Centene Corp (CNC) 2025 Q4 法說會逐字稿

Good day, and welcome to the Centene Corporation fourth quarter and full year 2025 earnings conference call. (Operator Instructions) Please note today's event is being recorded.

大家好，歡迎參加 Centene 公司 2025 年第四季及全年業績電話會議。（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.

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。請繼續。

Thank you, Rocco, and good morning, everyone. Thank you for joining us on our fourth quarter and year end 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. Also, guidance slides can be found on our website alongside the webcast.

謝謝你，羅科，大家早安。感謝您參加我們2025年第四季及全年收益業績電話會議。Centene執行長Sarah London和執行副總裁兼財務長Drew Asher將主持今天早上的電話會議，您也可以透過我們的網站centene.com收聽。此外，您可以在我們的網站上找到與網路直播一同發佈的指導性投影片。

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 commentary on 2026, including drivers of adjusted diluted earnings per share for 2026 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，我們對 2026 年的評論，包括 2026 年調整後稀釋每股盈餘的驅動因素，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 fourth quarter and year end 2025 press release and 2026 guidance presentation filed this morning and other public SEC filings, which are available on the company's website under the Investors section.

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存在重大差異，這些因素包括我們在今天早上提交的 2025 年第四季度和全年新聞稿以及 2026 年業績指引演示文稿中討論的因素，以及其他向美國證券交易委員會提交的公開文件，這些文件可在公司網站的「投資者」部分查閱。

Centene anticipates that subsequent events and developments may cause its estimates to change. 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. The call will also refer to certain non-GAAP measures.

Centene預計後續事件和發展可能會導致其估算發生變化。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。

A reconciliation of these measures with the most directly comparable GAAP measures can be found in our fourth quarter and year end 2025 press release and 2026 guidance presentation.

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 年第四季和年終新聞稿以及 2026 年業績指引簡報。

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

接下來，我將把電話交給我們的執行長莎拉倫敦。莎拉？

Thank you, Jen, and thanks, everyone, for joining us. This morning, we reported a fourth quarter adjusted diluted loss per share of $1.19, contributing to our full year 2025 adjusted diluted EPS of $2.08. While 2025 was undeniably challenging, disciplined execution enabled us to close the year slightly ahead of the expectations we outlined on our third quarter call. Medicaid profitability improved, strengthening the trajectory of our largest business.

謝謝Jen，也謝謝大家的參與。今天上午，我們公佈了第四季經調整後的每股攤薄虧損為1.19美元，預計2025年全年經調整後的每股攤薄收益為2.08美元。儘管2025年無疑充滿挑戰，但嚴謹的執行使我們能夠略微提前於第三季財報電話會議上提出的預期完成全年業績。醫療補助計劃的獲利能力有所提高，鞏固了我們最大業務的發展軌跡。

Underlying medical cost trend within marketplace and across the Medicare segment was in line to slightly favorable as we closed out Q4 and both segments delivered 2026 enrollment results consistent with our expectations, creating a solid foundation for next year's earnings power.

在第四季末，市場和整個聯邦醫療保險領域的潛在醫療成本趨勢略微向好，兩個領域的 2026 年參保人數均符合我們的預期，為明年的盈利能力奠定了堅實的基礎。

As we look to 2026, we are positioned to deliver meaningful margin improvement and renewed adjusted EPS growth. We expect full year 2026 adjusted EPS to be greater than $3, representing more than 40% year-over-year growth and marking important progress toward restoring the enterprise's embedded earnings power. This outlook incorporates Medicaid margin stability, significant margin recovery within our marketplace business, and continued progress towards our goal of breakeven in Medicare Advantage.

展望 2026 年，我們已做好準備，實現利潤率的顯著提升和調整後每股盈餘的持續成長。我們預計 2026 年全年調整後每股收益將超過 3 美元，年成長超過 40%，標誌著在恢復企業內在獲利能力方面取得了重要進展。這項展望包含了醫療補助利潤的穩定性、市場業務利潤的顯著恢復，以及我們在醫療保險優勢計劃中實現盈虧平衡目標的持續進展。

Now let's take a look at our business lines, beginning with Medicaid. As an organization, we have been laser-focused on restoring our Medicaid business to sustainable profitability while maintaining our focus on quality outcomes for our members and the communities we serve.

現在讓我們來看看我們的業務線，首先是醫療補助計劃。作為一個機構，我們一直專注於恢復我們的醫療補助業務的可持續盈利能力，同時繼續專注於為我們的成員和我們所服務的社區提供高品質的成果。

As a result of strong cross-enterprise execution, we demonstrated significant progress on this mission in the back half of 2025 with continued momentum through Q4. Our fourth quarter health benefits ratio of [930] was consistent with expectations we set for investors in October, representing 40 basis points of sequential improvement and 190 basis points of improvement from Q2 levels.

由於跨企業的強力執行，我們在 2025 年下半年實現了這一目標，並在第四季度繼續保持了這一勢頭。我們第四季的健康福利比率為 [930]，與我們 10 月向投資者設定的預期一致，環比改善 40 個基點，較第二季度水準改善 190 個基點。

While flu drove significant national media coverage, flu and influenza-related illness cost within Medicaid were consistent with the elevated expectations we had incorporated into our financial outlook. Trend patterns remained largely consistent in Q4 compared to Q3 with behavioral health still driving roughly half of excess trends in both home health and high-cost drugs as secondary pressure points.

雖然流感引起了全國媒體的廣泛關注，但醫療補助計劃中流感和流感相關疾病的成本與我們在財務展望中納入的較高預期相符。與第三季相比，第四季的趨勢模式基本上保持一致，行為健康仍然是家庭健康和高價藥物這兩個次要壓力點中約一半的超額趨勢的主要驅動因素。

As we head into 2026, we continue to organize around the key levers that will drive improvement in the Medicaid business, including optimizing our networks for cost and quality performance thoughtful implementation of new and enhanced clinical programs, rate advocacy and collaboration with our state partners on program reform, increasing vigilance in our detection and reduction of unnecessary utilization and a more aggressive approach to fraud within the provider ecosystem in service of our mandate to protect Medicaid program integrity.

展望 2026 年，我們將繼續圍繞推動 Medicaid 業務改進的關鍵槓桿進行組織，包括優化我們的網絡以提高成本和品質績效、深思熟慮地實施新的和改進的臨床項目、倡導費率以及與我們的州合作夥伴合作進行項目改革、提高對不必要使用情況的發現和減少的警惕性，以及採取更積極的措施打擊供應商的完整性系統中採取欺詐行為，提供措施保護措施

Our applied behavioral analytics or ABA task force established in Q2 of 2025 is a perfect example of how we have pulled critical levers to manage costs on behalf of our state partners while improving the quality of member care at the same time. Leveraging Centene's scale and reach, the team analyzed our ABA data across our 29-state footprint.

我們在 2025 年第二季度成立的應用行為分析 (ABA) 工作小組，完美地詮釋了我們如何運用關鍵手段來控製成本，同時提高會員護理質量，從而更好地服務於我們的州合作夥伴。借助 Centene 的規模和覆蓋範圍，團隊分析了我們在 29 個州的業務範圍內的 ABA 數據。

What we found were consistent patterns of outlier providers with volume versus outcomes-driven care patterns, where the maximum number of hours are prescribed for every patient instead of an individualized care plan. We found children who had been in therapy for 5 to 10 years, where clinical evidence suggests the optimal duration is two to three years as well as those enrolled in 40 hours per week of therapy instead of balanced school integrated care.

我們發現，一些醫療服務提供者存在著以數量為導向而非以結果為導向的照護模式，他們為每位患者規定了最長的照護時間，而不是製定個人化的照護計畫。我們發現有些孩子已經接受了 5 到 10 年的治療，而臨床證據表明最佳治療時長為 2 到 3 年；此外，我們還發現有些孩子每週接受 40 小時的治療，而不是接受均衡的學校綜合護理。

And we saw a lack of appropriate board-certified oversight of registered behavior technicians. These dynamics drive cost in the system, but far more importantly, they are red flags relative to the quality of patient care for a very vulnerable population.

我們發現，註冊行為技術人員缺乏適當的、經委員會認證的監督。這些動態因素推高了系統成本，但更重要的是，它們對於非常脆弱族群的病患照護品質而言，是一個危險訊號。

Centene's approach has been data-driven and multipronged. We engage directly with providers on gaps we see and focus our networks on providers who follow evidence-based best practices. We meet directly with our state partners to share data inform program design and reduce outlier payments. And we launched an ABA specific engagement program to support members, their parents and their providers.

Centene 的方法以數據為驅動，並採取多管齊下的方法。我們會直接與供應商溝通，了解我們發現的差距，並將我們的網路重點放在遵循實證最佳實踐的供應商身上。我們直接與州合作夥伴會面，分享數據，為專案設計提供信息，並減少異常支付。我們啟動了一項專門針對 ABA 的參與計劃，以支持會員、他們的父母和他們的服務提供者。

These programs are developed and led by PhD-level Board-certified behavioral analysts who are still practicing so this is not algorithmic or theoretical for us. It is about being responsible stewards of taxpayer dollars and transforming the health of the communities we serve one at a time in this case.

這些計畫由擁有博士學位且獲得委員會認證的行為分析師開發和領導，他們仍在執業，因此對我們來說，這不是演算法或理論。這關乎如何負責任地管理納稅人的錢，以及如何逐步改善我們所服務社區的健康狀況。

Rates continued to be another powerful and important tool to ensure program sustainability. On this front, we closed 2025 with a composite rate adjustment of approximately 5.5% above 2024 levels, consistent with our prior commentary. 1/1 final rates were in line with our expectation and as the underlying data naturally rolls forward, we believe rate decisions will increasingly be made on data that reflects the acuity and trend dynamics we have experienced in Medicaid over the last two years.

費率仍然是確保專案可持續性的另一個強大的重要工具。在這方面，我們最終對2025年進行了綜合費率調整，較2024年水準上調約5.5%，這與我們先前的評論一致。 1月1日的最終費率符合我們的預期，隨著基礎數據的自然更新，我們相信費率決策將越來越多地基於反映過去兩年醫療補助計劃（Medicaid）的嚴峻形勢和發展趨勢的數據。

We will continue to be proactive in our engagement and data sharing as we move through 2026 and prepare for 2027 program changes. Standing here today, we have greater visibility into the drivers of our core business and command of the levers needed to drive earnings recovery in Medicaid over the next few years, while maintaining and improving the quality of our care our members receive.

我們將繼續積極主動地參與互動和資料共享，以應對 2026 年的挑戰並為 2027 年的專案調整做好準備。今天，我們站在這裡，對核心業務的驅動因素有了更清晰的認識，也掌握了在未來幾年推動醫療補助計劃盈利復甦所需的槓桿，同時保持並提高我們成員所接受的護理質量。

Turning to Marketplace. Fundamental medical cost trend for our marketplace business came in slightly better than expectations in Q4. In December, we also received an updated view of the 2025 Wakely data, which showed favorable development relative to our reserve. We experienced two out-of-period items in the quarter, including a 2023 CMS reconciliation and costs related to no surprises at disputes.

轉向市場。第四季度，我們市場業務的基本醫療成本趨勢略優於預期。12 月，我們還收到了 2025 年 Wakely 數據的最新視圖，該數據顯示相對於我們的儲備而言，發展前景良好。本季度我們遇到了兩個非正常期間的項目，包括 2023 年 CMS 對帳和與爭議中沒有意外情況相關的成本。

This prompted us to add an accrual for further NSA development related to 2025 dates of service, which ultimately pushed the segment HBR up by roughly 100 basis points versus our original expectations. We have accounted for estimated 2026 MSA costs in our guidance. While the No Surprises Act was designed to protect consumers, it has increasingly become weaponized by market participants looking to extract profits from the system through the independent dispute resolutions or IDR process.

這促使我們增加了與 2025 年服務日期相關的 NSA 進一步發展的應計項目，最終使該細分市場的 HBR 比我們最初的預期提高了約 100 個基點。我們在指導方針中已考慮了預計的 2026 年 MSA 成本。雖然《無意外法案》旨在保護消費者，但它日益被市場參與者利用，他們試圖透過獨立爭議解決（IDR）程序從系統中榨取利潤。

We are vocal in advocating for NSA reform. And in the meantime, we'll be taking a more proactive litigious posture as necessary. As an example, earlier this week, we filed a multimillion-dollar lawsuit against the New York provider alleging fraudulent manipulation of in-network and out-of-network claims.

我們積極倡導對美國國家安全局進行改革。同時，我們將視情況採取更積極主動的訴訟策略。例如，本週早些時候，我們對紐約一家醫療服務提供者提起了一項數百萬美元的訴訟，指控其對網路內和網路外的索賠進行欺詐性操縱。

We will continue to take aggressive action to protect the system from fraudulent and abusive exploitation of NSA loopholes. Turning to 2026. The Marketplace team executed incredibly well over the last few months in a dynamic open enrollment period, investing in additional operational support to care for a customer base navigating significant change and uncertainty.

我們將繼續採取積極措施，保護系統免受欺詐和濫用美國國家安全局漏洞的行為侵害。展望2026年。在過去幾個月充滿活力的開放註冊期內，市場團隊表現出色，投入額外的營運支持，為正在經歷重大變化和不確定性的客戶群提供服務。

In the absence of congressional intervention enhanced advanced premium tax credits expired at the end of 2025. As a reminder, we accounted for this assumption and the impact it would have on the market risk pool and cost in our 2026 pricing. And better membership developed in line with expectations, and we are on track for first quarter ending membership of roughly 3.5 million members as compared to our December membership of $5.5 million.

如果沒有國會的干預，增強型預付保費稅收抵免將於 2025 年底到期。需要提醒的是，我們在 2026 年的定價中已經考慮了這一假設及其對市場風險池和成本的影響。會員人數的成長符合預期，我們預計在第一季末達到約 350 萬名會員，而 12 月的會員人數為 550 萬美元。

While market sign-ups are being reported publicly, this isn't the most helpful indicator of true market dynamics. Now that we are into February, paid membership is the most important metric for planning and forecasting. Through the end of January, and better paid rates while below historical levels are right in line with our expectations in a post-EAPTC environment.

雖然市場註冊數據會公開報道，但這並不是反映真實市場動態的最有效指標。現在已進入二月，付費會員人數是規劃和預測最重要的指標。截至一月底，雖然薪資水平低於歷史水平，但高於歷史水平的薪資水平完全符合我們在 EAPTC 政策實施後環境下的預期。

Relative to member demographics, our membership is more notably enrolled in Bronze plans for 2026 compared to prior years, with many of those members still able to access zero premium products. Broad's membership will represent a little over 30% of our marketplace enrollment this year compared to a range of 19% to 24% over the past four years. Age and gender demographics remain consistent with recent years.

與往年相比，從會員人口統計數據來看，我們的會員在 2026 年選擇銅級計劃的比例明顯更高，其中許多會員仍然可以獲得零保費產品。今年，Broad 的會員人數將占我們市場註冊人數的 30% 以上，而過去四年這一比例在 19% 到 24% 之間。年齡和性別組成與近年來基本保持一致。

Risk adjustment was obviously a source of significant deviation from our financial plans last year. As you think about the expectations incorporated into our 2026 plan, we anticipate being in a meaningful payable position for the 2026 plan year at this time. Consistent with other years, we will reassess our risk adjustment position and assumptions as we move through the year and receive additional data.

去年，風險調整顯然是我們財務計畫出現重大偏差的原因之一。當您考慮我們 2026 年計畫中包含的預期時，我們預計目前在 2026 年計畫年度將處於一個有意義的支付狀態。與往年一樣，我們將隨著時間的推移和獲得更多數據，重新評估我們的風險調整立場和假設。

To that end, in an effort to drive additional visibility at an industry level, we are pleased to have worked closely with Wakely, the independent actuarial firm to support publication of a new report reflecting market-wide paid membership metallic tier distribution and statewide average premium set to be released towards the end of Q1 in order to help market participants better inform risk adjustment assumptions going forward.

為此，為了提高行業層面的可見性，我們很高興與獨立精算公司 Wakely 密切合作，支持發布一份反映市場付費會員金屬等級分佈和全州平均保費的新報告，該報告將於第一季末發布，以幫助市場參與者更好地了解未來的風險調整假設。

While 2025 was a difficult year for the Marketplace business, we believe the actions we took in the back half of 2025 set us up to navigate 2026 with increased visibility and confidence. We continue to advocate for program reform that will drive affordability and further stabilize the individual marketplace overall as an alternative to employer-sponsored insurance and a solution for small business owners and other hard-working Americans and their families.

雖然 2025 年對 Marketplace 業務來說是艱難的一年，但我們相信，我們在 2025 年下半年採取的行動，使我們能夠以更高的可見性和信心迎接 2026 年。我們繼續倡導進行專案改革，以提高個人保險的可負擔性，並進一步穩定個人保險市場，以此作為雇主贊助保險的替代方案，並為小型企業主和其他辛勤工作的美國人及其家庭提供解決方案。

Finally, Medicare. Our Medicare segment delivered strong results throughout 2025. Fourth quarter fundamental Medicare Advantage performance was in line with our expectations, setting us up with a solid jump-off point for 2026. We completed a review of our provider contract portfolio in the quarter and adjusted certain receivables accordingly, which drove the slightly elevated HBR compared to expectations.

最後，是聯邦醫療保險（Medicare）。2025 年全年，我們的醫療保險業務部門均取得了強勁的業績。第四季 Medicare Advantage 的基本面表現符合我們的預期，為我們 2026 年的發展奠定了堅實的基礎。本季我們完成了對供應商合約組合的審查，並相應地調整了某些應收帳款，這導致 HBR 略高於預期。

Overall, we continue to look for opportunities to position the business for improved profitability in 2026 on the way to our goal of breakeven Medicare Advantage results in 2027, an important enterprise milestone. Our Medicare Advantage product positioning yielded the intended results for 2026 membership and we expect to end the first quarter with a decline in MA membership consistent with our strategy to refine our footprint and fine-tune our value proposition for Medicaid beneficiaries.

總體而言，我們將繼續尋找機會，使公司在 2026 年實現更高的盈利能力，從而在 2027 年實現 Medicare Advantage 收支平衡的目標，這是一個重要的企業里程碑。我們的 Medicare Advantage 產品定位已達到 2026 年會員預期目標，我們預計第一季末 MA 會員人數將有所下降，這符合我們優化業務佈局和完善 Medicaid 受益人價值主張的策略。

PDP ended Q4 with some additional favorability thanks to slightly moderating trend, and that team deserves a well-earned shout out for having managed the business expertly through significant program changes.

由於趨勢略有緩和，PDP 在第四季末業績略有好轉，該團隊在重大專案變更期間出色地管理了業務，值得表揚。

As we look ahead to 2026, Part D enrollment is tracking to high single-digit percentage growth at the end of the first quarter compared to year end 2025, with member mix across the products aligning well with program and formulary design.

展望 2026 年，與 2025 年底相比，第一季末 D 部分的參保人數預計將實現高個位數百分比的增長，而且各產品的會員組成與計劃和處方集的設計非常吻合。

This year provides an important opportunity to build on the meaningful progress we've made in Medicare Advantage and further strengthen the platform that will most effectively serve Medicare beneficiaries as well as dual eligible membership. We continue to focus on Starz improvement, clinical engagement and overall SG&A efficiencies.

今年為我們提供了一個重要的機會，讓我們能夠鞏固在 Medicare Advantage 方面取得的顯著進展，並進一步加強該平台，從而最有效地服務於 Medicare 受益人以及雙重資格會員。我們將繼續專注於 Starz 的改進、臨床參與和整體銷售、管理及行政費用的效率。

And at the same time, we launched a redesigned duals operating model, leveraging insights from our deep experience managing complex populations to enhance our service and member experience for a decent member base that now accounts for roughly 40% of our Medicare Advantage business.

同時，我們推出了重新設計的雙重保險營運模式，利用我們在管理複雜人群方面的豐富經驗，提升了我們為相當可觀的會員群體提供的服務和會員體驗，該會員群體目前約占我們 Medicare Advantage 業務的 40%。

Last week's 2027 advanced notice, at least initially suggests a more pressured view of rates than industry expectations, but it does not change our focus on returning our Medicare book to profitability, aligning closely with our key Medicaid markets, and continuing to invest in quality programs and benefits that support our core member base.

上週發布的 2027 年提前通知，至少在初期表明，費率方面比行業預期面臨更大的壓力，但這並沒有改變我們專注於恢復 Medicare 業務盈利、與我們的主要 Medicaid 市場緊密合作以及繼續投資於支持我們核心會員群體的優質項目和福利的重點。

We expect rates to be finalized in early April, consistent with prior years. Taking a step back, our long-term goal across our businesses is to deliver industry-leading outcomes at an industry-leading cost structure. As we create the road map to harvest Centene's full potential earnings power, there is no question that data, technology and artificial intelligence will be a critical lever and accelerant to this work.

我們預期利率將於4月初最終確定，與往年一致。從長遠來看，我們所有業務的長期目標是以行業領先的成本結構實現領先業界的成果。在製定充分發揮 Centene 獲利潛力的路線圖時，毫無疑問，數據、技術和人工智慧將是這項工作的關鍵槓桿和加速器。

Over the last few years, we have been building the necessary data foundation and systematically integrating AI into our operations, resulting in proof points around accelerated prior authorization approvals, improved call center operations enhanced member navigation and engagement experiences and advanced analytics capabilities that support our medical economics work and our payment integrity operations.

過去幾年，我們一直在建立必要的數據基礎，並將人工智慧系統地融入我們的營運中，從而在加快事先授權審批、改進呼叫中心運營、增強會員導航和互動體驗以及支持我們的醫療經濟工作和支付完整性運營的高級分析能力等方面取得了顯著成效。

As an example of the latter, we currently score our claims data against 75 different algorithms designed to triangulate potential fraud. Alerts are triggered and sent to a group of cross-functional experts for immediate review and intervention.

例如，我們目前使用 75 種不同的演算法對索賠數據進行評分，這些演算法旨在識別潛在的詐欺行為。警報觸發後，會發送給一組跨職能專家進行立即審查和介入。

As we step into 2026, we are closely tracking the inflection of Gen AI and accelerating our integration of Agentic capabilities into our core operations to drive automation and efficiency and using it as a catalyst to reimagine and elevate the experience we deliver to our members, partners and other stakeholders.

邁入 2026 年，我們將密切關注人工智慧的轉型，加快將智能體能力融入核心運營，以推動自動化和效率提升，並將其作為催化劑，重新構想和提升我們為會員、合作夥伴和其他利益相關者提供的體驗。

You should expect to hear more on this in the quarters ahead. 2025 challenged us but it also made us stronger. Amid continued landscape volatility and with the benefit of enhanced visibility across lines of business as we move through the back half of the year, we took the opportunity as an organization to reassess and refresh our views of both existing and emerging headwinds and tailwinds.

接下來的幾個季度，您應該會聽到更多相關資訊。 2025年對我們充滿挑戰，但也讓我們變得更強大。鑑於市場環境持續波動，並且隨著我們進入下半年，各業務線的可見性有所提高，我們藉此機會，作為一個組織重新評估並更新了我們對現有和新興的逆風和順風的看法。

We have prudently positioned our 2026 outlook, incorporating an expectation that policy-related variability will continue to influence our core business lines. We are confident in our ability to execute against the outlook we have provided today building on the positive momentum we have generated in recent months. And we see continued opportunity for margin expansion in the months and years ahead, while keeping our members at the center of everything we do.

我們審慎地制定了 2026 年的展望，預期政策相關的波動將繼續影響我們的核心業務線。我們有信心在最近幾個月取得的積極勢頭的基礎上，實現我們今天提出的展望目標。我們看到，在未來的幾個月和幾年裡，利潤率將持續成長，同時我們將始終將會員放在我們一切工作的中心。

As I have said before and feel only more strongly after the year we have navigated the SEN team is an incredibly powerful engine. They are fired up and focused on the opportunity ahead and committed to the hard work necessary to deliver margin that will power our mission.

正如我之前所說，而且在經歷了這一年之後，我更加強烈地感受到，SEN 團隊是一個極其強大的引擎。他們充滿熱情，專注於眼前的機遇，並致力於付出必要的努力，以實現利潤，從而推動我們的使命。

With that, I will turn it over to Drew to provide more details about the quarter and our view of 2026.

接下來，我將把發言權交給德魯，讓他詳細介紹本季的情況以及我們對 2026 年的展望。

Thank you, Sarah. Today, we reported fourth quarter and full year 2025 results, including $174.6 billion in premium and service revenue and adjusted diluted earnings per share of $2.08. The fourth quarter GAAP diluted loss per share of $2.24 includes a $389 million net loss prompted by a Q4 definitive agreement to divest the remaining Magellan business.

謝謝你，莎拉。今天，我們公佈了2025年第四季及全年業績，其中包括1,746億美元的保費及服務收入，以及調整後攤薄每股收益2.08美元。第四季以美國通用會計準則（GAAP）計算的攤薄每股虧損為2.24美元，其中包括因第四季達成最終協議剝離剩餘的麥哲倫業務而導致的3.89億美元淨虧損。

Recall, we previously divested the Magellan pharmacy and specialty businesses at gains over the past few years. From an adjusted earnings standpoint, we are pleased that the underlying fundamentals in Q4 are tracking our prior forecasted full year adjusted diluted EPS of greater than $2 and this sets us up well for our 2026 guidance that we'll cover in a minute.

回想一下，過去幾年我們曾剝離了麥哲倫藥局和特藥業務，並從中獲利。從調整後的收益角度來看，我們很高興第四季度的基本面符合我們先前預測的全年調整後攤薄每股收益超過 2 美元的目標，這為我們即將介紹的 2026 年業績指引奠定了良好的基礎。

Starting with Medicaid. We saw continued progress and improvement in the HBR with Q4 improving to 93.0% while we have a lot further to go in Medicaid to achieve a reasonable HBR and margin, the back half of 2025 was a good start with two consecutive quarters of HBR improvement. Our 1/1 net rates are supportive of our 2026 guidance of a stable Medicaid HBR with an assumed full year 2026 net rate impact of mid-4s and the corresponding mid-4s 206 net trend expectation.

從醫療補助計劃開始。我們看到 HBR 持續取得進展和改善，第四季度改善至 93.0%，雖然我們在 Medicaid 方面還有很長的路要走才能實現合理的 HBR 和利潤率，但 2025 年下半年是一個良好的開端，HBR 連續兩個季度都有所改善。我們的 1/1 淨利率支持我們對 2026 年 Medicaid HBR 穩定的指導，假設 2026 年全年淨利率影響為 4% 左右，相應的 2026 年淨趨勢預期為 4% 左右。

As expected, we continue to see slight attrition in membership closing out 2025 at 12.5 million members. We continue to drive quality and affordability healthcare initiatives and work with our state partners on the optimal program structures and associated rates. While certain areas are still elevated, behavioral, home health and high-cost drugs, we can see tangible progress in the business.

正如預期的那樣，會員人數繼續略有下降，到 2025 年底，會員人數為 1,250 萬人。我們將繼續推進高品質、高性價比的醫療保健計劃，並與州合作夥伴共同製定最佳的計劃結構和相關費率。雖然某些領域仍然存在問題，例如行為健康、家庭健康和高價藥物，但我們可以看到該行業取得了切實的進展。

Overall, this is another quarter of good progress in Medicaid. Our Commercial segment HBR in Q4 was about 1 point higher than our forecast with a few items moving in both directions, but the elements that matter most for 2026 were positive. Importantly, the current period medical costs and trends were slightly better than our expectations in the fourth quarter.

總體而言，醫療補助計劃在本季又取得了良好進展。我們第四季的商業部門 HBR 比我們的預測高出約 1 個百分點，其中一些項目上下波動，但對 2026 年最重要的因素是正面的。值得注意的是，本期醫療成本和趨勢略優於我們第四季的預期。

So we feel good about Q4 fundamentals as we turn the calendar into 2026. Another positive sign in the quarter was a favorable change in our view of 2025 relative morbidity or risk adjustment based upon the third round of Wakely data. This was a couple of hundred million worth of net P&L outperformance in the quarter, which also bodes well for our 2026 pricing assumptions.

因此，展望2026年，我們對第四季的基本面感到樂觀。本季另一個積極的跡像是，根據 Wakely 第三輪數據，我們對 2025 年相對發病率或風險調整的看法發生了有利的變化。本季淨損益超額報酬達數億美元，這對我們 2026 年的定價假設也是個好兆頭。

So what more than offset this good news, two items. A 2023 revenue reconciliation with CMS that has no bearing on 2026 and increases in cost and accruals related to the No Surprises Act that Sarah covered. Those two items drove the net 1% higher than planned HPR in Q4, which otherwise would have been quite favorable.

然而，除了這些好消息之外，還有兩件事需要彌補。與 CMS 進行的 2023 年收入核對與 2026 年無關，以及 Sarah 所報告的與《無意外法案》相關的成本和應計費用的增加。這兩個因素導致第四季度淨HPR比計劃高出1%，否則這將是一個非常有利的結果。

Consistent with our Q3 commentary and now bolstered by Q4 insights, we expect our marketplace pricing actions to adequately capture the 2025 and 2026 market shifts 2026 trends and policy changes in place during the open enrollment period, all of which support meaningful pre-tax margin expansion in 2026 compared to losing approximately 1% in 2025.

與我們第三季的評論一致，並得到第四季度洞察的加強，我們預計我們的市場定價措施將充分反映 2025 年和 2026 年的市場變化、2026 年的趨勢以及開放註冊期間的政策變化，所有這些都將支持 2026 年稅前利潤率的顯著增長，而 2025 年則損失了約 1%。

In our Medicare segment, we executed well in 2025, including the fourth quarter. In our growing PDP business, we delivered strong 2025 performance, including Q4 and despite the headwinds and uncertainties created by the Inflation Reduction Act. This is a testament to our experience, cost structure and market positioning in PDP.

在我們的醫療保險業務部門，2025 年的業績表現良好，包括第四季。在我們不斷發展的 PDP 業務中，我們實現了強勁的 2025 年業績，包括第四季度，儘管面臨通貨膨脹抑制法案的不利影響和不確定性。這證明了我們在PDP領域的經驗、成本結構和市場定位。

In our Medicare Advantage business in 2025, we progressed nicely toward our goal of breakeven in 2027. Q4 fundamentals were on track and the reported results include a write-off of some older provider receivables. As Sarah covered, we like our 2026 positioning as we wrapped up the annual enrollment period.

2025 年，我們的 Medicare Advantage 業務進展順利，朝著 2027 年實現收支平衡的目標邁進。第四季基本面符合預期，公佈的業績包括對一些較早的供應商應收款項的核銷。正如 Sarah 所報導的，隨著年度招生期的結束，我們對 2026 年的招生目標感到滿意。

We will provide CMS comments on the disappointing 2027 advanced notice Medicare rate, which will likely cut into seniors benefits and product selection. And as we construct the 2027 bids over the next few months, we will do so with the same goal to solve for breakeven performance in 2027. Our Q4 adjusted SG&A expense ratio of 7.5% brings our full year to 7.4% and which is 110 basis points lower than 2024, reflecting continued discipline and scale.

我們將就令人失望的 2027 年醫療保險提前通知費率提供 CMS 的評論，該費率可能會削減老年人的福利和產品選擇。在接下來的幾個月裡，當我們制定 2027 年的投標方案時，我們將以 2027 年實現收支平衡為目標。我們在第四季度調整後的銷售、一般及行政費用率為 7.5%，全年為 7.4%，比 2024 年低 110 個基點，反映了我們持續的紀律性和規模。

We ended the year with about $400 million of cash available for general corporate use. We reduced debt by $189 million in the quarter and ended up with a debt-to-cap ratio of 46.5%. Our medical claims liability totaled $20.5 billion and represents 46 days in claims payable, a decrease of two days as compared to the third quarter of 2025 and driven by payouts of state-directed payments and the elimination of the Medicare premium deficiency reserve in Q4, which is corroboration of the progress we are making in Medicare Advantage for 2026.

年底時，我們約有 4 億美元現金可供一般公司用途。本季我們減少了 1.89 億美元的債務，最終債務資本比率為 46.5%。我們的醫療索賠負債總額為 205 億美元，相當於 46 天的索賠支付期，比 2025 年第三季度減少了兩天，這主要得益於州政府支付款項的支出以及第四季度取消了醫療保險保費不足準備金，這也印證了我們在 2026 年醫療保險優勢計劃方面取得的進展。

That's a wrap on 2025, a strong finish to a rough year. Let's move to 2026 and associated guidance elements, including a few slides we posted on our website. We expect premium and service revenue of $170 billion to $174 billion. As you can see in the bridge, Medicaid premium revenue is down a couple of billion including some member attrition in 2026, partially offset by rate increases.

2025年圓滿結束，為艱難的一年畫下了圓滿的句點。讓我們展望 2026 年及相關指導要素，包括我們在網站上發布的一些投影片。我們預計保費和服務收入將達到 1700 億美元至 1740 億美元。正如您在圖中看到的，2026 年醫療補助計劃的保費收入將減少數十億美元，其中包括一些成員的流失，部分損失將被費率上漲所抵消。

We expect Medicaid member months down 5% to 6% in 2026. We expect Marketplace revenue to be down about $8 billion, driven by policy and market impacts, including the expiration of the enhanced APTCs net of rate increases designed to increase yield and improve margin.

我們預計 2026 年 Medicaid 會員月數將下降 5% 至 6%。我們預計市場收入將下降約 80 億美元，這主要是由於政策和市場的影響，包括旨在提高收益率和改善利潤率的增強 APTC 淨利率上調到期。

To give you some membership magnitude, as Sarah outlined, we expect around 3.5 million marketplace members as of the end of Q1 and slight attrition thereafter, though we are still in the payment grace periods, which could swing membership somewhat during Q1. We expect the Medicare segment to grow premium revenue approximately $7.5 billion, driven by our Medicare PDP business, the majority of which is from the premium yield increase, which we'll touch on in a moment.

為了讓大家對會員規模有所了解，正如 Sarah 所概述的，我們預計截至第一季末，市場會員數量約為 350 萬，之後會有輕微的流失，儘管我們仍處於付款寬限期，這可能會在第一季度對會員數量產生一定影響。我們預計，在Medicare PDP業務的推動下，Medicare業務的保費收入將成長約75億美元，其中大部分來自保費收益的成長，我們稍後會詳細介紹。

Coupled with growth in membership, which sits at about $8.7 million coming out of open enrollment. Medicare Advantage revenue is projected to be essentially flat from '25 to '26 with membership down intentionally and yields up.

再加上會員人數的成長，目前會員費約為 870 萬美元（來自公開註冊）。預計 2025 年至 2026 年，Medicare Advantage 的收入將基本持平，會員人數將有意減少，收益率將上升。

The forecasted 2026 revenue split in the Medicare segment is approximately 41% Medicare Advantage and 59% PDP. We expect the consolidated HBR of 90.9% to 91.7% in 2026 at the midpoint, down 60 basis points from 2025. That's driven by an expected recovery in marketplace, as you can see in the bridge.

預計 2026 年 Medicare 業務的收入分配比例約為 41% Medicare Advantage 和 59% PDP。我們預期 2026 年綜合 HBR 為 90.9% 至 91.7%（取中間值），比 2025 年下降 60 個基點。這是由市場預期復甦所驅動的，正如你在橋樑圖中看到的那樣。

Consistent with previous commentary, we initially expect a flat Medicaid segment HBR in 2026 and compared to 2025's 93.7%. And in the Medicare segment, we expect improvement in the Medicare Advantage and a higher PDP HBR driven by two things: one, we are initially assuming a 2026 pre-tax margin around 2%, down from a good year in the threes and two, there was a meaningful increase in the direct subsidy from $143 to $200 and reflecting industry pricing for higher pharmacy trends due to the IRA.

與先前的評論一致，我們最初預計 2026 年 Medicaid 部分的 HBR 將與 2025 年的 93.7% 持平。在 Medicare 領域，我們預計 Medicare Advantage 將會改善，PDP HBR 將會提高，這主要受以下兩方面因素驅動：第一，我們最初假設 2026 年的稅前利潤率約為 2%，低於 3% 的良好年份；第二，直接補貼從 143 美元大幅增加到 200 美元，反映了由於 IRA 政策導致的藥房價格。

So think about a rise in premium and pharmacy expense without any need to increase SG&A. This drives a higher mathematical HBR. That's factored into our initial 2% pre-tax margin forecast for PDP. You can see the other guidance elements, including stability in the SG&A rate, continued pay down of debt and associated impact on interest expense, reduced investment income from assumed Fed fund rate cuts an adjusted tax rate of 26% to 27%, slightly higher than a normal statutory rate given the mix and level of earnings forecasted for 2026.

因此，請考慮在無需增加銷售、一般及行政費用的情況下，提高保費和藥房費用。這將推動更高的數學哈佛商業評論。這已計入我們最初對 PDP 2% 的稅前利潤率預測中。您還可以看到其他指導要素，包括銷售、一般及行政費用率的穩定、債務的持續償還及其對利息支出的相關影響、由於聯邦基金利率下調而導致的投資收入減少，以及調整後的稅率為 26% 至 27%，鑑於 2026 年的盈利組合和水平預測，該稅率略高於正常的法定稅率。

No share buyback reflected in guidance. We will continue to assess the field of capital deployment opportunities as we generate excess cash. With respect to seasonality of earnings, as we sit here today, we expect the majority of 2026 adjusted EPS in Q1, stepping down in Q2 and further to around breakeven in Q3 with a loss in Q4. This is driven by the seasonality and benefit design of marketplace and PDP products, both with lower HBRs in the beginning of the year and higher at the end of the year.

業績指引中未反映任何股票回購計畫。我們將繼續評估資本部署機會，以便在產生盈餘現金時進行投資。就盈利的季節性而言，就目前情況來看，我們預計 2026 年調整後每股收益的大部分將在第一季度實現，第二季度將有所下降，第三季度將進一步降至盈虧平衡點附近，第四季度將出現虧損。這是由市場和 PDP 產品的季節性和福利設計驅動的，年初的 HBR 較低，年末的 HBR 較高。

Our EPS outlook of greater than $3 reflects a meaningful forecasted turnaround of marketplace margins, Medicaid stabilization, continued Medicare Advantage progress a prudent PDP margin assumption and lower interest expense from continued deleveraging.

我們對每股收益超過 3 美元的預期反映了市場利潤率的顯著好轉、醫療補助計劃的穩定、醫療保險優勢計劃的持續進展、謹慎的 PDP 利潤率假設以及持續去槓桿化帶來的利息支出降低。

I'm sure you are too, but we are pleased to turn the page on 2025 and with 2026 one step towards restoration of earnings for Centene. Thank you for your interest in Centene and Rocco, please open it up for questions.

我相信你也是，但我們很高興翻過 2025 年這一頁，2026 年將是 Centene 恢復盈利的又一步。感謝您對 Centene 和 Rocco 的關注，歡迎提問。

(Operator Instructions) Ann Hynes, Mizuho.

（操作說明）安·海恩斯，瑞穗。

On your great expectation from Medicaid or 4.5% I would think that would be higher just given trend has been so elevated over the past couple of years. Can you just give us more details what's happening on the state level and you view that as conservative? Would you be able to get the midyear rate increases? Any color would be great.

鑑於你對醫療補助計劃的期望值很高，或者說 4.5%，我認為這個數字應該更高，因為過去幾年的趨勢一直很高。您能否詳細介紹州一級正在發生的事情，以及您如何看待保守主義？您能獲得年中利率上漲嗎？任何顏色都可以。

Sure. Thanks, Ann, for the question. So a couple of things. One, as we said, throughout 2025, the conversation with our state partners continue to be constructive. I think we also have the benefit of the fact that as we step into this rate cycle we have a full two years of both the acuity dynamics and the step-up in trend and the data.

當然。謝謝安的提問。有兩件事。第一，正如我們所說，在整個 2025 年，我們與州合作夥伴的對話將繼續保持建設性。我認為我們也受益於這樣一個事實：當我們進入這個利率週期時，我們擁有整整兩年的敏銳度動態和趨勢上升的數據。

And so we think that is important and helpful to inform rate decisions. So again, we're starting with a prudent assumption around that 4.5% for 2026. I would point to the fact that our 2025 rates matured favorably from where we started at the beginning of 2025 and ended with that composite rate at roughly 5.5%.

因此，我們認為這對於制定費率決策至關重要且很有幫助。因此，我們再次謹慎地假設 2026 年的成長率為 4.5%。我想指出的是，我們的 2025 年利率從 2025 年初的水平來看非常有利，最終綜合利率約為 5.5%。

And then balanced against that obviously is all of the work that we've done over the back half of '25 to really bend trend, which is what's driving the assumption of the flat HBR year over year.

與此形成對比的是，我們在 2025 年下半年所做的所有工作，旨在真正扭轉趨勢，這正是 HBR 同比持平的依據。

Justin Lake, Wolfe Research.

賈斯汀·萊克，沃爾夫研究公司。

I wanted to follow up on Ann's question here. First, you talked about trend in 4.5% in 2026 for Medicaid curious what that trend was in 2025? And maybe you can help us understand first half versus second half, just to get the run rate coming out of the year versus that 4.5% assumption next year.

我想就安提出的問題做個後續探討。首先，您提到 2026 年 Medicaid 的趨勢是 4.5%，我想知道 2025 年的趨勢是什麼？或許您可以幫助我們了解上半年和下半年的區別，以便計算今年的運行率與明年 4.5% 的假設值之間的差異。

And then to Ann's question on the rates, your rates were 5.5% last year, your rates are 4.5% this year. I'm just curious how the states justify that, given when you have your conversations with them given what's going on in the market, what's going on with trend and acuity, et cetera? And maybe you could just tell us how 1/1 looks versus the 4.5 linger.

至於安提出的利率問題，你們去年的利率是 5.5%，今年的利率是 4.5%。我只是好奇，考慮到市場現狀、趨勢和敏銳度等等，當你和他們交談時，各州是如何證明這一點的？或許您可以告訴我們 1/1 的效果與 4.5 持久的效果相比如何。

Sure. Lots of pieces there. So 1/1 rates, were consistent with expectations. Let's go back to trend. So 2025 trend was in that mid-6s, which I think we talked about on the Q3 call. And then the view of 2026 around mid-4s is really a net trend assumption.

當然。那裡有很多碎片。所以，1/1的利率與預期一致。讓我們回到潮流上來。所以 2025 年的趨勢是 6 左右，我想我們在第三季電話會議上討論過這個問題。而對 2026 年左右 4% 中期的預測，其實是一種淨趨勢假設。

And so again, important to think about the fact that we are jumping off of an elevated baseline that included that 94.9% in Q2. And all of the aggressive action that we took in the back half of the year, obviously, coming Q4 with a [930].

因此，再次強調，重要的是要考慮到我們是從較高的基線開始的，其中包括第二季的 94.9%。顯然，我們在下半年採取的所有積極行動，都對第四季產生了積極影響。[930]

So equally important is the assumption around the proof points that we have in terms of bending trend in the back half of the year as well as bankable proof points around actions that we took in Q3 and Q4 that don't take effect until 2026.

同樣重要的是，我們對下半年趨勢轉變的證據點以及我們在第三季和第四季採取的行動的可靠證據點的假設，這些行動要到 2026 年才會生效。

So that's part of what gives us a view of that mid-4s net trend assumption. And then relative to rates, to your point, we ended the year with that composite of 5.5%. We started the year lower than that. So I believe that we've taken a prudent view of rates in the mid-4s for 2026, and we'll continue to work with the states as we have all along to make sure that they have the most recent trend data.

所以，這在某種程度上解釋了為什麼我們會看到4世紀中期的淨趨勢假設。至於利率方面，正如您所說，我們年底的綜合利率為 5.5%。年初的時候我們比這個數字還要低。所以我認為，我們對 2026 年利率在 4% 左右的預期是審慎的，我們將繼續像以往一樣與各州合作，確保他們獲得最新的趨勢數據。

Again, we have the benefit of that trailing two years now, which we've been working our way up to. And then also talking to states about places where in the absence of feeling like they can push rate, they can also make program changes. And we've called out a number of those.

同樣，我們現在也受益於過去兩年的經驗，我們一直在努力達到這個目標。然後還要與各州討論，在他們感覺無法提高費率的情況下，也可以對某些項目進行調整。我們已經指出了其中的一些問題。

But if I just think about the back half of 2025 we have proof points around states carving out high-cost drugs. They have clipped ABA outlier providers who are overbilling. We've seen PBM control and formulary control, shift further back to us around CCBHC.

但如果我只考慮 2025 年下半年，我們就能看到各州對高價藥品管制的實例。他們已經對過度收費的ABA服務提供者進行了處罰。我們看到藥品福利管理機構 (PBM) 和藥品目錄管理機構 (formal-booking) 的控制權進一步轉移到了我們 CCBHC 周圍。

So lots of, I think, thoughtful program decisions that are a proxy for addressing trend without having to do it explicitly through rate. So just net-net, we're obviously for a flat HBR year over year. And I will say, as I have said before, if that is all we deliver, I will be very disappointed, and I know the team will too.

所以，我認為，很多深思熟慮的節目決策都是在不明確地透過收視率來應對趨勢的替代方法。所以總的來說，我們顯然預計哈佛商業評論的業績將與去年持平。正如我之前所說，如果我們最終只能做到這些，我會非常失望，我知道團隊也會。

Kevin Fischbeck, BoA.

Kevin Fischbeck，美國銀行。

Great. I guess moving to the exchanges. Can you talk a little bit about the confidence and the visibility? Obviously, the exchange members have changed dramatically. You gave a little bit of color there.

偉大的。我猜是要轉到交易所了。能談談自信心和知名度嗎？顯然，交流成員發生了巨大變化。你為那裡增添了一點色彩。

But I guess in particular, you talked about the shift to your shifting. I remember brand not being a great plan historically, and now it seems to be growing overall. So I just want to make sure that we're not going to be caught offsides by this metal tier shift that you're going to be seeing next year?

但我想，你尤其談到了你轉變的轉變。我記得品牌建立在歷史上並不是一個好策略，但現在看來它整體正在發展壯大。所以我想確認一下，我們是否不會被明年即將出現的金屬樂分級變化所影響？

And any other additional color you can give about why you feel comfortable in margin improvement on exchanges this year.

您還能補充哪些其他信息，說明為什麼您對今年交易所利潤率的提升感到樂觀？

Yes. Thanks, Kevin. So let's go all the way back to Q3 as we read and reacted to the 2025 weekly data and a much improved visibility over the baseline morbidity that we would be carrying into 2026. And just incredible execution by the team, demonstrating agility and depth of expertise to reprice and reposition the entirety of the book in that short period of time.

是的。謝謝你，凱文。所以讓我們回到第三季度，當時我們閱讀並回應了 2025 年的每週數據，並且對我們將延續到 2026 年的基線發病率有了更清晰的了解。團隊的執行力令人難以置信，展現了敏捷的思維和深厚的專業知識，在如此短的時間內對整本書進行了重新定價和重新定位。

And taking into account, again, baseline morbidity trend assumptions, the risk pool impacts of both 2025 and anticipated 2026 program integrity measures as well as the expiration of the enhanced APCs, all of which netted out to that 30% pricing increase for 2026. So part of the confidence comes from, I think, the work that we did and the assumptions that we made coming into the year.

再次考慮到基線發病率趨勢假設、2025 年和預期 2026 年專案完整性措施的風險池影響以及增強型 APC 的到期，所有這些因素最終導致 2026 年價格上漲 30%。所以，我認為，部分自信來自於我們所做的工作以及我們年初所做的假設。

Then as we stepped into open enrollment, really watching membership progress through effectuation and down into paid membership where we sit here today in early February, we actually have a very good view of that paid membership base.

然後，隨著我們進入開放註冊階段，我們真正觀察了會員人數從增長到付費會員的進展，直到今天二月初，我們才真正了解付費會員基礎的情況。

And given our history, a view of how that paid membership matures through the February, March time frame, where there's still a little bit of administrative opportunity and grace period to get worked out, and that's where we get to that 3.5 million member estimate by the end of Q1.

鑑於我們的歷史，我們可以預見付費會員在二月、三月期間的發展情況，屆時還有一些行政方面的機會和寬限期需要解決，而這正是我們在第一季末達到 350 萬會員估計值的原因。

So I feel like standing here where we are today, I feel like we have pretty good visibility into how open enrollment played out and then the tail of that will continue to shake out. To your point, the distribution of metal tiers is different this year than in past years. So we're a little over 30% in bronze, which is up from that 19% to 24% range we talked about in past years.

所以我覺得，就我們今天所處的位置而言，我們對開放註冊的進展情況已經有了相當清晰的了解，而後續的影響還會繼續顯現。你說得對，今年的金屬等級分佈與往年不同。所以，我們目前在銅牌市場佔有率略高於 30%，比我們過去幾年討論的 19% 到 24% 的範圍有所上升。

We do see stability in core demographics around gender distribution and average age has not changed. And then to your question about how Bronze has operated historically, the bronze products operated differently pre-EAPTCs than they did during the EA/PTC period.

我們看到，性別分佈和平均年齡等核心人口統計保持穩定，沒有改變。至於你提出的關於青銅產品歷史上的運作方式的問題，青銅產品在EAPTC時期之前的運作方式與EA/PTC時期有所不同。

And again, one of the benefits of having been in the market for as long as we have, is that we have all of that data, and we had all of that data back in Q3 when we went through and reunderwrote all of our assumptions relative to 2026.

再次強調，我們在市場上待了這麼久的好處之一就是我們擁有所有這些數據，而我們在第三季重新調整了所有與 2026 年相關的假設時，就已經掌握了所有這些數據。

We did that across metal tiers, and we're thoughtful about what the impact might be. And I think what you would see year over year is also a reduction in the footprint where we are a low-cost bronze player.

我們在各個金屬等級中都進行了這樣的操作，並且我們認真考慮了這可能會產生的影響。而且我認為，逐年來看，我們的業務規模也會縮小，因為我們是一家低成本的銅牌公司。

So again, just trying to leverage not just the increased visibility that we had from the data, but just the depth of experience and data we have from end-to-end the tenure of the program to give us a view of where we're sitting today.

所以，我們再次嘗試利用的不僅是數據帶來的更高可見性，還有我們從專案整個週期中累積的豐富經驗和數據，以便了解我們目前的處境。

And also, I would just add, have the benefit of having set 2026 guidance with full visibility into how 2025 and the vast majority of open enrollment played out. So all of that goes into why we feel confident that we will be able to deliver meaningful margin improvement in this business in 2026.

另外，我還想補充一點，我們還有優勢，那就是在充分了解 2025 年以及絕大多數開放註冊情況的基礎上，制定 2026 年的指導方針。綜上所述，我們有信心在 2026 年實現該業務利潤率的顯著提升。

Stephen Baxter, Wells Fargo.

史蒂芬‧巴克斯特，富國銀行。

I wanted to come back to the Medicaid moving cases. I guess I just a little bit better of a sense of maybe how much incremental decline in membership. I think the membership months were guided down 5% or 6%, but I think a good deal that would be explained by basically what you saw in 2025.

我想回到醫療補助搬遷案例的討論。我想我對會員人數的逐步下降幅度有了更清楚的認知。我認為會員月份預計會下降 5% 或 6%，但我認為這很大程度上可以用 2025 年的情況來解釋。

And as you think about the acuity impact, to the extent that you continue to see disenrollment at pace closer to what you saw this past quarter, so down like 1.5%. Does that place any weight on the acuity assumptions that you have during the guidance at this point in time?

而且，當你考慮嚴重性影響時，你會發現退學率繼續以接近上個季度的速度下降，例如下降 1.5%。這是否會對您目前在指導過程中所依據的敏銳度假設產生任何影響？

Steel hit this at a high level and then ask you to add any color. So what we talked about member months, we talked about attrition in Q1 that there was an assumption for continued attrition consistent with what we've seen, for example, through 2025 in terms of states tightening the eligibility and normal reverification process coming out of COVID.

Steel 把這題寫得非常精彩，然後讓你加入任何顏色。所以，我們談到了會員月份，我們談到了第一季的流失情況，並假設會員流失會持續下去，這與我們看到的情況一致，例如，到 2025 年，各州收緊了資格要求，以及 COVID 疫情後正常的重新驗證流程。

And then we also have a couple of program changes that we know about, including, for example, the Florida CMS program rolling off 10 as well as a probability-weighted bucket of member puts and takes that we track state-by-state and I think if you were to unpack that, you would find that we're pretty prudent in our assumptions around membership there with an eye to what the additional acuity impact might be and all of that is considered in guidance. But I don't know if there's any other additional pieces you want to call out?

此外，我們還了解一些專案變更，例如佛羅裡達州 CMS 專案即將結束，以及我們按州追蹤的按機率加權的成員增減情況。我認為，如果你仔細分析一下，你會發現我們在成員資格方面的假設非常謹慎，考慮到額外的嚴重程度影響，所有這些都在指導意見中有所考慮。但我不知道您是否還有其他需要補充說明的地方？

Yes, right. You mentioned, Stephen, the 5% to 6% member months reduction through the year. The full year would be higher than that in terms of the membership attrition. And I think about it in two buckets, as Sarah indicated, one would be a -- maybe a little over a point per quarter of continued attrition.

沒錯。史蒂芬，你提到了全年會員月份減少 5% 到 6%。全年會員流失率會高於這個數字。正如莎拉所指出的，我把它分成兩類來考慮，一類是——也許每季持續流失略高於一個百分點。

And we saw that basically throughout 2025, and then the Children's Medical Services business that we expect to roll off 10.1 and then as Sarah mentioned, a pool of other RFP-related probability-weighted membership items.

我們看到，基本上在 2025 年，兒童醫療服務業務預計將於 10.1 年推出，然後正如 Sarah 所提到的，還有一系列其他與 RFP 相關的機率加權會員計畫。

The only other thing to think about is there's very few impacts of OBI in terms of membership in 2026, but one of those is I think, around 7.1 a subset of the New York essential plan will be rolling off due to an OP3 provision. That's about 140,000 or so members for us. So that's also in the $88 billion midpoint of guidance, the 5% to 6% member months reduction and the -- a little bit higher than that full year absolute membership attrition.

唯一需要考慮的一點是，OBI 對 2026 年的會員人數幾乎沒有影響，但其中之一是，我認為，大約 7.1 年後，由於 OP3 條款，紐約基本計劃的一部分將逐步取消。我們大約有14萬名會員。所以，這也符合 880 億美元的指導中位數，會員月份減少 5% 到 6%，以及——略高於全年絕對會員流失率。

Sarah James, Cantor.

莎拉詹姆斯，領唱。

Can you help us understand the mechanics of the actuarial soundness look-back process? Like how far back are they looking now? How long of a lag does that typically take to come to an agreement on what trends actually were.

您能幫助我們理解精算穩健性回顧過程的機制嗎？他們現在到底在追溯到多久以前？通常需要多長時間才能就實際趨勢達成一致意見？

And as we move forward into continued periods of disruption through work requirements or additional redeterminations. How are you thinking about being able to shorten that period or move forward to rate adjustments in a faster pace?

隨著我們繼續推進工作，並因工作要求或進一步重新評估而持續面臨中斷時期。您認為如何縮短這個週期，或是加快利率調整的步伐？

Yes. Thanks, Sarah. It's a great question. The short answer is that we are very focused on trying to shorten the period and maximize the amount of most recent data that's being included in the actuarial process but this is not a new thing, right? That has really been what we have been working on since the back half of 2024 as we started to see that dislocation between rate and acuity from and then the step-up in trend that we saw in 2025.

是的。謝謝你，莎拉。這是一個很好的問題。簡而言之，我們非常注重縮短週期，並最大限度地將最新數據納入精算流程，但這並不是什麼新鮮事，對吧？自 2024 年下半年以來，我們一直在努力解決這個問題，因為我們開始看到速度和敏銳度之間的脫節，然後在 2025 年看到了趨勢的上升。

And so, as we've said, we continue to very proactively engage with the states. We're obviously not alone in doing that. So our peers are also part of that conversation. Bringing forward most recent data direct correlation to the program changes.

因此，正如我們所說，我們將繼續非常積極地與各州進行溝通。顯然，我們並非唯一這樣做的人。所以我們的同行也參與這場討論。提出與專案變更直接相關的最新數據。

If I take a step back, I think that perhaps the silver lining of what has been a bit of a painful process to watch these rates lag is the fact that we have now proof points that you can actually have a significant forward-looking trend in ABA unlike anything the actuaries had ever seen before.

如果我退後一步來看，我認為，雖然看著這些利率滯後是一個有點痛苦的過程，但或許也有值得慶幸的地方，那就是我們現在有了證據，證明 ABA 實際上可以呈現出顯著的前瞻性趨勢，這是精算師們以前從未見過的。

We do have the proof points of states actually bringing forward more recent data and making in your adjustments, again, the Florida CMS contract in Q3 of last year is a great example of that. That was a very quick turnaround time between observed behavior and rate correction.

我們確實有證據表明，各州確實提出了更新的數據並進行了調整，而佛羅裡達州去年第三季 CMS 合約就是一個很好的例子。從觀察到行為到修正速率，時間非常短。

And so all of those lessons learned, we carry into the work that we're going to want to do in 2026 to try to preempt the changes that may come in 2027 and 2028 and make sure that we have appropriate rates as we think about what the impact of work requirements are going to be.

因此，我們將吸取所有這些經驗教訓，並運用到 2026 年的工作中，以期預先應對 2027 年和 2028 年可能出現的變化，並確保我們在考慮工作需求的影響時，能夠制定適當的費率。

It's also why I keep pointing back to the fact that as time rolls forward our need to push for that more recent data of being included is just happening organically. And so now those acuity shifts in '24, the rate -- sorry, the trend impact in '25 is now basically sitting in the middle of that two-year look-back period, which is probably the more conservative look back period or standard starting point for the actuarial process.

這也是為什麼我一直強調，隨著時間的推移，我們需要推動納入更多最新數據這一事實自然而然地發生。因此，現在 2024 年的敏銳度變化，2025 年的趨勢影響基本上處於兩年回顧期的中間，這可能是精算過程中較為保守的回顧期或標準起點。

But it is -- it's a dynamic process. It's why it has been really important for us to build and continue to have really strong relationships with our states and to lean in and help them as they're going through that process by bringing forward very specific data.

但事實的確如此──這是一個動態的過程。正因為如此，對我們來說，與各州建立並維持牢固的關係非常重要，我們要積極參與並幫助他們完成這個過程，提出非常具體的數據。

And then the last thing I would say is, just to go back to Justin's question is the idea that in the absence of rates and the states are thinking about what budget pressures they may be facing, it's also a great moment to talk about where there are program refinement opportunities that back into a reasonable cost of care that doesn't just come through the rate.

最後我想說的是，回到賈斯汀的問題，在沒有費率的情況下，各州都在考慮他們可能面臨的預算壓力，這也是一個很好的機會來討論哪些項目可以改進，從而實現合理的護理成本，而不僅僅是通過費率來實現。

And so we're finding those conversations to be really productive and seeing again some of those bankable proof points in the back half of 2025 that we think will bear fruit in 2026.

因此，我們發現這些對話非常有成效，並且在 2025 年下半年再次看到了一些可靠的證據點，我們認為這些證據點將在 2026 年結出碩果。

Josh Raskin, Nephron.

Josh Raskin，腎病學。

Could you just give a little more specifics on your actual segment margins that are implied in the 2026 guidance? And then maybe remind us what your long-term margin targets are by segment in case anything has changed there. And should I be reading into no PDR in Medicare Advantage, meaning that you may be closer to breakeven in 2026, a little ahead of 2027.

能否詳細說明一下2026年業績指引中隱含的實際分部利潤率？然後，或許可以提醒我們你們各業務板塊的長期利潤率目標，以防情況有所改變。我是否應該從 Medicare Advantage 中沒有 PDR 的解讀中得出結論，這意味著您可能在 2026 年就能更接近盈虧平衡點，比 2027 年略早一些。

Yes. So I think, obviously, a lot of stuff has changed across the business. So it's probably premature to talk about long-term margin targets for each business while policy is still shaking out.

是的。所以我覺得，很顯然，整個產業都發生了很大的變化。因此，在政策仍在逐步明朗的情況下，現在談論各業務的長期利潤目標可能還為時過早。

But the bottom line there is certainly that we do see prior margin improvement in all lines of business and meaningful margin improvement across the enterprise over the next couple of years. But let me turn it over to Drew to walk through the specific margin assumptions by line of business in 2026 guidance and then talk through the PDR.

但最根本的是，我們確實看到所有業務線的利潤率都有所提高，並且在未來幾年內，整個企業的利潤率都將有顯著提高。但讓我把麥克風交給德魯，讓他來詳細介紹 2026 年各業務線的具體利潤率假設，然後再討論一下 PDR。

Yes, sure. I'd express Medicaid margins in terms of a stable HBR year over year. The commercial segment, which is largely marketplace, we were at minus one last year. You could do the math on the HBR guidance slide and get to something around 4% pre-tax for 2026 in marketplace.

當然可以。我會用穩定的 HBR 逐年變動來表示 Medicaid 利潤率。商業領域（主要指市場領域）去年我們為負一。你可以根據哈佛商業評論的指導幻燈片進行計算，得出 2026 年市場稅前成長率約為 4%。

And then the Medicare segment, as I said in my remarks, PDP around 2% would be our target. We think that's a prudent starting place relative to well into the threes for 2025.

至於醫療保險部分，正如我在演講中所說，我們的目標PDP約為2%。我們認為，相對於 2025 年的 3 歲以上人士而言，這是一個謹慎的起點。

And then Medicare Advantage within that segment, not quite a breakeven yet, but you're right to recognize no PDR in 2026 means that on the margin, it's not losing money, but there are things that aren't incorporated in the accounting of the PDR such that it's still operating at a slight loss on a fully allocated basis for 2026.

然後是該細分市場中的 Medicare Advantage，雖然還沒有完全實現盈虧平衡，但您說得對，2026 年沒有 PDR 意味著從邊際上看，它並沒有虧損，但 PDR 的會計處理中沒有包含某些因素，因此在 2026 年完全分配的基礎上，它仍然略有虧損。

A.J. Rice, UBS.

A.J. Rice，瑞銀集團。

We still are trying and I still get this question a lot, maybe an unfair one to ask you guys, but I'll do it anyway. If you look at your national peers in Medicaid, two are still forecasting pretty significant drops in margin in '26 versus 25. One, who was more optimistic has now come in line with you with their comments today.

我們仍在努力，我仍然經常被問到這個問題，也許問你們這個問題不太公平，但我還是要問。如果你看看全國的醫療補助同行，你會發現有兩家機構仍然預測 2026 年的利潤率將比 2025 年大幅下降。一位原本比較樂觀的人，今天也發表了與你一致的看法。

And we all struggle to think about how can the company see such a different outlook. Do you think geographic footprint explains the difference? Or is there anything else there? And specifically, in your case, I wanted to ask about the PBM contract because you haven't said a lot about it -- but your vendor, your PBM partner has said that they have renegotiated your contract among a couple of other big ones and that it's a drag to them this year, presumably you're on the receiving end of that and benefiting.

我們都很難理解，公司怎麼會抱持如此不同的觀點。你認為地理分佈範圍可以解釋這種差異嗎？或者那裡還有其他東西嗎？具體來說，就您的情況而言，我想問關於 PBM 合同的事，因為您對此談得不多——但您的供應商，您的 PBM 合作夥伴表示，他們已經重新談判了您的合同以及其他幾份大合同，這對他們今年來說是個負擔，想必您是受益方。

And I wondered if that might be accounting for some of the difference or maybe that's helping you in other business lines, but any comment on that as well would be helpful.

我想知道這是否可以解釋部分差異，或者這是否對您在其他業務領域有所幫助，但如果您對此有任何評論，我將不勝感激。

Yes. Thanks, A.J. So let me hit Medicaid, and then I'll turn it over to Drew to talk about our bespoke contract with our PBM partner. So going all the way back to where we're starting, which I think is really important.

是的。謝謝，A.J.。那我先講講醫療補助計劃，然後把麥克風交給德魯，讓他談談我們與藥品福利管理合作夥伴的客製化合約。所以，讓我們回到最初的起點，我認為這非常重要。

So Again, it's important to remember that we are dumping off an elevated baseline. So as you think about trying to foot relativity with peers, just absolute, we are dumping off that elevated baseline in 2025 that included a 94.9% in Q2. We also have, again, proof point rates that matured favorably as we -- in 2025.

所以再次強調，重要的是要記住，我們是從較高的基線水平上下降的。所以，當你考慮如何與同行保持相對平衡時，僅僅是絕對的，我們將在 2025 年放棄那個較高的基線，其中包括第二季度的 94.9%。我們再次證明，到 2025 年，利率已經成熟並對我們有利。

So that's an important thing to think about relative to that mid-4s rate assumption. And then we have aggressive execution through the back half of the year that played out with that sequential improvement in HBR in Q3 and in Q4, getting to that 930 as the jump off as we step into 2026.

所以，相對於4%左右的利率假設，這是一個需要考慮的重要因素。然後，我們在下半年採取了積極的執行措施，在第三季度和第四季度實現了哈佛商業評論的連續改善，達到了 930 分，這為我們邁入 2026 年奠定了基礎。

And so that momentum I think, is really important. And the fact that we laid out the key levers that we were going after and again, executed on those really well in Q3 and Q4, but also took action and influence decisions in Q3 and Q4 are effective, for example, until 1126. And so just as a reminder, right, in some of those proof points, rate, obviously, an important one.

所以我認為，這種勢頭非常重要。事實上，我們制定了要追求的關鍵槓桿，並在第三季和第四季很好地執行了這些槓桿，而且在第三季和第四季採取的行動和影響決策也有效，例如，一直持續到 1126 年。所以再次提醒一下，對吧，在某些證明點中，評分顯然是一個重要的因素。

The favorable maturation of the 2025 composite, the fact that came in line with our expectation. The fact that we saw in year rate correction like Florida, the second biggest lever is network. And again, you heard me talk about the ABA example, but really making sure that we focus our network on the highest performing, highest quality providers.

2025 年綜合指數的良好成熟度與我們的預期相符。我們看到，像佛羅裡達州這樣的年度利率調整中，第二大槓桿是網路。還有，你們也聽我提到了 ABA 的例子，但真正重要的是確保我們將網路重點放在表現最佳、品質最高的服務提供者身上。

The introduction of clinical management programs hitting transitions of care and member engagement program reform. I talked about a bunch of those ongoing provider engagement, payment integrity and really addressing opportunities where that we're seeing pressure on coding from providers. And then again, a more aggressive stance in fraud, waste and abuse.

臨床管理計畫的引入對護理過渡和會員參與計畫改革產生了影響。我談到了很多關於持續的供應商參與、支付完整性以及真正解決供應商在編碼方面面臨的壓力等問題。此外，在打擊詐欺、浪費和濫用行為方面，也採取了更強硬的立場。

And you heard us talk about a provider that we termed in New York back in Q3 around ABA, but really leveraging that suspect list to go after bad actors. So a lot of proof points that did actually hit the P&L in the back half to 25% and are teed up for 2026.

你們也聽到我們談過，我們在第三季度在紐約圍繞 ABA 提出了一個供應商的概念，但實際上，他們利用這份嫌疑人名單來打擊不良行為者。因此，許多證據點確實在下半年對損益表產生了 25% 的影響，並為 2026 年做好了準備。

So that's where I think our view is that we've taken a prudent assumption around rates that the net trend assumption of 4.5% in 2026 takes into account the work that we've done relative to trend vendors and being able to see additional those actions bear additional fruit in 2026.

所以，我認為我們的觀點是，我們對利率做出了謹慎的假設，即 2026 年淨趨勢假設為 4.5%，這考慮到了我們相對於趨勢供應商所做的工作，並且能夠看到這些行動在 2026 年取得更多成果。

And I will say it again because I will just keep saying it, both internally and externally. If all we do is deliver a 93/7 in Medicaid, I will be very disappointed. But with that, I will let Drew talk about our PBM relationship.

我還要再說一遍，因為我會一直這樣說下去，無論是在心裡還是在外面。如果我們在醫療補助方面只能達到 93/7 的水平，我會非常失望。不過，接下來就讓德魯來談談我們與藥品福利管理機構（PBM）的關係吧。

Yes, A.J., thanks for the question. Over the last, really, decade plus, we've had a tailored transparent and flexible contract with like our current PBM, even our predecessor PBM. So we had those provisions before they were cool and before they were legislatively dictated. I think we benefit by having $60 billion of pharmacy spend and not owning our own PBM.

是的，A.J.，謝謝你的提問。在過去的十多年裡，我們與現在的藥品福利管理機構 (PBM)，甚至我們之前的藥品福利管理機構 (PBM) 都簽訂了量身定制、透明且靈活的合約。所以，在這些規定流行起來之前，在這些規定被立法規定之前，我們就已經有這些規定了。我認為，我們擁有 600 億美元的藥品支出，卻不擁有自己的藥品福利管理機構，這對我們是有好處的。

In other words, every ounce of the economic benefit that PBM arrangement and how we collaborate with our partner to go to the market together, whether it's pharma or network or other decisioning around formulary benefit plan designs we've got immense flexibility in how we work with our partner.

換句話說，PBM 安排以及我們與合作夥伴共同進入市場的方式所帶來的每一分經濟利益，無論是藥品、網絡還是圍繞處方集福利計劃設計的其他決策，我們在與合作夥伴的合作方式上都擁有巨大的靈活性。

And that goes into the cost structure of our products and our margin targets. So all of that is captured in our insurance risk business in our three segments and pleased with what we talked about last quarter in terms of the continued collaboration with our partner, and we will continue to fight for affordability in healthcare including other parts of the ecosystem that have margins, including what I saw on CNBC the other day, boasting about a 40% margin in his pharma business.

這會影響到我們產品的成本結構和利潤目標。因此，所有這些都體現在我們保險風險業務的三個業務板塊中。我們對上個季度與合作夥伴持續合作的進展感到滿意，並將繼續為醫療保健的可負擔性而奮鬥，包括生態系統中其他利潤豐厚的部分，例如我前幾天在 CNBC 上看到的，他吹噓其製藥業務的利潤率高達 40%。

So we will continue to drive affordability on behalf of our low-income and medically complex members, alongside with our PBM partner.

因此，我們將繼續與藥品福利管理夥伴一起，為我們的低收入和病情複雜的會員爭取更高的醫療保障。

Scott Fidel, Goldman Sachs.

Scott Fidel，高盛集團。

Help if you maybe just drill in a little bit more into Part D. And walk us through the book in terms of some of the dynamics through around the versus the non-LIS populations and what you're seeing in the market trends. Obviously, your book of business is heavily weighted towards the LIS.

如果您能再深入探討一下D部分，那就太好了。請帶我們了解書中關於LIS人群與非LIS人群的一些動態，以及您在市場趨勢中觀察到的情況。顯然，您的業務主要集中在 LIS 領域。

And in particular, just some of the underlying inputs like risk scores and economics in terms of the LIS business post IRA versus the non-LIS and then how you position the business to grow and be profitable, clearly through '25 and expect to continue to do that in '26.

特別是，一些基礎性投入，例如風險評分和經濟因素，就 IRA 之後 LIS 業務與非 LIS 業務而言，以及如何定位業務以實現增長和盈利，顯然要到 2025 年，並​​期望在 2026 年繼續這樣做。

Yes, really good question and questions, especially around the impact of the IRA in '25, which they were shifting sands. So the good news in '25 is the industry we had that expanded or more protective risk corridor that then reverted the statutory risk corridor that's been in place since the inception of the Part D program.

是的，這確實是很好的問題，尤其是關於愛爾蘭共和軍在 1925 年的影響，他們當時就像在玩火。因此，2025 年的好消息是，該行業擴大了風險走廊，使其更具保護性，從而恢復了自 D 部分計劃啟動以來一直存在的法定風險走廊。

But that gave us some, let's say, breathing room in terms of navigating pretty severe non-low-income specialty trend when the maximum amount of pocket dropped to $2,000. And so we got through that, executed really well. That's in the rearview mirror.

但這給了我們一些喘息的空間，讓我們能夠應對相當嚴重的非低收入特殊趨勢，因為最高自付額降至 2,000 美元。所以我們就順利完成了任務，執行得非常出色。那都已成為過去。

And now we and the rest of the industry had that data going into the bids in the summer of '25 as we set them for 2026 with eyes wide open in terms of the impact of the IRA on that non-low income population that was availing themselves of a much lower maximum amount of pocket.

現在，我們和業內其他人士在 2025 年夏季的投標中都掌握了這些數據，因為我們當時正密切關注 IRA 對非低收入人群的影響，而這些人可提取的最高金額要低得多。

So we can look at our January data. And you're right, we're growing the revenue growth is largely driven by that yield increase because the direct subsidy increase. But we're still growing membership from about $8.1 million to around $8.7 million across both the low-income population or the Ottawa signs and the non-low income population.

所以我們可以看一下一月份的數據。你說得對，我們的收入成長主要得益於收益率的提高，因為直接補貼增加了。但是，無論是在渥太華的低收入人群還是非低收入人群中，我們的會員人數仍在增長，從大約 810 萬美元增長到大約 870 萬美元。

So I feel pretty good about the mix of business we got -- we like both populations. You can have earnings on both populations and provide a really great value proposition for the senior giving them access to a great drug program.

所以我對我們目前的業務組合感到相當滿意——我們喜歡這兩個群體。你可以從這兩個群體身上獲得收益，並為老年人提供極具價值的方案，讓他們能夠獲得優質的藥物治療計劃。

So that in conjunction with the answer to the last question in terms of cost structure is an important leg of the stool, the underwriting acumen, you're having great actuaries to support and business teams to support that product, which is now a $26 billion product for us with a good margin as well.

因此，結合上一個問題的答案，成本結構是支撐業務的重要支柱，承保能力，以及優秀的精算師和業務團隊的支持，該產品現在對我們來說是一個價值 260 億美元的產品，而且利潤率也很高。

So we're pretty pleased with that business, our positioning. And maybe most importantly, what we're able to do for seniors to have an affordable product in the open market.

所以我們對這項業務和我們的市場定位相當滿意。或許最重要的是，我們能夠為老年人提供在公開市場上負擔得起的產品。

Lance Wilkes, Bernstein.

蘭斯威爾克斯，伯恩斯坦。

I want to talk a little on Medicaid. And if you could, could you walk through Medicaid trends '25 contrast with '26 in a couple of different ways because there's so many different moving elements. I was interested in your views as to how much risk shift had impacted '25. And if you saw any continued impacts in '26 with that, and whether you're seeing any impacts, either negative or positive from states making benefit design changes.

我想簡單談談醫療補助計劃（Medicaid）。如果可以的話，能否從幾個不同的方面來對比 2025 年和 2026 年的 Medicaid 趨勢，因為其中涉及的變動因素太多了。我很想知道您對風險轉移對 2025 年的影響程度有何看法。2026 年，您是否看到了任何持續的影響，以及各州在福利設計變更方面是否看到了任何影響，無論是負面的還是正面的。

And then I'm assuming that the remainder would be core trend. And so then in core trend, you could describe what's your experience with categories inpatient outpatient and/or units and cost inflation?

然後我假設剩餘部分將是核心趨勢。那麼，在核心趨勢方面，您可以描述一下您在住院、門診和/或病房以及成本通膨方面的經驗嗎？

And maybe as a tag on to that, if you could just talk a little bit about what you're seeing as far as competitive dynamics in states given the margin pressures in Medicaid. Are you seeing any issues with small plans not being able to fulfill obligations or any lack of folks stepping back up to try to renew contracts?

另外，能否請您談談，鑑於醫療補助計劃的利潤壓力，您觀察到的各州競爭動態是什麼情況？您是否發現小額套餐無法履行義務，或缺乏續約意願？

Yes. Thanks, Lance. I'll hit that at a high level and have Drew chime in as well. So as we said, we did continue to see a low level of continued membership attrition through 2025 as states were getting tighter with their eligibility criteria, which I think naturally put some on trend relative to core trends, the drivers are really consistent with what we called out throughout Q2 and rolling forward in terms of behavioral health, home health and high-cost drugs.

是的。謝謝你，蘭斯。我會從宏觀層面談談這個問題，也請德魯補充一些意見。正如我們所說，到 2025 年，隨著各州收緊資格標準，我們繼續看到會員流失率保持在較低水平。我認為這自然而然地使一些會員流失率與核心趨勢相符，其驅動因素與我們在第二季度以及未來一段時間內所指出的在行為健康、家庭健康和高價藥物方面的情況非常一致。

Those do not materially shift over the course of the last three quarters of the year with behavioral health really driving 50% of that excess trend, ABA being a primary underpinning of that. Home health and home and community-based services being another and then those high-cost drugs.

在今年最後三個季度中，這些情況並沒有發生實質變化，其中行為健康真正推動了 50% 的超額趨勢，而 ABA 是其主要基礎。家庭健康、居家和社區服務是另一個問題，還有那些高價藥物。

Relative to impact, those, particularly those excess trend areas were how we chalk the field in terms of organizing and looking to mitigate that trend. And so lots of proof points back half of 2025 in terms of actually being able to intervene and help moderate that trend, which is what contributed at least in part to ending the year at 93%.

就影響而言，這些，特別是那些過度趨勢領域，是我們劃分領域、組織和尋求緩解趨勢的方式。因此，大量證據表明，到 2025 年上半年，實際上可以介入並幫助緩和這一趨勢，這至少在一定程度上促成了當年最終達到 93%。

So again, feel good where we stand today in terms of having really solid visibility into the various forms of trends that are influencing the business and being organized around the levers that impact them. relative to competitive dynamics, we are seeing that continued rate pressure is having an impact on different markets and certainly some of the smaller nonprofit plans.

所以，就目前而言，我們對影響業務的各種趨勢有了非常清晰的了解，並圍繞著影響這些趨勢的關鍵因素進行了組織，這讓我們感到滿意。就競爭格局而言，我們看到持續的利率壓力正在對不同的市場產生影響，當然也包括一些較小的非營利計劃。

And frankly, that is an important input into states thinking about making sure that they're funding the program sufficiently so that they have a competitive marketplace and that members have the quality of services that they want and they deserve. And I think over time, it's something that we would watch relative to potential membership growth if competitors choose to exit any of those geographies.

坦白說，這對各州來說是一個重要的考慮因素，他們需要確保為該計劃提供充足的資金，從而建立一個具有競爭力的市場，並確保成員獲得他們想要和應得的高品質服務。我認為隨著時間的推移，如果競爭對手選擇退出這些地區，我們會密切關注其對潛在會員成長的影響。

Just two quick things to add to that. Interesting facts relative to your question, Lance. In patient looks good in Medicaid. And then if you isolate our TANF population, the continuous TANF population, which is like 5 million members.

還有兩點要補充。蘭斯，關於你的問題，有一些有趣的事實。住院病人狀況看起來不錯，符合醫療補助計畫的要求。然後，如果你把我們的 TANF 人群單獨拿出來，也就是持續領取 TANF 福利的人群，大約有 500 萬成員。

So it's a statistically valid cohort. And you set aside behavioral health, that trend looks fine, looks normal like it would historically.

所以這是一個具有統計意義的隊列。撇開心理健康問題不談，這個趨勢看起來不錯，看起來很正常，就像歷史上一樣。

So that enables us to zero in on, as Sarah said, both those areas that we started talking about and recognizing in Q2 of '25 as well as policy and product and benefit changes with our state partners to really zero in on what we need to do to pull those levers.

正如 Sarah 所說，這使我們能夠集中精力於我們在 2025 年第二季度開始討論和認識到的那些領域，以及與我們的州合作夥伴一起進行政策、產品和福利方面的改變，從而真正集中精力於我們需要做什麼才能撥動這些槓桿。

Andrew Mok, Barclays

Andrew Mok，巴克萊銀行

When I look at the segment MLR components embedded in guidance, the ACA improvement and Medicaid stability looked consistent with prior commentary, but the guide seems to imply incremental pressure within Medicare Advantage beyond the PDP reset.

當我查看指南中嵌入的細分市場醫療損失率 (MLR) 組成部分時，ACA 的改進和 Medicaid 的穩定性似乎與先前的評論一致，但該指南似乎暗示，除了 PDP 重置之外，Medicare Advantage 內部還存在逐步增加的壓力。

So first, is that correct? And second, can you help us understand the sources of that pressure and what that means for your target to achieve breakeven in 2027?

首先，這樣說對嗎？其次，您能否幫助我們了解這種壓力的來源，以及這對您實現 2027 年收支平衡的目標意味著什麼？

Yes. I think you'd have to understand bifurcating under Medicare. We absolutely expect progression in Medicare Advantage, meaning improvement in that HBR. PDP yes, there's a piece of going from well into the threes pre-tax margin to 2%, and that's HBR related.

是的。我認為你需要了解醫療保險的拆分規則。我們絕對期待Medicare Advantage取得進展，這意味著HBR有所改善。PDP：是的，稅前利潤率從 3% 以上降至 2% 是有一定原因的，這與哈佛商業評論有關。

But also think about the math on the direct subsidy going from $143 to $200 million and as I said in my script, roll that through a P&L and the yield impact where you need zero incremental admin for that. So you're increasing premium revenue, you're increasing medical cost that has a mathematical impact on the HBR.

但也要考慮直接補貼從 1.43 億美元增加到 2 億美元的數學問題，正如我在腳本中所說，將其計入損益表，並考慮收益率的影響，而這不需要任何額外的管理費用。所以，你增加了保費收入，也增加了醫療成本，這會對 HBR 產生數學上的影響。

That's embedded in that 35 basis points segment impact on the consolidated HBR as well. So I think that might be the missing piece Andrew, of what you're trying to achieve?

這也體現在對綜合哈佛商業評論的 35 個基點的影響中。所以我覺得這可能是安德魯你想要達成的目標中缺少的那一塊拼圖？

Dave Windley, Jefferies.

戴夫溫德利，傑富瑞集團。

I wanted to come back to exchange. Bronze, I think Bronze margins have been a little more volatile or MLRs have been more volatile in the past. You're seeing trade down as I think a lot of people expected. I'm wondering if you have enough data so far to see whether the utilization patterns of those buy down Bronze members are meeting your expectations?

我想回來交換。我認為，過去銅牌的賠率波動性更大一些，或者說MLR（最低賠率）波動性更大一些。正如許多人預期的那樣，交易價格正在下跌。我想知道您目前是否有足夠的數據來判斷那些降低會員資格的銅牌會員的使用模式是否符合您的期望？

Are they -- is there gross medical cost declining because the individual bears more of the cost and brands, things like that? I'm just wondering what that trade down profile looks like.

醫療總成本是否下降，是因為個人承擔了更多費用以及品牌等因素？我只是好奇這種降級交易的模式是什麼樣的。

Yes. Thanks, Dave. So I would say, in general, what we're seeing in terms of trade down again, largely consistent with what we would have expected. We expect that it's probably a market dynamic as well and was contemplated as we thought about overall pricing.

是的。謝謝你，戴夫。所以總的來說，我們看到的貿易下滑趨勢，基本上符合我們的預期。我們認為這也可能與市場動態有關，我們在考慮整體定價時也考慮到了這一點。

And then taking into account not just how the Bronze products have operated over the last years, but what they did pre-COVID and making -- or sorry, pre-candmaking sure that, that was part of the calculus. It's obviously very, very early. We have not closed January yet. But I would say, based on a very early look nothing alarming relative to utilization patterns.

然後不僅要考慮到 Bronze 產品在過去幾年的運作情況，還要考慮到它們在 COVID-19 疫情之前的表現，並且——或者抱歉，是製作罐頭之前——確保這一點，這都是計算的一部分。現在顯然還非常非常早。一月還沒結束。但就目前的初步觀察來看，就利用模式而言，沒有什麼令人擔憂的地方。

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

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. Thank you all for your time and interest this morning. Despite the challenges of 2025, we entered 2026 with increased visibility and important momentum. I believe that we are well positioned to drive margin improvement in 2026 and over the next few years while ensuring access to high-quality, affordable healthcare for the members and communities we serve.

謝謝你，羅科。感謝各位今天上午抽出時間並對此表示關注。儘管 2025 年充滿挑戰，但我們帶著更高的知名度和強勁的發展勢頭進入了 2026 年。我相信，我們已做好充分準備，在 2026 年及未來幾年內推動利潤率提升，同時確保我們所服務的會員和社區能夠獲得高品質、價格合理的醫療保健服務。

And finally, to my Centene colleagues, I just want to say thank you for your incredible resilience and commitment I am excited to see what we can deliver this year. And in the words of my legendary hometown quarterback, let's go. Back to you, Rocco.

最後，我想對我的 Centene 同事們說謝謝，感謝你們令人難以置信的韌性和奉獻精神，我很期待看到我們今年能取得怎樣的成果。用我家鄉傳奇四分衛的話來說，加油！羅科，該你了。

Thank you. Everyone, 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。各位，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。