Centene (CNC) 10-Q 25 Jul 24 2024 Q2 Quarterly report Financial data

Cover

Cover - shares shares in Thousands	6 Months Ended
	Jun. 30, 2024	Jul. 24, 2024
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Jun. 30, 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		526,030
Entity Central Index Key	0001071739
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2024
Document Fiscal Period Focus	Q2
Amendment Flag	false

CONSOLIDATED BALANCE SHEETS

CONSOLIDATED BALANCE SHEETS - USD ($) $ in Millions	Jun. 30, 2024	Dec. 31, 2023
Current assets:
Cash and cash equivalents	$ 17,605	$ 17,193
Premium and trade receivables	16,587	15,532
Short-term investments	2,609	2,459
Other current assets	1,605	5,572
Total current assets	38,406	40,756
Long-term investments	16,870	16,286
Restricted deposits	1,415	1,386
Property, software and equipment, net	2,041	2,019
Goodwill	17,558	17,558
Intangible assets, net	5,755	6,101
Other long-term assets	1,092	535
Total assets	83,137	84,641
Current liabilities:
Medical claims liability	18,173	18,000
Accounts payable and accrued expenses	12,232	16,420
Return of premium payable	1,615	1,462
Unearned revenue	597	715
Current portion of long-term debt	112	119
Total current liabilities	32,729	36,716
Long-term debt	17,516	17,710
Deferred tax liability	665	641
Other long-term liabilities	4,770	3,618
Total liabilities	55,680	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 June 30, 2024 and December 31, 2023	0	0
Common stock, $0.001 par value; authorized 800,000 shares; 619,495 issued and 526,001 outstanding at June 30, 2024, and 615,291 issued and 534,484 outstanding at December 31, 2023	1	1
Additional paid-in capital	20,461	20,304
Accumulated other comprehensive (loss)	(646)	(652)
Retained earnings	14,352	12,043
Treasury stock, at cost (93,494 and 80,807 shares, respectively)	(6,817)	(5,856)
Total Centene stockholders' equity	27,351	25,840
Nonredeemable noncontrolling interest	90	97
Total stockholders' equity	27,441	25,937
Total liabilities, redeemable noncontrolling interests and stockholders' equity	$ 83,137	$ 84,641

CONSOLIDATED BALANCE SHEETS (Pa

CONSOLIDATED BALANCE SHEETS (Parenthetical) - $ / shares	Jun. 30, 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)	619,495,000	615,291,000
Common stock, shares outstanding (in shares)	526,001,000	534,484,000
Treasury stock (in shares)	93,494,000	80,807,000

CONSOLIDATED STATEMENTS OF OPER

CONSOLIDATED STATEMENTS OF OPERATIONS - USD ($) shares in Thousands, $ in Millions	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Revenues:
Premium and service revenues	$ 35,973	$ 34,838	$ 72,310	$ 69,790
Premium tax	3,863	2,770	7,933	6,707
Total revenues	39,836	37,608	80,243	76,497
Expenses:
Medical costs	30,765	29,347	61,697	58,781
Cost of services	680	877	1,349	1,747
Selling, general and administrative expenses	2,894	3,016	6,112	6,027
Depreciation expense	133	146	268	288
Amortization of acquired intangible assets	173	179	346	362
Premium tax expense	3,962	2,854	8,123	6,865
Impairment	0	18	13	38
Total operating expenses	38,607	36,437	77,908	74,108
Earnings from operations	1,229	1,171	2,335	2,389
Other income (expense):
Investment and other income	463	425	1,008	778
Interest expense	(176)	(181)	(354)	(361)
Earnings before income tax	1,516	1,415	2,989	2,806
Income tax expense	370	360	685	621
Net earnings	1,146	1,055	2,304	2,185
Loss attributable to noncontrolling interests	0	3	5	3
Net earnings attributable to Centene Corporation	$ 1,146	$ 1,058	$ 2,309	$ 2,188
Net earnings per common share attributable to Centene Corporation:
Basic earnings per common share (in dollars per share)	$ 2.16	$ 1.93	$ 4.34	$ 3.98
Diluted earnings per common share (in dollars per share)	$ 2.16	$ 1.92	$ 4.32	$ 3.96
Weighted average number of common shares outstanding:
Basic (in shares)	529,602	548,932	532,385	549,850
Diluted (in shares)	530,755	550,308	534,517	551,996
Premium
Revenues:
Premium and service revenues	$ 35,140	$ 33,713	$ 70,669	$ 67,538
Service
Revenues:
Premium and service revenues	$ 833	$ 1,125	$ 1,641	$ 2,252

CONSOLIDATED STATEMENTS OF COMP

CONSOLIDATED STATEMENTS OF COMPREHENSIVE EARNINGS (LOSS) - USD ($) $ in Millions	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Statement of Comprehensive Income [Abstract]
Net earnings	$ 1,146	$ 1,055	$ 2,304	$ 2,185
Change in unrealized gain (loss) on investments	(26)	(142)	(107)	111
Change in unrealized gain (loss) on investments, tax effect	6	34	21	(27)
Change in unrealized gain (loss) on investments, net of tax	(20)	(108)	(86)	84
Reclassification adjustment, net of tax	4	2	92	4
Foreign currency translation adjustments, net of tax	0	23	0	46
Other comprehensive earnings (loss)	(16)	(83)	6	134
Comprehensive earnings	1,130	972	2,310	2,319
Comprehensive loss attributable to noncontrolling interests	0	3	5	3
Comprehensive earnings attributable to Centene Corporation	$ 1,130	$ 975	$ 2,315	$ 2,322

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, 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]
Other comprehensive earnings (loss), net of tax	134
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
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 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
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		619,173
Treasury stock (in shares) at Mar. 31, 2024						82,790
Balance at Mar. 31, 2024	$ 27,048	$ 1	20,388	(630)	13,206	$ (6,007)	90
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]
Other comprehensive earnings (loss), net of tax	$ 6
Balance (in shares) at Jun. 30, 2024	526,001	619,495
Treasury stock (in shares) at Jun. 30, 2024	93,494					93,494
Balance at Jun. 30, 2024	$ 27,441	$ 1	20,461	(646)	14,352	$ (6,817)	90
Balance (in shares) at Mar. 31, 2024		619,173
Treasury stock (in shares) at Mar. 31, 2024						82,790
Balance at Mar. 31, 2024	27,048	$ 1	20,388	(630)	13,206	$ (6,007)	90
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net earnings (loss)	1,146				1,146		0
Other comprehensive earnings (loss), net of tax	(16)			(16)
Common stock issued for employee benefit plans (in shares)		322
Common stock issued for employee benefit plans	11		11
Common stock repurchases (in shares)						10,704
Common stock repurchases	(810)					$ (810)
Stock compensation expense	$ 62		62
Balance (in shares) at Jun. 30, 2024	526,001	619,495
Treasury stock (in shares) at Jun. 30, 2024	93,494					93,494
Balance at Jun. 30, 2024	$ 27,441	$ 1	$ 20,461	$ (646)	$ 14,352	$ (6,817)	$ 90

CONSOLIDATED STATEMENTS OF ST_2

CONSOLIDATED STATEMENTS OF STOCKHOLDERS' EQUITY (Parenthetical) - USD ($) $ in Millions	3 Months Ended
	Jun. 30, 2024	Mar. 31, 2024	Jun. 30, 2023	Mar. 31, 2023	Dec. 31, 2023	Dec. 31, 2022
Par value (in dollars per share)	$ 0.001				$ 0.001
Other comprehensive earning (loss), tax	$ (5)	$ (12)	$ (34)	$ 61
Common Stock
Par value (in dollars per share)	$ 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

CONSOLIDATED STATEMENTS OF CASH

CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Millions	6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023
Cash flows from operating activities:
Net earnings	$ 2,304	$ 2,185
Adjustments to reconcile net earnings to net cash provided by operating activities
Depreciation and amortization	614	650
Stock compensation expense	132	117
Impairment	13	38
Deferred income taxes	40	(160)
(Gain) loss on divestitures, net	(103)	(172)
Other adjustments, net	(11)	68
Changes in assets and liabilities
Premium and trade receivables	(1,059)	(319)
Other assets	(404)	(325)
Medical claims liabilities	173	139
Unearned revenue	(118)	1,895
Accounts payable and accrued expenses	(1,704)	618
Other long-term liabilities	1,838	2,081
Other operating activities, net	4	0
Net cash provided by operating activities	1,719	6,815
Cash flows from investing activities:
Capital expenditures	(337)	(440)
Purchases of investments	(3,434)	(3,199)
Sales and maturities of investments	2,497	2,293
Divestiture proceeds, net of divested cash	959	669
Net cash used in investing activities	(315)	(677)
Cash flows from financing activities:
Proceeds from long-term debt	350	1,281
Payments and repurchases of long-term debt	(565)	(1,322)
Common stock repurchases	(954)	(828)
Proceeds from common stock issuances	25	21
Purchase of noncontrolling interest	0	(85)
Other financing activities, net	(4)	0
Net cash used in financing activities	(1,148)	(933)
Effect of exchange rate changes on cash, cash equivalents and restricted cash	7	(7)
Net increase in cash, cash equivalents and restricted cash and cash equivalents	263	5,198
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	17,715	17,528
Supplemental disclosures of cash flow information:
Interest paid	352	348
Income taxes paid	610	592
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	17,605	17,170
Restricted cash and cash equivalents, included in restricted deposits	110	358
Total cash, cash equivalents and restricted cash and cash equivalents	$ 17,715	$ 17,528

Organization and Operations

Organization and Operations	6 Months Ended
	Jun. 30, 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	6 Months Ended
	Jun. 30, 2024
Business Combination, Asset Acquisition, and Joint Venture Formation [Abstract]
Acquisitions and Divestitures	Acquisitions and Divestitures Magellan Specialty Health Divestiture For the six months ended June 30, 2024, the Company recorded an additional gain on the previously reported divestiture of Magellan Specialty Health of $83 million for achievement of contingent consideration related to the sale and finalization of working capital adjustments, 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 $20 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. During the six months ended June 30, 2024, the Company realized a net tax benefit of approximately $40 million on the loss recognized on the divestiture.

Short-term and Long-term Invest

Short-term and Long-term Investments, Restricted Deposits	6 Months Ended
	Jun. 30, 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): June 30, 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 $ 591 $ — $ (7) $ 584 $ 403 $ — $ (8) $ 395 Corporate securities 10,554 32 (468) 10,118 9,984 78 (461) 9,601 Restricted certificates of deposit 4 — — 4 4 — — 4 Restricted cash equivalents 110 — — 110 259 — — 259 Short-term time deposits 586 — — 586 746 — — 746 Municipal securities 4,229 7 (184) 4,052 4,135 21 (171) 3,985 Asset-backed securities 1,741 8 (29) 1,720 1,665 8 (35) 1,638 Residential mortgage-backed securities 1,606 2 (129) 1,479 1,503 7 (103) 1,407 Commercial mortgage-backed securities 1,222 2 (79) 1,145 1,149 5 (82) 1,072 Equity securities 17 — — 17 17 — — 17 Private equity investments 890 — — 890 833 — — 833 Life insurance contracts 189 — — 189 174 — — 174 Total $ 21,739 $ 51 $ (896) $ 20,894 $ 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 June 30, 2024, 99% of the Company's investments in rated securities carry an investment grade rating by nationally recognized statistical rating organizations. At June 30, 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 $168 million and $153 million at June 30, 2024 and December 31, 2023, respectively, and is included in other current assets in the Consolidated Balance Sheets. The Company's residential mortgage-backed securities are primarily issued by the Federal National Mortgage Association, Government National Mortgage Association or Federal Home Loan Mortgage Corporation, which carry implicit or explicit guarantees of the U.S. government. The Company's commercial mortgage-backed securities are primarily senior tranches with a weighted average rating of AA+ and a weighted average duration of 3 years at June 30, 2024. The fair value of available-for-sale debt securities with gross unrealized losses by investment type and length of time that individual securities have been in a continuous unrealized loss position were as follows ($ in millions): June 30, 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 $ — $ 205 $ (7) $ 224 $ — $ 79 $ (8) $ 232 Corporate securities (20) 1,895 (448) 6,017 (6) 658 (455) 6,260 Municipal securities (11) 959 (173) 2,365 (4) 553 (167) 2,237 Asset-backed securities (1) 266 (28) 519 (2) 197 (33) 855 Residential mortgage-backed securities (7) 397 (122) 857 (2) 153 (101) 814 Commercial mortgage-backed securities (1) 147 (78) 802 (2) 114 (80) 754 Short-term time deposits — — — — — 31 — — Total $ (40) $ 3,869 $ (856) $ 10,784 $ (16) $ 1,785 $ (844) $ 11,152 As of June 30, 2024, the gross unrealized losses were generated from 4,626 positions out of a total of 6,830 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): June 30, 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 $ 2,428 $ 2,403 $ 395 $ 392 $ 2,308 $ 2,284 $ 566 $ 564 One year through five years 7,877 7,546 733 709 7,738 7,431 527 504 Five years through ten years 4,166 3,947 291 278 3,905 3,735 298 283 Greater than ten years 147 143 37 36 155 154 34 35 Asset-backed securities 4,569 4,344 — — 4,317 4,117 — — Total $ 19,187 $ 18,383 $ 1,456 $ 1,415 $ 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	6 Months Ended
	Jun. 30, 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 June 30, 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 $ 17,605 $ — $ — $ 17,605 Investments: U.S. Treasury securities and obligations of U.S. government corporations and agencies $ 58 $ — $ — $ 58 Corporate securities — 10,080 — 10,080 Municipal securities — 3,315 — 3,315 Short-term time deposits — 586 — 586 Asset-backed securities — 1,720 — 1,720 Residential mortgage-backed securities — 1,479 — 1,479 Commercial mortgage-backed securities — 1,145 — 1,145 Equity securities 14 3 — 17 Total investments $ 72 $ 18,328 $ — $ 18,400 Restricted deposits: Cash and cash equivalents $ 110 $ — $ — $ 110 U.S. Treasury securities and obligations of U.S. government corporations and agencies 526 — — 526 Corporate securities — 38 — 38 Certificates of deposit — 4 — 4 Municipal securities — 737 — 737 Total restricted deposits $ 636 $ 779 $ — $ 1,415 Total assets at fair value $ 18,313 $ 19,107 $ — $ 37,420 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 $1,079 million and $1,007 million as of June 30, 2024 and December 31, 2023, respectively.

Medical Claims Liability

Medical Claims Liability	6 Months Ended
	Jun. 30, 2024
Insurance [Abstract]
Medical Claims Liability	Medical Claims Liability The following table summarizes the change in medical claims liability for the six months ended June 30, 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 39,398 10,953 12,274 758 63,383 Prior years (1,136) (316) (326) 7 (1,771) Total incurred 38,262 10,637 11,948 765 61,612 Paid related to: Current year 30,696 8,093 9,143 633 48,565 Prior years 7,918 2,562 2,367 121 12,968 Total paid 38,614 10,655 11,510 754 61,533 Plus: Premium deficiency reserve — 85 — — 85 Balance, June 30, 2024, net 10,457 3,679 3,854 125 18,115 Plus: Reinsurance recoverable 15 — 43 — 58 Balance, June 30, 2024 $ 10,472 $ 3,679 $ 3,897 $ 125 $ 18,173 The following table summarizes the change in medical claims liability for the six months ended June 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 40,622 10,083 8,857 773 60,335 Prior years (1,153) (191) (208) (2) (1,554) Total incurred 39,469 9,892 8,649 771 58,781 Paid related to: Current year 31,837 7,726 6,751 656 46,970 Prior years 7,890 2,357 1,282 137 11,666 Total paid 39,727 10,083 8,033 793 58,636 Balance, June 30, 2023, net 10,988 3,240 2,518 118 16,864 Plus: Reinsurance recoverable 5 — 15 — 20 Balance, June 30, 2023 $ 10,993 $ 3,240 $ 2,533 $ 118 $ 16,884 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 $88 million and $319 million as a reduction to premium revenue in the six months ended June 30, 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 June 30, 2024 was $12,337 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 and to $335 million in the second quarter of 2024 consistent with the intra-year flow of seasonality.

Affordable Care Act

Affordable Care Act	6 Months Ended
	Jun. 30, 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): June 30, 2024 December 31, 2023 Risk adjustment receivable $ 2,047 $ 893 Risk adjustment payable (3,475) (2,553) Minimum medical loss ratio (675) (164) Cost sharing reduction receivable 12 — Cost sharing reduction payable (111) (114) In July 2024, the Centers for Medicare and Medicaid Services (CMS) announced the final risk adjustment transfers for the 2023 benefit year. Based on the Company's estimate of the final settlement, the risk adjustment net payable was decreased by $1,344 million in the first half of 2024. After consideration of minimum MLR and other related impacts, the net pre-tax benefit recognized was $945 million in the six months ended June 30, 2024 ($78 million in the first quarter of 2024 and $867 million in the second quarter of 2024).

Debt

Debt	6 Months Ended
	Jun. 30, 2024
Debt Disclosure [Abstract]
Debt	Debt Debt consists of the following ($ in millions): June 30, 2024 December 31, 2023 $2,500 million 4.25% Senior Notes due December 15, 2027 $ 2,397 $ 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 15,677 15,675 Term Loan Facility 2,060 2,115 Revolving Credit Agreement — 150 Finance leases and other 2 11 Debt issuance costs (111) (122) Total debt 17,628 17,829 Less: current portion (112) (119) Long-term debt $ 17,516 $ 17,710

Stockholders' Equity

Stockholders' Equity	6 Months Ended
	Jun. 30, 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 June 30, 2024, the Company had a remaining amount of $4,378 million available under the stock repurchase program. The following represents the Company's share repurchase activity ($ in millions, shares in thousands): Three Months Ended June 30, Six Months Ended June 30, 2024 2023 2024 2023 Shares Cost Shares Cost Shares Cost Shares Cost Share buybacks 10,660 $ 800 6,028 $ 400 11,341 $ 851 10,880 $ 777 Income tax withholding 44 3 71 5 1,346 103 767 51 Total share repurchases (1) 10,704 $ 803 6,099 $ 405 12,687 $ 954 11,647 $ 828 (1) Excludes share repurchase excise tax of approximately $7 million and $3 million accrued as of June 30, 2024 and 2023, respectively. 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	6 Months Ended
	Jun. 30, 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 June 30, Six Months Ended June 30, 2024 2023 2024 2023 Earnings attributable to Centene Corporation $ 1,146 $ 1,058 $ 2,309 $ 2,188 Shares used in computing per share amounts: Weighted average number of common shares outstanding 529,602 548,932 532,385 549,850 Common stock equivalents (as determined by applying the treasury stock method) 1,153 1,376 2,132 2,146 Weighted average number of common shares and potential dilutive common shares outstanding 530,755 550,308 534,517 551,996 Net earnings per common share attributable to Centene Corporation: Basic earnings per common share $ 2.16 $ 1.93 $ 4.34 $ 3.98 Diluted earnings per common share $ 2.16 $ 1.92 $ 4.32 $ 3.96 The calculation of diluted earnings per common share for the three months ended June 30, 2024 and 2023 excludes 271 thousand shares and 1,519 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 six months ended June 30, 2024 and 2023 excludes 267 thousand shares and 1,611 thousand shares, respectively, related to anti-dilutive stock options, restricted stock and restricted stock units.

Segment Information

Segment Information	6 Months Ended
	Jun. 30, 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, 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 June 30, 2024, is as follows ($ in millions): Medicaid Medicare Commercial Other/Eliminations Consolidated Total Premium $ 20,229 $ 5,978 $ 8,534 $ 399 $ 35,140 Service 21 — 1 811 833 Premium and service revenues 20,250 5,978 8,535 1,210 35,973 Premium tax 3,863 — — — 3,863 Total external revenues 24,113 5,978 8,535 1,210 39,836 Internal revenues — — — 4,081 4,081 Eliminations — — — (4,081) (4,081) Total revenues $ 24,113 $ 5,978 $ 8,535 $ 1,210 $ 39,836 Medical costs $ 18,767 $ 5,333 $ 6,268 $ 397 $ 30,765 Cost of services $ 22 $ — $ — $ 658 $ 680 Gross margin (1) $ 1,461 $ 645 $ 2,267 $ 155 $ 4,528 (1) Gross margin represents premium and service revenues less medical costs and cost of services. Segment information for the three months ended June 30, 2023, is as follows ($ in millions): Medicaid Medicare Commercial Other/Eliminations Consolidated Total Premium $ 21,895 $ 5,665 $ 5,734 $ 419 $ 33,713 Service — — — 1,125 1,125 Premium and service revenues 21,895 5,665 5,734 1,544 34,838 Premium tax 2,770 — — — 2,770 Total external revenues 24,665 5,665 5,734 1,544 37,608 Internal revenues — — — 3,789 3,789 Eliminations — — — (3,789) (3,789) Total revenues $ 24,665 $ 5,665 $ 5,734 $ 1,544 $ 37,608 Medical costs $ 19,459 $ 4,884 $ 4,644 $ 360 $ 29,347 Cost of services $ 2 $ — $ — $ 875 $ 877 Gross margin (1) $ 2,434 $ 781 $ 1,090 $ 309 $ 4,614 (1) Gross margin represents premium and service revenues less medical costs and cost of services. Segment information for the six months ended June 30, 2024, is as follows ($ in millions): Medicaid Medicare Commercial Other/Eliminations Consolidated Total Premium $ 41,667 $ 11,913 $ 16,284 $ 805 $ 70,669 Service 43 — 2 1,596 1,641 Premium and service revenues 41,710 11,913 16,286 2,401 72,310 Premium tax 7,933 — — — 7,933 Total external revenues 49,643 11,913 16,286 2,401 80,243 Internal revenues — — — 8,161 8,161 Eliminations — — — (8,161) (8,161) Total revenues $ 49,643 $ 11,913 $ 16,286 $ 2,401 $ 80,243 Medical costs $ 38,262 $ 10,722 $ 11,948 $ 765 $ 61,697 Cost of services $ 43 $ — $ — $ 1,306 $ 1,349 Gross margin (1) $ 3,405 $ 1,191 $ 4,338 $ 330 $ 9,264 (1) Gross margin represents premium and service revenues less medical costs and cost of services. Segment information for the six months ended June 30, 2023, is as follows ($ in millions): Medicaid Medicare Commercial Other/Eliminations Consolidated Total Premium $ 44,122 $ 11,541 $ 10,986 $ 889 $ 67,538 Service — — — 2,252 2,252 Premium and service revenues 44,122 11,541 10,986 3,141 69,790 Premium tax 6,707 — — — 6,707 Total external revenues 50,829 11,541 10,986 3,141 76,497 Internal revenues — — — 7,656 7,656 Eliminations — — — (7,656) (7,656) Total revenues $ 50,829 $ 11,541 $ 10,986 $ 3,141 $ 76,497 Medical costs $ 39,469 $ 9,892 $ 8,649 $ 771 $ 58,781 Cost of services $ 2 $ — $ — $ 1,745 $ 1,747 Gross margin (1) $ 4,651 $ 1,649 $ 2,337 $ 625 $ 9,262 (1) Gross margin represents premium and service revenues less medical costs and cost of services.

Contingencies

Contingencies	6 Months Ended
	Jun. 30, 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		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Pay vs Performance Disclosure
Net earnings (loss)	$ 1,146	$ 1,058	$ 2,309	$ 2,188

Insider Trading Arrangements

Insider Trading Arrangements	3 Months Ended
	Jun. 30, 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)	6 Months Ended
	Jun. 30, 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)	6 Months Ended
	Jun. 30, 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): June 30, 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 $ 591 $ — $ (7) $ 584 $ 403 $ — $ (8) $ 395 Corporate securities 10,554 32 (468) 10,118 9,984 78 (461) 9,601 Restricted certificates of deposit 4 — — 4 4 — — 4 Restricted cash equivalents 110 — — 110 259 — — 259 Short-term time deposits 586 — — 586 746 — — 746 Municipal securities 4,229 7 (184) 4,052 4,135 21 (171) 3,985 Asset-backed securities 1,741 8 (29) 1,720 1,665 8 (35) 1,638 Residential mortgage-backed securities 1,606 2 (129) 1,479 1,503 7 (103) 1,407 Commercial mortgage-backed securities 1,222 2 (79) 1,145 1,149 5 (82) 1,072 Equity securities 17 — — 17 17 — — 17 Private equity investments 890 — — 890 833 — — 833 Life insurance contracts 189 — — 189 174 — — 174 Total $ 21,739 $ 51 $ (896) $ 20,894 $ 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): June 30, 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 $ — $ 205 $ (7) $ 224 $ — $ 79 $ (8) $ 232 Corporate securities (20) 1,895 (448) 6,017 (6) 658 (455) 6,260 Municipal securities (11) 959 (173) 2,365 (4) 553 (167) 2,237 Asset-backed securities (1) 266 (28) 519 (2) 197 (33) 855 Residential mortgage-backed securities (7) 397 (122) 857 (2) 153 (101) 814 Commercial mortgage-backed securities (1) 147 (78) 802 (2) 114 (80) 754 Short-term time deposits — — — — — 31 — — Total $ (40) $ 3,869 $ (856) $ 10,784 $ (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): June 30, 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 $ 2,428 $ 2,403 $ 395 $ 392 $ 2,308 $ 2,284 $ 566 $ 564 One year through five years 7,877 7,546 733 709 7,738 7,431 527 504 Five years through ten years 4,166 3,947 291 278 3,905 3,735 298 283 Greater than ten years 147 143 37 36 155 154 34 35 Asset-backed securities 4,569 4,344 — — 4,317 4,117 — — Total $ 19,187 $ 18,383 $ 1,456 $ 1,415 $ 18,423 $ 17,721 $ 1,425 $ 1,386

Fair Value Measurements (Tables

Fair Value Measurements (Tables)	6 Months Ended
	Jun. 30, 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 June 30, 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 $ 17,605 $ — $ — $ 17,605 Investments: U.S. Treasury securities and obligations of U.S. government corporations and agencies $ 58 $ — $ — $ 58 Corporate securities — 10,080 — 10,080 Municipal securities — 3,315 — 3,315 Short-term time deposits — 586 — 586 Asset-backed securities — 1,720 — 1,720 Residential mortgage-backed securities — 1,479 — 1,479 Commercial mortgage-backed securities — 1,145 — 1,145 Equity securities 14 3 — 17 Total investments $ 72 $ 18,328 $ — $ 18,400 Restricted deposits: Cash and cash equivalents $ 110 $ — $ — $ 110 U.S. Treasury securities and obligations of U.S. government corporations and agencies 526 — — 526 Corporate securities — 38 — 38 Certificates of deposit — 4 — 4 Municipal securities — 737 — 737 Total restricted deposits $ 636 $ 779 $ — $ 1,415 Total assets at fair value $ 18,313 $ 19,107 $ — $ 37,420 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)	6 Months Ended
	Jun. 30, 2024
Insurance [Abstract]
Schedule of change in medical claims liability	The following table summarizes the change in medical claims liability for the six months ended June 30, 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 39,398 10,953 12,274 758 63,383 Prior years (1,136) (316) (326) 7 (1,771) Total incurred 38,262 10,637 11,948 765 61,612 Paid related to: Current year 30,696 8,093 9,143 633 48,565 Prior years 7,918 2,562 2,367 121 12,968 Total paid 38,614 10,655 11,510 754 61,533 Plus: Premium deficiency reserve — 85 — — 85 Balance, June 30, 2024, net 10,457 3,679 3,854 125 18,115 Plus: Reinsurance recoverable 15 — 43 — 58 Balance, June 30, 2024 $ 10,472 $ 3,679 $ 3,897 $ 125 $ 18,173 The following table summarizes the change in medical claims liability for the six months ended June 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 40,622 10,083 8,857 773 60,335 Prior years (1,153) (191) (208) (2) (1,554) Total incurred 39,469 9,892 8,649 771 58,781 Paid related to: Current year 31,837 7,726 6,751 656 46,970 Prior years 7,890 2,357 1,282 137 11,666 Total paid 39,727 10,083 8,033 793 58,636 Balance, June 30, 2023, net 10,988 3,240 2,518 118 16,864 Plus: Reinsurance recoverable 5 — 15 — 20 Balance, June 30, 2023 $ 10,993 $ 3,240 $ 2,533 $ 118 $ 16,884

Affordable Care Act (Tables)

Affordable Care Act (Tables)	6 Months Ended
	Jun. 30, 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): June 30, 2024 December 31, 2023 Risk adjustment receivable $ 2,047 $ 893 Risk adjustment payable (3,475) (2,553) Minimum medical loss ratio (675) (164) Cost sharing reduction receivable 12 — Cost sharing reduction payable (111) (114)

Debt (Tables)

Debt (Tables)	6 Months Ended
	Jun. 30, 2024
Debt Disclosure [Abstract]
Schedule of Debt	Debt consists of the following ($ in millions): June 30, 2024 December 31, 2023 $2,500 million 4.25% Senior Notes due December 15, 2027 $ 2,397 $ 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 15,677 15,675 Term Loan Facility 2,060 2,115 Revolving Credit Agreement — 150 Finance leases and other 2 11 Debt issuance costs (111) (122) Total debt 17,628 17,829 Less: current portion (112) (119) Long-term debt $ 17,516 $ 17,710

Stockholders' Equity (Tables)

Stockholders' Equity (Tables)	6 Months Ended
	Jun. 30, 2024
Equity [Abstract]
Share Repurchase Activity	The following represents the Company's share repurchase activity ($ in millions, shares in thousands): Three Months Ended June 30, Six Months Ended June 30, 2024 2023 2024 2023 Shares Cost Shares Cost Shares Cost Shares Cost Share buybacks 10,660 $ 800 6,028 $ 400 11,341 $ 851 10,880 $ 777 Income tax withholding 44 3 71 5 1,346 103 767 51 Total share repurchases (1) 10,704 $ 803 6,099 $ 405 12,687 $ 954 11,647 $ 828 (1) Excludes share repurchase excise tax of approximately $7 million and $3 million accrued as of June 30, 2024 and 2023, respectively.

Earnings Per Share (Tables)

Earnings Per Share (Tables)	6 Months Ended
	Jun. 30, 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 June 30, Six Months Ended June 30, 2024 2023 2024 2023 Earnings attributable to Centene Corporation $ 1,146 $ 1,058 $ 2,309 $ 2,188 Shares used in computing per share amounts: Weighted average number of common shares outstanding 529,602 548,932 532,385 549,850 Common stock equivalents (as determined by applying the treasury stock method) 1,153 1,376 2,132 2,146 Weighted average number of common shares and potential dilutive common shares outstanding 530,755 550,308 534,517 551,996 Net earnings per common share attributable to Centene Corporation: Basic earnings per common share $ 2.16 $ 1.93 $ 4.34 $ 3.98 Diluted earnings per common share $ 2.16 $ 1.92 $ 4.32 $ 3.96

Segment Information (Tables)

Segment Information (Tables)	6 Months Ended
	Jun. 30, 2024
Segment Reporting [Abstract]
Segment Information	Segment information for the three months ended June 30, 2024, is as follows ($ in millions): Medicaid Medicare Commercial Other/Eliminations Consolidated Total Premium $ 20,229 $ 5,978 $ 8,534 $ 399 $ 35,140 Service 21 — 1 811 833 Premium and service revenues 20,250 5,978 8,535 1,210 35,973 Premium tax 3,863 — — — 3,863 Total external revenues 24,113 5,978 8,535 1,210 39,836 Internal revenues — — — 4,081 4,081 Eliminations — — — (4,081) (4,081) Total revenues $ 24,113 $ 5,978 $ 8,535 $ 1,210 $ 39,836 Medical costs $ 18,767 $ 5,333 $ 6,268 $ 397 $ 30,765 Cost of services $ 22 $ — $ — $ 658 $ 680 Gross margin (1) $ 1,461 $ 645 $ 2,267 $ 155 $ 4,528 (1) Gross margin represents premium and service revenues less medical costs and cost of services. Segment information for the three months ended June 30, 2023, is as follows ($ in millions): Medicaid Medicare Commercial Other/Eliminations Consolidated Total Premium $ 21,895 $ 5,665 $ 5,734 $ 419 $ 33,713 Service — — — 1,125 1,125 Premium and service revenues 21,895 5,665 5,734 1,544 34,838 Premium tax 2,770 — — — 2,770 Total external revenues 24,665 5,665 5,734 1,544 37,608 Internal revenues — — — 3,789 3,789 Eliminations — — — (3,789) (3,789) Total revenues $ 24,665 $ 5,665 $ 5,734 $ 1,544 $ 37,608 Medical costs $ 19,459 $ 4,884 $ 4,644 $ 360 $ 29,347 Cost of services $ 2 $ — $ — $ 875 $ 877 Gross margin (1) $ 2,434 $ 781 $ 1,090 $ 309 $ 4,614 (1) Gross margin represents premium and service revenues less medical costs and cost of services. Segment information for the six months ended June 30, 2024, is as follows ($ in millions): Medicaid Medicare Commercial Other/Eliminations Consolidated Total Premium $ 41,667 $ 11,913 $ 16,284 $ 805 $ 70,669 Service 43 — 2 1,596 1,641 Premium and service revenues 41,710 11,913 16,286 2,401 72,310 Premium tax 7,933 — — — 7,933 Total external revenues 49,643 11,913 16,286 2,401 80,243 Internal revenues — — — 8,161 8,161 Eliminations — — — (8,161) (8,161) Total revenues $ 49,643 $ 11,913 $ 16,286 $ 2,401 $ 80,243 Medical costs $ 38,262 $ 10,722 $ 11,948 $ 765 $ 61,697 Cost of services $ 43 $ — $ — $ 1,306 $ 1,349 Gross margin (1) $ 3,405 $ 1,191 $ 4,338 $ 330 $ 9,264 (1) Gross margin represents premium and service revenues less medical costs and cost of services. Segment information for the six months ended June 30, 2023, is as follows ($ in millions): Medicaid Medicare Commercial Other/Eliminations Consolidated Total Premium $ 44,122 $ 11,541 $ 10,986 $ 889 $ 67,538 Service — — — 2,252 2,252 Premium and service revenues 44,122 11,541 10,986 3,141 69,790 Premium tax 6,707 — — — 6,707 Total external revenues 50,829 11,541 10,986 3,141 76,497 Internal revenues — — — 7,656 7,656 Eliminations — — — (7,656) (7,656) Total revenues $ 50,829 $ 11,541 $ 10,986 $ 3,141 $ 76,497 Medical costs $ 39,469 $ 9,892 $ 8,649 $ 771 $ 58,781 Cost of services $ 2 $ — $ — $ 1,745 $ 1,747 Gross margin (1) $ 4,651 $ 1,649 $ 2,337 $ 625 $ 9,262 (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		6 Months Ended		12 Months Ended
	Jan. 12, 2024 USD ($)	Jun. 30, 2024 USD ($)	Jun. 30, 2023 USD ($)	Jun. 30, 2024 USD ($)	Jun. 30, 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				$ (103)	$ (172)
Income tax benefit		$ (370)	$ (360)	(685)	$ (621)
Currency Swap
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Notional amount							$ 931	£ 740
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				(83)
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]
Gain (loss) on divestitures				(20)
Proceeds from sale of business	$ 931
Income tax benefit				$ 40
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

Short-term and Long-term Inve_3

Short-term and Long-term Investments, Restricted Deposits - By Investment Type (Details) - USD ($) $ in Millions	Jun. 30, 2024	Dec. 31, 2023
Debt Securities
Gross Unrealized Gains	$ 51	$ 119
Gross Unrealized Losses	(896)	(860)
Equity securities	17	17
Private equity investments	890	833
Life insurance contracts	189	174
Total, Amortized Cost	21,739	20,872
Total, Fair Value	20,894	20,131
U.S. Treasury securities and obligations of U.S. government corporations and agencies
Debt Securities
Amortized Cost	591	403
Gross Unrealized Gains	0	0
Gross Unrealized Losses	(7)	(8)
Fair Value	584	395
Corporate securities
Debt Securities
Amortized Cost	10,554	9,984
Gross Unrealized Gains	32	78
Gross Unrealized Losses	(468)	(461)
Fair Value	10,118	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	110	259
Gross Unrealized Gains	0	0
Gross Unrealized Losses	0	0
Fair Value	110	259
Short-term time deposits
Debt Securities
Amortized Cost	586	746
Gross Unrealized Gains	0	0
Gross Unrealized Losses	0	0
Fair Value	586	746
Municipal securities
Debt Securities
Amortized Cost	4,229	4,135
Gross Unrealized Gains	7	21
Gross Unrealized Losses	(184)	(171)
Fair Value	4,052	3,985
Asset-backed securities
Debt Securities
Amortized Cost	1,741	1,665
Gross Unrealized Gains	8	8
Gross Unrealized Losses	(29)	(35)
Fair Value	1,720	1,638
Residential mortgage-backed securities
Debt Securities
Amortized Cost	1,606	1,503
Gross Unrealized Gains	2	7
Gross Unrealized Losses	(129)	(103)
Fair Value	1,479	1,407
Commercial mortgage-backed securities
Debt Securities
Amortized Cost	1,222	1,149
Gross Unrealized Gains	2	5
Gross Unrealized Losses	(79)	(82)
Fair Value	$ 1,145	$ 1,072

Short-term and Long-term Inve_4

Short-term and Long-term Investments, Restricted Deposits - Narrative (Details) $ in Millions	6 Months Ended
	Jun. 30, 2024 USD ($) position	Dec. 31, 2023 USD ($)
Schedule Of Investments And Restricted Deposits By Type [Line Items]
Accrued interest income | $	$ 168	$ 153
Positions from which gross unrealized losses were generated	4,626
Total investment positions	6,830
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)	3 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	Jun. 30, 2024	Dec. 31, 2023
Unrealized Losses
Less Than 12 Months	$ (40)	$ (16)
12 Months or More	(856)	(844)
Fair Value
Fair Value, Less Than 12 Months	3,869	1,785
Fair Value, 12 Months or More	10,784	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	(7)	(8)
Fair Value
Fair Value, Less Than 12 Months	205	79
Fair Value, 12 Months or More	224	232
Corporate securities
Unrealized Losses
Less Than 12 Months	(20)	(6)
12 Months or More	(448)	(455)
Fair Value
Fair Value, Less Than 12 Months	1,895	658
Fair Value, 12 Months or More	6,017	6,260
Municipal securities
Unrealized Losses
Less Than 12 Months	(11)	(4)
12 Months or More	(173)	(167)
Fair Value
Fair Value, Less Than 12 Months	959	553
Fair Value, 12 Months or More	2,365	2,237
Asset-backed securities
Unrealized Losses
Less Than 12 Months	(1)	(2)
12 Months or More	(28)	(33)
Fair Value
Fair Value, Less Than 12 Months	266	197
Fair Value, 12 Months or More	519	855
Residential mortgage-backed securities
Unrealized Losses
Less Than 12 Months	(7)	(2)
12 Months or More	(122)	(101)
Fair Value
Fair Value, Less Than 12 Months	397	153
Fair Value, 12 Months or More	857	814
Commercial mortgage-backed securities
Unrealized Losses
Less Than 12 Months	(1)	(2)
12 Months or More	(78)	(80)
Fair Value
Fair Value, Less Than 12 Months	147	114
Fair Value, 12 Months or More	802	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	0	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	Jun. 30, 2024	Dec. 31, 2023
Investments
Amortized Cost
One year or less	$ 2,428	$ 2,308
One year through five years	7,877	7,738
Five years through ten years	4,166	3,905
Greater than ten years	147	155
Asset-backed securities	4,569	4,317
Amortized Cost	19,187	18,423
Fair Value
One year or less	2,403	2,284
One year through five years	7,546	7,431
Five years through ten years	3,947	3,735
Greater than ten years	143	154
Asset-backed securities	4,344	4,117
Fair Value	18,383	17,721
Restricted Deposits
Amortized Cost
One year or less	395	566
One year through five years	733	527
Five years through ten years	291	298
Greater than ten years	37	34
Asset-backed securities	0	0
Amortized Cost	1,456	1,425
Fair Value
One year or less	392	564
One year through five years	709	504
Five years through ten years	278	283
Greater than ten years	36	35
Asset-backed securities	0	0
Fair Value	$ 1,415	$ 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	Jun. 30, 2024	Dec. 31, 2023
Assets
Cash and cash equivalents	$ 17,605	$ 17,193
Investments:
Equity securities	17	17
Total assets at fair value	37,420	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	584	395
Corporate securities
Investments:
Fair value	10,118	9,601
Municipal securities
Investments:
Fair value	4,052	3,985
Short-term time deposits
Investments:
Fair value	586	746
Asset-backed securities
Investments:
Fair value	1,720	1,638
Residential mortgage-backed securities
Investments:
Fair value	1,479	1,407
Commercial mortgage-backed securities
Investments:
Fair value	1,145	1,072
Level I
Assets
Cash and cash equivalents	17,605	17,193
Investments:
Total assets at fair value	18,313	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	19,107	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	18,383	17,721
Total investments	18,400	17,738
Investments | U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Fair value	58	62
Investments | Corporate securities
Investments:
Fair value	10,080	9,564
Investments | Municipal securities
Investments:
Fair value	3,315	3,232
Investments | Short-term time deposits
Investments:
Fair value	586	746
Investments | Asset-backed securities
Investments:
Fair value	1,720	1,638
Investments | Residential mortgage-backed securities
Investments:
Fair value	1,479	1,407
Investments | Commercial mortgage-backed securities
Investments:
Fair value	1,145	1,072
Investments | Equity Securities
Investments:
Equity securities	17	17
Investments | Level I
Investments:
Total investments	72	77
Investments | Level I | U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Fair value	58	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	18,328	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	10,080	9,564
Investments | Level II | Municipal securities
Investments:
Fair value	3,315	3,232
Investments | Level II | Short-term time deposits
Investments:
Fair value	586	746
Investments | Level II | Asset-backed securities
Investments:
Fair value	1,720	1,638
Investments | Level II | Residential mortgage-backed securities
Investments:
Fair value	1,479	1,407
Investments | Level II | Commercial mortgage-backed securities
Investments:
Fair value	1,145	1,072
Investments | Level II | Equity Securities
Investments:
Equity securities	3	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	1,415	1,386
Restricted Deposits | U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Fair value	526	333
Restricted Deposits | Corporate securities
Investments:
Fair value	38	37
Restricted Deposits | Municipal securities
Investments:
Fair value	737	753
Restricted Deposits | Cash and cash equivalents
Investments:
Fair value	110	259
Restricted Deposits | Certificates of deposit
Investments:
Fair value	4	4
Restricted Deposits | Level I
Investments:
Fair value	636	592
Restricted Deposits | Level I | U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Fair value	526	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	110	259
Restricted Deposits | Level I | Certificates of deposit
Investments:
Fair value	0	0
Restricted Deposits | Level II
Investments:
Fair value	779	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	737	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	Jun. 30, 2024	Dec. 31, 2023
Fair Value Disclosures [Abstract]
Aggregate carrying amount of life insurance contracts and equity investments, fair value	$ 1,079	$ 1,007

Medical Claims Liability - Sche

Medical Claims Liability - Schedule of Change in Medical Claims Liability (Details) - USD ($) $ in Millions	6 Months Ended
	Jun. 30, 2024	Jun. 30, 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	63,383	60,335
Prior years	(1,771)	(1,554)
Total incurred	61,612	58,781
Paid related to:
Current year	48,565	46,970
Prior years	12,968	11,666
Total paid	61,533	58,636
Plus: Premium deficiency reserve	85
Balance, June 30, net	18,115	16,864
Plus: Reinsurance recoverable	58	20
Balance, June 30	18,173	16,884
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	39,398	40,622
Prior years	(1,136)	(1,153)
Total incurred	38,262	39,469
Paid related to:
Current year	30,696	31,837
Prior years	7,918	7,890
Total paid	38,614	39,727
Plus: Premium deficiency reserve	0
Balance, June 30, net	10,457	10,988
Plus: Reinsurance recoverable	15	5
Balance, June 30	10,472	10,993
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	10,953	10,083
Prior years	(316)	(191)
Total incurred	10,637	9,892
Paid related to:
Current year	8,093	7,726
Prior years	2,562	2,357
Total paid	10,655	10,083
Plus: Premium deficiency reserve	85
Balance, June 30, net	3,679	3,240
Plus: Reinsurance recoverable	0	0
Balance, June 30	3,679	3,240
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	12,274	8,857
Prior years	(326)	(208)
Total incurred	11,948	8,649
Paid related to:
Current year	9,143	6,751
Prior years	2,367	1,282
Total paid	11,510	8,033
Plus: Premium deficiency reserve	0
Balance, June 30, net	3,854	2,518
Plus: Reinsurance recoverable	43	15
Balance, June 30	3,897	2,533
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	758	773
Prior years	7	(2)
Total incurred	765	771
Paid related to:
Current year	633	656
Prior years	121	137
Total paid	754	793
Plus: Premium deficiency reserve	0
Balance, June 30, net	125	118
Plus: Reinsurance recoverable	0	0
Balance, June 30	$ 125	$ 118

Medical Claims Liability - Narr

Medical Claims Liability - Narrative (Details) - USD ($) $ in Millions	6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Mar. 31, 2024	Dec. 31, 2023
Insurance [Abstract]
Amounts recorded as an adjustment to premium revenues related to minimum HBR and return of premium programs	$ 88	$ 319
Short-duration insurance contracts, Incurred but not reported and expected development on reported claims	12,337
Medicare
Segment Reporting Information [Line Items]
Premium deficiency reserve liability	$ 335		$ 300	$ 250

Affordable Care Act - Net Recei

Affordable Care Act - Net Receivables (Payables) for Each of the Ongoing Programs (Details) - USD ($) $ in Millions	Jun. 30, 2024	Dec. 31, 2023
Affordable Care Act [Abstract]
Risk adjustment receivable	$ 2,047	$ 893
Risk adjustment payable	(3,475)	(2,553)
Minimum medical loss ratio	(675)	(164)
Cost sharing reduction receivable	12	0
Cost sharing reduction payable	$ (111)	$ (114)

Affordable Care Act - Narrative

Affordable Care Act - Narrative (Details) - USD ($) $ in Millions	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Mar. 31, 2024	Jun. 30, 2024
Affordable Care Act [Abstract]
Risk adjustment, decrease to net payable			$ 1,344
Risk adjustment and reinsurance pre-tax benefit	$ 867	$ 78	$ 945

Debt - Schedule of Debt (Detail

Debt - Schedule of Debt (Details) - USD ($)	Jun. 30, 2024	Dec. 31, 2023
Debt Instrument [Line Items]
Total senior notes	$ 15,677,000,000	$ 15,675,000,000
Finance leases and other	2,000,000	11,000,000
Debt issuance costs	(111,000,000)	(122,000,000)
Total debt	17,628,000,000	17,829,000,000
Less: current portion	(112,000,000)	(119,000,000)
Long-term debt	17,516,000,000	17,710,000,000
Revolving Credit Agreement
Debt Instrument [Line Items]
Credit facility	0	150,000,000
Term Loan Facility
Debt Instrument [Line Items]
Credit facility	2,060,000,000	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	$ 2,397,000,000	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) $ in Millions	Jun. 30, 2024 USD ($)
Equity [Abstract]
Stock repurchase program, authorized amount	$ 10,000
Stock repurchase program, remaining available	$ 4,378

Stockholders' Equity - Share Re

Stockholders' Equity - Share Repurchase Activity (Details) - USD ($) shares in Thousands, $ in Millions	3 Months Ended				6 Months Ended
	Jun. 30, 2024	Mar. 31, 2024	Jun. 30, 2023	Mar. 31, 2023	Jun. 30, 2024	Jun. 30, 2023
Subsidiary, Sale of Stock [Line Items]
Common stock repurchases	$ 810	$ 151	$ 408	$ 423
Share repurchase program, excise tax, payable	$ 7		$ 3		$ 7	$ 3
Employee Stock Compensation Plan
Subsidiary, Sale of Stock [Line Items]
Income tax withholding (in shares)	44		71		1,346	767
Income tax withholding	$ 3		$ 5		$ 103	$ 51
Common Stock
Subsidiary, Sale of Stock [Line Items]
Share buybacks (in shares)	10,660		6,028		11,341	10,880
Common stock repurchases (in shares)	10,704		6,099		12,687	11,647
Share buybacks	$ 800		$ 400		$ 851	$ 777
Common stock repurchases	$ 803		$ 405		$ 954	$ 828

Earnings Per Share (Details)

Earnings Per Share (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Millions	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Net Income (Loss) Attributable to Parent [Abstract]
Earnings attributable to Centene Corporation	$ 1,146	$ 1,058	$ 2,309	$ 2,188
Shares used in computing per share amounts:
Weighted average number of common shares outstanding (in shares)	529,602	548,932	532,385	549,850
Common stock equivalents (as determined by applying the treasury stock method) (in shares)	1,153	1,376	2,132	2,146
Weighted average number of common shares and potential dilutive common shares outstanding (in shares)	530,755	550,308	534,517	551,996
Net earnings per common share attributable to Centene Corporation:
Basic earnings per common share (in dollars per share)	$ 2.16	$ 1.93	$ 4.34	$ 3.98
Diluted earnings per common share (in dollars per share)	$ 2.16	$ 1.92	$ 4.32	$ 3.96
Anti-dilutive restricted stock and restricted stock units excluded from the calculation of diluted earnings (loss) per common share (in shares)	271	1,519	267	1,611

Segment Information (Details)

Segment Information (Details) $ in Millions	3 Months Ended		6 Months Ended
	Jun. 30, 2024 USD ($)	Jun. 30, 2023 USD ($)	Jun. 30, 2024 USD ($) segment	Jun. 30, 2023 USD ($)
Segment Reporting [Abstract]
Number of operating segments | segment			4
Segment Reporting Information [Line Items]
Premium and service revenues	$ 35,973	$ 34,838	$ 72,310	$ 69,790
Premium tax	3,863	2,770	7,933	6,707
Total external revenues	39,836	37,608	80,243	76,497
Revenues	39,836	37,608	80,243	76,497
Medical costs	30,765	29,347	61,697	58,781
Cost of services	680	877	1,349	1,747
Gross margin	4,528	4,614	9,264	9,262
Operating Segments
Segment Reporting Information [Line Items]
Revenues	4,081	3,789	8,161	7,656
Eliminations
Segment Reporting Information [Line Items]
Revenues	(4,081)	(3,789)	(8,161)	(7,656)
Premium
Segment Reporting Information [Line Items]
Premium and service revenues	35,140	33,713	70,669	67,538
Service
Segment Reporting Information [Line Items]
Premium and service revenues	833	1,125	1,641	2,252
Premium and service revenues
Segment Reporting Information [Line Items]
Premium and service revenues	35,973	34,838	72,310	69,790
Medicaid
Segment Reporting Information [Line Items]
Revenues	24,113	24,665	49,643	50,829
Medical costs	18,767	19,459	38,262	39,469
Cost of services	22	2	43	2
Gross margin	1,461	2,434	3,405	4,651
Medicaid | Operating Segments
Segment Reporting Information [Line Items]
Premium tax	3,863	2,770	7,933	6,707
Total external revenues	24,113	24,665	49,643	50,829
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	20,229	21,895	41,667	44,122
Medicaid | Service | Operating Segments
Segment Reporting Information [Line Items]
Premium and service revenues	21	0	43	0
Medicaid | Premium and service revenues | Operating Segments
Segment Reporting Information [Line Items]
Premium and service revenues	20,250	21,895	41,710	44,122
Medicare
Segment Reporting Information [Line Items]
Revenues	5,978	5,665	11,913	11,541
Medical costs	5,333	4,884	10,722	9,892
Cost of services	0	0	0	0
Gross margin	645	781	1,191	1,649
Medicare | Operating Segments
Segment Reporting Information [Line Items]
Premium tax	0	0	0	0
Total external revenues	5,978	5,665	11,913	11,541
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	5,978	5,665	11,913	11,541
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	5,978	5,665	11,913	11,541
Commercial
Segment Reporting Information [Line Items]
Revenues	8,535	5,734	16,286	10,986
Medical costs	6,268	4,644	11,948	8,649
Cost of services	0	0	0	0
Gross margin	2,267	1,090	4,338	2,337
Commercial | Operating Segments
Segment Reporting Information [Line Items]
Premium tax	0	0	0	0
Total external revenues	8,535	5,734	16,286	10,986
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	8,534	5,734	16,284	10,986
Commercial | Service | Operating Segments
Segment Reporting Information [Line Items]
Premium and service revenues	1	0	2	0
Commercial | Premium and service revenues | Operating Segments
Segment Reporting Information [Line Items]
Premium and service revenues	8,535	5,734	16,286	10,986
Other/Eliminations
Segment Reporting Information [Line Items]
Revenues	1,210	1,544	2,401	3,141
Medical costs	397	360	765	771
Cost of services	658	875	1,306	1,745
Gross margin	155	309	330	625
Other/Eliminations | Operating Segments
Segment Reporting Information [Line Items]
Premium tax	0	0	0	0
Total external revenues	1,210	1,544	2,401	3,141
Revenues	4,081	3,789	8,161	7,656
Other/Eliminations | Eliminations
Segment Reporting Information [Line Items]
Revenues	(4,081)	(3,789)	(8,161)	(7,656)
Other/Eliminations | Premium | Operating Segments
Segment Reporting Information [Line Items]
Premium and service revenues	399	419	805	889
Other/Eliminations | Service | Operating Segments
Segment Reporting Information [Line Items]
Premium and service revenues	811	1,125	1,596	2,252
Other/Eliminations | Premium and service revenues | Operating Segments
Segment Reporting Information [Line Items]
Premium and service revenues	$ 1,210	$ 1,544	$ 2,401	$ 3,141