Centene Corp (CNC) 2025 Q3 法說會逐字稿

Good day, and welcome to the Centene Corporation 2025 third quarter financial results conference call. (Operator Instructions) Please note today's event is being recorded.

大家好，歡迎參加 Centene 公司 2025 年第三季財務業績電話會議。（操作說明）請注意，今天的活動正在錄製中。

I would now like to turn the conference over to Jennifer Gilligan, Senior Vice President, Investor Relations. Please go ahead, ma'am.

現在我將把會議交給投資者關係高級副總裁珍妮佛‧吉利根。請便，女士。

Thank you, Rocco, and good morning, everyone. Thank you for joining us on our third quarter 2025 earnings results conference Call. Sarah London, Chief Executive Officer; and Drew Asher, Executive Vice President and Chief Financial Officer of Centene, will host this morning's call, which also can be accessed through our website at centene.com.

謝謝你，羅科，大家早安。感謝您參加我們2025年第三季財報電話會議。Centene 執行長 Sarah London 和執行副總裁兼財務長 Drew Asher 將主持今天上午的電話會議，您也可以透過我們的網站 centene.com 存取會議。

Any remarks that Centene may make about future expectations, plans and prospects constitute forward-looking statements for the purpose of the Safe Harbor provision under the Private Securities Litigation Reform Act of 1995. Specifically, our discussion today of our expectations for the drivers of adjusted diluted earnings per share for 2025 and any commentary on expected adjusted diluted earnings per share for 2025 are forward-looking statements.

Centene 對未來預期、計畫和前景所作的任何評論均構成 1995 年《私人證券訴訟改革法案》安全港條款所指的前瞻性陳述。具體而言，我們今天對 2025 年調整後稀釋每股收益驅動因素的預期以及對 2025 年預期調整後稀釋每股收益的任何評論都是前瞻性陳述。

Actual results may differ materially from those indicated by those forward-looking statements as a result of various important factors, including those discussed in our third quarter 2025 press release, Centene's most recent Form 10-Q filed this morning and its 10-K filed on February 18, 2025. Additionally, other public SEC filings, which are available on the company's website under the Investors section. Centene anticipates that subsequent events and developments may cause its estimates to change.

由於各種重要因素的影響，實際結果可能與這些前瞻性聲明所指出的結果有重大差異，這些因素包括我們在 2025 年第三季新聞稿、Centene 今天早上提交的最新 10-Q 表格以及 2025 年 2 月 18 日提交的 10-K 表格中討論的因素。此外，還有其他向美國證券交易委員會 (SEC) 提交的公開文件，可在公司網站的「投資者」欄位下查閱。Centene預計後續事件和發展可能會導致其估算發生變化。

While the company may elect to update these forward-looking statements at some point in the future, we specifically disclaim any obligation to do so. This call will also refer to certain non-GAAP measures. A reconciliation of these measures with the most directly comparable GAAP measures can be found in our third quarter 2025 press release.

雖然公司未來可能會選擇更新這些前瞻性聲明，但我們特此聲明不承擔任何更新義務。本次電話會議也將提及某些非GAAP指標。這些措施與最直接可比較的 GAAP 措施的比較情況，請參閱我們 2025 年第三季的新聞稿。

With that, I will turn the call over to our CEO, Sarah London. Sarah?

接下來，我將把電話轉交給我們的執行長莎拉倫敦。莎拉？

Thanks, Jen, and thanks, everyone, for joining us to review our third quarter 2025 financial results and updated full year outlook. We are driving significant progress against the milestones we provided to investors in July, yielding a better-than-expected adjusted EPS result in the period.

謝謝Jen，也謝謝大家參加我們的2025年第三季財務業績和更新後的全年展望回顧會議。我們在實現 7 月向投資者公佈的里程碑方面取得了重大進展，該期間的調整後每股盈餘 (EPS) 結果優於預期。

This morning, we reported third quarter adjusted EPS of $0.50, ahead of our previous expectation. Within these results, our Medicaid business delivered anticipated HBR improvement in the period that was further aided by a positive 2025 retroactive revenue adjustment in our Florida business. SG&A and performance within our noncore segment were both slightly favorable.

今天早上，我們公佈了第三季調整後每股收益為 0.50 美元，高於我們先前的預期。在這些業績中，我們的 Medicaid 業務在本期實現了預期的 HBR 改善，這得益於我們在佛羅裡達州業務中 2025 年的積極追溯收入調整。銷售、管理及行政費用以及非核心業務板塊的業績均略好。

Net investment income was stronger than we previously expected, and we experienced a lower effective tax rate in the quarter than originally forecasted. Marketplace experienced additional medical cost pressure in the last month of the quarter, but the segment still produced an on-track result for the period.

淨投資收益強於預期，本季實際稅率低於預期。本季最後一個月，市場面臨額外的醫療成本壓力，但該業務部門仍實現了當期業績目標。

And our Medicare segment, including MA and PDP, performed in line with expectations we shared on our second quarter call. With three quarters of the year complete, we are increasing our adjusted EPS forecast to at least $2, up from our previous forecast of $1.75 per share.

我們的醫療保險業務（包括 MA 和 PDP）表現符合我們在第二季電話會議上的預期。今年已過三個季度，我們將調整後的每股盈餘預期從先前的每股 1.75 美元上調至至少 2 美元。

When we came to you in July with recalibrated earnings expectations, we laid out six key assumptions that bridged us from our April outlook to the $1.75 per share forecast. We'd like to take a moment to update you on how those six factors evolved during the quarter and are now treated within our new adjusted EPS outlook of at least $2.

今年 7 月，我們向大家公佈了重新調整後的獲利預期，並提出了六個關鍵假設，這些假設使我們從 4 月的展望過渡到每股 1.75 美元的預測。我們想花點時間向您介紹這六個因素在本季是如何演變的，以及它們現在在我們新的調整後每股收益預期（至少 2 美元）中是如何體現的。

One, relative to marketplace morbidity and its corresponding impact on risk adjustment assumptions, we received the second tranche of Wakely data in September, improving our visibility with industry-level paid claims through July. We are pleased this data was consistent with our previous estimates, and we have, therefore, made no changes to our original full-year assumption of a $2.4 billion pretax earnings impact within this new forecast. As a reminder, the next update from Wakely is expected in December.

第一，相對於市場疾病及其對風險調整假設的相應影響，我們在 9 月收到了 Wakely 的第二批數據，提高了我們對截至 7 月的行業層面已支付索賠的可見性。我們很高興這些數據與我們先前的估計一致，因此，在新預測中，我們沒有改變最初對全年稅前收益影響 24 億美元的假設。提醒一下，Wakely 的下一次更新預計將在 12 月發布。

Two, also in the forecast was $200 million we added to account for additional Marketplace medical spend in the back half of the year. Marketplace delivered an in-line result for the quarter. But given the uptick in utilization we saw in September, we are holding the remaining $125 million of this provision in Q4 and are adding another $75 million given the volatility around eAPTCs. While we may not need this cover, as of now, we believe this to be a prudent posture given the landscape uncertainty that remains.

其次，預測中還增加了 2 億美元，用於彌補下半年市場醫療支出的增加。Marketplace 本季業績符合預期。但鑑於我們在 9 月看到的利用率上升，我們將剩餘的 1.25 億美元撥備保留在第四季度，並鑑於 eAPTC 的波動性，再增加 7,500 萬美元。雖然目前我們可能不需要這種掩護，但考慮到當前情況的不確定性，我們認為這是一種謹慎的做法。

Three, in July, we pointed to a 2025 Medicaid composite rate of roughly 5% based on the rates in hand at the time. With all scheduled rate adjustments now finalized, we expect the 2025 composite rate adjustment to be roughly 5.5%.

第三，7 月份，我們根據當時掌握的費率預測，2025 年 Medicaid 綜合費率約為 5%。鑑於所有計劃的利率調整均已最終確定，我們預計 2025 年綜合利率調整幅度約為 5.5%。

Four, in July, we were targeting a second half Medicaid HBR of 93.5%. Our third quarter Medicaid HBR was 93.4%, which included $150 million in Florida Children's Medical Services program revenue, of which $90 million or 40 basis points was retro. As a result, we are now on a trajectory for a back half HBR of approximately 93.2%.

7 月，我們的目標是下半年 Medicaid HBR 達到 93.5%。我們第三季的 Medicaid HBR 為 93.4%，其中包括 1.5 億美元的佛羅裡達兒童醫療服務計畫收入，其中 9,000 萬美元或 40 個基點為追溯收入。因此，我們目前正朝著下半年 HBR 約為 93.2% 的目標邁進。

Five, we continue to expect the Medicare segment to deliver $700 million of pretax favorability relative to our April full year forecast. Medicare Advantage and PDP results in the quarter were consistent with our outlook, so no change to this expectation.

第五，我們仍然預計 Medicare 業務將比我們 4 月的全年預測帶來 7 億美元的稅前收益。本季 Medicare Advantage 和 PDP 的業績與我們的預期一致，因此這項預期沒有改變。

Six, we are also still on track to deliver $500 million in pretax benefit from SG&A. In fact, we performed slightly better than expected with administrative expense reduction in Q3. However, given the fluid nature of marketplace open enrollment and the potential for additional enrollment activities surrounding eAPTCs decisions, we are keeping the full year SG&A assumptions unchanged for the last quarter as of now.

第六，我們仍有望實現銷售、一般及行政費用5億美元的稅前收益。事實上，我們在第三季透過降低行政費用，表現略優於預期。然而，鑑於市場開放註冊的動態性以及圍繞 eAPTC 決策可能出現的額外註冊活動，我們目前仍將全年銷售、一般及行政費用假設維持在最後一個季度不變。

In addition to those items from our Q2 bridge, we want to highlight investment income and tax rate performance in the quarter and how they impact our expectations for the remainder of the year.

除了我們第二季過渡報告中提到的那些項目之外，我們還想重點介紹本季的投資收益和稅率表現，以及它們如何影響我們對今年剩餘時間的預期。

As mentioned earlier, Q3 investment income was stronger than expected. Gains were largely driven by one-time items and therefore, not expected to recur. We believe there may be opportunity to take some investment losses in the fourth quarter to improve the trajectory of investment income in 2026, and we are providing flexibility in the guidance to do so if the opportunity arises.

如前所述，第三季投資收益優於預期。收益主要由一次性項目驅動，因此預計不會再次發生。我們認為，第四季或許有機會承受一些投資損失，以改善 2026 年的投資收益軌跡，因此，如果機會出現，我們將在績效指引中提供彈性。

Tax favorability in the quarter was driven by a lower tax rate, which was purely a matter of timing. Our view of the full year tax rate remains unchanged. While we continue to track and pull levers to address Medicaid cost trend and are similarly watching marketplace utilization dynamics closely in this uncertain environment, we are pleased with the overall performance of the business in the quarter.

本季的稅收優惠是由較低的稅率造成的，這純粹是時機問題。我們對全年稅率的看法保持不變。儘管我們繼續追蹤並採取措施應對醫療補助成本趨勢，並且同樣密切關注當前不確定環境下的市場利用動態，但我們對本季業務的整體表現感到滿意。

With that, let's take a closer look at the performance and trajectory of each core business line, starting with Medicaid.

接下來，讓我們仔細看看每個核心業務線的業績和發展軌跡，首先從醫療補助計劃開始。

We were pleased to deliver 150 basis points of sequential improvement in our Medicaid HBR this quarter. While this was aided by improved revenue from the Florida Children's Medical Services contract, it also reflects fundamental improvement that is a direct result of the actions we described on our Q2 call, including rate advocacy, program changes, clinical management, network optimization, and more aggressive fraud, waste and abuse interventions, among others. Those efforts yielded tangible proof points in Q3.

本季度，我們的 Medicaid HBR 指標較上季改善了 150 個基點，我們對此感到非常高興。雖然佛羅裡達州兒童醫療服務合約帶來的收入增加對此有所幫助，但也反映了我們在第二季度電話會議上描述的行動所帶來的根本性改善，包括費率倡導、項目變更、臨床管理、網絡優化以及更積極的欺詐、浪費和濫用乾預措施等。這些努力在第三季取得了切實的成果。

During our second quarter call, we identified two states, Florida and New York, where we were experiencing outsized Medicaid medical cost pressure. In Florida, you'll recall we saw significant trend pressure in the CMS population as members receiving ABA services were transitioned into that sole-source contract. We engaged in constructive dialogue with the state and shared real-time data throughout the summer.

在第二季電話會議上，我們確定了佛羅裡達州和紐約州這兩個州，這兩個州正面臨醫療補助醫療成本的巨大壓力。您可能還記得，在佛羅裡達州，隨著接受 ABA 服務的成員過渡到單一來源合同，我們看到 CMS 人群出現了明顯的趨勢壓力。整個夏季，我們與州政府進行了建設性對話，並分享了即時數據。

In September, the state moved to address the underfunding of that program going back to February 1. Additionally, the state provided a rate update for the coming year that better reflects the underlying medical demand within that population.

9 月，該州著手解決該項目自 2 月 1 日以來資金不足的問題。此外，該州還提供了來年的費率更新方案，該方案更好地反映了該族群的潛在醫療需求。

In New York, we made real progress on the fraud, waste, and abuse front, particularly in the behavioral health space. Fidelis team was able to terminate a provider group that engaged in suspicious billing practices and drove sizable excess medical costs at the expense of New York taxpayers. The state has simultaneously taken several serious actions against the same provider. It's a great example of the confidence our state partners in Albany have in Centene.

在紐約，我們在打擊詐欺、浪費和濫用方面取得了真正的進展，尤其是在行為健康領域。Fidelis 團隊成功終止了一家供應商集團的合作，該集團存在可疑的收費行為，導致紐約納稅人承擔了巨額的額外醫療費用。州政府同時對同一供應商採取了多項嚴厲措施。這充分體現了我們在奧爾巴尼的州合作夥伴對 Centene 的信任。

Through these and other performance improvement efforts, the New York team is currently on track to deliver meaningful HBR improvement in the back half of the year compared to Q2 results.

透過這些以及其他績效改善措施，紐約團隊目前預計在今年下半年實現哈佛商業評論業績較第二季有顯著提升。

We continue to see trend in Medicaid with the same drivers we described in Q2, namely behavioral health with ABA a primary contributor, home and community-based services with home health the major driver and high-cost drugs, though high-cost drug trend did show slight moderation in the period.

我們繼續看到 Medicaid 的發展趨勢與第二季度描述的驅動因素相同，即行為健康（ABA 是主要貢獻者）、以家庭健康為主要驅動因素的家庭和社區服務以及高價藥品，儘管高價藥品的趨勢在這一時期略有緩和。

As you heard on the Q2 call, we have organized enterprise-wide to address these dynamics and saw solid momentum in the quarter on those initiatives.

正如您在第二季電話會議上聽到的那樣，我們已經在全公司範圍內組織起來應對這些動態，並且在本季度這些舉措取得了穩步進展。

A few examples. We have been actively working with states on solutions to address high-cost drugs and have seen multiple states make movements over the last quarter to implement drug-specific carve-outs and revised formulary decisions, including two states who have reversed course on GLP-1.

舉幾個例子。我們一直在積極與各州合作，尋求解決高價藥物問題的方案，並且在過去一個季度中，我們看到多個州採取了行動，實施針對特定藥物的豁免和修訂的處方集決定，其中包括兩個州改變了對 GLP-1 的態度。

Additionally, our ABA task force successfully leveraged our multistate experience and unique breadth of data to drive important policy advancements with our state partners. One state established increased precision in ABA clinical service definition as well as more stringent supervisory and caregiver engagement requirements.

此外，我們的 ABA 工作小組成功地利用了我們在多州的經驗和獨特的廣度數據，與我們的州合作夥伴一起推動了重要的政策進步。一個州提高了 ABA 臨床服務定義的精確度，並制定了更嚴格的監督和照顧者參與要求。

This drove a 45% reduction to outlier payment rates, which results in tangible financial improvement for the state's program and aligns members to higher quality services. We are pleased to be making real progress on our Medicaid margin improvement agenda, but we are certainly not declaring victory.

這使得異常支付率降低了 45%，從而為該州的計劃帶來了切實的財務改善，並使成員能夠獲得更高品質的服務。我們很高興在提高醫療補助利潤率方面取得了實質進展，但我們當然不會宣布勝利。

With behavioral health still driving 50% of above-baseline trend, we continue to aggressively pull levers internally to appropriately manage medical costs and advocate for rates that reflect the medical demand in the ecosystem, all part of returning Medicaid margins to a more normalized long-term levels.

由於行為健康仍然佔基線以上趨勢的 50%，我們繼續積極地在內部採取各種措施，以適當控制醫療成本，並倡導制定反映生態系統中醫療需求的費率，所有這些都是為了使 Medicaid 利潤率恢復到更正常的長期水平。

Despite the challenges we have navigated over the last few years, our commitment to serving low-income and underserved populations has never been stronger. We are pleased to be making progress against our financial goals and making good on our commitment to be responsible stewards of state taxpayer dollars, all while continuing to provide high-quality care and access to vital health care services for our members.

儘管過去幾年我們經歷了許多挑戰，但我們為低收入和弱勢群體提供服務的承諾從未動搖。我們很高興在實現財務目標方面取得進展，並履行了我們對負責任地管理州納稅人資金的承諾，同時繼續為我們的成員提供高品質的照護和獲得重要醫療保健服務的機會。

Turning to Marketplace. From a membership standpoint, we ended the quarter with roughly 5.8 million members, slightly better than expectations. As you heard earlier, the business produced an in-line result inclusive of medical cost pressure in September.

轉向市場。從會員數量來看，本季末我們擁有約 580 萬會員，略好於預期。正如您之前聽到的，儘管面臨醫療成本壓力，但該公司9月的業績仍符合預期。

Given what we saw in September and the reality that we are supporting a population staring down eAPTC expiration and potentially the wholesale loss of affordable health care coverage next year, we felt it was prudent to provide for additional coverage in Q4 against a potentially more pronounced year-end utilization push.

鑑於我們在 9 月看到的情況，以及我們正在支持的人群正面臨 eAPTC 到期，並且明年可能全面失去負擔得起的醫療保健保障的現實，我們認為在第四季度提供額外的保障是謹慎的，以應對年底可能更加明顯的醫療資源使用高峰。

In the meantime, we have been laser-focused on positioning our marketplace book for 2026 margin expansion, and Q3 was the critical window for that effort. We were data-driven in the buildup of our revised rates, which ultimately averaged in the mid-30s, taking into account increased 2025 baseline morbidity, a prudent assumption for year-over-year trend and the combined risk pool impacts of expiring eAPTCs and program integrity measures.

同時，我們一直專注於調整市場佈局，以實現 2026 年利潤率的擴張，而第三季是這項工作的關鍵時期。我們在製定修訂後的費率時以數據為依據，最終平均費率在 30 多，其中考慮了 2025 年基線發病率的增加、對逐年趨勢的謹慎假設以及到期 eAPTC 和項目完整性措施的綜合風險池影響。

Consistent with what we shared in September, we were able to reprice our products for 2026 in states that cover 95% of our current membership and where we were not able to fully reflect the expected morbidity in the rates, we took additional actions to minimize margin impact for the remaining membership. Those rates have now been officially approved, and absent any late-breaking policy changes, will drive open enrollment as it launches this weekend.

與我們在 9 月分享的內容一致，我們能夠對覆蓋我們 95% 現有會員的州的 2026 年產品進行重新定價，而對於我們無法在費率中完全反映預期發病率的州，我們採取了額外的措施，以最大限度地減少對剩餘會員利潤的影響。這些費率現已正式獲得批准，如果沒有突發的政策變化，將推動本週末開始的公開註冊。

Congressional dialogue around eAPTCs has obviously gained traction in recent weeks, the outcome remains uncertain. While our products are priced to support year-over-year margin improvement in a scenario where eAPTCs expire, we believe these tax credits offer critical support for hard-working Americans, small business owners and rural health care infrastructure, and we are hopeful Congress can find a path forward.

最近幾週，國會圍繞電子高級實踐稅收抵免（eAPTC）的對話顯然取得了進展，但結果仍不確定。雖然我們的產品定價旨在支持在 eAPTC 到期的情況下實現逐年利潤率的提高，但我們相信這些稅收抵免為辛勤工作的美國人、小企業主和農村醫療保健基礎設施提供了至關重要的支持，我們希望國會能夠找到前進的道路。

In the meantime, we are ready to open enrollment with strengthened digital tools and well-trained call center personnel to aid members during this time of uncertainty. Regardless of the outcome, we remain confident in the long-term importance and viability of the individual health insurance market as a critical coverage solution for millions of Americans.

同時，我們已做好準備，透過加強數位化工具和訓練有素的呼叫中心人員，開放註冊，以幫助會員度過這段不確定的時期。無論結果如何，我們仍然對個人健康保險市場的長期重要性和可行性充滿信心，認為它是數百萬美國人的重要保障解決方案。

As we move beyond this moment of policy evolution, we continue to see a greater role for this platform to support a more affordable, portable individual insurance experience that we are excited to lean into and lead forward.

隨著我們走出政策演變的這個階段，我們繼續看到該平台在支持更經濟實惠、更便利的個人保險體驗方面發揮更大的作用，我們很高興能夠積極參與並引領這一進程。

Finally, Medicare. Both of our Medicare segment businesses performed well during the quarter, producing results consistent with our updated outlook provided this summer. Our reported Medicare segment HBR was 94.3%, reflecting typical cost of care patterns within Medicare Advantage as well as the inverted seasonality of pharmacy costs within PDP, owing largely to changes related to the IRA. Note that these dynamics are even more pronounced now that PDP is half of our Medicare segment revenue.

最後，是聯邦醫療保險（Medicare）。本季度，我們的兩大醫療保險業務部門均表現良好，業績與我們今年夏天發布的最新展望一致。我們報告的 Medicare 部門 HBR 為 94.3%，反映了 Medicare Advantage 中典型的護理成本模式，以及 PDP 中藥房成本的季節性反轉，這主要是由於與 IRA 相關的變化。請注意，由於 PDP 目前占我們 Medicare 業務收入的一半，這些動態更加明顯。

Medicare Advantage medical cost trend remains elevated compared to historic levels, but was consistent with our expectations for the quarter. PDP performance was consistent with our previous view and is now largely contained by risk corridors, providing for increased visibility into the fourth quarter as the corridor serves to narrow the band of outcomes through downside protection for the product. AEP is live, and we are actively enrolling members in our 2026 Medicare products.

與歷史水準相比，聯邦醫療保險優勢計劃的醫療成本趨勢仍然較高，但與我們對本季的預期一致。PDP 的表現與我們先前的觀點一致，現在很大程度上受到風險走廊的控制，這提高了第四季度的可見性，因為該走廊透過對產品的下行保護來縮小結果範圍。AEP 現已上線，我們正在積極招募會員參加我們的 2026 年醫療保險產品。

Margin recovery once again took priority over membership as we constructed Medicare Advantage bids, but we are pleased with both the value proposition we are offering beneficiaries as well as our competitive positioning. We continue to invest in our member experience, providing enhanced digital tools and resources for members and prospective members.

在製定 Medicare Advantage 投標方案時，利潤恢復再次優先於會員發展，但我們對我們為受益人提供的價值主張以及我們的競爭地位都感到滿意。我們持續投資於會員體驗，為會員和潛在會員提供更完善的數位化工具和資源。

Dual eligible populations are a strategic focus for Centene, and we recently launched the first phase of our enhanced integrated duals model across eight states as part of the broader transition of MMPs to integrated D-SNPs effective January 1, 2026.

雙重資格族群是 Centene 的戰略重點，我們最近在八個州啟動了增強型綜合雙重資格模式的第一階段，這是 MMP 向綜合 D-SNP 的更廣泛過渡的一部分，將於 2026 年 1 月 1 日生效。

We look forward to the opportunity to serve these beneficiaries as their needs and our capabilities continue to align and evolve. Earlier this month, CMS released 2026 Star ratings that impact 2027 financial results, and we are pleased to have generated another year of progress. During this cycle, we elevated our performance despite continued cut point headwinds to 60% of members in plans at or above 3.5 stars versus 55% from the prior year with roughly 20% of members in four-star plans.

我們期待有機會為這些受益者提供服務，因為他們的需求與我們的能力將持續契合和發展。本月初，CMS 發布了 2026 年星級評定，該評定將影響 2027 年的財務業績，我們很高興又取得了一年的進步。在本週期中，儘管面臨持續的削減壓力，我們的業績仍有所提升，60% 的會員計劃達到或超過 3.5 星，而上一年這一比例為 55%，其中約 20% 的會員計劃達到四星級。

These results demonstrate a true One CenTeam effort with the initiatives being planned and executed at every level of the organization and provide us with increased confidence in our ability to achieve breakeven pretax margin in 2027.

這些結果體現了 CenTeam 的真正團結協作精神，各項舉措在組織的各個層面都得到了規劃和執行，這讓我們更有信心在 2027 年實現稅前利潤率收支平衡。

We are proud of the Medicare Advantage Star score advancements we have achieved over the last 3 years, but remain focused on the opportunity for continued improvement. In the near term, we are leaning into provider interoperability, multimodal member engagement and advanced VBC partnerships as levers for the future.

我們為過去 3 年在 Medicare Advantage 星級評分方面取得的進步感到自豪，但我們仍將專注於繼續改進的機會。短期內，我們將專注於發展供應商互通性、多模式會員參與和先進的基於價值的醫療保健合作夥伴關係，以此作為面向未來的槓桿。

Overall, we are pleased to have maintained strong Medicare segment results, including positioning PDP well to achieve results better than the 1% pretax margin guidance we began the year with and putting Medicare Advantage on an even stronger path to achieve breakeven in 2027.

總體而言，我們很高興保持了 Medicare 業務的強勁業績，包括將 PDP 定位良好，以實現比年初設定的 1% 稅前利潤率預期更高的業績，並使 Medicare Advantage 走上更加強勁的道路，在 2027 年實現盈虧平衡。

As we reflect on the quarter, we are pleased to have made material and necessary progress on Medicaid profitability and delivered solid results across the balance of the business. It is a testament to the resilience and discipline of this entire organization that we are able to raise the outlook today. And while a tremendous amount of work remains ahead of us, we intend to harness the positive momentum we have generated here in the third quarter to help power the balance of the year.

回顧本季度，我們很高興在 Medicaid 盈利能力方面取得了實質和必要的進展，並在其他業務領域取得了穩健的業績。今天我們能夠提升前景，這充分證明了整個組織的韌性和紀律。雖然我們面前還有大量工作要做，但我們打算利用第三季度取得的積極勢頭，為今年剩餘時間的發展注入動力。

Looking ahead, given that we will not be hosting an Investor Day in December, our plan is to provide detailed 2026 guidance on our Q4 earnings call in early February. In the meantime, we wanted to offer some initial comments on the major building blocks of our 2026 plan.

展望未來，鑑於我們不會在 12 月舉辦投資者日，我們的計劃是在 2 月初的第四季度收益電話會議上提供詳細的 2026 年業績指引。同時，我們想就我們 2026 年計劃的主要組成部分提出一些初步意見。

In Marketplace, as we've shared, we were able to successfully take actions to account for baseline morbidity, trend, eAPTC expiry and program integrity impacts for 2026 across 95% or more of our membership. While the policy landscape remains uncertain, based on what we know today, we believe we have positioned the portfolio well for meaningful margin improvement in 2026.

正如我們之前分享的，在 Marketplace，我們能夠成功地採取措施，考慮 2026 年 95% 或以上會員的基線發病率、趨勢、eAPTC 到期和專案完整性影響。儘管政策環境仍不明朗，但根據我們目前所了解的情況，我們相信我們已經為 2026 年實現利潤率的顯著提高做好了充分的準備。

As a result of thoughtful bid construction and disciplined management, we believe our Medicare Advantage business is also well positioned for margin improvement in 2026. CP continues to outperform in 2025, but you can assume we would not guide to a similar level of outperformance as we step into 2026, making this a year-over-year headwind as we set initial guidance.

由於精心設計的投標方案和嚴謹的管理，我們相信我們的 Medicare Advantage 業務在 2026 年也將實現利潤率的提升。CP 在 2025 年繼續表現出色，但可以預見的是，我們不會預期 2026 年也能達到類似的優異表現，因此，在我們制定初步業績指引時，這將是一個同比不利因素。

In Medicaid, in light of our now better-than-expected full-year trajectory, we believe a prudent posture for 2026 is profitability consistent with our current full-year outlook in 2025. Additionally, you should assume that a lower tax rate environment makes net investment income a headwind and that our tax rate increases. Overall, we remain focused on driving margin improvement across the enterprise and delivering EPS growth in 2026.

在醫療補助方面，鑑於我們目前全年的發展軌跡優於預期，我們認為 2026 年審慎的做法是保持獲利能力與我們 2025 年的全年展望一致。此外，您還應該假設較低的稅率環境會使淨投資收益成為不利因素，並且我們的稅率會上升。整體而言，我們將繼續專注於提升整個企業的利潤率，並在 2026 年實現每股收益成長。

The current dynamic policy landscape has presented significant challenges in 2025, but also offers meaningful opportunity in the months and years to come. We have incredible runway ahead of us in the form of operational improvements, efficiency gains, and margin expansion, all in service of our dual mandate to ensure quality health outcomes and serve as responsible stewards of taxpayer dollars.

當前瞬息萬變的政策環境為 2025 年帶來了重大挑戰，但也為未來幾個月和幾年提供了重要的機會。我們未來還有巨大的發展空間，包括營運改善、效率提升和利潤率擴大，所有這些都是為了履行我們的雙重使命：確保高品質的醫療成果，並負責任地管理納稅人的錢。

None of this would be possible without the tireless work of more than 60,000 Centeneers across the nation, serving and supporting our nearly 28 million members. Thank you once again for showing up day in and day out in service of our mission.

如果沒有遍布全國的 6 萬多名 Centeneers 員工的不懈努力，為近 2,800 萬名會員提供服務和支持，這一切都不可能實現。再次感謝你們日復一日地為我們的使命服務。

With that, I'll turn it over to Drew.

接下來，我將把麥克風交給德魯。

Thank you, Sarah. Today, we reported third quarter 2025 results, including $44.9 billion in premium and service revenue and adjusted diluted earnings per share of $0.50. The GAAP loss per share of $13.50 was the direct result of a $6.7 billion non-cash goodwill impairment charge recorded in the quarter. More on that in a minute.

謝謝你，莎拉。今天，我們公佈了2025年第三季業績，其中包括449億美元的保費和服務收入，以及調整後攤薄每股收益0.50美元。以美國通用會計準則計算，每股虧損13.50美元，這是由於本季提列了67億美元的非現金商譽減損費用所致。稍後將詳細介紹。

Within the $0.50 of adjusted EPS, we had a temporarily low adjusted effective tax rate in the quarter, which contributed about $0.10 compared to an expected full year 2025 adjusted tax rate of 20% to 21%. Let's go through the drivers for the quarter and then map that to the full year.

在調整後的每股盈餘 0.50 美元中，我們本季的調整後有效稅率暫時較低，與預計 2025 年全年調整後稅率 20% 至 21% 相比，這貢獻了約 0.10 美元。讓我們先來分析一下本季的驅動因素，然後將其與全年情況進行比較。

Starting with Medicaid. We are pleased to report a Q3 HBR of 93.4%, better than we expected for the quarter and heading in the right direction. Of the three previously discussed high trending areas, Medicaid high-cost drug trends settled a little in the quarter, and we successfully advocated for much improved revenue in our Florida Children's Medical Services or CMS business, where we've seen very high ABA costs.

從醫療補助計劃開始。我們很高興地宣布，第三季 HBR 為 93.4%，優於我們對該季度的預期，並且正朝著正確的方向發展。在先前討論過的三個高趨勢領域中，醫療補助高成本藥品趨勢在本季度略有穩定，我們成功地爭取到佛羅裡達兒童醫療服務或 CMS 業務收入大幅提高，因為我們在該業務中看到了非常高的 ABA 成本。

As Sarah covered, we received a net $150 million positive revenue adjustment in Q3 for the Florida CMS program for the 2/1 -- February 1 -- to September 30, 2025 period, of which about $90 million was retro to Q1 and Q2 2025. Retro piece was worth about 40 basis points on the Q3 Medicaid HBR. We also made some progress in New York, but there is more work to do to further improve performance.

正如 Sarah 所報導的，我們在 2025 年 2 月 1 日至 9 月 30 日期間的佛羅裡達州 CMS 項目第三季度獲得了 1.5 億美元的淨正收入調整，其中約 9000 萬美元追溯至 2025 年第一季和第二季度。復古元素在第三季度 Medicaid HBR 中價值約 40 個基點。我們在紐約也取得了一些進展，但要進一步提高業績，還有更多工作要做。

Overall, given the Q3 result and momentum we are seeing from actions we have taken in 2025, we're a little ahead of our back half Medicaid HBR goal. On the rate front, the 9/1 to 10/1 cohort that represents about 28% of annualized premium averaged in the mid-5s, consistent with the full year 2025 composite rate.

總體而言，鑑於第三季的業績以及我們在 2025 年採取的行動所帶來的勢頭，我們略微領先於下半年的 Medicaid HBR 目標。在費率方面，9/1 至 10/1 群體約佔年化保費的 28%，平均費率在 5 分左右，與 2025 年全年綜合費率一致。

We are focused on 1/1 and 4/1 rates, representing about half of our 2026 annualized premium revenue, and that advocacy is in process. Medicaid membership is at $12.7 million, and we would expect slight attrition over the next few quarters. Stepping back, we are pleased with the sequential progress in Medicaid with opportunity for improvement ahead.

我們重點關注 1/1 和 4/1 費率，這約占我們 2026 年年度保費收入的一半，目前我們正在積極爭取這些費率。醫療補助計劃的投保人數為 1,270 萬美元，我們預計未來幾季投保人數將略有下降。總的來說，我們對醫療補助計劃的進展感到滿意，未來還有改進的空間。

In our Commercial segment, our HBR was on track for Q3 at 89.9%. As Sarah indicated, in September, we received and evaluated the second run of marketplace Wakely data, which represents updated claims through July. Our review of this data is consistent with the $2.4 billion forecast change we described on the Q2 call.

在我們的商業部門，第三季的哈佛商業評論指數 (HBR) 為 89.9%，與預期相符。正如 Sarah 所指出的，9 月我們收到了 Wakely 市場數據的第二批數據，並對其進行了評估，這些數據代表了截至 7 月的最新索賠情況。我們對這些數據的審查結果與我們在第二季電話會議上描述的 24 億美元的預測變化一致。

Recall also, our previous guidance had accounted for a pickup in marketplace trend in the back half of the year, especially given the level of public discourse around the eAPTCs. We did see a pickup in utilization in September, including ER. And as we assess risks and opportunities for Q4, we added another $75 million to our prior marketplace medical expense forecast.

此外，我們先前的指導意見已經考慮到了下半年市場趨勢的回升，特別是考慮到圍繞 eAPTC 的公眾討論程度。9 月我們看到使用率上升，包括急診室。在評估第四季度的風險和機會時，我們在先前的市場醫療費用預測中又增加了 7,500 萬美元。

The more critical activity during Q3 was focused on 2026 rate filings and eAPTC education and advocacy. We sit here today based upon our rate filings in 29 states. We have priced for our estimates of: one, 2025 baseline correction; plus two, 2026 forecasted trend; plus three, the impact of program integrity rules implemented in 2025 and those announced for 2026; and four, the sunset of eAPTCs.

第三季更重要的活動集中在 2026 年費率備案和 eAPTC 教育和宣傳方面。我們今天能坐在這裡，是基於我們在29個州提交的費率申請。我們對以下各項的估計進行了定價：一、2025 年基線修正；二、2026 年預測趨勢；三、2025 年實施的計劃完整性規則和 2026 年宣布的規則的影響；四、eAPTC 的終止。

Unlike 2025, which is expected to run at a slight loss, we expect these pricing actions to support margin expansion in our Marketplace business in 2026.

與預計略有虧損的 2025 年不同，我們預計這些定價措施將在 2026 年支持我們市場業務的利潤率擴張。

Our Medicare segment was also on track in the quarter. Medicare Advantage continues to show progress toward our 2027 goal of breakeven, and we were pleased with the progress with the October Stars announcement, as Sarah covered.

本季我們的醫療保險業務也進展順利。Medicare Advantage 繼續朝著我們 2027 年實現收支平衡的目標穩步前進，我們對 10 月份的“明星計劃”公告中公佈的進展感到滿意，正如 Sarah 所報道的那樣。

Within PDP, while trends are still high in the non-low-income PDP population, they weren't as high as we had planned for in Q3. That's good for cash flow and forward forecasting, but is largely offset against the risk corridor receivable for current earnings purposes.

在 PDP 內部，雖然非低收入 PDP 族群的趨勢仍然很高，但第三季並沒有達到我們預期的水平。這對現金流量和未來預測是有利的，但很大程度上會被當前收益所需的風險走廊應收款所抵消。

As we discussed at a webcast conference during Q3, we are pleased with our 2026 PDP product positioning relative to the relevant benchmarks and direct subsidy estimates. More to come on the Medicare segment after AEP.

正如我們在第三季的網路直播會議上所討論的那樣，我們對 2026 年 PDP 產品相對於相關基準和直接補貼估算的定位感到滿意。AEP結束後，我們將發布更多關於Medicare部分的資訊。

Our adjusted SG&A expense ratio continues to be strong at 7.0% in the third quarter compared to 8.3% last year and 7.3% year-to-date compared to 8.3% year-to-date last year. This is largely due to growth in 2025 PDP revenue and continued leveraging of expenses over higher revenues, coupled with good discipline.

我們的調整後銷售、一般及行政費用率第三季持續強勁，為 7.0%，而去年同期為 8.3%；今年迄今為 7.3%，而去年同期為 8.3%。這主要歸功於 2025 年 PDP 收入的成長，以及持續利用更高的收入來降低支出，再加上良好的紀律。

Given the amount of activity expected in Q4 with open enrollments and member communications, we are assuming for now that we will spend any remaining Q3 SG&A outperformance in Q4. You will notice investment and other income is up $79 million in Q3 compared to Q2. We had a few gains in the quarter, plus temporarily higher cash balances than expected.

鑑於預計第四季度將有大量活動，包括開放註冊和會員溝通，我們目前假設我們將把第三季剩餘的任何銷售、管理及行政費用超額收益用於第四季度。你會注意到，第三季的投資和其他收入比第二季增加了 7,900 萬美元。本季我們取得了一些收益，現金餘額也暫時高於預期。

As we think about Q4, we may harvest some unrealized losses like we did a couple of years ago in Q4. as we think about reinvesting in higher-yielding instruments for 2026 and beyond. So for now, we are assuming that Q3 investment and other income outperformance will be earmarked for that purpose.

展望第四季度，我們可能會像幾年前第四季度一樣，收回一些未實現的損失，同時考慮在 2026 年及以後投資於收益更高的工具。因此，目前我們假設第三季的投資和其他收益超額部分將用於此目的。

Overall, the fundamental business performance was good in Q3 relative to our July forecast. Our GAAP results, you can see a reduction or write-down of about 38% of our goodwill during Q3. As we covered on the Q2 call, the drop in market cap required us to accelerate our annual goodwill evaluation into Q3. After going through an accounting promulgated and detailed review of our goodwill, we took a onetime non-cash charge of $6.7 billion in our GAAP results. This has no impact on statutory capital, cash or adjusted EPS results.

整體而言，第三季基本面業務表現良好，符合我們7月的預測。根據我們的 GAAP 結果，您可以看到我們在第三季商譽減少了約 38% 或進行了減記。正如我們在第二季電話會議上提到的，市值下降迫使我們將年度商譽評估提前到第三季進行。在經過會計準則的製定和對商譽的詳細審查後，我們在 GAAP 結果中計提了 67 億美元的一次性非現金支出。這不會對法定資本、現金或調整後的每股盈餘產生任何影響。

Our sole credit facility financial covenant is a debt-to-cap limit at 60%, and we sit at 45.5% on 9/30/25 after this write-down. The topic of the balance sheet, we had 0 drawn on our $4 billion revolver that has a duration until 2030. We also had a strong cash quarter with cash flow provided by operations of $1.4 billion in Q3, primarily driven by net earnings and the net timing of pass-through and other payments.

我們唯一的信貸融資財務契約是債務資本比率上限為 60%，在本次減記後，截至 2025 年 9 月 30 日，我們的負債資本比率為 45.5%。關於資產負債表，我們40億美元的循環信貸額度（有效期至2030年）並沒有提取任何資金。第三季我們的現金流也十分強勁，經營活動產生的現金流為 14 億美元，主要得益於淨利潤以及轉嫁和其他付款的淨時間安排。

Unregulated cash on hand at quarter end was $357 million. As you can see in the 10-Q, we expect to receive net $200 million in dividends from subsidiaries in Q4. Medical claims liability totaled $21.5 billion and represents 48 days in claims payable, an increase of one day as compared to the second quarter of 2025.

截至季末，公司持有的非管制現金為3.57億美元。正如您在 10-Q 文件中看到的那樣，我們預計在第四季度將從子公司收到 2 億美元的淨股息。醫療索賠負債總額為 215 億美元，相當於 48 天的索賠支付期，比 2025 年第二季增加了一天。

We look at the full-year 2025, we are increasing our 2025 adjusted EPS forecast from the previous $1.75 to at least $2, driven by early execution on the improved Florida CMS revenue. 2026. We look forward to providing 2026 guidance on our next quarterly call in early February once we have closed out 2025. But as you heard from Sarah, we look forward to growing adjusted EPS in 2026.

我們展望 2025 年全年，由於佛羅裡達州 CMS 收入改善帶來的早期執行，我們將 2025 年調整後每股收益預測從先前的 1.75 美元上調至至少 2 美元。2026年。我們期待在2025年結束後，在2月初的下一次季度電話會議上提供2026年的業績指引。但正如你從 Sarah 那裡聽到的，我們期待在 2026 年實現調整後每股收益成長。

Thank you for your interest in Centene, and we can -- Rocco, we can open it up for questions.

感謝您對 Centene 的關注，我們可以—Rocco，我們可以開放提問環節。

(Operator Instructions) Josh Raskin, Nephron Research.

（操作說明）Josh Raskin，腎單位研究。

I guess my question really would be, how do you get comfortable that you are getting ahead of trend in the exchanges? And do competitor exits make the pool less stable for 2026? And is there a point where this adverse selection spiral causes you to rethink certain markets or maybe even the segment entirely?

我想問的其實是，如何才能確信自己在交易所的交易中領先趨勢？競爭對手的退出是否會降低2026年獎金池的穩定性？那麼，這種逆向選擇螺旋是否會促使你重新思考某些市場，甚至整個細分市場呢？

Josh, thanks for the question. Let me hit utilization and trend in marketplace both as we think about the back half of 2025 and then how we've thought about it for 2026. So as we said, we saw a slight uptick in utilization in September, primarily outpatient ED. It correlated from a time standpoint with the direct uptick in dialogue nationally around both rate increases for 2026 and the eAPTC discussion at the congressional level. So not a perfect correlation or causation, I guess, but correlation there.

喬希，謝謝你的提問。讓我談談市場利用率和趨勢，包括我們對 2025 年下半年的展望，以及我們對 2026 年的展望。正如我們所說，9 月的使用率略有上升，主要是門診急診。從時間上看，這與全國範圍內圍繞 2026 年利率上漲和國會層面 eAPTC 討論的對話直接增加相吻合。所以，這不算是完全的相關性或因果關係，但確實有相關性。

And as we thought about Q4 and thought about that $200 million provision, pushing the remainder of the $125 million into Q4 and then adding another $75 million was really based on taking what we saw in September, extrapolating that out and assuming that given just the volatility in the landscape and the fact that some folks are going to be concerned about their ability to access health care next year, we may see more of an uptick than we normally do in terms of that Q4 utilization.

當我們考慮第四季度以及那 2 億美元的撥備時，將剩餘的 1.25 億美元撥到第四季度，然後再增加 7500 萬美元，實際上是基於我們在 9 月份看到的情況，並據此推斷，考慮到當前形勢的波動性以及一些人擔心明年能否獲得醫療保健，我們可能會看到第四季度的醫療服務利用率比往常更高。

So we feel like we've put prudent coverage in Q4 as we run out the year. Relative to 2026, we obviously did a lot of work and just want to call out again the marketplace team jumping on top of the weekly data in July really through that and understanding the drivers of what we were seeing and the fact that there were indicators in that data of what the extrapolated morbidity shifts would be above and beyond what we're seeing in '25 or '26.

因此，我們感覺在年底的第四季度，我們已經做出了審慎的報導。相對於 2026 年，我們顯然做了很多工作，我只想再次強調市場團隊在 7 月認真研究了每週數據，真正理解了我們所看到的情況的驅動因素，以及這些數據中存在的指標，這些指標表明，在 2025 年或 2026 年，推斷出的發病率變化將超出我們所看到的。

So what we built into the revised rates that we talked about filing across 95% of membership were four major components. One was that adjusted 2025 baseline morbidity. And obviously, the fact that the September Wakely data came in consistent with our extrapolation of the July data is a strong reinforcing data point. So that's one.

因此，我們在修訂後的費率中加入了四個主要組成部分，我們討論過向 95% 的會員提交這些費率。其中之一是調整後的 2025 年基線發生率。顯然，9 月 Wakely 的數據與我們根據 7 月數據推斷出的結果一致，這是一個強有力的佐證數據點。這是其中之一。

Two is a healthy provision for trend as we step in -- year-over-year trend as we step into 2026. Three is the assumption of the expiration of eAPTCs because that is current law of the land and what that will do to risk pool shifts. And then the last is a composite view of the additional risk pool shifts that would be driven by both the continuation of the 2025 program integrity measures and sort of enrollment hurdles that were put in place as well as those hurdles that are -- were in the final rule and also in OB-3. And so all of that was loaded as part of that revised rate.

2 是進入 2026 年之際，對趨勢的一個健康準備－同比趨勢。第三點是假設 eAPTC 到期，因為這是現行法律，以及這將對風險池轉移產生什麼影響。最後，對額外風險池轉移的綜合看法是，2025 年計畫完整性措施的延續以及已經實施的入學障礙，以及最終規則和 OB-3 中存在的障礙，都將推動這些轉移。因此，所有這些因素都包含在修訂後的利率中。

And that gives us confidence that an average step-up, as I mentioned, in the 30s, really with a focus on margin over membership sets us up well for meaningful margin recovery in '26. Now there are multiple pieces that are still moving, right?

這讓我們有信心，正如我所提到的，在 30 年代平均水平的提高，真正關注利潤率而不是會員人數，將使我們在 2026 年實現有意義的利潤率恢復。現在還有好幾個環節在進行中，對吧？

Obviously, we don't know where eAPTCs will land. The payment program integrity measures that were in the final rule have been stayed in the courts. And our view is it's unlikely that those move ahead of Saturday and possibly not even through at least the original planned open enrollment period. And so we need to see where those land, but the bottom line is that our pricing took into account sort of all of those actually being in place during the open enrollment period.

顯然，我們不知道 eAPTC 最終會落到什麼程度。最終規則中包含的支付計劃完整性措施已被法院暫停執行。我們認為，這些措施不太可能在周六之前實施，甚至可能至少在原計劃的開放註冊期內都不會實施。因此，我們需要看看這些措施最終會如何實施，但關鍵在於，我們的定價已經考慮到了所有這些措施在開放註冊期間的實際實施情況。

Lastly, just relative to your comment on overall stability, we do feel like there is still a competitive market. We feel like peers were thoughtful about '26 in terms of understanding the risk pool shifts. And we do think that the fundamental construction of the market with those advanced premium tax credits prevents any kind of sort of death spiral, but we've been cautious as we constructed our view of 2026.

最後，就您提到的整體穩定性而言，我們確實認為市場仍然存在競爭。我們覺得同儕們對 2026 年的風險池變化進行了深入思考。我們確實認為，透過這些提前發放的保費稅收抵免政策對市場進行的基本結構調整，可以防止任何形式的死亡螺旋，但我們在構建對 2026 年的展望時一直保持謹慎。

A.J. Rice, UBS.

A.J. Rice，瑞銀集團。

Maybe just a follow-up on that and then maybe ask you something on Medicaid as well. On -- so presumably, the open enrollment people -- the open enrollment that enrollees are going to see will reflect the loss of these tax credits, and there may well be a move by Congress to extend them in some form or fashion. Do you have the ability to quickly reengage people to get them to sign up?

或許可以就此做個後續跟進，然後再問您關於醫療補助計劃（Medicaid）的問題。因此，據推測，開放註冊的人員認為，受保者將看到的開放註冊將反映出這些稅收抵免的損失，國會很可能會採取行動，以某種形式或方式延長這些抵免。您是否有能力快速重新吸引用戶並促使他們註冊？

I assume the people that are sicker and dealing with the health system through their providers will get prompted to resign, but I'm thinking about those that are younger, healthier, and have less frequent contacts, many of those still using the exchanges.

我猜想那些病情較重、需要透過醫療服務提供者與醫療系統打交道的人會被建議辭職，但我想到的是那些更年輕、更健康、接觸醫療服務提供者較少的人，其中許多人仍在利用醫療保險交易平台。

How easy is it to notify them that now it may make sense to re-sign up? And what efforts do you have in place for that? And then just quickly on your comment about stable margins or stable contribution in Medicaid next year.

通知他們現在重新註冊可能更合適，這有多容易？為此，你們採取了哪些措施？然後，我再快速回答您關於明年醫療補助計劃利潤率或繳款額穩定的評論。

There's a lot of discussion about some states trying to adopt work rules early and also putting in place program integrity measures on that side of the business. How are you thinking about that when you think about your outlook for Medicaid next year? And is that a meaningful swing factor?

目前有許多討論指出，一些州正在嘗試儘早制定工作規則，並在此方面實施專案誠信措施。您在考慮明年醫療補助計劃的前景時，是如何看待這個問題的？那是重要的搖擺因素嗎？

Yeah. Thanks, AJ. Great questions -- easy questions. So let me hit marketplace first. And you're right. So what we are navigating through is the idea that traditional open enrollment launches on Saturday. The eAPTC discussion is, we assume live as we speak with the possibility that there may be action before the end of the year. And so I think what you're really asking about is breakage.

是的。謝謝，AJ。好問題——簡單的問題。那麼，讓我先看看市場行情。你說得對。所以我們現在面臨的問題是，傳統的公開註冊將於週六啟動。我們假設 eAPTC 的討論目前仍在進行中，並且有可能在年底前採取行動。所以我覺得你真正想問的是破損狀況。

So even if we got eAPTC extension, are we able to go and recapture folks who maybe got an initial letter, made a decision about the affordability of their insurance based on that data point and don't actually reengage or return of their own volition to understand how that landscape may change. So that is something that we are paying a lot of attention to.

所以即使我們獲得了 eAPTC 延期，我們能否重新吸引那些可能收到初始信函、根據該數據點決定了保險是否負擔得起，但實際上並沒有主動重新參與或返回了解情況可能發生哪些變化的人呢？所以這是我們非常關注的事情。

And in fact, if you think about our commentary about rolling forward some of the SG&A favorability that we saw in Q3 because of this idea that we may be going through a multilayered enrollment process. We may find ourselves with a special enrollment period or an extension, we may want to be putting forward additional marketing efforts, obviously, mobilizing our broker relationships to go and find those members if and as the landscape changes midstream.

事實上，如果你想想我們之前關於將第三季度看到的 SG&A 優惠提前的評論，那是因為我們可能正在經歷一個多層次的註冊過程。我們可能會遇到特殊的註冊期或延期，我們可能希望加強行銷力度，顯然，如果市場環境在中途發生變化，我們將調動經紀人關係去尋找這些會員。

Our view is that there will still be some degree of breakage. And so even if the eAPTCs are extended in the middle of the cycle and you go forward, for example, with an additional 60-day special enrollment period, our view of market contraction for 2026 is in the high teens to mid-30s range.

我們認為，破損現象仍會存在一定程度。因此，即使 eAPTC 在週期中期延長，例如增加 60 天的特殊註冊期，我們對 2026 年市場萎縮的預期僅為 10% 到 30% 左右。

So again, that's based on all of the different factors that could be at play. But it tells you that even that bottom end where, for example, the program integrity rules remain stayed and eAPTCs are extended that there is going to be some degree of market contraction.

所以，這又取決於所有可能起作用的不同因素。但這說明，即使在專案完整性規則保持不變、電子高級產品稅收抵免 (eAPTC) 延長的最低端，市場也會出現一定程度的萎縮。

And again, some of that is the roll-through of '25 program integrity enrollment hurdles, but also a view that there will be some abrasion and breakage on members who get that initial letter and don't come back.

再次強調，部分原因是 2025 年計畫誠信註冊障礙的延續，但也存在這樣一種觀點，即收到第一封信後不再回來的成員會受到一些摩擦和打擊。

But we are certainly prepared to do everything we can to go find those members and help them understand in the event of an extension that they do have access to affordable insurance and certainly have done all of the work both mathematically and administratively to be prepared, frankly, for any of these scenarios, so that we can help be a good partner both to the administration as they navigate through this, but also supportive of our member base.

但我們絕對會盡一切努力去找到這些成員，幫助他們了解，如果延期，他們仍然可以獲得負擔得起的保險，而且我們已經在數學和行政方面做了所有工作，坦白地說，為應對任何這些情況都做好了準備，這樣我們既可以成為管理層的好夥伴，幫助他們應對這種情況，也可以支持我們的成員。

So that's Marketplace. Medicaid, so a couple of things embedded there. Relative to work requirements, we saw some movement over the summer for states that were putting in waivers and thinking about potential early start, call it, 7/1/26 implementation of work requirements. As of now, those states that were early in that have all moved back to a 1/1/27 start date.

這就是市場。醫療補助計劃，所以其中包含一些內容。關於工作要求，我們看到一些州在夏季採取了一些行動，他們申請豁免，並考慮提前開始實施工作要求，例如從 2026 年 7 月 1 日開始實施。截至目前，較早採取這項措施的州都已將開工日期改回 2027 年 1 月 1 日。

So we don't have any firm data points of states that have our intent or have explicitly pinned 7/1/26 start date. There's also quite a bit of important guidance that is still to come from CMS that is not scheduled to come down in rule-making until the summer.

因此，我們沒有任何確切的數據點表明哪些州與我們的想法一致，或明確確定了 2026 年 7 月 1 日的開始日期。此外，CMS還有相當多的重要指導意見尚未出台，這些意見要到夏季才會通過規則制定程序公佈。

And those are really important provisions relative to state flexibility, how to define able bodied what additional population states may be able to carve out what the data capture and reporting requirements are going to be, what the frequency is of all of this.

這些條款對於各州的靈活性至關重要，例如如何定義“有勞動能力的人”，各州可以劃撥哪些額外的人口，數據收集和報告的要求是什麼，以及所有這些的頻率是多少。

So states can certainly and it should be, and we are working very closely with them to plan ahead, but there's a lot about what this is actually going to look like that is not even scheduled to become clear until the summer, which means that 2027 and for some states beyond that is going to be the more rational sort of implementation time frame of that.

所以各州當然可以而且應該這樣做，我們正在與他們密切合作，提前做好規劃，但關於這實際上會是什麼樣子，還有很多事情要到夏天才能明朗，這意味著 2027 年，以及對一些州來說更晚，將是更合理的實施時間框架。

And then what, therefore, is the impact as we think about '26, we don't see a huge impact in '26 relative to work requirements as we think about the overall margin profile and our ability to retain, as we said, initial view of '26 consistent profitability. And then the program integrity measures, similarly, we are expecting some degree of membership attrition next year just as we're seeing states get better at the reverification process, but we don't see that as a huge swing factor.

那麼，當我們展望 2026 年時，我們認為其影響為何？考慮到整體利潤率以及我們維持 2026 年持續獲利能力的能力，我們認為 2026 年相對於工作需求不會產生巨大影響。同樣，在專案完整性措施方面，我們預計明年會出現一定程度的成員流失，因為我們看到各州在重新核實流程方面做得越來越好，但我們認為這不會是一個巨大的搖擺因素。

Justin Lake, Wolfe Research.

賈斯汀·萊克，沃爾夫研究公司。

First, just a quick follow-up on the exchanges. I appreciate you sharing your thoughts on the market contraction potential. I wanted to hear your view on competitive positioning for '26 versus '25. And would you expect your growth overall to be in line with that market [SAR] or better or worse and by how much?

首先，簡單跟進一下交流狀況。感謝您分享對市場萎縮可能性的看法。我想聽聽您對 2026 年與 2025 年競爭定位的看法。您預計您的整體成長會與該市場（SAR）持平、更好還是更差？如果是，會好多少？

And then maybe, Drew, any color you could share with us in terms of how much of that $700 million of Part D upside we should think about unwinding next year? Thanks.

那麼，德魯，你能否透露一下，對於明年我們應該考慮解除7億美元D部分收益中的多少？謝謝。

Yeah. Thanks, Justin. So a little bit about market competitive position. So again, a slightly refined view of overall market contraction in that high teens to mid-30s. Obviously, it depends on which scenario lands, and we need to see how open enrollment, which may be extra complex plays out. But it's possible that we end up slightly on the higher end of that range.

是的。謝謝你，賈斯汀。接下來簡單談談市場競爭地位。所以，再次強調，整體市場萎縮幅度略有調整，預計在十幾度到三十幾度之間。顯然，這取決於哪種情況最終發生，我們需要看看開放註冊（這可能會格外複雜）會如何發展。但我們最終的結果有可能略微接近該範圍的上限。

However, relative to our competitive positioning and the landscape, relativity, we had 55% of our portfolio in the low-cost silver positions in '25 and 42% in '26. So not a huge change, but a change that I think reflects the fact that we were very focused on margin recovery over membership as we stepped into those 2026 pricing decisions.

然而，相對於我們的競爭地位和市場格局而言，2025 年我們 55% 的投資組合都集中在低成本白銀領域，2026 年這一比例為 42%。所以這並不是一個巨大的變化，但我認為這一變化反映了這樣一個事實：在製定 2026 年定價決策時，我們非常注重利潤恢復而不是會員發展。

And then I'll kick it over to Drew on PDP.

然後我會把話題轉給PDP上的Drew。

Yeah. PDP, good question, Justin. So as Sarah said in her remarks, PDP is now about half of our $37 billion of full year '25 Medicare segment revenue. So you can keep that in mind on the impact on the full segment. And then underneath that, PDP, think about it this way. We're running -- we expect to run in the 3s in terms of pretax margin in 2025.

是的。PDP，問得好，賈斯汀。正如 Sarah 在演講中所說，PDP 目前約占我們 2025 年全年 370 億美元 Medicare 業務收入的一半。所以你可以把這一點記在心裡，以評估其對整個細分市場的影響。然後，在PDP之下，你可以這樣想。我們正在努力——我們預計到 2025 年，稅前利潤率將達到 3%。

And while we're still constructing all the elements of the plan, and we need to see how open enrollment plays out, we would probably come out of the gate something less than that as we think about initial guidance that we will give in February for 2026.

雖然我們仍在建立該計劃的所有要素，我們需要看看開放註冊的情況如何，但當我們考慮在 2 月發布的 2026 年初步指導意見時，我們一開始可能會給出比這更少的方案。

Andrew Mok, Barclays.

Andrew Mok，巴克萊銀行。

Last quarter, you expressed confidence in margin improvement across all business lines, including Medicaid. Now it sounds like you're not expecting much improvement in Medicaid profitability. First, was that comment framed through the lens of earnings dollars or margins? Because I think there might be some pressure on the revenue line from disenrollment and contract losses.

上個季度，您對包括醫療補助在內的所有業務線的利潤率提升表示有信心。聽起來你似乎並不指望醫療補助計劃的獲利能力會有太大改善。首先，這個評論是從獲利金額還是利潤率的角度來看的？因為我認為，由於學生退學和合約損失，收入可能會面臨一些壓力。

And second, was there a change in underlying performance across the broader portfolio when excluding some of the idiosyncratic events in Florida? Thanks.

其次，如果排除佛羅裡達州的一些特殊事件，整個投資組合的基本面表現是否改變了？謝謝。

Yeah. So let me step through Medicaid, and I'll take your last question or last piece of the question first and just reinforce that, first, obviously, very pleased to be delivering sequential HBR improvement quarter-over-quarter.

是的。那麼，讓我來詳細介紹一下 Medicaid，我先回答你最後一個問題或問題的最後一部分，並重​​申一下，首先，顯然，我非常高興能夠實現 HBR 逐季的持續改進。

And the fact that what we delivered is reflective of the improvement that we were expecting in the July guidance. It was further aided by the $150 million in Florida, which actually, I think, is a great proof point of the fact that rate advocacy is an important lever. And that while in Medicaid, we don't set the rates, we can influence the rates and those rates are ultimately data-driven.

而我們實際取得的成績也反映了我們在7月業績指引中預期的改善。佛羅裡達州的 1.5 億美元也為此提供了幫助，我認為這實際上很好地證明了利率倡導是一項重要的槓桿作用。而且，雖然在醫療補助計劃中，我們不設定費率，但我們可以影響費率，而這些費率最終是由數據驅動的。

So what influences our view of '26 now versus July, the biggest shift is really that we're on a better-than-expected trajectory than we were in July. But a couple of factors as you think about how we're looking at progression and important to note that regardless, we are not taking our foot off the gas on HBR improvement overall as an organizational focus.

那麼，是什麼影響了我們現在對 2026 年的看法與 7 月的看法呢？最大的變化是，我們現在的發展軌跡比 7 月預期的要好。但有幾個因素需要考慮，在考慮我們如何看待發展進程時，需要注意的是，無論如何，我們不會放鬆對哈佛商業評論整體改進的重視，這仍然是我們組織的重點。

But we were jumping off a very high starting point in Q2 and a first half HBR of 94.2%. So we're going -- we're expecting to have a lower HBR in Q4 even than Q3, which was lower than Q2. We have the benefit of solid rates at 5.5% composite, which is sitting in that back half cohort annualizing into 2026. We'll also have -- be lapping the acceleration of trend. And so does trend step up at the same accelerated rate?

但我們在第二季有一個非常高的起點，上半年哈佛商業評論指數為 94.2%。所以我們預期－我們預期第四季的哈佛商業評論(HBR)甚至會低於第三季度，而第三季又低於第二季。我們享有 5.5% 的綜合利率這一穩健利率，該利率屬於後半段年利率，將持續到 2026 年。我們也將——超越趨勢加速發展的速度。那麼，趨勢是否也以同樣的加速速度發展呢？

Our belief is that it is more likely to moderate to some degree, but that is also something that we are very focused on controlling where we can. And so a big proof point for us in Q3 was the fact that we were able to put points on the board against every one of those major levers that we talked about.

我們認為這種情況可能會有所緩和，但這也是我們正在努力控制的事情。因此，第三季對我們來說的一個重要證明是，我們能夠針對我們討論過的每一個主要槓桿都取得相應的進展。

So rate advocacy, not just in Florida, but the fact that the 10/1 rates materialized better than expected, clinical policy design in states. And I talked about a couple of those examples where we are influencing states to change their approach to high-cost drugs. And in fact, some of those changes that I described are effective 1/1/26. So we have hard data points about how states are making changes.

因此，費率倡議不僅在佛羅裡達州，而且 10/1 費率的實際效果比預期更好，各州的臨床政策設計也是如此。我談到了其中幾個例子，在這些例子中，我們正在影響一些州改變對高價藥物的態度。事實上，我所描述的一些變更將於 2026 年 1 月 1 日生效。因此，我們掌握了各州如何進行變革的可靠數據。

We've got another great example of states that are adding CCBHCs to their program and the fact that we have experienced where that can drive unintended high costs in states from other parts of our portfolio have been able to inform states about what could happen if you don't put those in place with the right guardrails. And so they're stepping into those program changes in the right way in the first instance.

我們又找到了一個很好的例子，一些州正在將社區行為健康中心 (CCBHC) 納入其計劃，而我們從其他領域的經驗中了解到，這可能會導致一些州出現意想不到的高成本。這些經驗能夠讓各州了解，如果不採取適當的保障措施，會發生什麼事。因此，他們一開始就以正確的方式介入這些專案變革。

Network optimization, I talked about some examples of that, not just from a fraud waste and abuse perspective, but we have a great program called Partnerships in Care when we go out to outlier providers and provide them with data and really talk about -- sometimes it's just a question of education about a better path of care for members.

網路優化方面，我舉了一些例子，不僅從防止詐欺、浪費和濫用的角度出發，我們還有一個名為「護理夥伴關係」的優秀項目，我們會與一些表現不佳的醫療機構合作，向他們提供數據，並真正地進行討論——有時，這只是一個關於如何為會員提供更好護理途徑的教育問題。

And then, of course, stamping out fraud waste and abuse. So really strong proof points of that work in the quarter and the fact that we've been at this now for almost a year. So good visibility into additional opportunities and additional tactical efforts that are out there and ahead and will manifest in '26.

當然，還有要杜絕詐欺、浪費和濫用。所以，本季所取得的成果以及我們為此努力了近一年的事實，都充分證明了這項工作的成效。因此，可以更好地了解未來將會出現的其他機會和戰術舉措，這些都將在 2026 年顯現出來。

We also have almost 40% of the membership that re-rates in the 1/1 cohort. So our view, as we stand here today, sitting on a better-than-expected trajectory with important dates in 2025 still to play out, which will tell us a lot about Q4 trends, will tell us about the right jump-off point for next year.

我們還有近 40% 的會員在 1/1 組別中重新評級。因此，就我們目前所處的位置而言，我們正處於比預期更好的發展軌跡上，2025 年還有一些重要日期尚未到來，這將告訴我們很多關於第四季度趨勢的信息，也將告訴我們明年的正確起點。

We only have about visibility into 50% of 1/1 rates, and those are only draft. So if asked what jump-off point for '26, we believe it's prudent to say consistent profitability and margin as we go from '25 to '26. I will tell you that I will be disappointed if that's all we can deliver.

我們目前只掌握了大約 50% 的 1/1 匯率信息，而且這些都只是草案。因此，如果有人問我們 2026 年的起點是什麼，我們認為謹慎的做法是說，從 2025 年到 2026 年，保持穩定的獲利能力和利潤率。如果這就是我們最終能做到的，我會很失望的。

But we think that, that is a prudent assumption at this time, given where we stand and what we know and also what we don't yet know. But we absolutely look forward to giving much more detailed perspective and formal guidance on the Q4 call.

但我們認為，鑑於我們目前的處境、已知資訊以及未知資訊，這是一個謹慎的假設。但我們非常期待在第四季財報電話會議上提供更詳細的觀點和正式的指導。

Ann Hynes, Mizuho.

安海恩斯，瑞穗。

Just in your main businesses, Medicaid, Medicare health exchanges, can you tell us what -- you had that initial 2026 outlook, what you're assuming the trend is in each segment? And then with Medicaid, can you tell us what your initial thoughts are for the composite rate increase? Thanks.

就你們的主要業務，醫療補助、醫療保險交易市場而言，你們能否告訴我們──你們最初的 2026 年展望，你們認為每個細分市場的趨勢是什麼？那麼關於醫療補助計劃，您能否告訴我們您對綜合費率成長的初步想法？謝謝。

Yeah. So thanks, Ann. Let's start with Medicare. Medicare trend has been running high-single digit to even maybe 10-plus for the last couple of years. And so we're assuming that, that continues. If you compose it with respect to our bids and what's baked into that progression towards breakeven, that would be low double digits. And at some point, that's going to start being reflected in the fee-for-service rates that we all get as an industry. So we look forward to getting an advanced notice in February and seeing what that looks like.

是的。謝謝你，安。我們先從醫療保險（Medicare）說起。過去幾年，Medicare 的成長趨勢一直保持在個位數高位，甚至可能超過 10%。因此，我們假設這種情況會持續下去。如果考慮到我們的出價以及實現損益平衡過程中所包含的因素，那麼漲幅將達到兩位數以下。從某種程度上說，這種情況將會反映在我們整個產業的服務收費標準中。所以我們期待在二月收到提前通知，看看具體情況如何。

In Marketplace, you have to think of the four buckets that I laid out in my remarks because they foot to like a mid-30s average rate increase. And certainly, fundamental trend is a component of that, but probably even more important than trend in Marketplace is the expected risk pool shift. And we learned -- and back to an earlier question, we learned a lot in 2025, which we talked about in the Q2 call, like what happens to risk pools when program integrity measures are put in place.

在市場方面，你必須考慮我在演講中提到的四個方面，因為它們平均會導致 30% 左右的利率上漲。當然，基本面趨勢是其中的一個組成部分，但可能比市場趨勢更重要的是預期風險池的轉變。我們也了解到——回到先前的問題，我們在 2025 年學到了很多東西，我們在第二季度電話會議上也談到了這一點，例如當專案完整性措施到位時，風險池會發生什麼變化。

And it was fortuitous that we were able to see that and learn that before we undertook the repricing effort that was largely successful, as Sarah indicated. So you've got to add a bunch of things up to get to that mid-30s, but that would include one of the four pieces is the fundamental trend.

幸運的是，我們在進行重新定價工作之前就看到了這一點並了解到了這一點，正如莎拉所指出的那樣，重新定價工作在很大程度上取得了成功。所以，要達到 30 多歲，需要把很多因素加起來，但這其中包括四個要素之一——基本趨勢。

And then in Medicaid, -- if you think about this year, our HBR is up probably 120 basis points from 2024, and we got mid-5s rates. And as Sarah said, 30% of that will roll into next year and 2026 in terms of the annualization of what we got in 7/1 and 9/1 and 10/1. And then we have a little bit of the visibility into the 1/1 cohort.

然後，就醫療補助而言，——如果你考慮今年，我們的 HBR 可能比 2024 年上漲了 120 個基點，而我們的費率在 5% 左右。正如莎拉所說，其中 30% 將延續到明年和 2026 年，這是根據 7 月 1 日、9 月 1 日和 10 月 1 日的年化收益計算得出的。然後我們對 1/1 小組的情況也有了一些了解。

And jumping off of a high baseline, including, as Sarah said, like a 94.9% in Q2, a 94.2% for the first half of the year. And then with the levers we've been able to pull a couple of things Sarah mentioned in her script, the two, maybe even three states rolling back on GLP-1s for weight loss, high-cost drug pools being formed, carve-outs of high-cost drugs like Zolgensma, Elevidys, Lyfgenia.

而且，從較高的基數起步，正如莎拉所說，第二季度達到了 94.9%，上半年達到了 94.2%。然後，憑藉我們能夠採取的措施，莎拉在她的劇本中提到了一些事情，例如兩個甚至三個州取消了 GLP-1 減肥藥的使用，建立了高成本藥物池，並將 Zolgensma、Elevidys、Lyfgenia 等高成本藥物排除在外。

And so examples of where we're able to pull levers impacting the trajectory of even then home health with private duty nursing management and behavioral health with the -- what we're being able to do with the task force, we think we're taking a bite out of forward trends. So we'll give more details on the components.

因此，我們可以舉例說明，我們能夠透過私人護理管理和行為健康等手段來影響家庭醫療保健的發展軌跡——透過工作小組，我們認為我們正在扭轉一些發展趨勢。接下來我們將詳細介紹各個組成部分。

But all of that goes into the formula where we can sit here today, once again, with the visibility we have and the visibility we don't have about 2026 and feel like stability in that HBR relative to 93.7%, if you do the math on 2025, expecting to be able to maintain that in 2026 is the starting point of our forecasting for 2026.

但所有這些都納入了我們今天能夠坐在這裡，再次考慮到我們對 2026 年的了解程度，以及我們目前不了解的情況，並認為哈佛商業評論相對於 93.7% 的穩定性，如果你計算一下 2025 年的數據，預期 2026 年能夠保持這一水平，這就是我們對 2026 年預測的起點。

Kevin Fischbeck, Bank of America.

凱文‧菲施貝克，美國銀行。

I was wondering if you could talk a little bit about Medicaid margins, obviously, flat next year. Are you guys expecting that 2026 is going to be basically more of a trough year and that you should be expecting to build on that in '27? It sounds like you're assuming work requirements more of an issue in '27. Is that enough of a risk pool shift to offset the catch-up of prior rates? Or is it clear from this point that probably '26 is where you think the low point will be? Thanks.

我想請您談談醫療補助計劃的利潤率，顯然，明年將持平。你們是否預計 2026 年將是一個低谷年，並期望在 2027 年在此基礎上有所增長？聽起來你認為 2027 年工作需求會變成一個更大的問題。這種風險池轉移是否足以抵銷先前利率的追趕效應？或者從目前來看，你認為2026年可能是低谷期？謝謝。

Yeah. Thanks, Kevin. It's a fair question. And as we look out over the next couple of years, our goal continues to be to drive back to more normalized Medicaid margins. As Drew walked through and I referenced, I think we've got a lot of momentum as we think about stepping into 2026 and our view of flat profitability, again, is sort of a prudent posture.

是的。謝謝你，凱文。這是一個公平的問題。展望未來幾年，我們的目標仍然是努力使醫療補助利潤率恢復到更正常的水平。正如德魯走過來和我提到的那樣，我認為我們在展望 2026 年時勢頭強勁，而我們對盈利能力持平的看法，再次強調，是一種謹慎的態度。

As I said, I will be disappointed if we don't do better than that because I think that the enterprise is really organized around pulling the levers that we are in control of and those that we can influence. 2027 and 2028, to your point, is where we will start to see, I think, the real introduction of impacts of [OB3].

正如我所說，如果我們做得不夠好，我會很失望，因為我認為企業的運作方式是圍繞著如何運用我們能夠控制和影響的因素展開的。正如您所說，我認為2027年和2028年我們將開始真正看到影響的顯現。[OB3]

And what that means for work requirements within the expansion population there is a lot, as I mentioned, a lot still there to play out, including how much of that programmatic change actually takes root and how it manifests state by state. And so the way that we're approaching that is really leveraging lessons learned from the redeterminations process, leaning into state conversations.

至於這對擴張人口的工作需求意味著什麼，正如我所提到的，還有很多事情需要解決，包括有多少程序性的變化能夠真正紮根，以及它如何在各州得到體現。因此，我們採取的方法是真正利用從重新評估過程中學到的經驗教訓，並積極參與州級對話。

We've got a formal team that has already been organized around this over the last six months and starting to plan, again, at the enterprise level, coordinating with each one of our boots on the ground health plan teams to understand how the states are thinking about this, where we can step in and leverage the data that we have as an MCO and the expertise to help make sure that every member who is eligible and who is contributing to their community and who is working has access coverage.

在過去六個月裡，我們已經組建了一個正式團隊，圍繞這項工作展開工作，並開始在企業層面進行規劃，與我們每個一線健康計劃團隊協調，了解各州對此的看法，以及我們可以在哪些方面介入，利用我們作為管理式醫療機構所擁有的數據和專業知識，以確保每個符合條件、為社區做出貢獻且有工作的成員都能獲得醫療保障。

So we feel like we are preparing very well for that. We also feel like we have the precedent now of states incorporating more recent data and also understanding that as there are seminal program shifts, they need to make different decisions in terms of how the risk pools are going to shift prospectively.

所以我覺得我們已經為此做好了非常充分的準備。我們也覺得現在各州已經將最新的數據納入考量，並且認識到，隨著重大專案變革的發生，他們需要在風險池的未來發展方向上做出不同的決定。

And so bringing forward a very concrete view of the expansion population, the specific rate that they're getting, what we think the shift is going to be so the states think about the '27 rate setting process as early as 2026, back half of '26 that we're having those conversations as well.

因此，我們提出了一個非常具體的觀點，即人口擴張的具體速度，以及我們認為將會發生的轉變，以便各州早在 2026 年就考慮 2027 年的費率制定過程，我們在 2026 年下半年也進行了這些討論。

So we obviously can't guarantee that states are going to perfectly nail the rate relative to what that shift will be. And so we're thinking about how that will play through in '27 and '28, but doing everything we can to set up the organization to continue to drive consistent margin improvement over the next couple of years to get to a place where we're back at long-term margins in Medicaid.

因此，我們顯然無法保證各州能夠完美地預測出與這種轉變相關的比率。因此，我們正在考慮這將在 2027 年和 2028 年如何發展，但我們會盡一切努力使組織能夠在未來幾年內繼續推動利潤率的持續提高，最終使我們在醫療補助方面恢復到長期利潤率水平。

George Hill, Deutsche Bank.

喬治·希爾，德意志銀行。

I guess this is more for Drew. I guess, Drew, can you talk about any of the assumptions that underpin the margin stability for Medicaid in '26? In particular, does that include the Florida retro and what's changed in New York. And I'd be interested if you'd be able to talk about the contribution of benefit cuts or benefit design changes you called out the high-cost drug carve-outs as it relates to margin stability in '26.

我想這更多是給德魯的。德魯，我想請你談談支撐 2026 年 Medicaid 利潤率穩定性的假設有哪些？具體來說，這是否包括佛羅裡達復古風潮以及紐約的變化？如果您能談談您提到的高成本藥品豁免對 2026 年利潤穩定性的影響，以及福利削減或福利設計變更的貢獻，我將很感興趣。

Yes, George, thanks for the question. So if you think about -- you asked about the retro, that's actually not retro to a prior year. It's just retro. The Florida retro was retro to Q1 and Q2. So when you look at the full year, once again, around 93.7%, you guys could do the math, some I will tell you, 93.7% is what we're forecasting for 2025 and stability, the goal of stability in that.

是的，喬治，謝謝你的提問。所以如果你仔細想想——你問的是復古風，那其實不是復古到前一年。它只是復古而已。佛羅裡達州的追溯期追溯至第一季和第二季。所以，縱觀全年，再次達到 93.7% 左右，你們可以自己算算，我告訴你們，93.7% 是我們對 2025 年的預測，也是穩定性的目標。

And I agree with Sarah, that's our initial goal, but we'd be disappointed if we don't move that down a little. But 93.7% -- some of the things I covered with Ann, including the levers that we're pulling, you mentioned high-cost drugs. And so yeah, those would get -- in one case, in one large state, they're going to do a carve-out. In another state, there's a kick pool, kick payment pool for those payers that have those encounters.

我同意莎拉的看法，那是我們最初的目標，但如果我們不能把目標降低一點，我們會很失望的。但 93.7%——我和安討論過的一些事情，包括我們正在採取的措施，你提到了高價藥物。所以，是的，在某個案例中，在一個大州，他們會進行一項例外處理。在另一個州，有一個專門用於支付那些發生此類情況的付款人的「踢球池」或「踢球支付池」。

And there's other examples of well-run reinsurance pools that other states are considering because of the lumpiness of some of those high-cost drugs. So that's just -- that's one example of sort of the hand-to-hand combat we have to go through in terms of managing care and creating affordability for our state partners and our members. So I won't repeat everything I went over with Ann, but those were some of the levers we thought about when we contemplate being able to have stability as we go into 2026.

還有一些運作良好的再保險基金的例子，其他州正在考慮效仿，因為某些高價藥物的價格波動較大。所以，這只是——這只是我們在管理醫療保健和為我們的州合作夥伴和成員創造可負擔性方面必須經歷的一場實戰的一個例子。所以我不會重複我和安討論過的所有事情，但這些是我們考慮在 2026 年保持穩定時所考慮的一些因素。

Erin Wright, Morgan Stanley.

艾琳·賴特，摩根士丹利。

So you're still very committed to the business. And I know last week, I think, Sarah, you were at an industry conference talking about ICHRA still being a compelling area. But how do you just think about some of the longer-term dynamics across the exchange business, the longer-term margin targets and growth profile of that business? I guess a lot is dependent on the regulatory changes, right? But just given your level of commitment, how confident are you in some of those targets? And then -- and just what would potentially make you change your commitment to that as well?

所以你仍然對這項事業充滿熱情。我知道上週，莎拉，你參加了一個行業會議，談到 ICHRA 仍然是一個引人注目的領域。但是，您如何看待交易所業務的一些長期動態、長期利潤目標和成長前景？我想很大程度取決於監管政策的變化，對吧？但就你目前的投入程度而言，你對實現這些目標有多少信心？那麼——究竟是什麼原因會讓你改變對那件事的承諾呢？

Yeah. Thanks, Erin. So we haven't changed our commitment, obviously, to this product and not -- we haven't really changed our view of what philosophically we should be able to price for long term. And as we said, the work that we did for 2026 was really designed with the intention to make a meaningful step forward in margin recovery in 2026. But I think to your point, longer-term stability, you're absolutely right.

是的。謝謝，艾琳。所以，顯然，我們對這款產品的承諾並沒有改變，而且——我們也沒有真正改變我們對長期定價理念的看法。正如我們所說，我們為 2026 年所做的工作，其真正目的是為了在 2026 年實現利潤率恢復的實質進步。但就你所說的長期穩定性而言，你的觀點完全正確。

First of all, a fair amount depends, although not ultimately, but some short term certainly depends on what plays out relative to policy changes. eAPTCs, I think, is probably the biggest swing factor just in terms of getting to a really, really stable base so that we can think about building on the platform.

首先，很大程度取決於政策變化，雖然並非最終決定因素，但短期內肯定要看政策走向。我認為，eAPTC可能是最大的轉捩點，它決定著我們能否建立一個真正穩定的基礎，以便在此基礎上進行後續發展。

There are still millions and millions of Americans even if eAPTCs go away that rely on the individual marketplace for coverage that have the backstop of the eAPTCs. And so we believe that this product stabilizes, we still think there is growth or millions of Americans who are still uninsured.

即使 eAPTC 取消，仍有數以百萬計的美國人依賴個人市場獲得保險，而 eAPTC 為他們提供了保障。因此，我們相信，隨著產品的穩定，我們仍然認為仍有數百萬美國人沒有醫療保險，市場需求將會成長。

And actually, I think the way that this administration is thinking about, at least in conversations, the possibility of getting creative about different product design and different ways to drive affordability in this market is really encouraging. We obviously think that the individual market is a compelling chassis as we consider the future of insurance and a view that individuals are going to want more agency.

實際上，我認為本屆政府在思考如何創造性地設計不同的產品，以及如何以不同的方式降低市場價格方面所展現出的積極態度，確實令人鼓舞。我們顯然認為，個人市場是一個引人注目的基礎，因為我們考慮保險的未來，並且認為個人會希望擁有更大的自主權。

They're going to want more affordability. And as I mentioned last week in the conference, it's really hard to take a small number of benefit options across for Centene's 60,000 employees and feel like you're really customizing to each individual's needs. I use the example of the fact that I'm a 45-year-old healthy woman, and I didn't go to the doctor until last Saturday. And so I am definitely paying more for health insurance at Centene than I need.

他們會想要更實惠的價格。正如我上週在會議上提到的那樣，要為 Centene 的 6 萬名員工提供數量有限的福利選擇，並感覺真正滿足了每個人的需求，這真的很難。我舉個例子，我是一個45歲的健康女性，直到上週六才去看醫生。因此，我在Centene支付的健康保險費肯定比我需要的要多。

And so we continue to be excited and lean into ICHRA. We're hopeful that this administration is also very interested in ICHRA because it is -- a lot of the legislation is a legacy of Trump's first term, and we have leaders in the administration who have spent careers thinking about how this could be a way to reinvent individual coverage. So we are going through a policy transition on the base, and we feel very confident that we will get through that. We're thinking about ways to drive additional transparency and stability in the core business.

因此，我們繼續保持熱情，並積極參與 ICHRA。我們希望本屆政府也對 ICHRA 非常感興趣，因為許多立法都是川普第一任期的遺產，而本屆政府的領導人畢生都在思考如何透過這種方式重塑個人健保。所以我們正在經歷基地政策的過渡，我們非常有信心能夠順利度過這一階段。我們正在思考如何提高核心業務的透明度和穩定性。

And so how can we partner with CMS, how can we partner with the DOIs, how can we partner with our peer set and actually do a better job of sharing data as we step through each year so that the risk adjustment conversation itself is incrementally derisked. But we're not backing off the view that we can design benefits that drive value and price for that value on the exchange and that this is a platform for future individual growth that I think we are investing in and positioned well to help capture.

那麼，我們如何與 CMS 合作，如何與 DOI 合作，如何與同行合作，並在每年的進程中更好地共享數據，從而逐步降低風險調整討論本身的風險呢？但我們並沒有放棄這樣的觀點：我們可以設計出能夠推動價值成長的福利，並在交易所中為這種價值定價，而且這是一個促進未來個人成長的平台，我認為我們正在投資並佔據有利地位，以幫助實現這一目標。

Stephen Baxter, Wells Fargo.

史蒂芬‧巴克斯特，富國銀行。

I just wanted to ask about the rate mechanics in Florida. It's obviously good to hear that CMS, the population there, Florida saw reason on the rates. But just in terms of the cadence, it looks like in the third quarter, obviously, you got trued up on your performance there.

我只是想了解佛羅裡達州的利率機制。顯然，聽到 CMS（美國醫療保險和醫療補助服務中心）以及佛羅裡達州的民眾都對費率表示理解，這是一件好事。但就節奏而言，顯然在第三節，你的表現已經明顯提升了。

So if we're thinking about the Florida rate update, does Florida actually improve sequentially in the fourth quarter now, which is normally what you would expect when you see those rate updates come in? Or should we think about the Q3 performance effectively showing that you've got the rate year-to-date rather than getting it in Q4? Thnaks. Hopefully, that makes sense.

所以，如果我們考慮佛羅裡達州的利率更新，佛羅裡達州的利率在第四季度是否真的環比有所改善？這通常是我們在看到這些利率更新時所期望的。或者我們應該認為第三季的業績實際上表明你今年迄今為止的成長率已經達到目標，而不是在第四季達到目標？謝謝。希望這是有意義的。

Yeah. No, good question on the progression. And so the way I'd probably look at it is we put up a 93.4% in the quarter. And the $150 million, if you take that out and you want to sort of judge the progression into Q4, that's 60 bps, the full $150 million, of which [40] of that related to prior periods. So you're jumping off a 94.0%. And then, yes, you can evaluate, call it, mid-5s in terms of the 9/1, 10/1 cohort and Florida was slightly above that in terms of the mix between CMS, MMA and the long-term care population.

是的。不，關於進展的問題問得很好。所以，我個人的看法是，我們本季的成長率為 93.4%。如果把這 1.5 億美元扣除，再去評估第四季的發展情況，那就是 60 個基點，也就是全部 1.5 億美元，其中 [40] 是與前期相關的。所以你的起點是 94.0%。是的，你可以評估，或者說，根據 9/1、10/1 群體的情況，將其視為 5 歲以上人群，而佛羅裡達州在 CMS、MMA 和長期護理人群的組成方面略高於這個水平。

And so yeah, we expect a sequential lift going from Q3 to Q4 given the cohort of 9/1 and 10/1 rates, and that will be a contributor to the improvement that we expect in Q4. And then obviously, we have trend as well as a pretty soft November in terms of the day count. If you look at November, it looks more like a February in terms of the number of business days and the holidays.

所以，是的，鑑於 9 月 1 日和 10 月 1 日的統計數據，我們預計從第三季到第四季會有環比成長，這將有助於我們預期第四季度的改善。顯然，從趨勢來看，11 月的營業天數也相當疲軟。如果你看一下十一月，你會發現它的工作日和假日數量更像是二月。

So that all goes in the formula of how we can get -- how we expect to get to around 93% for Q4, which then when you add to all the other numbers you know would get us to the 93.7% for the full year that we would jump off of and seek to maintain for 2026.

所以，所有這些都納入了我們如何達到——我們預計第四季度將達到 93% 左右的公式中，然後，當你把所有其他數字加起來，你就知道這將使我們全年達到 93.7% 的目標，我們將以此為起點，力爭在 2026 年保持這一目標。

Lance Wilkes, Bernstein.

蘭斯威爾克斯，伯恩斯坦。

Great. Yeah. Could you give some maybe additional color on the resetting environment at the states? And what I was interested in is what variability are you seeing across states in rates? And then as you're looking at the budget outlook for fiscal '26, '27, how is that budget, the '25, '26 fiscal year and then the '26, '27 kind of conversations that you're seeing impacting the potential for future rate increases?

偉大的。是的。您能否再補充一些關於各州重置環境的資訊？我感興趣的是，您觀察到各州之間的比率有哪些差異？那麼，當您展望 2026、2027 財年的預算前景時，您認為 2025、2026 財年的預算以及您看到的關於 2026、2027 財年的討論，會對未來利率上漲的可能性產生怎樣的影響？

And as a result of these things, are you seeing any smaller competitors that are looking to either exit contracts or not rebidding in any of the states you participate in? Thanks.

因此，您是否看到任何規模較小的競爭對手正在考慮退出合約或不再在您參與的任何州重新投標？謝謝。

Yeah. Thanks, Lance. So every state is a little bit different. So there's certainly variability in the actual absolute rates. But I would say that what we have seen consistent across the states and consistently now for more than 18 months is very constructive collaborative dialogue around rates. The integration of more recent data.

是的。謝謝，蘭斯。所以每個州的情況都略有不同。因此，實際絕對速率肯定存在差異。但我想說的是，在過去 18 個月多的時間裡，我們在各州都看到了圍繞利率問題的非常建設性的合作對話。整合最新數據。

We've obviously now got for the 1/1 rates, the benefit of a full 12 months with the step-up in trend drivers that we're seeing and then 18 months with the acuity impacts from redeterminations. And again, I think this increased cadence and reflex around leveraging more recent data, both at a baseline period, but also being able to better anticipate what inflation may be prospectively into the future period.

顯然，對於 1/1 利率，我們現在可以享受整整 12 個月的優惠，這得益於我們所看到的趨勢驅動因素的逐步增強，然後還有 18 個月的優惠，這得益於重新評估帶來的嚴重影響。而且，我認為這種節奏加快、反應迅速的做法，既可以用於基準時期，也可以用於更好地預測未來一段時間內的通膨情況。

Obviously, Florida is a great example of that because they had to use '25 rates to make the '25 adjustment. But again, that has become normal course, and it's how we think about what we expect to see in the 1/1 cohort and going forward. The budget outlook for the states, there are obviously concerns that with the changes in legislation, there will start to be budget impacts in '26 as states need to balance their budgets and go through those legislative sessions.

顯然，佛羅裡達州就是一個很好的例子，因為他們必須使用 2025 年的利率來進行 2025 年的調整。但話說回來，這已經成為正常情況，這也是我們對 1/1 群體以及未來發展方向的預期。各州的預算前景顯然令人擔憂，隨著立法的變化，各州需要在 2026 年平衡預算並完成立法會議，屆時預算將開始受到影響。

One of the things that I would point to, and we've said this before, but I think this is really a moment where we will start potentially to see this play out because we're seeing it play out from a program design standpoint is this is a moment where we -- our partnership with the states can really drive value.

我想指出的一點是，我們以前也說過，但我認為現在真的是我們開始看到這種情況發生的時刻，因為從專案設計的角度來看，我們看到這種情況正在發生，那就是我們——我們與各州的合作可以真正創造價值的時刻。

And they're coming to us and saying, we've got a balanced budget. We've got tighter guardrails, how can we think about continuing to deliver the core benefits that we want to and continuing to drive health outcomes, but make adjustments where we can to optimize the program. And Drew and I have both given a bunch of examples of that.

他們來找我們說，我們的預算是平衡的。我們有了更嚴格的監管，我們如何在繼續提供我們想要的核心益處並繼續推動健康結果的同時，盡可能地進行調整以優化該計劃？我和德魯都舉了很多例子來說明這一點。

But we think there are -- there's definitely runway on that front. But then also states thinking about carving in fee-for-service populations where if you have a state that has ABA and a fee-for-service disposition over the last 12 months, they are struggling right now.

但我們認為，在這方面肯定還有很大的發展空間。但有些州也在考慮將按服務收費的人群納入其中，如果一個州在過去 12 個月中採用了 ABA 和按服務收費的模式，那麼他們現在就面臨著困境。

And so there's opportunity as they go through upcoming procurement cycles to think about aligning some of those fee-for-service populations into the core procurement. We started to see some opportunity for net new program adds in the RFP pipeline in '26.

因此，在接下來的採購週期中，他們有機會考慮將一些按服務收費的人口納入核心採購系統。2026 年，我們開始看到 RFP 流程中出現一些新增專案的機會。

And so yeah, we do expect there will be budget pressures. But in our world, that's actually an opportunity to help them think about managing care and therefore, managing taxpayer dollars. And that's really the business that we're in.

所以，是的，我們預計會面臨預算壓力。但在我們看來，這實際上是一個幫助他們思考如何管理醫療保健，從而如何管理納稅人資金的機會。這就是我們所從事的業務。

Thank you. This concludes our question-and-answer session. I'd like to turn the conference back over to Sarah London for closing remarks.

謝謝。我們的問答環節到此結束。我謹將會議交還給莎拉·倫敦，請她作閉幕致詞。

Thanks, Rocco. Thanks, everyone, for the questions and for your time and interest in Centene this morning. 2025 has definitely been a challenging year, but I firmly believe that the Centene is stronger for it. And I just want to take a moment to thank my teammates for being unwavering in your focus on and commitment to our mission. We look forward to continuing to provide updates on these key inputs and milestones and then obviously provide formal guidance for 2026 on our Q4 call. Thanks, everybody.

謝謝你，羅科。感謝各位提出的問題，也感謝大家今天早上抽空關注Centene。 2025年無疑是充滿挑戰的一年，但我堅信，Centene會因此變得更強大。我只想藉此機會感謝我的隊友們，感謝你們始終堅定不移地專注於我們的使命並全力以赴。我們期待繼續提供有關這些關鍵投入和里程碑的最新信息，然後在第四季度電話會議上正式提供 2026 年的指導意見。謝謝大家。

Thank you. This concludes today's conference call. We thank you all for attending today's presentation. You may now disconnect your lines, and have a wonderful day.

謝謝。今天的電話會議到此結束。感謝各位蒞臨今天的報告會。現在您可以斷開線路了，祝您有美好的一天。