Balance Sheet.

Short-term and Long-term Invest

Short-term and Long-term Investments, Restricted Deposits	9 Months Ended
	Sep. 30, 2023
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, 2023 December 31, 2022 Amortized Cost Gross Gross Fair Value Amortized Cost Gross Gross Fair Value Debt securities: U.S. Treasury securities and obligations of U.S. government corporations and agencies $ 421 $ — $ (13) $ 408 $ 695 $ — $ (16) $ 679 Corporate securities 9,922 2 (750) 9,174 10,127 12 (778) 9,361 Restricted certificates of deposit 4 — — 4 4 — — 4 Restricted cash equivalents 260 — — 260 256 — — 256 Short-term time deposits 470 — — 470 204 — — 204 Municipal securities 3,931 1 (294) 3,638 4,055 6 (280) 3,781 Asset-backed securities 1,633 2 (52) 1,583 1,396 — (70) 1,326 Residential mortgage-backed securities 1,475 — (172) 1,303 1,165 2 (121) 1,046 Commercial mortgage-backed securities 1,100 — (112) 988 961 — (99) 862 Equity securities 2 — — 2 5 — — 5 Private equity investments 810 — — 810 529 — — 529 Life insurance contracts 178 — — 178 169 — — 169 Total $ 20,206 $ 5 $ (1,393) $ 18,818 $ 19,566 $ 20 $ (1,364) $ 18,222 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. Private equity investments include direct investments in private equity securities as well as private equity funds. The Company's investment policies are designed to provide liquidity, preserve capital, and maximize total return on invested assets with a 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, 2023, 99% of the Company's investments in rated securities carry an investment grade rating by nationally recognized statistical rating organizations. At September 30, 2023, 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 $144 million and $132 million at September 30, 2023 and December 31, 2022, respectively, and is included in other current assets in the Consolidated Balance Sheets. The Company's residential mortgage-backed securities are primarily issued by the Federal National Mortgage Association, Government National Mortgage Association, or Federal Home Loan Mortgage Corporation, which carry implicit or explicit guarantees of the U.S. government. The Company's commercial mortgage-backed securities are primarily senior tranches with a weighted average rating of AA+ and a weighted average duration of 4 years at September 30, 2023. The fair value of available-for-sale debt securities with gross unrealized losses by investment type and length of time that individual securities have been in a continuous unrealized loss position were as follows ($ in millions): September 30, 2023 December 31, 2022 Less Than 12 Months 12 Months or More Less Than 12 Months 12 Months or More Unrealized Losses Fair Value Unrealized Losses Fair Value Unrealized Losses Fair Value Unrealized Losses Fair Value U.S. Treasury securities and obligations of U.S. government corporations and agencies $ (1) $ 161 $ (12) $ 247 $ (5) $ 342 $ (11) $ 184 Corporate securities (76) 2,470 (674) 6,393 (340) 5,368 (438) 3,400 Municipal securities (44) 1,308 (250) 2,211 (142) 2,437 (138) 995 Asset-backed securities (7) 486 (45) 946 (29) 786 (41) 486 Residential mortgage-backed securities (23) 517 (149) 786 (55) 629 (66) 352 Commercial mortgage-backed securities (11) 228 (101) 748 (49) 513 (50) 330 Total $ (162) $ 5,170 $ (1,231) $ 11,331 $ (620) $ 10,075 $ (744) $ 5,747 As of September 30, 2023, the gross unrealized losses were generated from 6,355 positions out of a total of 6,604 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): September 30, 2023 December 31, 2022 Investments Restricted Deposits Investments Restricted Deposits Amortized Cost Fair Value Amortized Cost Fair Value Amortized Cost Fair Value Amortized Cost Fair Value One year or less $ 2,121 $ 2,091 $ 537 $ 534 $ 2,207 $ 2,179 $ 534 $ 532 One year through five years 7,421 6,906 531 496 7,651 7,147 524 490 Five years through ten years 3,931 3,501 312 282 4,066 3,613 224 195 Greater than ten years 123 113 32 31 135 129 — — Asset-backed securities 4,208 3,874 — — 3,522 3,234 — — Total $ 17,804 $ 16,485 $ 1,412 $ 1,343 $ 17,581 $ 16,302 $ 1,282 $ 1,217 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 substantially all of the securities included in the greater than ten years category listed above at amortized cost.

Fair Value Measurements

Fair Value Measurements	9 Months Ended
	Sep. 30, 2023
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, 2023, 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 $ 18,190 $ — $ — $ 18,190 Investments: U.S. Treasury securities and obligations of U.S. government corporations and agencies $ 81 $ — $ — $ 81 Corporate securities — 9,142 — 9,142 Municipal securities — 2,918 — 2,918 Short-term time deposits — 470 — 470 Asset-backed securities — 1,583 — 1,583 Residential mortgage-backed securities — 1,303 — 1,303 Commercial mortgage-backed securities — 988 — 988 Equity securities — 2 — 2 Total investments $ 81 $ 16,406 $ — $ 16,487 Restricted deposits: Cash and cash equivalents $ 260 $ — $ — $ 260 U.S. Treasury securities and obligations of U.S. government corporations and agencies 327 — — 327 Corporate securities — 32 — 32 Certificates of deposit — 4 — 4 Municipal securities — 720 — 720 Total restricted deposits $ 587 $ 756 $ — $ 1,343 Other current assets: Foreign currency swap agreement $ — $ 27 $ — $ 27 Total assets at fair value $ 18,858 $ 17,189 $ — $ 36,047 The following table summarizes fair value measurements by level at December 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 $ 12,074 $ — $ — $ 12,074 Investments: U.S. Treasury securities and obligations of U.S. government corporations and agencies $ 366 $ 5 $ — $ 371 Corporate securities — 9,328 — 9,328 Municipal securities — 3,165 — 3,165 Short-term time deposits — 204 — 204 Asset backed securities — 1,326 — 1,326 Residential mortgage-backed securities — 1,046 — 1,046 Commercial mortgage-backed securities — 862 — 862 Equity securities 3 2 — 5 Total investments $ 369 $ 15,938 $ — $ 16,307 Restricted deposits: Cash and cash equivalents $ 256 $ — $ — $ 256 U.S. Treasury securities and obligations of U.S. government corporations and agencies 308 — — 308 Corporate securities — 33 — 33 Certificates of deposit — 4 — 4 Municipal securities — 616 — 616 Total restricted deposits $ 564 $ 653 $ — $ 1,217 Total assets at fair value $ 13,007 $ 16,591 $ — $ 29,598 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 $988 million and $698 million as of September 30, 2023 and December 31, 2022, respectively.

Goodwill and Intangible Assets

Goodwill and Intangible Assets	9 Months Ended
	Sep. 30, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill and Intangible Assets	Goodwill and Intangible Assets As discussed in Note 1. Organization and Operations, in the first quarter of 2023, the Company updated its segment structure. Prior year information has been adjusted to reflect the change in segment reporting. The following table summarizes the changes in goodwill by operating segment ($ in millions): Medicaid Medicare Commercial Other Consolidated Total Balance, December 31, 2021 $ 10,194 $ 1,592 $ 5,424 $ 2,561 $ 19,771 Acquisition and purchase accounting adjustments — — — 1,077 1,077 Divestitures — — — (1,533) (1,533) Reallocation 4 — — (4) — Impairments — — — (370) (370) Translation impact — — — (133) (133) Balance, December 31, 2022 $ 10,198 $ 1,592 $ 5,424 $ 1,598 $ 18,812 Divestitures — — — (933) (933) Impairments — — — (348) (348) Translation impact — — — 27 27 Balance, September 30, 2023 $ 10,198 $ 1,592 $ 5,424 $ 344 $ 17,558 The decrease in the Other segment goodwill in 2023 was primarily driven by the pending divestiture of Circle Health, which resulted in held for sale accounting and an impairment of $251 million as discussed in Note 2. Acquisitions and Divestitures, and an impairment of the Company's Operose Health business based on market indicators of fair value.

Medical Claims Liability

Medical Claims Liability	9 Months Ended
	Sep. 30, 2023
Insurance [Abstract]
Medical Claims Liability	Medical Claims Liability As discussed in Note 1. Organization and Operations, in the first quarter of 2023, the Company updated its segment structure. Prior year information has been adjusted to reflect the change in segment reporting. The following table summarizes the change in medical claims liability for the nine months ended September 30, 2023 ($ in millions): Medicaid Medicare Commercial Other Consolidated Total Balance, January 1, 2023 $ 11,253 $ 3,431 $ 1,921 $ 140 $ 16,745 Less: Reinsurance recoverable 7 — 19 — 26 Balance, January 1, 2023, net 11,246 3,431 1,902 140 16,719 Incurred related to: Current year 60,379 14,680 13,994 1,095 90,148 Prior years (1,303) (326) (256) (3) (1,888) Total incurred 59,076 14,354 13,738 1,092 88,260 Paid related to: Current year 50,774 12,069 11,575 984 75,402 Prior years 8,517 2,452 1,376 136 12,481 Total paid 59,291 14,521 12,951 1,120 87,883 Balance, September 30, 2023, net 11,031 3,264 2,689 112 17,096 Plus: Reinsurance recoverable 4 — 41 — 45 Balance, September 30, 2023 $ 11,035 $ 3,264 $ 2,730 $ 112 $ 17,141 The following table summarizes the change in medical claims liability for the nine months ended September 30, 2022 ($ in millions): Medicaid Medicare Commercial Other Consolidated Total Balance, January 1, 2022 $ 9,845 $ 2,286 $ 2,014 $ 98 $ 14,243 Less: Reinsurance recoverable 23 — — — 23 Balance, January 1, 2022, net 9,822 2,286 2,014 98 14,220 Acquisitions and divestitures — — — 249 249 Incurred related to: Current year 57,074 14,624 10,609 2,150 84,457 Prior years (966) (22) (193) (15) (1,196) Total incurred 56,108 14,602 10,416 2,135 83,261 Paid related to: Current year 47,481 11,603 9,046 2,175 70,305 Prior years 7,343 1,963 1,580 82 10,968 Total paid 54,824 13,566 10,626 2,257 81,273 Balance, September 30, 2022, net 11,106 3,322 1,804 225 16,457 Plus: Reinsurance recoverable 8 — — — 8 Balance, September 30, 2022 $ 11,114 $ 3,322 $ 1,804 $ 225 $ 16,465 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 development within "Incurred related to: Prior years," the Company recorded $341 million and $121 million as a reduction to premium revenue in the nine months ended September 30, 2023 and 2022, respectively, for minimum health benefits ratio (HBR) and other return of premium programs. Incurred but not reported (IBNR) plus expected development on reported claims as of September 30, 2023 was $11,661 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, 2023
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): September 30, 2023 December 31, 2022 Risk adjustment receivable $ 1,130 $ 838 Risk adjustment payable (2,312) (780) Minimum medical loss ratio (90) (103) Cost sharing reduction payable (104) (99) In June 2023, the Centers for Medicare and Medicaid Services (CMS) announced the final risk adjustment transfers for the 2022 benefit year. As a result of and subsequent to the announcement, the Company increased its risk adjustment net receivables by $244 million from December 31, 2022. After consideration of minimum MLR and other related impacts, the net pre-tax benefit recognized was approximately $198 million in the nine months ended September 30, 2023.

Debt

Debt	9 Months Ended
	Sep. 30, 2023
Debt Disclosure [Abstract]
Debt	Debt Debt consists of the following ($ in millions): September 30, 2023 December 31, 2022 $2,500 million 4.25% Senior Notes due December 15, 2027 $ 2,395 $ 2,393 $2,300 million 2.45% Senior Notes due July 15, 2028 2,303 2,303 $3,500 million 4.625% Senior Notes due December 15, 2029 3,277 3,277 $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 15,675 15,673 Term Loan Facility 2,142 2,183 Revolving Credit Agreement 309 58 Finance leases and other 3 253 Debt issuance costs (128) (147) Total debt 18,001 18,020 Less: current portion (113) (82) Long-term debt $ 17,888 $ 17,938 In May 2023, the Company entered into a first amendment to the Company's Fourth Amended and Restated Credit Agreement. The amendment removed and replaced the interest rate benchmark based on the London Interbank Offered Rate (LIBOR) and related LIBOR-based mechanics applicable to U.S. dollar borrowings under the Amended and Restated Credit Agreement with an interest rate benchmark based on the Secured Overnight Financing Rate (SOFR) (including a customary credit spread adjustment) and related SOFR-based mechanics. Additionally, the amendment removed certain provisions which required the Company to make certain mandatory prepayments of the Term Loan Facility.

Leases

Leases	9 Months Ended
	Sep. 30, 2023
Leases [Abstract]
Leases	Leases The following table sets forth the right-of-use (ROU) assets and lease liabilities ($ in millions): September 30, 2023 December 31, 2022 Assets ROU assets (recorded within other long-term assets) $ 430 $ 2,554 Liabilities Short-term (recorded within accounts payable and accrued expenses) $ 170 $ 180 Long-term (recorded within other long-term liabilities) 936 3,133 Total lease liabilities $ 1,106 $ 3,313 The decrease in ROU assets and lease liabilities in 2023 was primarily driven by divestiture related activity as discussed in Note 2. Acquisitions and Divestitures . Specifically, as of September 30, 2023, Circle Health was considered held for sale and accordingly the associated ROU assets and lease liabilities were reclassified to other current assets and accounts payable and accrued expenses, respectively, in the Consolidated Balance Sheet. Additionally, in conjunction with ongoing real estate optimization initiatives, the Company recognized $35 million and $37 million of ROU asset impairments for the three and nine months ended September 30, 2023, respectively. The remainder of the $85 million real estate optimization impairment charge for the nine months ended September 30, 2023 was related to property, software and equipment. As of September 30, 2023, the weighted average remaining lease term for the Company was 20.3 years. The average remaining lease term of the Circle Health portfolio is 26.5 years. Excluding Circle Health, the Company's portfolio average remaining lease term is 8.3 years. The lease liabilities as of September 30, 2023, reflect a weighted average discount rate of 5.8%, or 3.2% excluding Circle Health. Excluding Circle Health, the Company had $51 million remaining in lease payments for 2023 as of September 30, 2023. Lease payments over the next five years and thereafter are as follows ($ in millions): Lease Payments 2024 $ 201 2025 176 2026 151 2027 133 2028 113 Thereafter 441 Total lease payments 1,215 Less: imputed interest (160) Total lease liabilities $ 1,055

Stockholders' Equity

Stockholders' Equity	9 Months Ended
	Sep. 30, 2023
Equity [Abstract]
Stockholders' Equity	Stockholders' Equity The Company's Board of Directors has authorized a stock repurchase program of the Company's common stock from time to time on the open market or through privately negotiated transactions. In 2022, the Company's Board of Directors authorized increases under the program including $3,000 million in June 2022 and an additional $2,000 million in December 2022. With these increases, the Company is authorized to repurchase up to $6,000 million, inclusive of past authorizations. As of September 30, 2023, the Company had a remaining amount of $1,256 million available under the stock repurchase program. In October 2023, the Company repurchased an additional 397 thousand shares for $27 million. The following represents the Company's share repurchase activity ($ in millions, shares in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2023 2022 (2) 2023 2022 (2) Shares Cost Shares Cost Shares Cost Shares Cost Share buybacks 11,609 $ 773 11,486 $ 1,040 22,489 $ 1,550 15,674 $ 1,384 Income tax withholding 11 1 34 3 778 52 941 79 Total share repurchases (1) 11,620 $ 774 11,520 $ 1,043 23,267 $ 1,602 16,615 $ 1,463 (1) Excludes share repurchase excise tax of $10 million accrued as of September 30, 2023. (2) Includes 8.6 million shares delivered as part of an accelerated share repurchase (ASR) agreement, representing 80% of the $1,000 million notional amount. Remaining shares were delivered in the fourth quarter of 2022 upon the settlement of the ASR. Shares repurchased for income tax withholding are shares withheld in connection with employee stock plans to meet applicable tax withholding requirements. These shares are typically included in the Company's treasury stock.

Earnings Per Share

Earnings Per Share	9 Months Ended
	Sep. 30, 2023
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, 2023 2022 2023 2022 Earnings attributable to Centene Corporation $ 469 $ 738 $ 2,657 $ 1,415 Shares used in computing per share amounts: Weighted average number of common shares outstanding 539,535 573,961 546,374 580,277 Common stock equivalents (as determined by applying the treasury stock method) (1) 1,735 6,646 2,038 6,807 Weighted average number of common shares and potential dilutive common shares outstanding 541,270 580,607 548,412 587,084 Net earnings per common share attributable to Centene Corporation: Basic earnings per common share $ 0.87 $ 1.29 $ 4.86 $ 2.44 Diluted earnings per common share $ 0.87 $ 1.27 $ 4.85 $ 2.41 (1) The reduction in common stock equivalents is primarily driven by the distribution of long-term stock awards to the estate of the Company's former CEO during the first quarter of 2023, which were fully dilutive prior to their distribution. The calculation of diluted earnings per common share for the three months ended September 30, 2023 and 2022 excludes 1,313 thousand shares and 152 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, 2023 and 2022 excludes 1,383 thousand shares and 193 thousand shares, respectively, related to anti-dilutive stock options, restricted stock, and restricted stock units.

Segment Information

Segment Information	9 Months Ended
	Sep. 30, 2023
Segment Reporting [Abstract]
Segment Information	Segment Information In the first quarter of 2023, and in conjunction with the Company's updated strategic plan, executive leadership realignment, and corresponding 2023 divestitures, the Company revised the way it manages the business, evaluates performance, and allocates resources, resulting in an updated segment structure comprised of (1) a Medicaid segment, (2) a Medicare segment, (3) a Commercial segment and (4) an Other segment. Prior year information has been adjusted to reflect the change in segment reporting. The Medicaid, Medicare, and Commercial segments represent the government-sponsored or subsidized programs under which the Company offers managed healthcare services. The Other segment includes the Company's pharmacy operations, vision and dental services, clinical healthcare, behavioral health, international operations, and corporate management companies, among others. 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. The Company does not report total assets by segment since this is not a metric used to allocate resources or evaluate segment performance. Segment information for the three months ended September 30, 2023, is as follows ($ in millions): Medicaid Medicare Commercial Other/Eliminations Consolidated Total Premium $ 21,619 $ 5,430 $ 6,451 $ 366 $ 33,866 Service — — 2 1,099 1,101 Premium and service revenues 21,619 5,430 6,453 1,465 34,967 Premium tax 3,075 — — — 3,075 Total external revenues 24,694 5,430 6,453 1,465 38,042 Internal revenues — — — 3,978 3,978 Eliminations — — — (3,978) (3,978) Total revenues $ 24,694 $ 5,430 $ 6,453 $ 1,465 $ 38,042 Medical costs $ 19,607 $ 4,462 $ 5,089 $ 321 $ 29,479 Cost of services $ — $ — $ — $ 856 $ 856 Gross margin (1) $ 2,012 $ 968 $ 1,364 $ 288 $ 4,632 (1) Gross margin represents premium and service revenues less medical costs and cost of services. Segment information for the three months ended September 30, 2022, is as follows ($ in millions): Medicaid Medicare Commercial Other/Eliminations Consolidated Total Premium $ 21,154 $ 5,639 $ 4,291 $ 764 $ 31,848 Service — — 1 1,877 1,878 Premium and service revenues 21,154 5,639 4,292 2,641 33,726 Premium tax 2,139 — — — 2,139 Total external revenues 23,293 5,639 4,292 2,641 35,865 Internal revenues — — — 6,420 6,420 Eliminations — — — (6,420) (6,420) Total revenues $ 23,293 $ 5,639 $ 4,292 $ 2,641 $ 35,865 Medical costs $ 19,075 $ 4,730 $ 3,613 $ 693 $ 28,111 Cost of services $ — $ — $ — $ 1,571 $ 1,571 Gross margin (1) $ 2,079 $ 909 $ 679 $ 377 $ 4,044 (1) Gross margin represents premium and service revenues less medical costs and cost of services. Segment information for the nine months ended September 30, 2023, is as follows ($ in millions): Medicaid Medicare Commercial Other/Eliminations Consolidated Total Premium $ 65,741 $ 16,971 $ 17,437 $ 1,255 $ 101,404 Service — — 2 3,351 3,353 Premium and service revenues 65,741 16,971 17,439 4,606 104,757 Premium tax 9,782 — — — 9,782 Total external revenues 75,523 16,971 17,439 4,606 114,539 Internal revenues — — — 11,634 11,634 Eliminations — — — (11,634) (11,634) Total revenues $ 75,523 $ 16,971 $ 17,439 $ 4,606 $ 114,539 Medical costs $ 59,076 $ 14,354 $ 13,738 $ 1,092 $ 88,260 Cost of services $ 2 $ — $ — $ 2,601 $ 2,603 Gross margin (1) $ 6,663 $ 2,617 $ 3,701 $ 913 $ 13,894 (1) Gross margin represents premium and service revenues less medical costs and cost of services. Segment information for the nine months ended September 30, 2022, is as follows ($ in millions): Medicaid Medicare Commercial Other/Eliminations Consolidated Total Premium $ 62,763 $ 17,035 $ 12,977 $ 2,472 $ 95,247 Service (1) — 2 6,678 6,679 Premium and service revenues 62,762 17,035 12,979 9,150 101,926 Premium tax 7,060 — — — 7,060 Total external revenues 69,822 17,035 12,979 9,150 108,986 Internal revenues — — — 18,856 18,856 Eliminations — — — (18,856) (18,856) Total revenues $ 69,822 $ 17,035 $ 12,979 $ 9,150 $ 108,986 Medical costs $ 56,108 $ 14,602 $ 10,416 $ 2,135 $ 83,261 Cost of services $ — $ — $ — $ 5,658 $ 5,658 Gross margin (1) $ 6,654 $ 2,433 $ 2,563 $ 1,357 $ 13,007 (1) Gross margin represents premium and service revenues less medical costs and cost of services.

Contingencies

Contingencies	9 Months Ended
	Sep. 30, 2023
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 related to risk adjustment payments, or the False Claims Act, the calculation of minimum MLR 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, cybersecurity issues, including those related to the Company's or the Company's third party vendors' information systems, 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 management (PBM) 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 discussion 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. Accellion 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 at a mediation in September 2021, the Company reached a settlement with plaintiffs in three of the pending class actions which, if approved by court, should resolve most or all of the pending litigation related to this matter. 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 condition, 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 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 a no-fault settlement with the Ohio Attorney General regarding this matter and the complaint was dismissed.

Organization and Operations (Po

Organization and Operations (Policies)	9 Months Ended
	Sep. 30, 2023
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, 2022. 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, 2022 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 2022 amounts in the consolidated financial statements and notes to the consolidated financial statements have been reclassified to conform to the 2023 presentation, including reclassifications related to the Company's new segment reporting structure as outlined below. These reclassifications have no effect on net earnings or stockholders' equity as previously reported.
Segment Reporting	Segment Reporting In the first quarter of 2023, and in conjunction with the Company's updated strategic plan, executive leadership realignment, and corresponding 2023 divestitures, the Company revised the way it manages the business, evaluates performance, and allocates resources, resulting in an updated segment structure comprised of (1) a Medicaid segment, (2) a Medicare segment, (3) a Commercial segment, and (4) an Other segment. The Medicaid, Medicare, and Commercial segments represent the government-sponsored or subsidized programs under which the Company offers managed healthcare services. Specifically, the Medicaid segment includes the Temporary Assistance for Needy Families (TANF) program, Medicaid Expansion programs, the Aged, Blind, or Disabled (ABD) program, the Children's Health Insurance Program (CHIP), Long-Term Services and Supports (LTSS), Foster Care, Medicare-Medicaid Plans (MMP), which cover beneficiaries who are dually eligible for Medicaid and Medicare, and other state-based programs. The Medicare segment includes Medicare Advantage, Medicare Supplement, Dual Eligible Special Needs Plans (D-SNPs), and Medicare Prescription Drug Plans (PDPs), also known as Medicare Part D. The Commercial segment includes the Health Insurance Marketplace product along with individual, small group, and large group commercial health insurance products. The Other segment includes the Company's pharmacy operations, vision and dental services, clinical healthcare, behavioral health, international operations, and corporate management companies, among others.
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.

Short-term and Long-term Inve_2

Short-term and Long-term Investments, Restricted Deposits (Tables)	9 Months Ended
	Sep. 30, 2023
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, 2023 December 31, 2022 Amortized Cost Gross Gross Fair Value Amortized Cost Gross Gross Fair Value Debt securities: U.S. Treasury securities and obligations of U.S. government corporations and agencies $ 421 $ — $ (13) $ 408 $ 695 $ — $ (16) $ 679 Corporate securities 9,922 2 (750) 9,174 10,127 12 (778) 9,361 Restricted certificates of deposit 4 — — 4 4 — — 4 Restricted cash equivalents 260 — — 260 256 — — 256 Short-term time deposits 470 — — 470 204 — — 204 Municipal securities 3,931 1 (294) 3,638 4,055 6 (280) 3,781 Asset-backed securities 1,633 2 (52) 1,583 1,396 — (70) 1,326 Residential mortgage-backed securities 1,475 — (172) 1,303 1,165 2 (121) 1,046 Commercial mortgage-backed securities 1,100 — (112) 988 961 — (99) 862 Equity securities 2 — — 2 5 — — 5 Private equity investments 810 — — 810 529 — — 529 Life insurance contracts 178 — — 178 169 — — 169 Total $ 20,206 $ 5 $ (1,393) $ 18,818 $ 19,566 $ 20 $ (1,364) $ 18,222
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, 2023 December 31, 2022 Less Than 12 Months 12 Months or More Less Than 12 Months 12 Months or More Unrealized Losses Fair Value Unrealized Losses Fair Value Unrealized Losses Fair Value Unrealized Losses Fair Value U.S. Treasury securities and obligations of U.S. government corporations and agencies $ (1) $ 161 $ (12) $ 247 $ (5) $ 342 $ (11) $ 184 Corporate securities (76) 2,470 (674) 6,393 (340) 5,368 (438) 3,400 Municipal securities (44) 1,308 (250) 2,211 (142) 2,437 (138) 995 Asset-backed securities (7) 486 (45) 946 (29) 786 (41) 486 Residential mortgage-backed securities (23) 517 (149) 786 (55) 629 (66) 352 Commercial mortgage-backed securities (11) 228 (101) 748 (49) 513 (50) 330 Total $ (162) $ 5,170 $ (1,231) $ 11,331 $ (620) $ 10,075 $ (744) $ 5,747
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, 2023 December 31, 2022 Investments Restricted Deposits Investments Restricted Deposits Amortized Cost Fair Value Amortized Cost Fair Value Amortized Cost Fair Value Amortized Cost Fair Value One year or less $ 2,121 $ 2,091 $ 537 $ 534 $ 2,207 $ 2,179 $ 534 $ 532 One year through five years 7,421 6,906 531 496 7,651 7,147 524 490 Five years through ten years 3,931 3,501 312 282 4,066 3,613 224 195 Greater than ten years 123 113 32 31 135 129 — — Asset-backed securities 4,208 3,874 — — 3,522 3,234 — — Total $ 17,804 $ 16,485 $ 1,412 $ 1,343 $ 17,581 $ 16,302 $ 1,282 $ 1,217

Fair Value Measurements (Tables

Fair Value Measurements (Tables)	9 Months Ended
	Sep. 30, 2023
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, 2023, 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 $ 18,190 $ — $ — $ 18,190 Investments: U.S. Treasury securities and obligations of U.S. government corporations and agencies $ 81 $ — $ — $ 81 Corporate securities — 9,142 — 9,142 Municipal securities — 2,918 — 2,918 Short-term time deposits — 470 — 470 Asset-backed securities — 1,583 — 1,583 Residential mortgage-backed securities — 1,303 — 1,303 Commercial mortgage-backed securities — 988 — 988 Equity securities — 2 — 2 Total investments $ 81 $ 16,406 $ — $ 16,487 Restricted deposits: Cash and cash equivalents $ 260 $ — $ — $ 260 U.S. Treasury securities and obligations of U.S. government corporations and agencies 327 — — 327 Corporate securities — 32 — 32 Certificates of deposit — 4 — 4 Municipal securities — 720 — 720 Total restricted deposits $ 587 $ 756 $ — $ 1,343 Other current assets: Foreign currency swap agreement $ — $ 27 $ — $ 27 Total assets at fair value $ 18,858 $ 17,189 $ — $ 36,047 The following table summarizes fair value measurements by level at December 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 $ 12,074 $ — $ — $ 12,074 Investments: U.S. Treasury securities and obligations of U.S. government corporations and agencies $ 366 $ 5 $ — $ 371 Corporate securities — 9,328 — 9,328 Municipal securities — 3,165 — 3,165 Short-term time deposits — 204 — 204 Asset backed securities — 1,326 — 1,326 Residential mortgage-backed securities — 1,046 — 1,046 Commercial mortgage-backed securities — 862 — 862 Equity securities 3 2 — 5 Total investments $ 369 $ 15,938 $ — $ 16,307 Restricted deposits: Cash and cash equivalents $ 256 $ — $ — $ 256 U.S. Treasury securities and obligations of U.S. government corporations and agencies 308 — — 308 Corporate securities — 33 — 33 Certificates of deposit — 4 — 4 Municipal securities — 616 — 616 Total restricted deposits $ 564 $ 653 $ — $ 1,217 Total assets at fair value $ 13,007 $ 16,591 $ — $ 29,598

Goodwill and Intangible Assets

Goodwill and Intangible Assets (Tables)	9 Months Ended
	Sep. 30, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule of Goodwill	The following table summarizes the changes in goodwill by operating segment ($ in millions): Medicaid Medicare Commercial Other Consolidated Total Balance, December 31, 2021 $ 10,194 $ 1,592 $ 5,424 $ 2,561 $ 19,771 Acquisition and purchase accounting adjustments — — — 1,077 1,077 Divestitures — — — (1,533) (1,533) Reallocation 4 — — (4) — Impairments — — — (370) (370) Translation impact — — — (133) (133) Balance, December 31, 2022 $ 10,198 $ 1,592 $ 5,424 $ 1,598 $ 18,812 Divestitures — — — (933) (933) Impairments — — — (348) (348) Translation impact — — — 27 27 Balance, September 30, 2023 $ 10,198 $ 1,592 $ 5,424 $ 344 $ 17,558

Medical Claims Liability (Table

Medical Claims Liability (Tables)	9 Months Ended
	Sep. 30, 2023
Insurance [Abstract]
Schedule of change in medical claims liability	The following table summarizes the change in medical claims liability for the nine months ended September 30, 2023 ($ in millions): Medicaid Medicare Commercial Other Consolidated Total Balance, January 1, 2023 $ 11,253 $ 3,431 $ 1,921 $ 140 $ 16,745 Less: Reinsurance recoverable 7 — 19 — 26 Balance, January 1, 2023, net 11,246 3,431 1,902 140 16,719 Incurred related to: Current year 60,379 14,680 13,994 1,095 90,148 Prior years (1,303) (326) (256) (3) (1,888) Total incurred 59,076 14,354 13,738 1,092 88,260 Paid related to: Current year 50,774 12,069 11,575 984 75,402 Prior years 8,517 2,452 1,376 136 12,481 Total paid 59,291 14,521 12,951 1,120 87,883 Balance, September 30, 2023, net 11,031 3,264 2,689 112 17,096 Plus: Reinsurance recoverable 4 — 41 — 45 Balance, September 30, 2023 $ 11,035 $ 3,264 $ 2,730 $ 112 $ 17,141 The following table summarizes the change in medical claims liability for the nine months ended September 30, 2022 ($ in millions): Medicaid Medicare Commercial Other Consolidated Total Balance, January 1, 2022 $ 9,845 $ 2,286 $ 2,014 $ 98 $ 14,243 Less: Reinsurance recoverable 23 — — — 23 Balance, January 1, 2022, net 9,822 2,286 2,014 98 14,220 Acquisitions and divestitures — — — 249 249 Incurred related to: Current year 57,074 14,624 10,609 2,150 84,457 Prior years (966) (22) (193) (15) (1,196) Total incurred 56,108 14,602 10,416 2,135 83,261 Paid related to: Current year 47,481 11,603 9,046 2,175 70,305 Prior years 7,343 1,963 1,580 82 10,968 Total paid 54,824 13,566 10,626 2,257 81,273 Balance, September 30, 2022, net 11,106 3,322 1,804 225 16,457 Plus: Reinsurance recoverable 8 — — — 8 Balance, September 30, 2022 $ 11,114 $ 3,322 $ 1,804 $ 225 $ 16,465

Affordable Care Act (Tables)

Affordable Care Act (Tables)	9 Months Ended
	Sep. 30, 2023
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, 2023 December 31, 2022 Risk adjustment receivable $ 1,130 $ 838 Risk adjustment payable (2,312) (780) Minimum medical loss ratio (90) (103) Cost sharing reduction payable (104) (99)

Debt (Tables)

Debt (Tables)	9 Months Ended
	Sep. 30, 2023
Debt Disclosure [Abstract]
Schedule of Debt	Debt consists of the following ($ in millions): September 30, 2023 December 31, 2022 $2,500 million 4.25% Senior Notes due December 15, 2027 $ 2,395 $ 2,393 $2,300 million 2.45% Senior Notes due July 15, 2028 2,303 2,303 $3,500 million 4.625% Senior Notes due December 15, 2029 3,277 3,277 $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 15,675 15,673 Term Loan Facility 2,142 2,183 Revolving Credit Agreement 309 58 Finance leases and other 3 253 Debt issuance costs (128) (147) Total debt 18,001 18,020 Less: current portion (113) (82) Long-term debt $ 17,888 $ 17,938

Leases (Tables)

Leases (Tables)	9 Months Ended
	Sep. 30, 2023
Leases [Abstract]
ROU Assets and Liabilities	The following table sets forth the right-of-use (ROU) assets and lease liabilities ($ in millions): September 30, 2023 December 31, 2022 Assets ROU assets (recorded within other long-term assets) $ 430 $ 2,554 Liabilities Short-term (recorded within accounts payable and accrued expenses) $ 170 $ 180 Long-term (recorded within other long-term liabilities) 936 3,133 Total lease liabilities $ 1,106 $ 3,313
Maturity of Operating Lease Liabilities	Lease payments over the next five years and thereafter are as follows ($ in millions): Lease Payments 2024 $ 201 2025 176 2026 151 2027 133 2028 113 Thereafter 441 Total lease payments 1,215 Less: imputed interest (160) Total lease liabilities $ 1,055

Stockholders' Equity (Tables)

Stockholders' Equity (Tables)	9 Months Ended
	Sep. 30, 2023
Equity [Abstract]
Class of Treasury Stock	The following represents the Company's share repurchase activity ($ in millions, shares in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2023 2022 (2) 2023 2022 (2) Shares Cost Shares Cost Shares Cost Shares Cost Share buybacks 11,609 $ 773 11,486 $ 1,040 22,489 $ 1,550 15,674 $ 1,384 Income tax withholding 11 1 34 3 778 52 941 79 Total share repurchases (1) 11,620 $ 774 11,520 $ 1,043 23,267 $ 1,602 16,615 $ 1,463 (1) Excludes share repurchase excise tax of $10 million accrued as of September 30, 2023. (2) Includes 8.6 million shares delivered as part of an accelerated share repurchase (ASR) agreement, representing 80% of the $1,000 million notional amount. Remaining shares were delivered in the fourth quarter of 2022 upon the settlement of the ASR.

Earnings Per Share (Tables)

Earnings Per Share (Tables)	9 Months Ended
	Sep. 30, 2023
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, 2023 2022 2023 2022 Earnings attributable to Centene Corporation $ 469 $ 738 $ 2,657 $ 1,415 Shares used in computing per share amounts: Weighted average number of common shares outstanding 539,535 573,961 546,374 580,277 Common stock equivalents (as determined by applying the treasury stock method) (1) 1,735 6,646 2,038 6,807 Weighted average number of common shares and potential dilutive common shares outstanding 541,270 580,607 548,412 587,084 Net earnings per common share attributable to Centene Corporation: Basic earnings per common share $ 0.87 $ 1.29 $ 4.86 $ 2.44 Diluted earnings per common share $ 0.87 $ 1.27 $ 4.85 $ 2.41 (1) The reduction in common stock equivalents is primarily driven by the distribution of long-term stock awards to the estate of the Company's former CEO during the first quarter of 2023, which were fully dilutive prior to their distribution.

Segment Information (Tables)

Segment Information (Tables)	9 Months Ended
	Sep. 30, 2023
Segment Reporting [Abstract]
Segment Information	Segment information for the three months ended September 30, 2023, is as follows ($ in millions): Medicaid Medicare Commercial Other/Eliminations Consolidated Total Premium $ 21,619 $ 5,430 $ 6,451 $ 366 $ 33,866 Service — — 2 1,099 1,101 Premium and service revenues 21,619 5,430 6,453 1,465 34,967 Premium tax 3,075 — — — 3,075 Total external revenues 24,694 5,430 6,453 1,465 38,042 Internal revenues — — — 3,978 3,978 Eliminations — — — (3,978) (3,978) Total revenues $ 24,694 $ 5,430 $ 6,453 $ 1,465 $ 38,042 Medical costs $ 19,607 $ 4,462 $ 5,089 $ 321 $ 29,479 Cost of services $ — $ — $ — $ 856 $ 856 Gross margin (1) $ 2,012 $ 968 $ 1,364 $ 288 $ 4,632 (1) Gross margin represents premium and service revenues less medical costs and cost of services. Segment information for the three months ended September 30, 2022, is as follows ($ in millions): Medicaid Medicare Commercial Other/Eliminations Consolidated Total Premium $ 21,154 $ 5,639 $ 4,291 $ 764 $ 31,848 Service — — 1 1,877 1,878 Premium and service revenues 21,154 5,639 4,292 2,641 33,726 Premium tax 2,139 — — — 2,139 Total external revenues 23,293 5,639 4,292 2,641 35,865 Internal revenues — — — 6,420 6,420 Eliminations — — — (6,420) (6,420) Total revenues $ 23,293 $ 5,639 $ 4,292 $ 2,641 $ 35,865 Medical costs $ 19,075 $ 4,730 $ 3,613 $ 693 $ 28,111 Cost of services $ — $ — $ — $ 1,571 $ 1,571 Gross margin (1) $ 2,079 $ 909 $ 679 $ 377 $ 4,044 (1) Gross margin represents premium and service revenues less medical costs and cost of services. Segment information for the nine months ended September 30, 2023, is as follows ($ in millions): Medicaid Medicare Commercial Other/Eliminations Consolidated Total Premium $ 65,741 $ 16,971 $ 17,437 $ 1,255 $ 101,404 Service — — 2 3,351 3,353 Premium and service revenues 65,741 16,971 17,439 4,606 104,757 Premium tax 9,782 — — — 9,782 Total external revenues 75,523 16,971 17,439 4,606 114,539 Internal revenues — — — 11,634 11,634 Eliminations — — — (11,634) (11,634) Total revenues $ 75,523 $ 16,971 $ 17,439 $ 4,606 $ 114,539 Medical costs $ 59,076 $ 14,354 $ 13,738 $ 1,092 $ 88,260 Cost of services $ 2 $ — $ — $ 2,601 $ 2,603 Gross margin (1) $ 6,663 $ 2,617 $ 3,701 $ 913 $ 13,894 (1) Gross margin represents premium and service revenues less medical costs and cost of services. Segment information for the nine months ended September 30, 2022, is as follows ($ in millions): Medicaid Medicare Commercial Other/Eliminations Consolidated Total Premium $ 62,763 $ 17,035 $ 12,977 $ 2,472 $ 95,247 Service (1) — 2 6,678 6,679 Premium and service revenues 62,762 17,035 12,979 9,150 101,926 Premium tax 7,060 — — — 7,060 Total external revenues 69,822 17,035 12,979 9,150 108,986 Internal revenues — — — 18,856 18,856 Eliminations — — — (18,856) (18,856) Total revenues $ 69,822 $ 17,035 $ 12,979 $ 9,150 $ 108,986 Medical costs $ 56,108 $ 14,602 $ 10,416 $ 2,135 $ 83,261 Cost of services $ — $ — $ — $ 5,658 $ 5,658 Gross margin (1) $ 6,654 $ 2,433 $ 2,563 $ 1,357 $ 13,007 (1) Gross margin represents premium and service revenues less medical costs and cost of services.

Acquisitions and Divestitures -

Acquisitions and Divestitures - Divestiture (Details) £ in Millions, $ in Millions			1 Months Ended	3 Months Ended			9 Months Ended		12 Months Ended
	Jun. 13, 2023 USD ($)	Jan. 20, 2023 USD ($)	Apr. 30, 2023 USD ($)	Sep. 30, 2023 USD ($)	Jun. 30, 2023 USD ($)	Sep. 30, 2022 USD ($)	Sep. 30, 2023 USD ($)	Sep. 30, 2022 USD ($)	Dec. 31, 2022 USD ($)	Aug. 31, 2023 USD ($)	Aug. 31, 2023 GBP (£)
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Gain on divestiture							$ 172	$ 503
Impairment charge				$ (440)		$ (289)	(478)	$ (1,739)
Goodwill impairment							348		$ 370
Currency Swap
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Notional amount										$ 931	£ 740
Fair value, swap agreement				27			27
Centurion | Disposal Group, Disposed of by Sale, Not Discontinued Operations
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Gain on divestiture					$ 15
Magellan Specialty Health | Disposal Group, Disposed of by Sale, Not Discontinued Operations
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Gain on divestiture		$ 79
Consideration received on divestiture		646
Proceeds from sale of business			$ 245
Contingent consideration on disposal (up to)		$ 150
Apixio | Disposal Group, Disposed of by Sale, Not Discontinued Operations
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Gain on disposal	$ 91
Gain on disposal, net of tax	$ 63
Spanish and Central European Businesses | Disposal Group, Disposed of by Sale, Not Discontinued Operations
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Gain on divestiture					$ 13
Impairment charge									(163)
Impairment charge, net of tax									$ (140)
Circle Health | Disposal Group, Held-for-sale, Not Discontinued Operations
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Assets held for sale				3,744			3,744
Liabilities held for sale				2,947			$ 2,947
Goodwill impairment				251
Goodwill, impairment, net of tax				$ 269

Short-term and Long-term Inve_3

Short-term and Long-term Investments, Restricted Deposits - By Investment Type (Details) - USD ($) $ in Millions	Sep. 30, 2023	Dec. 31, 2022
Debt Securities
Gross Unrealized Gains	$ 5	$ 20
Gross Unrealized Losses	(1,393)	(1,364)
Equity securities	2	5
Private equity investments	810	529
Life insurance contracts	178	169
Total, Amortized Cost	20,206	19,566
Total, Fair Value	18,818	18,222
U.S. Treasury securities and obligations of U.S. government corporations and agencies
Debt Securities
Amortized Cost	421	695
Gross Unrealized Gains	0	0
Gross Unrealized Losses	(13)	(16)
Fair Value	408	679
Corporate securities
Debt Securities
Amortized Cost	9,922	10,127
Gross Unrealized Gains	2	12
Gross Unrealized Losses	(750)	(778)
Fair Value	9,174	9,361
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	260	256
Gross Unrealized Gains	0	0
Gross Unrealized Losses	0	0
Fair Value	260	256
Short-term time deposits
Debt Securities
Amortized Cost	470	204
Gross Unrealized Gains	0	0
Gross Unrealized Losses	0	0
Fair Value	470	204
Municipal securities
Debt Securities
Amortized Cost	3,931	4,055
Gross Unrealized Gains	1	6
Gross Unrealized Losses	(294)	(280)
Fair Value	3,638	3,781
Asset-backed securities
Debt Securities
Amortized Cost	1,633	1,396
Gross Unrealized Gains	2	0
Gross Unrealized Losses	(52)	(70)
Fair Value	1,583	1,326
Residential mortgage-backed securities
Debt Securities
Amortized Cost	1,475	1,165
Gross Unrealized Gains	0	2
Gross Unrealized Losses	(172)	(121)
Fair Value	1,303	1,046
Commercial mortgage-backed securities
Debt Securities
Amortized Cost	1,100	961
Gross Unrealized Gains	0	0
Gross Unrealized Losses	(112)	(99)
Fair Value	$ 988	$ 862

Short-term and Long-term Inve_4

Short-term and Long-term Investments, Restricted Deposits - Narrative (Details) $ in Millions	9 Months Ended
	Sep. 30, 2023 USD ($) position	Dec. 31, 2022 USD ($)
Schedule Of Investments And Restricted Deposits By Type [Line Items]
Accrued interest income | $	$ 144	$ 132
Positions from which gross unrealized losses were generated	6,355
Total investment positions	6,604
Commercial mortgage-backed securities
Schedule Of Investments And Restricted Deposits By Type [Line Items]
Investments recorded at fair value that carry rating of AAA 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	99%

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, 2023	Dec. 31, 2022
Unrealized Losses
Less Than 12 Months	$ (162)	$ (620)
12 Months or More	(1,231)	(744)
Fair Value
Fair Value, Less Than 12 Months	5,170	10,075
Fair Value, 12 Months or More	11,331	5,747
U.S. Treasury securities and obligations of U.S. government corporations and agencies
Unrealized Losses
Less Than 12 Months	(1)	(5)
12 Months or More	(12)	(11)
Fair Value
Fair Value, Less Than 12 Months	161	342
Fair Value, 12 Months or More	247	184
Corporate securities
Unrealized Losses
Less Than 12 Months	(76)	(340)
12 Months or More	(674)	(438)
Fair Value
Fair Value, Less Than 12 Months	2,470	5,368
Fair Value, 12 Months or More	6,393	3,400
Municipal securities
Unrealized Losses
Less Than 12 Months	(44)	(142)
12 Months or More	(250)	(138)
Fair Value
Fair Value, Less Than 12 Months	1,308	2,437
Fair Value, 12 Months or More	2,211	995
Asset-backed securities
Unrealized Losses
Less Than 12 Months	(7)	(29)
12 Months or More	(45)	(41)
Fair Value
Fair Value, Less Than 12 Months	486	786
Fair Value, 12 Months or More	946	486
Residential mortgage-backed securities
Unrealized Losses
Less Than 12 Months	(23)	(55)
12 Months or More	(149)	(66)
Fair Value
Fair Value, Less Than 12 Months	517	629
Fair Value, 12 Months or More	786	352
Commercial mortgage-backed securities
Unrealized Losses
Less Than 12 Months	(11)	(49)
12 Months or More	(101)	(50)
Fair Value
Fair Value, Less Than 12 Months	228	513
Fair Value, 12 Months or More	$ 748	$ 330

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, 2023	Dec. 31, 2022
Investments
Amortized Cost
One year or less	$ 2,121	$ 2,207
One year through five years	7,421	7,651
Five years through ten years	3,931	4,066
Greater than ten years	123	135
Asset-backed securities	4,208	3,522
Amortized Cost	17,804	17,581
Fair Value
One year or less	2,091	2,179
One year through five years	6,906	7,147
Five years through ten years	3,501	3,613
Greater than ten years	113	129
Asset-backed securities	3,874	3,234
Fair Value	16,485	16,302
Restricted Deposits
Amortized Cost
One year or less	537	534
One year through five years	531	524
Five years through ten years	312	224
Greater than ten years	32	0
Asset-backed securities	0	0
Amortized Cost	1,412	1,282
Fair Value
One year or less	534	532
One year through five years	496	490
Five years through ten years	282	195
Greater than ten years	31	0
Asset-backed securities	0	0
Fair Value	$ 1,343	$ 1,217

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, 2023	Dec. 31, 2022
Assets
Cash and cash equivalents	$ 18,190	$ 12,074
Investments:
Equity securities	2	5
Total assets at fair value	36,047	29,598
U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Fair Value	408	679
Corporate securities
Investments:
Fair Value	9,174	9,361
Municipal securities
Investments:
Fair Value	3,638	3,781
Short-term time deposits
Investments:
Fair Value	470	204
Asset-backed securities
Investments:
Fair Value	1,583	1,326
Residential mortgage-backed securities
Investments:
Fair Value	1,303	1,046
Commercial mortgage-backed securities
Investments:
Fair Value	988	862
Investments
Investments:
Fair Value	16,485	16,302
Total investments	16,487	16,307
Investments | U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Fair Value	81	371
Investments | Corporate securities
Investments:
Fair Value	9,142	9,328
Investments | Municipal securities
Investments:
Fair Value	2,918	3,165
Investments | Short-term time deposits
Investments:
Fair Value	470	204
Investments | Asset-backed securities
Investments:
Fair Value	1,583	1,326
Investments | Residential mortgage-backed securities
Investments:
Fair Value	1,303	1,046
Investments | Commercial mortgage-backed securities
Investments:
Fair Value	988	862
Investments | Equity securities
Investments:
Equity securities	2	5
Restricted deposits
Investments:
Fair Value	1,343	1,217
Restricted deposits | U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Fair Value	327	308
Restricted deposits | Corporate securities
Investments:
Fair Value	32	33
Restricted deposits | Municipal securities
Investments:
Fair Value	720	616
Restricted deposits | Cash and cash equivalents
Investments:
Fair Value	260	256
Restricted deposits | Certificates of deposit
Investments:
Fair Value	4	4
Other current assets | Currency Swap
Investments:
Foreign currency swap agreement	27
Level I
Assets
Cash and cash equivalents	18,190	12,074
Investments:
Total assets at fair value	18,858	13,007
Level I | Investments
Investments:
Total investments	81	369
Level I | Investments | U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Fair Value	81	366
Level I | Investments | Corporate securities
Investments:
Fair Value	0	0
Level I | Investments | Municipal securities
Investments:
Fair Value	0	0
Level I | Investments | Short-term time deposits
Investments:
Fair Value	0	0
Level I | Investments | Asset-backed securities
Investments:
Fair Value	0	0
Level I | Investments | Residential mortgage-backed securities
Investments:
Fair Value	0	0
Level I | Investments | Commercial mortgage-backed securities
Investments:
Fair Value	0	0
Level I | Investments | Equity securities
Investments:
Equity securities	0	3
Level I | Restricted deposits
Investments:
Fair Value	587	564
Level I | Restricted deposits | U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Fair Value	327	308
Level I | Restricted deposits | Corporate securities
Investments:
Fair Value	0	0
Level I | Restricted deposits | Municipal securities
Investments:
Fair Value	0	0
Level I | Restricted deposits | Cash and cash equivalents
Investments:
Fair Value	260	256
Level I | Restricted deposits | Certificates of deposit
Investments:
Fair Value	0	0
Level I | Other current assets | Currency Swap
Investments:
Foreign currency swap agreement	0
Level II
Assets
Cash and cash equivalents	0	0
Investments:
Total assets at fair value	17,189	16,591
Level II | Investments
Investments:
Total investments	16,406	15,938
Level II | Investments | U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Fair Value	0	5
Level II | Investments | Corporate securities
Investments:
Fair Value	9,142	9,328
Level II | Investments | Municipal securities
Investments:
Fair Value	2,918	3,165
Level II | Investments | Short-term time deposits
Investments:
Fair Value	470	204
Level II | Investments | Asset-backed securities
Investments:
Fair Value	1,583	1,326
Level II | Investments | Residential mortgage-backed securities
Investments:
Fair Value	1,303	1,046
Level II | Investments | Commercial mortgage-backed securities
Investments:
Fair Value	988	862
Level II | Investments | Equity securities
Investments:
Equity securities	2	2
Level II | Restricted deposits
Investments:
Fair Value	756	653
Level II | Restricted deposits | U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Fair Value	0	0
Level II | Restricted deposits | Corporate securities
Investments:
Fair Value	32	33
Level II | Restricted deposits | Municipal securities
Investments:
Fair Value	720	616
Level II | Restricted deposits | Cash and cash equivalents
Investments:
Fair Value	0	0
Level II | Restricted deposits | Certificates of deposit
Investments:
Fair Value	4	4
Level II | Other current assets | Currency Swap
Investments:
Foreign currency swap agreement	27
Level III
Assets
Cash and cash equivalents	0	0
Investments:
Total assets at fair value	0	0
Level III | Investments
Investments:
Total investments	0	0
Level III | Investments | U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Fair Value	0	0
Level III | Investments | Corporate securities
Investments:
Fair Value	0	0
Level III | Investments | Municipal securities
Investments:
Fair Value	0	0
Level III | Investments | Short-term time deposits
Investments:
Fair Value	0	0
Level III | Investments | Asset-backed securities
Investments:
Fair Value	0	0
Level III | Investments | Residential mortgage-backed securities
Investments:
Fair Value	0	0
Level III | Investments | Commercial mortgage-backed securities
Investments:
Fair Value	0	0
Level III | Investments | Equity securities
Investments:
Equity securities	0	0
Level III | Restricted deposits
Investments:
Fair Value	0	0
Level III | Restricted deposits | U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Fair Value	0	0
Level III | Restricted deposits | Corporate securities
Investments:
Fair Value	0	0
Level III | Restricted deposits | Municipal securities
Investments:
Fair Value	0	0
Level III | Restricted deposits | Cash and cash equivalents
Investments:
Fair Value	0	0
Level III | Restricted deposits | Certificates of deposit
Investments:
Fair Value	0	$ 0
Level III | Other current assets | Currency Swap
Investments:
Foreign currency swap agreement	$ 0

Fair Value Measurements - Narra

Fair Value Measurements - Narrative (Details) - USD ($) $ in Millions	Sep. 30, 2023	Dec. 31, 2022
Fair Value Disclosures [Abstract]
Aggregate carrying amount of life insurance contracts and equity investments, fair value	$ 988	$ 698

Goodwill and Intangible Asset_2

Goodwill and Intangible Assets - Summary of Changes in Goodwill (Details) - USD ($) $ in Millions	9 Months Ended	12 Months Ended
	Sep. 30, 2023	Dec. 31, 2022
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill, Balance beginning	$ 18,812	$ 19,771
Acquisition and purchase accounting adjustments		1,077
Divestitures	(933)	(1,533)
Reallocation		0
Impairments	(348)	(370)
Translation impact	27	(133)
Goodwill, Balance ending	17,558	18,812
Medicaid
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill, Balance beginning	10,198	10,194
Acquisition and purchase accounting adjustments		0
Divestitures	0	0
Reallocation		4
Impairments	0	0
Translation impact	0	0
Goodwill, Balance ending	10,198	10,198
Medicare
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill, Balance beginning	1,592	1,592
Acquisition and purchase accounting adjustments		0
Divestitures	0	0
Reallocation		0
Impairments	0	0
Translation impact	0	0
Goodwill, Balance ending	1,592	1,592
Commercial
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill, Balance beginning	5,424	5,424
Acquisition and purchase accounting adjustments		0
Divestitures	0	0
Reallocation		0
Impairments	0	0
Translation impact	0	0
Goodwill, Balance ending	5,424	5,424
Other
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill, Balance beginning	1,598	2,561
Acquisition and purchase accounting adjustments		1,077
Divestitures	(933)	(1,533)
Reallocation		(4)
Impairments	(348)	(370)
Translation impact	27	(133)
Goodwill, Balance ending	$ 344	$ 1,598

Goodwill and Intangible Asset_3

Goodwill and Intangible Assets - Narrative (Details) - USD ($) $ in Millions	3 Months Ended	9 Months Ended	12 Months Ended
	Sep. 30, 2023	Sep. 30, 2023	Dec. 31, 2022
Goodwill [Line Items]
Impairments		$ 348	$ 370
Circle Health | Disposal Group, Held-for-sale, Not Discontinued Operations
Goodwill [Line Items]
Impairments	$ 251

Medical Claims Liability - Sche

Medical Claims Liability - Schedule of Change in Medical Claims Liability (Details) - USD ($) $ in Millions	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022
Liability for Unpaid Claims and Claims Adjustment Expense [Roll Forward]
Balance, January 1	$ 16,745	$ 14,243
Less: Reinsurance recoverable	26	23
Balance, January 1, net	16,719	14,220
Acquisitions and divestitures		249
Incurred related to:
Current year	90,148	84,457
Prior years	(1,888)	(1,196)
Total incurred	88,260	83,261
Paid related to:
Current year	75,402	70,305
Prior years	12,481	10,968
Total paid	87,883	81,273
Balance, June 30, net	17,096	16,457
Plus: Reinsurance recoverable	45	8
Balance, June 30	17,141	16,465
Medicaid
Liability for Unpaid Claims and Claims Adjustment Expense [Roll Forward]
Balance, January 1	11,253	9,845
Less: Reinsurance recoverable	7	23
Balance, January 1, net	11,246	9,822
Acquisitions and divestitures		0
Incurred related to:
Current year	60,379	57,074
Prior years	(1,303)	(966)
Total incurred	59,076	56,108
Paid related to:
Current year	50,774	47,481
Prior years	8,517	7,343
Total paid	59,291	54,824
Balance, June 30, net	11,031	11,106
Plus: Reinsurance recoverable	4	8
Balance, June 30	11,035	11,114
Medicare
Liability for Unpaid Claims and Claims Adjustment Expense [Roll Forward]
Balance, January 1	3,431	2,286
Less: Reinsurance recoverable	0	0
Balance, January 1, net	3,431	2,286
Acquisitions and divestitures		0
Incurred related to:
Current year	14,680	14,624
Prior years	(326)	(22)
Total incurred	14,354	14,602
Paid related to:
Current year	12,069	11,603
Prior years	2,452	1,963
Total paid	14,521	13,566
Balance, June 30, net	3,264	3,322
Plus: Reinsurance recoverable	0	0
Balance, June 30	3,264	3,322
Commercial
Liability for Unpaid Claims and Claims Adjustment Expense [Roll Forward]
Balance, January 1	1,921	2,014
Less: Reinsurance recoverable	19	0
Balance, January 1, net	1,902	2,014
Acquisitions and divestitures		0
Incurred related to:
Current year	13,994	10,609
Prior years	(256)	(193)
Total incurred	13,738	10,416
Paid related to:
Current year	11,575	9,046
Prior years	1,376	1,580
Total paid	12,951	10,626
Balance, June 30, net	2,689	1,804
Plus: Reinsurance recoverable	41	0
Balance, June 30	2,730	1,804
Other
Liability for Unpaid Claims and Claims Adjustment Expense [Roll Forward]
Balance, January 1	140	98
Less: Reinsurance recoverable	0	0
Balance, January 1, net	140	98
Acquisitions and divestitures		249
Incurred related to:
Current year	1,095	2,150
Prior years	(3)	(15)
Total incurred	1,092	2,135
Paid related to:
Current year	984	2,175
Prior years	136	82
Total paid	1,120	2,257
Balance, June 30, net	112	225
Plus: Reinsurance recoverable	0	0
Balance, June 30	$ 112	$ 225

Medical Claims Liability - Narr

Medical Claims Liability - Narrative (Details) - USD ($) $ in Millions	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022
Insurance [Abstract]
Amounts recorded as an adjustment to premium revenues related to minimum HBR and return of premium programs	$ 341	$ 121
Short-duration insurance contracts, Incurred but not reported and expected development on reported claims	$ 11,661

Affordable Care Act - Net Recei

Affordable Care Act - Net Receivables (Payables) for Each of the Ongoing Programs (Details) - USD ($) $ in Millions	Sep. 30, 2023	Dec. 31, 2022
Affordable Care Act [Abstract]
Risk adjustment receivable	$ 1,130	$ 838
Risk adjustment payable	(2,312)	(780)
Minimum medical loss ratio	(90)	(103)
Cost sharing reduction payable	$ (104)	$ (99)

Affordable Care Act - Additiona

Affordable Care Act - Additional information (Details) $ in Millions	9 Months Ended
	Sep. 30, 2023 USD ($)
Affordable Care Act [Abstract]
Risk adjustment, increase to net receivables	$ 244
Risk adjustment and reinsurance pre-tax benefit	$ 198

Debt - Schedule of Debt (Detail

Debt - Schedule of Debt (Details) - USD ($)	Sep. 30, 2023	Dec. 31, 2022
Debt Instrument [Line Items]
Total senior notes	$ 15,675,000,000	$ 15,673,000,000
Finance leases and other	3,000,000	253,000,000
Debt issuance costs	(128,000,000)	(147,000,000)
Total debt	18,001,000,000	18,020,000,000
Less: current portion	(113,000,000)	(82,000,000)
Long-term debt	17,888,000,000	17,938,000,000
Revolving Credit Agreement
Debt Instrument [Line Items]
Credit facility	309,000,000	58,000,000
Term Loan Facility
Debt Instrument [Line Items]
Credit facility	2,142,000,000	2,183,000,000
$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	$ 2,395,000,000	2,393,000,000
$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	$ 2,303,000,000	2,303,000,000
$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	$ 3,277,000,000	3,277,000,000
$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%
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

Leases - Right-of-use (ROU) Ass

Leases - Right-of-use (ROU) Assets and Lease Liabilities (Details) - USD ($) $ in Millions	Sep. 30, 2023	Dec. 31, 2022
Assets
ROU assets (recorded within other long-term assets)	$ 430	$ 2,554
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)	$ 170	$ 180
Long-term (recorded within other long-term liabilities)	936	3,133
Total lease liabilities	$ 1,106	$ 3,313
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 - Narrative (Details)

Leases - Narrative (Details) $ in Millions	3 Months Ended	9 Months Ended
	Sep. 30, 2023 USD ($)	Sep. 30, 2023 USD ($)
Lessee, Lease, Description [Line Items]
ROU impairment	$ 35	$ 37
Remaining asset impairment charges		$ 85
Weighted average remaining lease term	20 years 3 months 18 days	20 years 3 months 18 days
Weighted-average discount rate for operating leases	5.80%	5.80%
Weighted-average discount rate for operating leases excluding disposal group	3.20%	3.20%
Remaining lease payments in 2023 excluding disposal group	$ 51	$ 51
Circle Health
Lessee, Lease, Description [Line Items]
Weighted average remaining lease term	26 years 6 months	26 years 6 months
Excluding Circle Health
Lessee, Lease, Description [Line Items]
Weighted average remaining lease term	8 years 3 months 18 days	8 years 3 months 18 days

Leases - Operating Lease Paymen

Leases - Operating Lease Payments Over Next Five Years Excluding Circle Health (Details) $ in Millions	Sep. 30, 2023 USD ($)
Leases [Abstract]
2024	$ 201
2025	176
2026	151
2027	133
2028	113
Thereafter	441
Total lease payments	1,215
Less: imputed interest	(160)
Total lease liabilities	$ 1,055

Stockholders' Equity - Narrativ

Stockholders' Equity - Narrative (Details) - USD ($) shares in Thousands, $ in Millions	1 Months Ended			3 Months Ended
	Oct. 24, 2023	Dec. 31, 2022	Jun. 30, 2022	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023	Sep. 30, 2022	Jun. 30, 2022	Mar. 31, 2022
Equity, Class of Treasury Stock [Line Items]
Stock repurchase program, increase to authorized amount		$ 2,000	$ 3,000
Stock repurchase program, authorized amount				$ 6,000
Stock repurchase program, remaining available				1,256
Common stock repurchases				$ 781	$ 408	$ 423	$ 1,243	$ 349	$ 71
Subsequent Event
Equity, Class of Treasury Stock [Line Items]
Common stock repurchases (in shares)	397
Common stock repurchases	$ 27

Stockholders' Equity - Share Re

Stockholders' Equity - Share Repurchase Activity (Details) - USD ($) shares in Thousands, $ in Millions	3 Months Ended						9 Months Ended
	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023	Sep. 30, 2022	Jun. 30, 2022	Mar. 31, 2022	Sep. 30, 2023	Sep. 30, 2022
Subsidiary, Sale of Stock [Line Items]
Common stock repurchases	$ 781	$ 408	$ 423	$ 1,243	$ 349	$ 71
Stock repurchases, excise tax accrual	$ 10						$ 10
Employee Stock Compensation Plan
Subsidiary, Sale of Stock [Line Items]
Income tax withholding (in shares)	11			34			778	941
Income tax withholding	$ 1			$ 3			$ 52	$ 79
Common Stock
Subsidiary, Sale of Stock [Line Items]
Share buybacks (in shares)	11,609			11,486			22,489	15,674
Common stock repurchases (in shares)	11,620			11,520			23,267	16,615
Share buybacks	$ 773			$ 1,040			$ 1,550	$ 1,384
Common stock repurchases	$ 774			$ 1,043			$ 1,602	$ 1,463
Common Stock | Accelerated Share Repurchase Agreement
Subsidiary, Sale of Stock [Line Items]
Common stock repurchases (in shares)				8,600				8,600
Percentage of notional amount under ASR				80%				80%
Accelerated share repurchases agreement, amount (up to)				$ 1,000				$ 1,000

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, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Net Income (Loss) Attributable to Parent [Abstract]
Earnings attributable to Centene Corporation	$ 469	$ 738	$ 2,657	$ 1,415
Shares used in computing per share amounts:
Weighted average number of common shares outstanding (in shares)	539,535	573,961	546,374	580,277
Common stock equivalents (as determined by applying the treasury stock method) (in shares)	1,735	6,646	2,038	6,807
Weighted average number of common shares and potential dilutive common shares outstanding (in shares)	541,270	580,607	548,412	587,084
Net earnings per common share attributable to Centene Corporation:
Basic earnings per common share (in dollars per share)	$ 0.87	$ 1.29	$ 4.86	$ 2.44
Diluted earnings per common share (in dollars per share)	$ 0.87	$ 1.27	$ 4.85	$ 2.41
Anti-dilutive restricted stock and restricted stock units excluded from the calculation of diluted earnings (loss) per common share (in shares)	1,313	152	1,383	193

Segment Information (Details)

Segment Information (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Segment Reporting Information [Line Items]
Premium and service revenues	$ 34,967	$ 33,726	$ 104,757	$ 101,926
Premium tax	3,075	2,139	9,782	7,060
Total external revenues	38,042	35,865	114,539	108,986
Revenues	38,042	35,865	114,539	108,986
Medical costs	29,479	28,111	88,260	83,261
Cost of services	856	1,571	2,603	5,658
Gross margin	4,632	4,044	13,894	13,007
Operating Segments
Segment Reporting Information [Line Items]
Revenues	3,978	6,420	11,634	18,856
Eliminations
Segment Reporting Information [Line Items]
Revenues	(3,978)	(6,420)	(11,634)	(18,856)
Premium
Segment Reporting Information [Line Items]
Premium and service revenues	33,866	31,848	101,404	95,247
Service
Segment Reporting Information [Line Items]
Premium and service revenues	1,101	1,878	3,353	6,679
Premium and service revenues
Segment Reporting Information [Line Items]
Premium and service revenues	34,967	33,726	104,757	101,926
Medicaid
Segment Reporting Information [Line Items]
Revenues	24,694	23,293	75,523	69,822
Medical costs	19,607	19,075	59,076	56,108
Cost of services	0	0	2	0
Gross margin	2,012	2,079	6,663	6,654
Medicaid | Operating Segments
Segment Reporting Information [Line Items]
Premium tax	3,075	2,139	9,782	7,060
Total external revenues	24,694	23,293	75,523	69,822
Revenues	0	0	0	0
Medicaid | Eliminations
Segment Reporting Information [Line Items]
Revenues	0	0	0	0
Medicaid | Premium | Operating Segments
Segment Reporting Information [Line Items]
Premium and service revenues	21,619	21,154	65,741	62,763
Medicaid | Service | Operating Segments
Segment Reporting Information [Line Items]
Premium and service revenues	0	0	0	(1)
Medicaid | Premium and service revenues | Operating Segments
Segment Reporting Information [Line Items]
Premium and service revenues	21,619	21,154	65,741	62,762
Medicare
Segment Reporting Information [Line Items]
Revenues	5,430	5,639	16,971	17,035
Medical costs	4,462	4,730	14,354	14,602
Cost of services	0	0	0	0
Gross margin	968	909	2,617	2,433
Medicare | Operating Segments
Segment Reporting Information [Line Items]
Premium tax	0	0	0	0
Total external revenues	5,430	5,639	16,971	17,035
Revenues	0	0	0	0
Medicare | Eliminations
Segment Reporting Information [Line Items]
Revenues	0	0	0	0
Medicare | Premium | Operating Segments
Segment Reporting Information [Line Items]
Premium and service revenues	5,430	5,639	16,971	17,035
Medicare | Service | Operating Segments
Segment Reporting Information [Line Items]
Premium and service revenues	0	0	0	0
Medicare | Premium and service revenues | Operating Segments
Segment Reporting Information [Line Items]
Premium and service revenues	5,430	5,639	16,971	17,035
Commercial
Segment Reporting Information [Line Items]
Revenues	6,453	4,292	17,439	12,979
Medical costs	5,089	3,613	13,738	10,416
Cost of services	0	0	0	0
Gross margin	1,364	679	3,701	2,563
Commercial | Operating Segments
Segment Reporting Information [Line Items]
Premium tax	0	0	0	0
Total external revenues	6,453	4,292	17,439	12,979
Revenues	0	0	0	0
Commercial | Eliminations
Segment Reporting Information [Line Items]
Revenues	0	0	0	0
Commercial | Premium
Segment Reporting Information [Line Items]
Premium and service revenues	6,451	4,291	17,437	12,977
Commercial | Service | Operating Segments
Segment Reporting Information [Line Items]
Premium and service revenues	2	1	2	2
Commercial | Premium and service revenues | Operating Segments
Segment Reporting Information [Line Items]
Premium and service revenues	6,453	4,292	17,439	12,979
Other/Eliminations
Segment Reporting Information [Line Items]
Revenues	1,465	2,641	4,606	9,150
Medical costs	321	693	1,092	2,135
Cost of services	856	1,571	2,601	5,658
Gross margin	288	377	913	1,357
Other/Eliminations | Operating Segments
Segment Reporting Information [Line Items]
Premium tax	0	0	0	0
Total external revenues	1,465	2,641	4,606	9,150
Revenues	3,978	6,420	11,634	18,856
Other/Eliminations | Eliminations
Segment Reporting Information [Line Items]
Revenues	(3,978)	(6,420)	(11,634)	(18,856)
Other/Eliminations | Premium | Operating Segments
Segment Reporting Information [Line Items]
Premium and service revenues	366	764	1,255	2,472
Other/Eliminations | Service | Operating Segments
Segment Reporting Information [Line Items]
Premium and service revenues	1,099	1,877	3,351	6,678
Other/Eliminations | Premium and service revenues | Operating Segments
Segment Reporting Information [Line Items]
Premium and service revenues	$ 1,465	$ 2,641	$ 4,606	$ 9,150

Contingencies (Details)

Contingencies (Details) - Pending Litigation $ in Millions	Sep. 30, 2021 claim	Jun. 30, 2021 USD ($)
Loss Contingencies [Line Items]
Pending claims | claim	3
Reserve estimate | $		$ 1,250