Centene (CNC) 10-Q 25 Apr 24 2024 Q1 Quarterly report Financial data

Cover

Cover - shares shares in Thousands	3 Months Ended
	Mar. 31, 2024	Apr. 24, 2024
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Mar. 31, 2024
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		533,656
Entity Central Index Key	0001071739
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2024
Document Fiscal Period Focus	Q1
Amendment Flag	false

CONSOLIDATED BALANCE SHEETS

CONSOLIDATED BALANCE SHEETS - USD ($) $ in Millions	Mar. 31, 2024	Dec. 31, 2023
Assets, Current [Abstract]
Cash and cash equivalents	$ 17,585	$ 17,193
Premium and trade receivables	16,824	15,532
Short-term investments	2,082	2,459
Other current assets	1,957	5,572
Total current assets	38,448	40,756
Long-term investments	16,496	16,286
Restricted deposits	1,383	1,386
Property, software and equipment, net	1,988	2,019
Goodwill	17,558	17,558
Intangible assets, net	5,928	6,101
Other long-term assets	823	535
Total assets	82,624	84,641
Current liabilities:
Medical claims liability	18,109	18,000
Accounts payable and accrued expenses	12,130	16,420
Return of premium payable	1,751	1,462
Unearned revenue	681	715
Current portion of long-term debt	113	119
Total current liabilities	32,784	36,716
Long-term debt	17,887	17,710
Deferred tax liability	734	641
Other long-term liabilities	4,155	3,618
Total liabilities	55,560	58,685
Commitments and contingencies
Redeemable noncontrolling interests	16	19
Stockholders' equity:
Preferred stock, $0.001 par value; authorized 10,000 shares; no shares issued or outstanding at March 31, 2024 and December 31, 2023	0	0
Common stock, $0.001 par value; authorized 800,000 shares; 619,173 issued and 536,383 outstanding at March 31, 2024, and 615,291 issued and 534,484 outstanding at December 31, 2023	1	1
Additional paid-in capital	20,388	20,304
Accumulated other comprehensive (loss)	(630)	(652)
Retained earnings	13,206	12,043
Treasury stock, at cost (82,790 and 80,807 shares, respectively)	(6,007)	(5,856)
Total Centene stockholders' equity	26,958	25,840
Nonredeemable noncontrolling interest	90	97
Total stockholders' equity	27,048	25,937
Total liabilities, redeemable noncontrolling interests and stockholders' equity	$ 82,624	$ 84,641

CONSOLIDATED BALANCE SHEETS (Pa

CONSOLIDATED BALANCE SHEETS (Parenthetical) - $ / shares	Mar. 31, 2024	Dec. 31, 2023
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)	619,173,000	615,291,000
Common stock, shares outstanding (in shares)	536,383,000	534,484,000
Treasury stock (in shares)	82,790,000	80,807,000

CONSOLIDATED STATEMENTS OF OPER

CONSOLIDATED STATEMENTS OF OPERATIONS - USD ($) shares in Thousands, $ in Millions	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Revenues:
Premium and service revenues	$ 36,337	$ 34,952
Premium tax	4,070	3,937
Total revenues	40,407	38,889
Expenses:
Medical costs	30,932	29,434
Cost of services	669	870
Selling, general and administrative expenses	3,218	3,011
Depreciation expense	135	142
Amortization of acquired intangible assets	173	183
Premium tax expense	4,161	4,011
Impairment	13	20
Total operating expenses	39,301	37,671
Earnings from operations	1,106	1,218
Other income (expense):
Investment and other income	545	353
Interest expense	(178)	(180)
Earnings before income tax	1,473	1,391
Income tax expense	315	261
Net earnings	1,158	1,130
Loss attributable to noncontrolling interests	5	0
Net earnings attributable to Centene Corporation	$ 1,163	$ 1,130
Net earnings per common share attributable to Centene Corporation:
Basic earnings per common share (in dollars per share)	$ 2.17	$ 2.05
Diluted earnings per common share (in dollars per share)	$ 2.16	$ 2.04
Weighted average number of common shares outstanding:
Basic (in shares)	535,109	550,779
Diluted (in shares)	538,060	553,845
Premium
Revenues:
Premium and service revenues	$ 35,529	$ 33,825
Service
Revenues:
Premium and service revenues	$ 808	$ 1,127

CONSOLIDATED STATEMENTS OF COMP

CONSOLIDATED STATEMENTS OF COMPREHENSIVE EARNINGS (LOSS) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Statement of Comprehensive Income [Abstract]
Net earnings	$ 1,158	$ 1,130
Change in unrealized gain (loss) on investments	(81)	253
Change in unrealized gain (loss) on investments, tax effect	15	(61)
Change in unrealized gain (loss) on investments, net of tax	(66)	192
Reclassification adjustment, net of tax	88	2
Foreign currency translation adjustments, net of tax	0	23
Other comprehensive earnings	22	217
Comprehensive earnings	1,180	1,347
Comprehensive loss attributable to noncontrolling interests	5	0
Comprehensive earnings attributable to Centene Corporation	$ 1,185	$ 1,347

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, 2022		607,847
Treasury stock (in shares) at Dec. 31, 2022						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		0
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 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, 2023	534,484	615,291
Treasury stock (in shares) at Dec. 31, 2023	80,807					80,807
Balance at Dec. 31, 2023	$ 25,937	$ 1	20,304	(652)	12,043	$ (5,856)	97
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net earnings (loss)	1,159				1,163		(4)
Other comprehensive earnings (loss), net of tax	22			22
Common stock issued for employee benefit plans (in shares)		3,882
Common stock issued for employee benefit plans	14		14
Common stock repurchases (in shares)						1,983
Common stock repurchases	(151)					$ (151)
Stock compensation expense	70		70
Divestiture of noncontrolling interest	$ (3)						(3)
Balance (in shares) at Mar. 31, 2024	536,383	619,173
Treasury stock (in shares) at Mar. 31, 2024	82,790					82,790
Balance at Mar. 31, 2024	$ 27,048	$ 1	$ 20,388	$ (630)	$ 13,206	$ (6,007)	$ 90

CONSOLIDATED STATEMENTS OF ST_2

CONSOLIDATED STATEMENTS OF STOCKHOLDERS' EQUITY (Parenthetical) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023	Dec. 31, 2023	Dec. 31, 2022
Par value (in dollars per share)	$ 0.001		$ 0.001
Other comprehensive earning (loss), tax	$ (12)	$ 61
Common Stock
Par value (in dollars per share)	$ 0.001	$ 0.001	0.001	$ 0.001
Treasury Stock
Par value (in dollars per share)	$ 0.001	$ 0.001	$ 0.001	$ 0.001

CONSOLIDATED STATEMENTS OF CASH

CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Cash flows from operating activities:
Net earnings	$ 1,158	$ 1,130
Adjustments to reconcile net earnings to net cash (used in) provided by operating activities
Depreciation and amortization	308	325
Stock compensation expense	70	61
Impairment	13	20
Deferred income taxes	104	(159)
(Gain) loss on divestitures, net	(98)	(79)
Other adjustments, net	(2)	7
Changes in assets and liabilities
Premium and trade receivables	(1,211)	(1,938)
Other assets	(474)	(315)
Medical claims liabilities	108	759
Unearned revenue	(34)	1,919
Accounts payable and accrued expenses	(1,411)	1,548
Other long-term liabilities	1,013	970
Other operating activities, net	0	21
Net cash (used in) provided by operating activities	(456)	4,269
Cash flows from investing activities:
Capital expenditures	(151)	(225)
Purchases of investments	(1,317)	(1,619)
Sales and maturities of investments	1,441	1,148
Divestiture proceeds, net of divested cash	879	443
Net cash provided by (used in) investing activities	852	(253)
Cash flows from financing activities:
Proceeds from long-term debt	350	287
Payments and repurchases of long-term debt	(187)	0
Common stock repurchases	(151)	(423)
Proceeds from common stock issuances	14	12
Purchase of noncontrolling interest	0	(58)
Other financing activities, net	(3)	(1)
Net cash provided by (used in) financing activities	23	(183)
Effect of exchange rate changes on cash, cash equivalents and restricted cash	6	2
Net increase in cash, cash equivalents and restricted cash and cash equivalents	425	3,835
Cash, cash equivalents and restricted cash and cash equivalents, beginning of period	17,452	12,330
Cash, cash equivalents and restricted cash and cash equivalents, end of period	17,877	16,165
Supplemental disclosures of cash flow information:
Interest paid	155	144
Income taxes paid	13	11
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	17,585	15,853
Restricted cash and cash equivalents, included in restricted deposits	292	312
Total cash, cash equivalents and restricted cash and cash equivalents	$ 17,877	$ 16,165

Organization and Operations

Organization and Operations	3 Months Ended
	Mar. 31, 2024
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 Annual Report on Form 10-K for the fiscal year ended December 31, 2023. The unaudited interim financial statements herein have been prepared pursuant to the rules and regulations of the Securities and Exchange Commission (SEC). Accordingly, footnote disclosures that would substantially duplicate the disclosures contained in the December 31, 2023 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 2023 amounts in the consolidated financial statements and notes to the consolidated financial statements have been reclassified to conform to the 2024 presentation. These reclassifications have no effect on net earnings or stockholders' equity as previously reported. Accounting Guidance Not Yet Adopted In November 2023, the Financial Accounting Standards Board (FASB) issued an Accounting Standards Update (ASU) which is intended to improve reportable segment disclosure requirements, primarily through enhanced disclosures about significant expenses. The amendments will require public entities to disclose significant segment expenses that are regularly provided to the chief operating decision-maker and included within segment profit and loss. The new standard is effective for annual periods beginning after December 15, 2023, and for interim periods within fiscal years beginning after December 15, 2024. The Company is currently evaluating the effect of the new disclosure requirements. In December 2023, the FASB issued an ASU which includes amendments that further enhance income tax disclosures, primarily through standardization and disaggregation of rate reconciliation categories and income taxes paid by jurisdiction. The new standard is effective for annual periods beginning after December 15, 2024. The Company is currently evaluating the effect of the new disclosure requirements. In March 2024, the SEC adopted the final rule under SEC Release No. 33-11275, The Enhancement and Standardization of Climate-Related Disclosures for Investors. This rule will require disclosure of material climate-related risks and material direct greenhouse gas emissions from operations owned or controlled (Scope 1) and/or material indirect greenhouse gas emissions from purchased energy consumed in owned or controlled operations (Scope 2). Additionally, the rules require disclosure in the notes to the financial statements of the effects of severe weather events and other natural conditions, subject to certain materiality thresholds. The disclosure requirements will begin phasing in for reports and registration statements including financial information with respect to annual periods beginning in 2025. In April 2024, the SEC voluntarily stayed the final rule pending the completion of judicial review by the Court of Appeals for the Eighth Circuit. The Company is monitoring the development of litigation related to the SEC's rule, and is currently evaluating the effect of the new disclosure requirements.

Acquisitions and Divestitures

Acquisitions and Divestitures	3 Months Ended
	Mar. 31, 2024
Business Combination and Asset Acquisition [Abstract]
Acquisitions and Divestitures	Acquisitions and Divestitures Magellan Specialty Health Divestiture During the first quarter of 2024, the Company recorded an additional gain on the previously reported divestiture of Magellan Specialty Health of $81 million for achievement of contingent consideration related to the sale, which 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. In accordance with the signed definitive agreement in the third quarter of 2023, and subsequently updated in the fourth quarter of 2023, the Company recorded impairment charges related to goodwill associated with the pending divestiture totaling $292 million, or $258 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 expired on the earlier of the divestiture closing date or March 28, 2024. The gain or loss due to changes in the fair value of the foreign currency swap was recorded in other comprehensive income until the Circle Health divestiture closed, at which time the gain or loss was recorded in earnings to the same line in the Consolidated Statement of Operations as the gain or loss on sale. On January 12, 2024, the Company completed the divestiture for $931 million. Upon closing the divestiture, the Company settled the foreign currency swap and recorded a corresponding gain of $10 million, which includes the cumulative translation adjustment previously recorded in accumulated other comprehensive income in the Consolidated Balance Sheet. The gain is included in investment and other income in the Consolidated Statements of Operations. The Company realized a net tax benefit of approximately $45 million in the first quarter of 2024 on the loss recognized on the divestiture.

Short-term and Long-term Invest

Short-term and Long-term Investments, Restricted Deposits	3 Months Ended
	Mar. 31, 2024
Investments, Debt and Equity Securities [Abstract]
Short-term and Long-term Investments, Restricted Deposits	Short-term and Long-term Investments, Restricted Deposits Short-term and long-term investments and restricted deposits by investment type consist of the following ($ in millions): March 31, 2024 December 31, 2023 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 $ 390 $ — $ (8) $ 382 $ 403 $ — $ (8) $ 395 Corporate securities 10,262 43 (476) 9,829 9,984 78 (461) 9,601 Restricted certificates of deposit 4 — — 4 4 — — 4 Restricted cash equivalents 292 — — 292 259 — — 259 Short-term time deposits 289 — — 289 746 — — 746 Municipal securities 4,182 13 (177) 4,018 4,135 21 (171) 3,985 Asset-backed securities 1,648 8 (31) 1,625 1,665 8 (35) 1,638 Residential mortgage-backed securities 1,511 2 (120) 1,393 1,503 7 (103) 1,407 Commercial mortgage-backed securities 1,167 4 (80) 1,091 1,149 5 (82) 1,072 Equity securities 16 — — 16 17 — — 17 Private equity investments 837 — — 837 833 — — 833 Life insurance contracts 185 — — 185 174 — — 174 Total $ 20,783 $ 70 $ (892) $ 19,961 $ 20,872 $ 119 $ (860) $ 20,131 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 March 31, 2024, 99% of the Company's investments in rated securities carry an investment grade rating by nationally recognized statistical rating organizations. At March 31, 2024, 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 $161 million and $153 million at March 31, 2024 and December 31, 2023, respectively, and is included in other current assets in the Consolidated Balance Sheets. The Company's residential mortgage-backed securities are primarily issued by the Federal National Mortgage Association, Government National Mortgage Association or Federal Home Loan Mortgage Corporation, which carry implicit or explicit guarantees of the U.S. government. The Company's commercial mortgage-backed securities are primarily senior tranches with a weighted average rating of AA+ and a weighted average duration of 4 years at March 31, 2024. The fair value of available-for-sale debt securities with gross unrealized losses by investment type and length of time that individual securities have been in a continuous unrealized loss position were as follows ($ in millions): March 31, 2024 December 31, 2023 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 $ — $ 136 $ (8) $ 214 $ — $ 79 $ (8) $ 232 Corporate securities (14) 1,462 (462) 6,031 (6) 658 (455) 6,260 Municipal securities (9) 972 (168) 2,223 (4) 553 (167) 2,237 Asset-backed securities (2) 411 (29) 479 (2) 197 (33) 855 Residential mortgage-backed securities (6) 357 (114) 805 (2) 153 (101) 814 Commercial mortgage-backed securities (3) 145 (77) 744 (2) 114 (80) 754 Short-term time deposits — 3 — — — 31 — — Total $ (34) $ 3,486 $ (858) $ 10,496 $ (16) $ 1,785 $ (844) $ 11,152 As of March 31, 2024, the gross unrealized losses were generated from 4,915 positions out of a total of 6,742 positions. The change in fair value of available-for-sale debt securities is primarily a result of movement in interest rates subsequent to the purchase of the security. For each security in an unrealized loss position, the Company assesses whether it intends to sell the security or if it is more likely than not the Company will be required to sell the security before recovery of the amortized cost basis for reasons such as liquidity, contractual or regulatory purposes. If the security meets this criterion, the decline in fair value is recorded in earnings. The Company does not intend to sell these securities prior to maturity and it is not likely that the Company will be required to sell these securities prior to maturity; therefore, the Company did not record an impairment for these securities. In addition, the Company monitors available-for-sale debt securities for credit losses. Certain investments have experienced a decline in fair value due to changes in credit quality, market interest rates and/or general economic conditions. The Company recognizes an allowance when evidence demonstrates that the decline in fair value is credit related. Evidence of a credit-related loss may include rating agency actions, adverse conditions specifically related to the security or failure of the issuer of the security to make scheduled payments. The contractual maturities of short-term and long-term debt securities and restricted deposits are as follows ($ in millions): March 31, 2024 December 31, 2023 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 $ 1,932 $ 1,906 $ 641 $ 639 $ 2,308 $ 2,284 $ 566 $ 564 One year through five years 7,848 7,518 488 465 7,738 7,431 527 504 Five years through ten years 4,038 3,832 281 267 3,905 3,735 298 283 Greater than ten years 178 175 13 12 155 154 34 35 Asset-backed securities 4,326 4,109 — — 4,317 4,117 — — Total $ 18,322 $ 17,540 $ 1,423 $ 1,383 $ 18,423 $ 17,721 $ 1,425 $ 1,386 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	3 Months Ended
	Mar. 31, 2024
Fair Value Disclosures [Abstract]
Fair Value Measurements	Fair Value Measurements Assets and liabilities recorded at fair value in the Consolidated Balance Sheets are categorized based upon observable or unobservable inputs used to estimate fair value. Level inputs are as follows: Level Input: Input Definition: Level I Inputs are unadjusted, quoted prices for identical assets or liabilities in active markets at the measurement date. Level II Inputs other than quoted prices included in Level I that are observable for the asset or liability through corroboration with market data at the measurement date. Level III Unobservable inputs that reflect management's best estimate of what market participants would use in pricing the asset or liability at the measurement date. The following table summarizes fair value measurements by level at March 31, 2024, 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 $ 17,585 $ — $ — $ 17,585 Investments: U.S. Treasury securities and obligations of U.S. government corporations and agencies $ 59 $ — $ — $ 59 Corporate securities — 9,791 — 9,791 Municipal securities — 3,292 — 3,292 Short-term time deposits — 289 — 289 Asset-backed securities — 1,625 — 1,625 Residential mortgage-backed securities — 1,393 — 1,393 Commercial mortgage-backed securities — 1,091 — 1,091 Equity securities 14 2 — 16 Total investments $ 73 $ 17,483 $ — $ 17,556 Restricted deposits: Cash and cash equivalents $ 292 $ — $ — $ 292 U.S. Treasury securities and obligations of U.S. government corporations and agencies 323 — — 323 Corporate securities — 38 — 38 Certificates of deposit — 4 — 4 Municipal securities — 726 — 726 Total restricted deposits $ 615 $ 768 $ — $ 1,383 Total assets at fair value $ 18,273 $ 18,251 $ — $ 36,524 The following table summarizes fair value measurements by level at December 31, 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 $ 17,193 $ — $ — $ 17,193 Investments: U.S. Treasury securities and obligations of U.S. government corporations and agencies $ 62 $ — $ — $ 62 Corporate securities — 9,564 — 9,564 Municipal securities — 3,232 — 3,232 Short-term time deposits — 746 — 746 Asset backed securities — 1,638 — 1,638 Residential mortgage-backed securities — 1,407 — 1,407 Commercial mortgage-backed securities — 1,072 — 1,072 Equity securities 15 2 — 17 Total investments $ 77 $ 17,661 $ — $ 17,738 Restricted deposits: Cash and cash equivalents $ 259 $ — $ — $ 259 U.S. Treasury securities and obligations of U.S. government corporations and agencies 333 — — 333 Corporate securities — 37 — 37 Certificates of deposit — 4 — 4 Municipal securities — 753 — 753 Total restricted deposits $ 592 $ 794 $ — $ 1,386 Total assets at fair value $ 17,862 $ 18,455 $ — $ 36,317 Liabilities Accounts payable and accrued expenses: Foreign currency swap agreement $ — $ 13 $ — $ 13 Total liabilities at fair value $ — $ 13 $ — $ 13 The Company utilizes matrix-pricing services to estimate fair value for securities which are not actively traded on the measurement date. The Company designates these securities as Level II fair value measurements. In addition, the aggregate carrying amount of the Company's private equity investments and life insurance contracts, which approximates fair value, was $1,022 million and $1,007 million as of March 31, 2024 and December 31, 2023, respectively.

Medical Claims Liability

Medical Claims Liability	3 Months Ended
	Mar. 31, 2024
Insurance [Abstract]
Medical Claims Liability	Medical Claims Liability The following table summarizes the change in medical claims liability for the three months ended March 31, 2024 ($ in millions): Medicaid Medicare Commercial Other Consolidated Total Balance, January 1, 2024 $ 10,814 $ 3,612 $ 3,460 $ 114 $ 18,000 Less: Reinsurance recoverable 5 — 44 — 49 Balance, January 1, 2024, net 10,809 3,612 3,416 114 17,951 Incurred related to: Current year 20,179 5,495 5,884 373 31,931 Prior years (684) (156) (204) (5) (1,049) Total incurred 19,495 5,339 5,680 368 30,882 Paid related to: Current year 12,823 3,266 3,339 258 19,686 Prior years 6,993 2,050 1,973 108 11,124 Total paid 19,816 5,316 5,312 366 30,810 Plus: Premium deficiency reserve — 50 — — 50 Balance, March 31, 2024, net 10,488 3,685 3,784 116 18,073 Plus: Reinsurance recoverable 4 — 32 — 36 Balance, March 31, 2024 $ 10,492 $ 3,685 $ 3,816 $ 116 $ 18,109 The following table summarizes the change in medical claims liability for the three months ended March 31, 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 20,813 5,163 4,177 418 30,571 Prior years (803) (155) (172) (7) (1,137) Total incurred 20,010 5,008 4,005 411 29,434 Paid related to: Current year 12,679 2,988 2,541 294 18,502 Prior years 6,834 2,145 1,063 132 10,174 Total paid 19,513 5,133 3,604 426 28,676 Balance, March 31, 2023, net 11,743 3,306 2,303 125 17,477 Plus: Reinsurance recoverable 9 — 18 — 27 Balance, March 31, 2023 $ 11,752 $ 3,306 $ 2,321 $ 125 $ 17,504 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 $54 million and $159 million as a reduction to premium revenue in the three months ended March 31, 2024 and 2023, 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 March 31, 2024 was $12,311 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. The Company reviews actual and anticipated experience compared to the assumptions used to establish medical costs. The Company establishes premium deficiency reserves if actual and anticipated experience indicates that existing policy liabilities together with the present value of future gross premiums will not be sufficient to cover the present value of future benefits, settlement and maintenance costs. For purposes of determining premium deficiencies, contracts are grouped in a manner consistent with the method of acquiring, servicing and measuring the profitability of such contracts and expected investment income is excluded. In December 2023, the Company recorded a premium deficiency reserve of $250 million related to the 2024 Medicare Advantage contract year, which was increased to $300 million in the first quarter of 2024 consistent with the intra-year flow of seasonality.

Affordable Care Act

Affordable Care Act	3 Months Ended
	Mar. 31, 2024
Affordable Care Act [Abstract]
Affordable Care Act	Affordable Care Act The Affordable Care Act established risk spreading premium stabilization programs as well as a minimum annual medical loss ratio (MLR) and cost sharing reductions. The Company's net receivables (payables) for each of the programs are as follows ($ in millions): March 31, 2024 December 31, 2023 Risk adjustment receivable $ 1,124 $ 893 Risk adjustment payable (3,266) (2,553) Minimum medical loss ratio (237) (164) Cost sharing reduction receivable 18 — Cost sharing reduction payable (113) (114)

Debt

Debt	3 Months Ended
	Mar. 31, 2024
Debt Disclosure [Abstract]
Debt	Debt Debt consists of the following ($ in millions): March 31, 2024 December 31, 2023 $2,500 million 4.25% Senior Notes due December 15, 2027 $ 2,396 $ 2,395 $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 15,676 15,675 Term Loan Facility 2,088 2,115 Revolving Credit Agreement 350 150 Finance leases and other 3 11 Debt issuance costs (117) (122) Total debt 18,000 17,829 Less: current portion (113) (119) Long-term debt $ 17,887 $ 17,710

Stockholders' Equity

Stockholders' Equity	3 Months Ended
	Mar. 31, 2024
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. The Company is authorized to repurchase up to $10,000 million, inclusive of past authorizations. As of March 31, 2024, the Company had a remaining amount of $5,178 million available under the stock repurchase program. In April 2024, the Company repurchased an additional 2.7 million shares for $200 million. The following represents the Company's share repurchase activity ($ in millions, shares in thousands): Three Months Ended March 31, 2024 2023 Shares Cost Shares Cost Share buybacks 681 $ 51 4,852 $ 377 Income tax withholding 1,302 100 696 46 Total share repurchases 1,983 $ 151 5,548 $ 423 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	3 Months Ended
	Mar. 31, 2024
Earnings Per Share [Abstract]
Earnings Per Share	Earnings Per Share The following table sets forth the calculation of basic and diluted net earnings per common share ($ in millions, except per share data in dollars and shares in thousands): Three Months Ended March 31, 2024 2023 Earnings attributable to Centene Corporation $ 1,163 $ 1,130 Shares used in computing per share amounts: Weighted average number of common shares outstanding 535,109 550,779 Common stock equivalents (as determined by applying the treasury stock method) 2,951 3,066 Weighted average number of common shares and potential dilutive common shares outstanding 538,060 553,845 Net earnings per common share attributable to Centene Corporation: Basic earnings per common share $ 2.17 $ 2.05 Diluted earnings per common share $ 2.16 $ 2.04 The calculation of diluted earnings per common share for the three months ended March 31, 2024 and 2023 excludes 684 thousand shares and 1,606 thousand shares, respectively, related to anti-dilutive stock options, restricted stock and restricted stock units.

Segment Information

Segment Information	3 Months Ended
	Mar. 31, 2024
Segment Reporting [Abstract]
Segment Information	Segment Information The Company operates in four segments: (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. The Other segment includes the Company's pharmacy operations, Envolve Benefit Options' vision and dental services, clinical healthcare, behavioral health, international operations, and corporate management companies, among others. The Company's international businesses, Operose Health Group (Operose Health) and Circle Health, were divested in December 2023 and January 2024, respectively. 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 March 31, 2024, is as follows ($ in millions): Medicaid Medicare Commercial Other/Eliminations Consolidated Total Premium $ 21,438 $ 5,935 $ 7,750 $ 406 $ 35,529 Service 22 — 1 785 808 Premium and service revenues 21,460 5,935 7,751 1,191 36,337 Premium tax 4,070 — — — 4,070 Total external revenues 25,530 5,935 7,751 1,191 40,407 Internal revenues — — — 4,080 4,080 Eliminations — — — (4,080) (4,080) Total revenues $ 25,530 $ 5,935 $ 7,751 $ 1,191 $ 40,407 Medical costs $ 19,495 $ 5,389 $ 5,680 $ 368 $ 30,932 Cost of services $ 21 $ — $ — $ 648 $ 669 Gross margin (1) $ 1,944 $ 546 $ 2,071 $ 175 $ 4,736 (1) Gross margin represents premium and service revenues less medical costs and cost of services. Segment information for the three months ended March 31, 2023, is as follows ($ in millions): Medicaid Medicare Commercial Other/Eliminations Consolidated Total Premium $ 22,227 $ 5,876 $ 5,252 $ 470 $ 33,825 Service — — — 1,127 1,127 Premium and service revenues 22,227 5,876 5,252 1,597 34,952 Premium tax 3,937 — — — 3,937 Total external revenues 26,164 5,876 5,252 1,597 38,889 Internal revenues — — — 3,867 3,867 Eliminations — — — (3,867) (3,867) Total revenues $ 26,164 $ 5,876 $ 5,252 $ 1,597 $ 38,889 Medical costs $ 20,010 $ 5,008 $ 4,005 $ 411 $ 29,434 Cost of services $ — $ — $ — $ 870 $ 870 Gross margin (1) $ 2,217 $ 868 $ 1,247 $ 316 $ 4,648 (1) Gross margin represents premium and service revenues less medical costs and cost of services.

Contingencies

Contingencies	3 Months Ended
	Mar. 31, 2024
Commitments and Contingencies Disclosure [Abstract]
Contingencies	Contingencies 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, compliance with CMS Medicare and Marketplace regulations, including risk adjustment and broker compensation, compliance with 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 (HIPAA) 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, vendor disputes 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, vendors 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 previously disclosed in the Company's 2023 Annual Report on Form 10-K 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. The Company has reached no-fault settlement agreements related to services previously provided by Envolve with the vast majority of states impacted. Such agreements have provided for payment amounts consistent with the initial reserve estimate established in the second quarter of 2021 related to this issue. 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. 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.

Pay vs Performance Disclosure

Pay vs Performance Disclosure - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Pay vs Performance Disclosure
Net earnings (loss)	$ 1,163	$ 1,130

Insider Trading Arrangements

Insider Trading Arrangements	3 Months Ended
	Mar. 31, 2024
Trading Arrangements, by Individual
Rule 10b5-1 Arrangement Adopted	false
Non-Rule 10b5-1 Arrangement Adopted	false
Rule 10b5-1 Arrangement Terminated	false
Non-Rule 10b5-1 Arrangement Terminated	false

Organization and Operations (Po

Organization and Operations (Policies)	3 Months Ended
	Mar. 31, 2024
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 Annual Report on Form 10-K for the fiscal year ended December 31, 2023. The unaudited interim financial statements herein have been prepared pursuant to the rules and regulations of the Securities and Exchange Commission (SEC). Accordingly, footnote disclosures that would substantially duplicate the disclosures contained in the December 31, 2023 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 2023 amounts in the consolidated financial statements and notes to the consolidated financial statements have been reclassified to conform to the 2024 presentation. These reclassifications have no effect on net earnings or stockholders' equity as previously reported.
Accounting Guidance Not Yet Adopted	Accounting Guidance Not Yet Adopted In November 2023, the Financial Accounting Standards Board (FASB) issued an Accounting Standards Update (ASU) which is intended to improve reportable segment disclosure requirements, primarily through enhanced disclosures about significant expenses. The amendments will require public entities to disclose significant segment expenses that are regularly provided to the chief operating decision-maker and included within segment profit and loss. The new standard is effective for annual periods beginning after December 15, 2023, and for interim periods within fiscal years beginning after December 15, 2024. The Company is currently evaluating the effect of the new disclosure requirements. In December 2023, the FASB issued an ASU which includes amendments that further enhance income tax disclosures, primarily through standardization and disaggregation of rate reconciliation categories and income taxes paid by jurisdiction. The new standard is effective for annual periods beginning after December 15, 2024. The Company is currently evaluating the effect of the new disclosure requirements. In March 2024, the SEC adopted the final rule under SEC Release No. 33-11275, The Enhancement and Standardization of Climate-Related Disclosures for Investors. This rule will require disclosure of material climate-related risks and material direct greenhouse gas emissions from operations owned or controlled (Scope 1) and/or material indirect greenhouse gas emissions from purchased energy consumed in owned or controlled operations (Scope 2). Additionally, the rules require disclosure in the notes to the financial statements of the effects of severe weather events and other natural conditions, subject to certain materiality thresholds. The disclosure requirements will begin phasing in for reports and registration statements including financial information with respect to annual periods beginning in 2025. In April 2024, the SEC voluntarily stayed the final rule pending the completion of judicial review by the Court of Appeals for the Eighth Circuit. The Company is monitoring the development of litigation related to the SEC's rule, and is currently evaluating the effect of the new disclosure requirements.

Short-term and Long-term Inve_2

Short-term and Long-term Investments, Restricted Deposits (Tables)	3 Months Ended
	Mar. 31, 2024
Investments, Debt and Equity Securities [Abstract]
Short-term and long-term investments and restricted deposits by investment type	Short-term and long-term investments and restricted deposits by investment type consist of the following ($ in millions): March 31, 2024 December 31, 2023 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 $ 390 $ — $ (8) $ 382 $ 403 $ — $ (8) $ 395 Corporate securities 10,262 43 (476) 9,829 9,984 78 (461) 9,601 Restricted certificates of deposit 4 — — 4 4 — — 4 Restricted cash equivalents 292 — — 292 259 — — 259 Short-term time deposits 289 — — 289 746 — — 746 Municipal securities 4,182 13 (177) 4,018 4,135 21 (171) 3,985 Asset-backed securities 1,648 8 (31) 1,625 1,665 8 (35) 1,638 Residential mortgage-backed securities 1,511 2 (120) 1,393 1,503 7 (103) 1,407 Commercial mortgage-backed securities 1,167 4 (80) 1,091 1,149 5 (82) 1,072 Equity securities 16 — — 16 17 — — 17 Private equity investments 837 — — 837 833 — — 833 Life insurance contracts 185 — — 185 174 — — 174 Total $ 20,783 $ 70 $ (892) $ 19,961 $ 20,872 $ 119 $ (860) $ 20,131
Fair value of available-for-sale investments with gross unrealized losses by investment type and length of time	The fair value of available-for-sale debt securities with gross unrealized losses by investment type and length of time that individual securities have been in a continuous unrealized loss position were as follows ($ in millions): March 31, 2024 December 31, 2023 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 $ — $ 136 $ (8) $ 214 $ — $ 79 $ (8) $ 232 Corporate securities (14) 1,462 (462) 6,031 (6) 658 (455) 6,260 Municipal securities (9) 972 (168) 2,223 (4) 553 (167) 2,237 Asset-backed securities (2) 411 (29) 479 (2) 197 (33) 855 Residential mortgage-backed securities (6) 357 (114) 805 (2) 153 (101) 814 Commercial mortgage-backed securities (3) 145 (77) 744 (2) 114 (80) 754 Short-term time deposits — 3 — — — 31 — — Total $ (34) $ 3,486 $ (858) $ 10,496 $ (16) $ 1,785 $ (844) $ 11,152
Contractual maturities of short-term and long-term investments and restricted deposits	The contractual maturities of short-term and long-term debt securities and restricted deposits are as follows ($ in millions): March 31, 2024 December 31, 2023 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 $ 1,932 $ 1,906 $ 641 $ 639 $ 2,308 $ 2,284 $ 566 $ 564 One year through five years 7,848 7,518 488 465 7,738 7,431 527 504 Five years through ten years 4,038 3,832 281 267 3,905 3,735 298 283 Greater than ten years 178 175 13 12 155 154 34 35 Asset-backed securities 4,326 4,109 — — 4,317 4,117 — — Total $ 18,322 $ 17,540 $ 1,423 $ 1,383 $ 18,423 $ 17,721 $ 1,425 $ 1,386

Fair Value Measurements (Tables

Fair Value Measurements (Tables)	3 Months Ended
	Mar. 31, 2024
Fair Value Disclosures [Abstract]
Assets and Liabilities, Based Upon Observable or Unobservable Inputs, Level Input Definitions	Assets and liabilities recorded at fair value in the Consolidated Balance Sheets are categorized based upon observable or unobservable inputs used to estimate fair value. Level inputs are as follows: Level Input: Input Definition: Level I Inputs are unadjusted, quoted prices for identical assets or liabilities in active markets at the measurement date. Level II Inputs other than quoted prices included in Level I that are observable for the asset or liability through corroboration with market data at the measurement date. Level III Unobservable inputs that reflect management's best estimate of what market participants would use in pricing the asset or liability at the measurement date.
Fair Value Measurements by Level for Assets and Liabilities Measured at Fair Value on a Recurring Basis	The following table summarizes fair value measurements by level at March 31, 2024, 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 $ 17,585 $ — $ — $ 17,585 Investments: U.S. Treasury securities and obligations of U.S. government corporations and agencies $ 59 $ — $ — $ 59 Corporate securities — 9,791 — 9,791 Municipal securities — 3,292 — 3,292 Short-term time deposits — 289 — 289 Asset-backed securities — 1,625 — 1,625 Residential mortgage-backed securities — 1,393 — 1,393 Commercial mortgage-backed securities — 1,091 — 1,091 Equity securities 14 2 — 16 Total investments $ 73 $ 17,483 $ — $ 17,556 Restricted deposits: Cash and cash equivalents $ 292 $ — $ — $ 292 U.S. Treasury securities and obligations of U.S. government corporations and agencies 323 — — 323 Corporate securities — 38 — 38 Certificates of deposit — 4 — 4 Municipal securities — 726 — 726 Total restricted deposits $ 615 $ 768 $ — $ 1,383 Total assets at fair value $ 18,273 $ 18,251 $ — $ 36,524 The following table summarizes fair value measurements by level at December 31, 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 $ 17,193 $ — $ — $ 17,193 Investments: U.S. Treasury securities and obligations of U.S. government corporations and agencies $ 62 $ — $ — $ 62 Corporate securities — 9,564 — 9,564 Municipal securities — 3,232 — 3,232 Short-term time deposits — 746 — 746 Asset backed securities — 1,638 — 1,638 Residential mortgage-backed securities — 1,407 — 1,407 Commercial mortgage-backed securities — 1,072 — 1,072 Equity securities 15 2 — 17 Total investments $ 77 $ 17,661 $ — $ 17,738 Restricted deposits: Cash and cash equivalents $ 259 $ — $ — $ 259 U.S. Treasury securities and obligations of U.S. government corporations and agencies 333 — — 333 Corporate securities — 37 — 37 Certificates of deposit — 4 — 4 Municipal securities — 753 — 753 Total restricted deposits $ 592 $ 794 $ — $ 1,386 Total assets at fair value $ 17,862 $ 18,455 $ — $ 36,317 Liabilities Accounts payable and accrued expenses: Foreign currency swap agreement $ — $ 13 $ — $ 13 Total liabilities at fair value $ — $ 13 $ — $ 13

Medical Claims Liability (Table

Medical Claims Liability (Tables)	3 Months Ended
	Mar. 31, 2024
Insurance [Abstract]
Schedule of change in medical claims liability	The following table summarizes the change in medical claims liability for the three months ended March 31, 2024 ($ in millions): Medicaid Medicare Commercial Other Consolidated Total Balance, January 1, 2024 $ 10,814 $ 3,612 $ 3,460 $ 114 $ 18,000 Less: Reinsurance recoverable 5 — 44 — 49 Balance, January 1, 2024, net 10,809 3,612 3,416 114 17,951 Incurred related to: Current year 20,179 5,495 5,884 373 31,931 Prior years (684) (156) (204) (5) (1,049) Total incurred 19,495 5,339 5,680 368 30,882 Paid related to: Current year 12,823 3,266 3,339 258 19,686 Prior years 6,993 2,050 1,973 108 11,124 Total paid 19,816 5,316 5,312 366 30,810 Plus: Premium deficiency reserve — 50 — — 50 Balance, March 31, 2024, net 10,488 3,685 3,784 116 18,073 Plus: Reinsurance recoverable 4 — 32 — 36 Balance, March 31, 2024 $ 10,492 $ 3,685 $ 3,816 $ 116 $ 18,109 The following table summarizes the change in medical claims liability for the three months ended March 31, 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 20,813 5,163 4,177 418 30,571 Prior years (803) (155) (172) (7) (1,137) Total incurred 20,010 5,008 4,005 411 29,434 Paid related to: Current year 12,679 2,988 2,541 294 18,502 Prior years 6,834 2,145 1,063 132 10,174 Total paid 19,513 5,133 3,604 426 28,676 Balance, March 31, 2023, net 11,743 3,306 2,303 125 17,477 Plus: Reinsurance recoverable 9 — 18 — 27 Balance, March 31, 2023 $ 11,752 $ 3,306 $ 2,321 $ 125 $ 17,504

Affordable Care Act (Tables)

Affordable Care Act (Tables)	3 Months Ended
	Mar. 31, 2024
Affordable Care Act [Abstract]
Schedule of net receivables (payables) related to the Affordable Care Act Programs	The Company's net receivables (payables) for each of the programs are as follows ($ in millions): March 31, 2024 December 31, 2023 Risk adjustment receivable $ 1,124 $ 893 Risk adjustment payable (3,266) (2,553) Minimum medical loss ratio (237) (164) Cost sharing reduction receivable 18 — Cost sharing reduction payable (113) (114)

Debt (Tables)

Debt (Tables)	3 Months Ended
	Mar. 31, 2024
Debt Disclosure [Abstract]
Schedule of Debt	Debt consists of the following ($ in millions): March 31, 2024 December 31, 2023 $2,500 million 4.25% Senior Notes due December 15, 2027 $ 2,396 $ 2,395 $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 15,676 15,675 Term Loan Facility 2,088 2,115 Revolving Credit Agreement 350 150 Finance leases and other 3 11 Debt issuance costs (117) (122) Total debt 18,000 17,829 Less: current portion (113) (119) Long-term debt $ 17,887 $ 17,710

Stockholders' Equity (Tables)

Stockholders' Equity (Tables)	3 Months Ended
	Mar. 31, 2024
Equity [Abstract]
Share Repurchase Activity	The following represents the Company's share repurchase activity ($ in millions, shares in thousands): Three Months Ended March 31, 2024 2023 Shares Cost Shares Cost Share buybacks 681 $ 51 4,852 $ 377 Income tax withholding 1,302 100 696 46 Total share repurchases 1,983 $ 151 5,548 $ 423

Earnings Per Share (Tables)

Earnings Per Share (Tables)	3 Months Ended
	Mar. 31, 2024
Earnings Per Share [Abstract]
Calculation of Basic and Diluted Net Earnings Per Common Share	The following table sets forth the calculation of basic and diluted net earnings per common share ($ in millions, except per share data in dollars and shares in thousands): Three Months Ended March 31, 2024 2023 Earnings attributable to Centene Corporation $ 1,163 $ 1,130 Shares used in computing per share amounts: Weighted average number of common shares outstanding 535,109 550,779 Common stock equivalents (as determined by applying the treasury stock method) 2,951 3,066 Weighted average number of common shares and potential dilutive common shares outstanding 538,060 553,845 Net earnings per common share attributable to Centene Corporation: Basic earnings per common share $ 2.17 $ 2.05 Diluted earnings per common share $ 2.16 $ 2.04

Segment Information (Tables)

Segment Information (Tables)	3 Months Ended
	Mar. 31, 2024
Segment Reporting [Abstract]
Segment Information	Segment information for the three months ended March 31, 2024, is as follows ($ in millions): Medicaid Medicare Commercial Other/Eliminations Consolidated Total Premium $ 21,438 $ 5,935 $ 7,750 $ 406 $ 35,529 Service 22 — 1 785 808 Premium and service revenues 21,460 5,935 7,751 1,191 36,337 Premium tax 4,070 — — — 4,070 Total external revenues 25,530 5,935 7,751 1,191 40,407 Internal revenues — — — 4,080 4,080 Eliminations — — — (4,080) (4,080) Total revenues $ 25,530 $ 5,935 $ 7,751 $ 1,191 $ 40,407 Medical costs $ 19,495 $ 5,389 $ 5,680 $ 368 $ 30,932 Cost of services $ 21 $ — $ — $ 648 $ 669 Gross margin (1) $ 1,944 $ 546 $ 2,071 $ 175 $ 4,736 (1) Gross margin represents premium and service revenues less medical costs and cost of services. Segment information for the three months ended March 31, 2023, is as follows ($ in millions): Medicaid Medicare Commercial Other/Eliminations Consolidated Total Premium $ 22,227 $ 5,876 $ 5,252 $ 470 $ 33,825 Service — — — 1,127 1,127 Premium and service revenues 22,227 5,876 5,252 1,597 34,952 Premium tax 3,937 — — — 3,937 Total external revenues 26,164 5,876 5,252 1,597 38,889 Internal revenues — — — 3,867 3,867 Eliminations — — — (3,867) (3,867) Total revenues $ 26,164 $ 5,876 $ 5,252 $ 1,597 $ 38,889 Medical costs $ 20,010 $ 5,008 $ 4,005 $ 411 $ 29,434 Cost of services $ — $ — $ — $ 870 $ 870 Gross margin (1) $ 2,217 $ 868 $ 1,247 $ 316 $ 4,648 (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		3 Months Ended		12 Months Ended
	Jan. 12, 2024 USD ($)	Mar. 31, 2024 USD ($)	Mar. 31, 2023 USD ($)	Dec. 31, 2023 USD ($)	Aug. 31, 2023 USD ($)	Aug. 31, 2023 GBP (£)
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Gain (loss) on divestitures		$ 98	$ 79
Income tax benefit		(315)	$ (261)
Magellan Rx | 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 (loss) on divestitures		(81)
Circle Health
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Gain (loss) on divestitures		10
Circle 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]
Proceeds from sale of business	$ 931
Income tax benefit		$ 45
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]
Goodwill impairment				$ 292
Goodwill, impairment, net of tax				$ 258
Currency Swap
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Notional amount					$ 931	£ 740

Short-term and Long-term Inve_3

Short-term and Long-term Investments, Restricted Deposits - By Investment Type (Details) - USD ($) $ in Millions	Mar. 31, 2024	Dec. 31, 2023
Debt Securities
Gross Unrealized Gains	$ 70	$ 119
Gross Unrealized Losses	(892)	(860)
Equity securities	16	17
Private equity investments	837	833
Life insurance contracts	185	174
Total, Amortized Cost	20,783	20,872
Total, Fair Value	19,961	20,131
U.S. Treasury securities and obligations of U.S. government corporations and agencies
Debt Securities
Amortized Cost	390	403
Gross Unrealized Gains	0	0
Gross Unrealized Losses	(8)	(8)
Fair Value	382	395
Corporate securities
Debt Securities
Amortized Cost	10,262	9,984
Gross Unrealized Gains	43	78
Gross Unrealized Losses	(476)	(461)
Fair Value	9,829	9,601
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	292	259
Gross Unrealized Gains	0	0
Gross Unrealized Losses	0	0
Fair Value	292	259
Short-term time deposits
Debt Securities
Amortized Cost	289	746
Gross Unrealized Gains	0	0
Gross Unrealized Losses	0	0
Fair Value	289	746
Municipal securities
Debt Securities
Amortized Cost	4,182	4,135
Gross Unrealized Gains	13	21
Gross Unrealized Losses	(177)	(171)
Fair Value	4,018	3,985
Asset-backed securities
Debt Securities
Amortized Cost	1,648	1,665
Gross Unrealized Gains	8	8
Gross Unrealized Losses	(31)	(35)
Fair Value	1,625	1,638
Residential mortgage-backed securities
Debt Securities
Amortized Cost	1,511	1,503
Gross Unrealized Gains	2	7
Gross Unrealized Losses	(120)	(103)
Fair Value	1,393	1,407
Commercial mortgage-backed securities
Debt Securities
Amortized Cost	1,167	1,149
Gross Unrealized Gains	4	5
Gross Unrealized Losses	(80)	(82)
Fair Value	$ 1,091	$ 1,072

Short-term and Long-term Inve_4

Short-term and Long-term Investments, Restricted Deposits - Narrative (Details) $ in Millions	3 Months Ended
	Mar. 31, 2024 USD ($) position	Dec. 31, 2023 USD ($)
Schedule Of Investments And Restricted Deposits By Type [Line Items]
Accrued interest income | $	$ 161	$ 153
Positions from which gross unrealized losses were generated	4,915
Total investment positions	6,742
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	Mar. 31, 2024	Dec. 31, 2023
Unrealized Losses
Less Than 12 Months	$ (34)	$ (16)
12 Months or More	(858)	(844)
Fair Value
Fair Value, Less Than 12 Months	3,486	1,785
Fair Value, 12 Months or More	10,496	11,152
U.S. Treasury securities and obligations of U.S. government corporations and agencies
Unrealized Losses
Less Than 12 Months	0	0
12 Months or More	(8)	(8)
Fair Value
Fair Value, Less Than 12 Months	136	79
Fair Value, 12 Months or More	214	232
Corporate securities
Unrealized Losses
Less Than 12 Months	(14)	(6)
12 Months or More	(462)	(455)
Fair Value
Fair Value, Less Than 12 Months	1,462	658
Fair Value, 12 Months or More	6,031	6,260
Municipal securities
Unrealized Losses
Less Than 12 Months	(9)	(4)
12 Months or More	(168)	(167)
Fair Value
Fair Value, Less Than 12 Months	972	553
Fair Value, 12 Months or More	2,223	2,237
Asset-backed securities
Unrealized Losses
Less Than 12 Months	(2)	(2)
12 Months or More	(29)	(33)
Fair Value
Fair Value, Less Than 12 Months	411	197
Fair Value, 12 Months or More	479	855
Residential mortgage-backed securities
Unrealized Losses
Less Than 12 Months	(6)	(2)
12 Months or More	(114)	(101)
Fair Value
Fair Value, Less Than 12 Months	357	153
Fair Value, 12 Months or More	805	814
Commercial mortgage-backed securities
Unrealized Losses
Less Than 12 Months	(3)	(2)
12 Months or More	(77)	(80)
Fair Value
Fair Value, Less Than 12 Months	145	114
Fair Value, 12 Months or More	744	754
Short-term time deposits
Unrealized Losses
Less Than 12 Months	0	0
12 Months or More	0	0
Fair Value
Fair Value, Less Than 12 Months	3	31
Fair Value, 12 Months or More	$ 0	$ 0

Short-term and Long-term Inve_6

Short-term and Long-term Investments, Restricted Deposits - Contractual Maturities of Short-Term and Long-Term Investments and Restricted Deposits (Details) - USD ($) $ in Millions	Mar. 31, 2024	Dec. 31, 2023
Investments
Amortized Cost
One year or less	$ 1,932	$ 2,308
One year through five years	7,848	7,738
Five years through ten years	4,038	3,905
Greater than ten years	178	155
Asset-backed securities	4,326	4,317
Amortized Cost	18,322	18,423
Fair Value
One year or less	1,906	2,284
One year through five years	7,518	7,431
Five years through ten years	3,832	3,735
Greater than ten years	175	154
Asset-backed securities	4,109	4,117
Fair Value	17,540	17,721
Restricted Deposits
Amortized Cost
One year or less	641	566
One year through five years	488	527
Five years through ten years	281	298
Greater than ten years	13	34
Asset-backed securities	0	0
Amortized Cost	1,423	1,425
Fair Value
One year or less	639	564
One year through five years	465	504
Five years through ten years	267	283
Greater than ten years	12	35
Asset-backed securities	0	0
Fair Value	$ 1,383	$ 1,386

Fair Value Measurements - Fair

Fair Value Measurements - Fair Value Measurements by Level for Assets and Liabilities Measured at Fair Value on a Recurring Basis (Details) - USD ($) $ in Millions	Mar. 31, 2024	Dec. 31, 2023
Assets
Cash and cash equivalents	$ 17,585	$ 17,193
Investments:
Equity securities	16	17
Total assets at fair value	36,524	36,317
Total liabilities at fair value		13
Accounts payable and accrued expenses: | Currency Swap
Investments:
Derivative liability		13
U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Fair value	382	395
Corporate securities
Investments:
Fair value	9,829	9,601
Municipal securities
Investments:
Fair value	4,018	3,985
Short-term time deposits
Investments:
Fair value	289	746
Asset-backed securities
Investments:
Fair value	1,625	1,638
Residential mortgage-backed securities
Investments:
Fair value	1,393	1,407
Commercial mortgage-backed securities
Investments:
Fair value	1,091	1,072
Level I
Assets
Cash and cash equivalents	17,585	17,193
Investments:
Total assets at fair value	18,273	17,862
Total liabilities at fair value		0
Level I | Accounts payable and accrued expenses: | Currency Swap
Investments:
Derivative liability		0
Level II
Assets
Cash and cash equivalents	0	0
Investments:
Total assets at fair value	18,251	18,455
Total liabilities at fair value		13
Level II | Accounts payable and accrued expenses: | Currency Swap
Investments:
Derivative liability		13
Level III
Assets
Cash and cash equivalents	0	0
Investments:
Total assets at fair value	0	0
Total liabilities at fair value		0
Level III | Accounts payable and accrued expenses: | Currency Swap
Investments:
Derivative liability		0
Investments
Investments:
Fair value	17,540	17,721
Total investments	17,556	17,738
Investments | U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Fair value	59	62
Investments | Corporate securities
Investments:
Fair value	9,791	9,564
Investments | Municipal securities
Investments:
Fair value	3,292	3,232
Investments | Short-term time deposits
Investments:
Fair value	289	746
Investments | Asset-backed securities
Investments:
Fair value	1,625	1,638
Investments | Residential mortgage-backed securities
Investments:
Fair value	1,393	1,407
Investments | Commercial mortgage-backed securities
Investments:
Fair value	1,091	1,072
Investments | Equity Securities
Investments:
Equity securities	16	17
Investments | Level I
Investments:
Total investments	73	77
Investments | Level I | U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Fair value	59	62
Investments | Level I | Corporate securities
Investments:
Fair value	0	0
Investments | Level I | Municipal securities
Investments:
Fair value	0	0
Investments | Level I | Short-term time deposits
Investments:
Fair value	0	0
Investments | Level I | Asset-backed securities
Investments:
Fair value	0	0
Investments | Level I | Residential mortgage-backed securities
Investments:
Fair value	0	0
Investments | Level I | Commercial mortgage-backed securities
Investments:
Fair value	0	0
Investments | Level I | Equity Securities
Investments:
Equity securities	14	15
Investments | Level II
Investments:
Total investments	17,483	17,661
Investments | Level II | U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Fair value	0	0
Investments | Level II | Corporate securities
Investments:
Fair value	9,791	9,564
Investments | Level II | Municipal securities
Investments:
Fair value	3,292	3,232
Investments | Level II | Short-term time deposits
Investments:
Fair value	289	746
Investments | Level II | Asset-backed securities
Investments:
Fair value	1,625	1,638
Investments | Level II | Residential mortgage-backed securities
Investments:
Fair value	1,393	1,407
Investments | Level II | Commercial mortgage-backed securities
Investments:
Fair value	1,091	1,072
Investments | Level II | Equity Securities
Investments:
Equity securities	2	2
Investments | Level III
Investments:
Total investments	0	0
Investments | Level III | U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Fair value	0	0
Investments | Level III | Corporate securities
Investments:
Fair value	0	0
Investments | Level III | Municipal securities
Investments:
Fair value	0	0
Investments | Level III | Short-term time deposits
Investments:
Fair value	0	0
Investments | Level III | Asset-backed securities
Investments:
Fair value	0	0
Investments | Level III | Residential mortgage-backed securities
Investments:
Fair value	0	0
Investments | Level III | Commercial mortgage-backed securities
Investments:
Fair value	0	0
Investments | Level III | Equity Securities
Investments:
Equity securities	0	0
Restricted Deposits
Investments:
Fair value	1,383	1,386
Restricted Deposits | U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Fair value	323	333
Restricted Deposits | Corporate securities
Investments:
Fair value	38	37
Restricted Deposits | Municipal securities
Investments:
Fair value	726	753
Restricted Deposits | Cash and cash equivalents
Investments:
Fair value	292	259
Restricted Deposits | Certificates of deposit
Investments:
Fair value	4	4
Restricted Deposits | Level I
Investments:
Fair value	615	592
Restricted Deposits | Level I | U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Fair value	323	333
Restricted Deposits | Level I | Corporate securities
Investments:
Fair value	0	0
Restricted Deposits | Level I | Municipal securities
Investments:
Fair value	0	0
Restricted Deposits | Level I | Cash and cash equivalents
Investments:
Fair value	292	259
Restricted Deposits | Level I | Certificates of deposit
Investments:
Fair value	0	0
Restricted Deposits | Level II
Investments:
Fair value	768	794
Restricted Deposits | Level II | U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Fair value	0	0
Restricted Deposits | Level II | Corporate securities
Investments:
Fair value	38	37
Restricted Deposits | Level II | Municipal securities
Investments:
Fair value	726	753
Restricted Deposits | Level II | Cash and cash equivalents
Investments:
Fair value	0	0
Restricted Deposits | Level II | Certificates of deposit
Investments:
Fair value	4	4
Restricted Deposits | Level III
Investments:
Fair value	0	0
Restricted Deposits | Level III | U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Fair value	0	0
Restricted Deposits | Level III | Corporate securities
Investments:
Fair value	0	0
Restricted Deposits | Level III | Municipal securities
Investments:
Fair value	0	0
Restricted Deposits | Level III | Cash and cash equivalents
Investments:
Fair value	0	0
Restricted Deposits | Level III | Certificates of deposit
Investments:
Fair value	$ 0	$ 0

Fair Value Measurements - Narra

Fair Value Measurements - Narrative (Details) - USD ($) $ in Millions	Mar. 31, 2024	Dec. 31, 2023
Fair Value Disclosures [Abstract]
Aggregate carrying amount of life insurance contracts and equity investments, fair value	$ 1,022	$ 1,007

Medical Claims Liability - Sche

Medical Claims Liability - Schedule of Change in Medical Claims Liability (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Liability for Unpaid Claims and Claims Adjustment Expense [Roll Forward]
Balance, January 1	$ 18,000	$ 16,745
Less: Reinsurance recoverable	49	26
Balance, January 1, net	17,951	16,719
Incurred related to:
Current year	31,931	30,571
Prior years	(1,049)	(1,137)
Total incurred	30,882	29,434
Paid related to:
Current year	19,686	18,502
Prior years	11,124	10,174
Total paid	30,810	28,676
Plus: Premium deficiency reserve	50
Balance, March 31, net	18,073	17,477
Plus: Reinsurance recoverable	36	27
Balance, March 31	18,109	17,504
Medicaid
Liability for Unpaid Claims and Claims Adjustment Expense [Roll Forward]
Balance, January 1	10,814	11,253
Less: Reinsurance recoverable	5	7
Balance, January 1, net	10,809	11,246
Incurred related to:
Current year	20,179	20,813
Prior years	(684)	(803)
Total incurred	19,495	20,010
Paid related to:
Current year	12,823	12,679
Prior years	6,993	6,834
Total paid	19,816	19,513
Plus: Premium deficiency reserve	0
Balance, March 31, net	10,488	11,743
Plus: Reinsurance recoverable	4	9
Balance, March 31	10,492	11,752
Medicare
Liability for Unpaid Claims and Claims Adjustment Expense [Roll Forward]
Balance, January 1	3,612	3,431
Less: Reinsurance recoverable	0	0
Balance, January 1, net	3,612	3,431
Incurred related to:
Current year	5,495	5,163
Prior years	(156)	(155)
Total incurred	5,339	5,008
Paid related to:
Current year	3,266	2,988
Prior years	2,050	2,145
Total paid	5,316	5,133
Plus: Premium deficiency reserve	50
Balance, March 31, net	3,685	3,306
Plus: Reinsurance recoverable	0	0
Balance, March 31	3,685	3,306
Commercial
Liability for Unpaid Claims and Claims Adjustment Expense [Roll Forward]
Balance, January 1	3,460	1,921
Less: Reinsurance recoverable	44	19
Balance, January 1, net	3,416	1,902
Incurred related to:
Current year	5,884	4,177
Prior years	(204)	(172)
Total incurred	5,680	4,005
Paid related to:
Current year	3,339	2,541
Prior years	1,973	1,063
Total paid	5,312	3,604
Plus: Premium deficiency reserve	0
Balance, March 31, net	3,784	2,303
Plus: Reinsurance recoverable	32	18
Balance, March 31	3,816	2,321
Other
Liability for Unpaid Claims and Claims Adjustment Expense [Roll Forward]
Balance, January 1	114	140
Less: Reinsurance recoverable	0	0
Balance, January 1, net	114	140
Incurred related to:
Current year	373	418
Prior years	(5)	(7)
Total incurred	368	411
Paid related to:
Current year	258	294
Prior years	108	132
Total paid	366	426
Plus: Premium deficiency reserve	0
Balance, March 31, net	116	125
Plus: Reinsurance recoverable	0	0
Balance, March 31	$ 116	$ 125

Medical Claims Liability - Narr

Medical Claims Liability - Narrative (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023	Dec. 31, 2023
Insurance [Abstract]
Amounts recorded as an adjustment to premium revenues related to minimum HBR and return of premium programs	$ 54	$ 159
Short-duration insurance contracts, Incurred but not reported and expected development on reported claims	12,311
Medicare
Segment Reporting Information [Line Items]
Premium deficiency reserve liability	$ 300		$ 250

Affordable Care Act - Net Recei

Affordable Care Act - Net Receivables (Payables) for Each of the Ongoing Programs (Details) - USD ($) $ in Millions	Mar. 31, 2024	Dec. 31, 2023
Affordable Care Act [Abstract]
Risk adjustment receivable	$ 1,124	$ 893
Risk adjustment payable	(3,266)	(2,553)
Minimum medical loss ratio	(237)	(164)
Cost sharing reduction receivable	18	0
Cost sharing reduction payable	$ (113)	$ (114)

Debt - Schedule of Debt (Detail

Debt - Schedule of Debt (Details) - USD ($)	Mar. 31, 2024	Dec. 31, 2023
Debt Instrument [Line Items]
Total senior notes	$ 15,676,000,000	$ 15,675,000,000
Finance leases and other	3,000,000	11,000,000
Debt issuance costs	(117,000,000)	(122,000,000)
Total debt	18,000,000,000	17,829,000,000
Less: current portion	(113,000,000)	(119,000,000)
Long-term debt	17,887,000,000	17,710,000,000
Revolving Credit Agreement
Debt Instrument [Line Items]
Credit facility	350,000,000	150,000,000
Term Loan Facility
Debt Instrument [Line Items]
Credit facility	2,088,000,000	2,115,000,000
$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	$ 2,396,000,000	2,395,000,000
$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

Stockholders' Equity - Narrativ

Stockholders' Equity - Narrative (Details) - USD ($) shares in Thousands, $ in Millions	1 Months Ended	3 Months Ended
	Apr. 26, 2024	Mar. 31, 2024	Mar. 31, 2023
Equity, Class of Treasury Stock [Line Items]
Stock repurchase program, authorized amount		$ 10,000
Stock repurchase program, remaining available		5,178
Common stock repurchases		$ 151	$ 423
Subsequent Event
Equity, Class of Treasury Stock [Line Items]
Common stock repurchases (in shares)	2,700
Common stock repurchases	$ 200

Stockholders' Equity - Share Re

Stockholders' Equity - Share Repurchase Activity (Details) - USD ($) shares in Thousands, $ in Millions	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Subsidiary, Sale of Stock [Line Items]
Common stock repurchases	$ 151	$ 423
Employee Stock Compensation Plan
Subsidiary, Sale of Stock [Line Items]
Income tax withholding (in shares)	1,302	696
Income tax withholding	$ 100	$ 46
Common Stock
Subsidiary, Sale of Stock [Line Items]
Share buybacks (in shares)	681	4,852
Common stock repurchases (in shares)	1,983	5,548
Share buybacks	$ 51	$ 377
Common stock repurchases	$ 151	$ 423

Earnings Per Share (Details)

Earnings Per Share (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Millions	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Net Income (Loss) Attributable to Parent [Abstract]
Earnings attributable to Centene Corporation	$ 1,163	$ 1,130
Shares used in computing per share amounts:
Weighted average number of common shares outstanding (in shares)	535,109	550,779
Common stock equivalents (as determined by applying the treasury stock method) (in shares)	2,951	3,066
Weighted average number of common shares and potential dilutive common shares outstanding (in shares)	538,060	553,845
Net earnings per common share attributable to Centene Corporation:
Basic earnings per common share (in dollars per share)	$ 2.17	$ 2.05
Diluted earnings per common share (in dollars per share)	$ 2.16	$ 2.04
Anti-dilutive restricted stock and restricted stock units excluded from the calculation of diluted earnings (loss) per common share (in shares)	684	1,606

Segment Information (Details)

Segment Information (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Segment Reporting Information [Line Items]
Premium and service revenues	$ 36,337	$ 34,952
Premium tax	4,070	3,937
Total external revenues	40,407	38,889
Revenues	40,407	38,889
Medical costs	30,932	29,434
Cost of services	669	870
Gross margin	4,736	4,648
Operating Segments
Segment Reporting Information [Line Items]
Revenues	4,080	3,867
Eliminations
Segment Reporting Information [Line Items]
Revenues	(4,080)	(3,867)
Premium
Segment Reporting Information [Line Items]
Premium and service revenues	35,529	33,825
Service
Segment Reporting Information [Line Items]
Premium and service revenues	808	1,127
Premium and service revenues
Segment Reporting Information [Line Items]
Premium and service revenues	36,337	34,952
Medicaid
Segment Reporting Information [Line Items]
Revenues	25,530	26,164
Medical costs	19,495	20,010
Cost of services	21	0
Gross margin	1,944	2,217
Medicaid | Operating Segments
Segment Reporting Information [Line Items]
Premium tax	4,070	3,937
Total external revenues	25,530	26,164
Revenues	0	0
Medicaid | Eliminations
Segment Reporting Information [Line Items]
Revenues	0	0
Medicaid | Premium | Operating Segments
Segment Reporting Information [Line Items]
Premium and service revenues	21,438	22,227
Medicaid | Service | Operating Segments
Segment Reporting Information [Line Items]
Premium and service revenues	22	0
Medicaid | Premium and service revenues | Operating Segments
Segment Reporting Information [Line Items]
Premium and service revenues	21,460	22,227
Medicare
Segment Reporting Information [Line Items]
Revenues	5,935	5,876
Medical costs	5,389	5,008
Cost of services	0	0
Gross margin	546	868
Medicare | Operating Segments
Segment Reporting Information [Line Items]
Premium tax	0	0
Total external revenues	5,935	5,876
Revenues	0	0
Medicare | Eliminations
Segment Reporting Information [Line Items]
Revenues	0	0
Medicare | Premium | Operating Segments
Segment Reporting Information [Line Items]
Premium and service revenues	5,935	5,876
Medicare | Service | Operating Segments
Segment Reporting Information [Line Items]
Premium and service revenues	0	0
Medicare | Premium and service revenues | Operating Segments
Segment Reporting Information [Line Items]
Premium and service revenues	5,935	5,876
Commercial
Segment Reporting Information [Line Items]
Revenues	7,751	5,252
Medical costs	5,680	4,005
Cost of services	0	0
Gross margin	2,071	1,247
Commercial | Operating Segments
Segment Reporting Information [Line Items]
Premium tax	0	0
Total external revenues	7,751	5,252
Revenues	0	0
Commercial | Eliminations
Segment Reporting Information [Line Items]
Revenues	0	0
Commercial | Premium
Segment Reporting Information [Line Items]
Premium and service revenues	7,750	5,252
Commercial | Service | Operating Segments
Segment Reporting Information [Line Items]
Premium and service revenues	1	0
Commercial | Premium and service revenues | Operating Segments
Segment Reporting Information [Line Items]
Premium and service revenues	7,751	5,252
Other/Eliminations
Segment Reporting Information [Line Items]
Revenues	1,191	1,597
Medical costs	368	411
Cost of services	648	870
Gross margin	175	316
Other/Eliminations | Operating Segments
Segment Reporting Information [Line Items]
Premium tax	0	0
Total external revenues	1,191	1,597
Revenues	4,080	3,867
Other/Eliminations | Eliminations
Segment Reporting Information [Line Items]
Revenues	(4,080)	(3,867)
Other/Eliminations | Premium | Operating Segments
Segment Reporting Information [Line Items]
Premium and service revenues	406	470
Other/Eliminations | Service | Operating Segments
Segment Reporting Information [Line Items]
Premium and service revenues	785	1,127
Other/Eliminations | Premium and service revenues | Operating Segments
Segment Reporting Information [Line Items]
Premium and service revenues	$ 1,191	$ 1,597