Centene Corp (CNC) 2026 Q3 法說會逐字稿

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

各位早安，歡迎參加 Centene Corporation 第三季財報電話會議。(接線員指示) 也請注意，今天的活動將會錄音。

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

現在我想將會議交給投資人關係資深副總裁 Jennifer Gilligan。請開始。

Thank you, Rocco, and good morning, everyone. Thank you for joining us on our third quarter 2026 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，Rocco，各位早安。感謝各位參加我們 2026 年第三季財報結果電話會議。Centene 執行長 Sarah London 與執行副總裁兼財務長 Drew Asher 將主持今天上午的電話會議；各位也可透過我們的網站 centene.com 收聽。

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 our full-year 2026 outlook, including the drivers of such outlook, are forward-looking statements.

Centene 可能就未來預期、計畫與前景所作的任何評論，均構成 1995 年《私人證券訴訟改革法》安全港條款目的下的前瞻性陳述。具體而言，我們對 2026 全年展望（包括該展望的驅動因素）的評論，均屬前瞻性陳述。

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 2026 press release and 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. 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.

由於各項重要因素，實際結果可能與這些前瞻性陳述所示存在重大差異；相關因素包括我們 2026 年第三季新聞稿及其他公開的 SEC 申報文件中所討論者，這些文件可於公司網站「投資人」專區取得。Centene 預期後續事件與發展可能導致其估計值改變。雖然公司未來可能選擇在某個時間點更新這些前瞻性陳述，但我們明確聲明不負有任何更新義務。

The 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 2026 press release.

本次電話會議亦將提及若干非 GAAP 指標。這些指標與最直接可比的 GAAP 指標之調節表，可於我們 2026 年第三季新聞稿中查閱。

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

接下來，我想把電話會議交給我們的執行長 Sarah London。Sarah？

Thanks, Jen, and thank you all for joining us to review Centene's third quarter results. This morning, we reported third quarter adjusted diluted earnings per share of $0.58 ahead of our previous expectations. These results driven by outperformance in our Medicare segment and in line performance from our Medicaid and commercial businesses support an improved full-year financial outlook. We now expect 2026 adjusted diluted earnings per share of greater than $5.20.

謝謝你，Jen，也感謝各位一同參與並檢視 Centene 第三季業績。今天上午，我們公布第三季調整後稀釋每股盈餘為 0.58 美元，高於我們先前的預期。這些結果主要來自 Medicare 事業部的優於預期表現，以及 Medicaid 與商業業務符合預期的表現，並支持我們上調全年財務展望。我們目前預期 2026 年調整後稀釋每股盈餘將高於 5.20 美元。

As we remain focused on disciplined execution to finish the year strong we are excited to carry the positive momentum we are producing across our businesses into 2027. Let's unpack the results by business line, starting with Medicaid.

在我們持續專注於紀律性執行、力求強勢收官之際，我們也很期待把目前在各項業務所創造的正向動能延續到 2027 年。接下來我們將按業務線拆解本季成果，先從 Medicaid 開始。

Our Medicaid business is right on track for the quarter, reflecting the positive rate actions highlighted during our second quarter call and effective execution against key quality and affordability initiatives, including member and provider engagement, network management, and a diverse portfolio of fraud, waste and abuse interventions.

我們的 Medicaid 業務本季進展完全符合軌道，反映了我們在第二季電話會議中提到的正向費率調整措施，以及在關鍵品質與可負擔性計畫上的有效執行，包括會員與提供者互動、網絡管理，以及多元的詐欺、浪費與濫用（FWA）介入措施組合。

We reported a Medicaid HBR of 93.6%, improving sequentially by 30 basis points from Q2 and keeping pace with our trajectory to achieve a full year Medicaid HBR of 93.5%. Overall, core trend in the quarter was in line with expectations, and the key drivers that we have been watching for the last 18 months, namely behavioral health, home health and high-cost drugs remain among our top areas of focus and intervention.

我們公布的 Medicaid HBR 為 93.6%，較第二季按季改善 30 個基點，並持續符合我們達成全年 Medicaid HBR 93.5% 的軌跡。

On a positive note, we observed another quarter of year-over-year stabilization in behavioral health trend with a similar pattern beginning to emerge in home health, evidence of the impact of our cost management and policy advocacy efforts.

正面來看，我們觀察到行為健康趨勢連續另一季呈現年對年穩定化；居家健康也開始出現類似的型態，顯示我們在成本管理與政策倡議上的努力正在產生影響。

In the quarter, as expected, we continue to see evidence of the states cleaning up eligibility ahead of OB3 implementation, including mix impact from New York's EP program changes. In the back half of the quarter, we also saw some increased utilization from Children's Medical Services members in Florida ahead of the program transition. In all cases, we were able to absorb that pressure with no impact to our overall trajectory.

本季如預期，我們持續看到各州在 OB3 實施前清理資格認定的跡象，包括紐約 EP 計畫變更所帶來的組合影響。在本季後半段，我們也看到佛羅里達州兒童醫療服務（Children's Medical Services）會員在計畫轉換前出現一些使用量上升。在所有情況下，我們都能吸收這些壓力，且不影響我們整體的既定軌跡。

Medicaid membership tracked largely in line with expectations at quarter end. We continue to expect an incremental step down in Q4, in line with our previous view that year-end 2026 membership would reflect attrition of roughly 8% to 9% and compared to year-end 2025.

截至季末，Medicaid 會員數大致符合預期。我們仍預期第四季會員數將進一步小幅下滑，與我們先前的看法一致：2026 年底會員數相較 2025 年底將反映約 8% 至 9% 的流失。

As a reminder, 10/1 marked both the roll-off of the Florida CMS membership as well as the beginning of OB3 eligibility terminations for legal noncitizens and we have at least one state planning to begin work requirements in Q4. These shifts are reflected in our full-year membership projections and we have accounted for corresponding Q4 acuity impacts in our guidance.

提醒各位，10/1 同時標誌著佛羅里達 CMS 會員的退出，以及針對合法非公民的 OB3 資格終止作業開始；此外，至少有一個州計畫在第四季開始推動工作要求。這些變動已反映在我們全年會員數預測中，我們也已在指引中納入相應的第四季病況嚴重度（acuity）影響。

Rate updates since July have been consistent with expectations and our view of the full year 2026 composite rate remains steady at roughly 5%. Just over 40% of our Medicaid revenue re-rates as of 1/1. And while our view there is still early, we do see signs that rates will continue to reflect better alignment with our cost experience particularly as 2025 dates of service come more fully into focus for the look-back period.

自 7 月以來的費率更新與預期一致，我們對 2026 全年綜合費率的看法仍維持約 5% 不變。截至 1/1，我們超過 40% 的 Medicaid 收入將重新定價。雖然我們目前的判斷仍屬初期，但我們確實看到一些跡象顯示，費率將持續更貼近我們的成本經驗，特別是當 2025 年服務日期在回溯期內更完整地納入考量之後。

As we think about rate actions specific to the Medicaid expansion population, you'll recall that we had a few states in the 7/1 cohort who explicitly accounted for anticipated acuity shifts related to work requirements; mainly states with either early starts or intentional OB3 prep activity in the period. Based on our discussions, we expect the remaining expansion states to revisit rate discussions mid-cycle once their implementation time lines and plans become clearer.

在思考針對 Medicaid 擴張人口的費率措施時，各位會記得，在 7/1 這一批州別中，我們有少數州在費率中明確納入與工作要求相關、預期的病況嚴重度變動；主要是那些在期間內較早啟動或刻意進行 OB3 前置準備活動的州。根據我們的討論，我們預期其餘擴張州將在其實施時程與計畫更明朗後，於週期中段重新檢視費率討論。

For the 1/1 cohort, we are similarly seeing strong engagement in the rate setting process with explicit dialogue around the best way to address OB3 acuity impacts as they construct and draft 2027 rates.

對於 1/1 這一批州別，我們同樣看到在費率制定流程中有高度且積極的參與，並就如何在建構與起草 2027 年費率時最佳處理 OB3 病況嚴重度影響，展開明確對話。

Looking ahead, we are confident we can work with Medicaid departments across our portfolio to make progress on rate adequacy amid the evolving coverage landscape. In the meantime, our local teams are actively partnering to prepare for the implementation of work requirements. States are broadly opting for a more methodical approach to eligibility verification, which should smooth both membership and acuity impacts across 2027, and into early 2028. This will create more opportunities to correctly calibrate rate to the ultimate mix shift.

展望未來，我們有信心能與我們投資組合內各州的 Medicaid 主管機關合作，在保障範圍持續演變的環境下，推動費率充足性（rate adequacy）的進展。同時，我們的在地團隊正積極協作，為工作要求的實施做準備。各州普遍採取較為審慎、循序的方法進行資格驗證，這將有助於在 2027 年乃至 2028 年初，平滑會員數與病況嚴重度的影響。這也將創造更多機會，將費率更精準地校準至最終的組合變化。

Based on state guidance, we are mobilizing to support member education, work and community resource referrals, as well as provider education and readiness support. These efforts are important to ensure that as a system, we can maximize the opportunity for coverage continuity.

根據各州指引，我們正動員資源以支援會員教育、工作與社區資源轉介，以及提供者教育與就緒度支援。這些努力對於確保整體系統能最大化保障連續性的機會至關重要。

Ultimately, we see significant opportunity for margin restoration and sustainable long-term growth in Medicaid. Our unmatched expertise and uniquely mission-driven model position us to help our state partners achieve their Medicaid program goals while supporting our members throughout their health journeys.

最終而言，我們認為 Medicaid 在利潤率修復與可持續的長期成長方面存在顯著機會。我們無可匹敵的專業能力與獨特的使命導向模式，使我們能協助各州合作夥伴達成其 Medicaid 計畫目標，同時在會員的健康旅程中提供支持。

As signs of trend stabilization emerge and policy changes advance, we look forward to helping to shape the next chapter of Medicaid managed care.

隨著趨勢穩定化的跡象浮現、政策變革持續推進，我們期待協助塑造 Medicaid 管理式照護的下一個篇章。

Turning to Medicare. Our Medicare segment results were strong in the quarter, with Medicare Advantage and stand-alone Part D performance, both exceeding our expectations. Strength in Medicare Advantage was driven by favorable medical cost experience and continued disciplined management of the business. As a result of strong execution against our turnaround plan, we are now on track to achieve breakeven financial results in 2026, a year ahead of expectations.

接著談 Medicare。我們的 Medicare 事業部本季表現強勁，Medicare Advantage 與獨立 Part D 的表現皆超出我們預期。Medicare Advantage 的強勁表現主要由有利的醫療成本經驗，以及持續以紀律方式管理該業務所帶動。由於我們在轉型計畫上的強力執行，我們目前已按軌道在 2026 年達成損益兩平的財務結果，較原先預期提前一年。

With the annual enrollment period underway, we are closely monitoring our portfolio evolution for 2027. As many on this call are aware, we made changes to the way we are going to market for Medicare Advantage in 2027, focusing our efforts on populations and geographies where we can provide differentiated products that create the most value for our members and the communities we serve.

隨著年度投保期間展開，我們正密切監測我們在 2027 年的投資組合演變。如同本次電話會議上的許多人所知，我們已調整 2027 年 Medicare Advantage 的市場推廣方式，將資源聚焦於我們能提供差異化產品、並為會員及我們服務的社區創造最大價值的人群與地理區域。

We expect Medicare Advantage membership to be down year-over-year in 2027, as we construct a footprint that will allow us to advance margin expansion in 2027 and beyond while delivering high-quality service and benefits to our members.

我們預期 2027 年 Medicare Advantage 會員數將較去年下降，因為我們正在打造一個足以在 2027 年及其後推動利潤率擴張的布局，同時為會員提供高品質的服務與福利。

Earlier this month, CMS released Medicare Advantage STARS results, which impact the 2028 plan year. These results representing roughly 42% of members at or above 3.5 STARS with 10% of members in 4 STARS were in line with our expectations given known program headwinds.

本月稍早，CMS 公布了 Medicare Advantage 的 STARS 評等結果，該結果將影響 2028 計畫年度。這些結果顯示約 42% 的會員達到或高於 3.5 STARS，且 10% 的會員在 4 STARS；在已知的計畫逆風下，整體符合我們的預期。

Despite cut point pressure, the team delivered meaningful raw score improvement in key categories, including results that outpaced the industry in several measures related to preventative care and clinical outcomes. We remain focused on improving quality fundamentals, and we continue to advocate for STARS reforms that will better support the vulnerable populations we serve. We believe this important work will ultimately lead to better STARS scores and the associated revenue benefit.

儘管 cut point 壓力存在，團隊仍在關鍵類別交出顯著的原始分數（raw score）改善，包括在多項與預防照護及臨床結果相關的衡量指標上，表現優於同業。我們仍專注於改善品質基本面，並持續倡議 STARS 改革，以更好地支持我們所服務的弱勢族群。我們相信這項重要工作最終將帶來更佳的 STARS 分數及其相關的營收效益。

Our stand-alone Part D offerings also performed well in the quarter, once again demonstrating the benefits of prudent bid posture, scale and continued optimization of our cost structure. Reflecting year-to-date results, we now expect PDP to generate pretax margins in the mid- to high 3s, a step-up from the greater than 3% outlook we shared in July. While we are still early in [AP] based on the landscape and our product positioning, we expect enrollment to tilt toward growth.

我們的獨立 Part D 產品在本季亦表現良好，再次展現審慎的投標策略、規模效益以及持續優化成本結構所帶來的好處。反映年初至今的結果，我們目前預期 PDP 的稅前利潤率將落在 3% 中段至高段，較我們 7 月分享的「高於 3%」展望有所上修。雖然我們在 [AP] 仍屬早期階段，但基於市場態勢與我們的產品定位，我們預期投保將更偏向成長。

We continue to see excellent long-term opportunity in Part D, leveraging a deeply established footprint and expertise that we believe uniquely positions us to provide affordable access to pharmacy benefits for American seniors.

我們持續看好 Part D 的長期機會，憑藉深厚且已建立的布局與專業能力，我們相信這使我們具備獨特優勢，能為美國高齡族群提供可負擔的藥局福利取得途徑。

Finally, our marketplace team continues to deliver, positioning the product for meaningful year-over-year margin restoration in 2026. The Marketplace business fundamentally outperformed in the quarter with trend in our higher acuity Silver tier continuing to moderate.

最後，我們的 Marketplace 團隊持續交出成果，並使該產品在 2026 年具備顯著的年對年利潤率修復動能。Marketplace 業務在本季基本面表現優於預期，我們高病況（higher acuity）的 Silver 層級趨勢持續趨緩。

During the quarter, we received updated data and refreshed our estimates relative to 2026 independent dispute resolution activity and other standard program integrity processes. The strength of the underlying business allowed us to absorb the impact of these adjustments, and we now expect Marketplace will produce a full year pretax margin at the top of our previous range of 4.5% to 5%.

本季期間，我們取得更新資料，並就 2026 年獨立爭議解決（independent dispute resolution）活動及其他標準計畫完整性流程，更新了我們的估計。基礎業務的強勁表現使我們得以吸收這些調整的影響；我們目前預期 Marketplace 全年稅前利潤率將落在先前 4.5% 至 5% 區間的上緣。

CMS continues their efforts to reduce unauthorized rolls and crack down further on broker fraud. The reserves we had in place coming into Q3 sufficiently accounted for the revenue and risk adjustment impact of this activity in the quarter, and we believe we have similarly accounted for the trailing effects of these efforts through the end of the year in our full-year guidance.

CMS 持續致力於降低未經授權的名冊（unauthorized rolls），並進一步打擊經紀人詐欺。我們在第三季開始前已提列的準備金，已充分涵蓋本季該活動對營收與風險調整的影響；我們也相信在全年指引中，已同樣反映這些措施至年底的遞延影響。

Our full year assumptions for Marketplace also include continued membership attrition and the expected sloping of Q4 medical expenses. In September, we received updated risk adjustment data from Wakely, reflecting claims through July of 2026, and inclusive of data on unauthorized membership. This data was in line with our expectations, and we continue to expect to be in a meaningful receivable position at the end of the year.

我們對 Marketplace 的全年假設亦包含會員持續流失，以及第四季醫療費用預期呈現上升斜率（sloping）。9 月，我們收到 Wakely 提供的更新風險調整資料，反映截至 2026 年 7 月的理賠情況，並納入未經授權會員的資料。該資料符合我們的預期，我們仍預期在年底將處於顯著的應收款（receivable）部位。

While the Ambetter team has been expertly navigating a dynamic landscape, they have also found time to innovate. We will step into 2027, open enrollment with an expanded product suite, including more tailored benefit plans and whole health programs that meet our members where they are and make it easier for them to get affordable, local and innovative support for their health.

Ambetter 團隊在專業應對多變環境的同時，也騰出時間進行創新。我們將以擴充的產品組合迎接 2027 年的開放投保期，包括更量身打造的福利方案與全人健康（whole health）計畫，能在會員所在之處與其接軌，並讓他們更容易獲得可負擔、在地且創新的健康支持。

We are pleased with where Ambetter's pricing strategy has positioned our products for the 2027 shopping season and remain focused on driving additional margin expansion for Marketplace in 2027. We are proud of how this team has executed in the wake of market disruption and coverage changes, demonstrating agility in 2025 that paved the way for meaningful margin recovery in 2026. We believe we are well positioned to harness this positive momentum as we enter the 2027 cycle.

我們對 Ambetter 的定價策略在 2027 年投保季為產品所建立的定位感到滿意，並將持續專注於在 2027 年推動 Marketplace 進一步的利潤率擴張。我們為團隊在市場動盪與保障變動後的執行表現感到自豪；其在 2025 年展現的敏捷性，為 2026 年顯著的利潤率回升鋪路。我們相信，隨著進入 2027 年週期，我們已具備良好條件把握這股正向動能。

Overall, we are pleased with the performance of our core businesses in the quarter and the momentum we are building across the portfolio. And while we have made great progress managing cost trends and improving our own cost structure, I'm equally excited about the impact the Centene team has had, delivering health outcomes for our members.

整體而言，我們對本季核心業務的表現，以及我們在整體投資組合上所累積的動能感到滿意。此外，雖然我們在管理成本趨勢與改善自身成本結構方面已取得重大進展，但我同樣對 Centene 團隊所帶來的影響感到振奮——為會員帶來更佳的健康結果。

One example of this is the work we have done across the country to turn food from a basic need into a powerful driver of health and affordability. For example, our Nebraska Total Care team has partnered with a leading grocer to offer a healthy food benefit with incremental rewards for evidence-based nutrition counseling, education, and blood sugar screenings to reengage at-risk members and drive behaviors that improve diabetes management.

其中一個例子是，我們在全國各地所做的工作，將食物從基本需求轉化為推動健康與可負擔性的強大動力。例如，我們的 Nebraska Total Care 團隊與一家領先的雜貨零售商合作，提供健康食品福利，並針對具實證基礎的營養諮詢、教育與血糖篩檢提供額外獎勵，以重新吸引高風險會員並促進有助於改善糖尿病管理的行為。

Improving quality of life, encouraging healthy choices, and supporting chronic disease management are just some of the ways our members can benefit from healthy food programs. Along the same lines, over the last two years, Centene has taken a data-driven approach to design our Medicare D-SNP supplemental benefits around groceries, housing and transportation, based on a hypothesis that by investing in critical needs like food and security, we would not only be offering an attractive benefit for enrollees, but one that we know drives better health outcomes.

提升生活品質、鼓勵健康選擇，以及支持慢性病管理，只是會員能從健康食品計畫中受益的部分方式。同樣地，在過去兩年中，Centene 採取數據驅動的方法，基於一項假設來設計我們的 Medicare D-SNP 補充福利，聚焦於雜貨、住房與交通：也就是透過投資食物與安全等關鍵需求，我們不僅能提供對投保人具吸引力的福利，也能提供我們已知可帶來更佳健康結果的福利。

Over the last two quarters, we have completed analysis of these member cohorts and saw that members with higher healthy food benefits had almost $200 per member per month in lower claims spend and better clinical outcomes, including lower blood pressure, HbA1c, and BMI.

在過去兩個季度，我們已完成對這些會員族群的分析，並發現享有較高健康食品福利的會員，其每位會員每月（PMPM）的理賠支出幾乎低了 200 美元，且臨床結果更佳，包括較低的血壓、HbA1c 與 BMI。

By using proven models, prioritizing rigorous data-driven evaluation and embracing innovation, Centene is delivering on the promise of managed care: better outcomes, lower costs and improve quality for the members we serve.

透過採用經驗證的模型、優先進行嚴謹的數據驅動評估並擁抱創新，Centene 正在兌現管理式照護的承諾：更好的結果、更低的成本，並提升我們所服務會員的品質。

As we turn our focus to next year, we look forward to building on the important progress we are making operationally, financially and relative to the impact we have on our members and the communities we serve.

當我們把焦點轉向明年時，我們期待在營運、財務，以及我們對會員與所服務社區影響力等面向，持續累積目前取得的重要進展。

Drew will speak to headwinds and tailwinds in more detail in a moment. But based on what we know today, we expect to grow earnings in 2027 off both our updated baseline and our updated guidance. We'll be able to provide more precision on this view as we gain visibility into AEP and OEP performance, one on Medicaid rates and the overall extra trajectory of the businesses. We look forward to sharing more details when we issue formal 2027 guidance in early February.

Drew 稍後將更詳細說明逆風與順風因素。但就我們目前所知，我們預期 2027 年的獲利將在更新後的基準與更新後的指引之上實現成長。隨著我們對 AEP 與 OEP 表現、Medicaid 費率，以及各業務整體額外走勢（trajectory）的能見度提升，我們將能更精準地說明此觀點。我們期待在 2 月初發布正式的 2027 年指引時，分享更多細節。

With that, I'll turn it over to Drew to provide more detail on the quarter and our early view of 2027.

接下來，我把時間交給 Drew，請他就本季表現與我們對 2027 年的初步看法提供更多細節。

Thank you, Sarah. We are pleased to report another very good quarter on our path to margin restoration, including $45.1 billion in premium and service revenue and adjusted diluted earnings per share of $0.58. This was better than our expectations, such that we are raising our full-year adjusted EPS guidance to greater than $5.20 per diluted share.

謝謝你，Sarah。我們很高興回報，在邁向利潤率修復的道路上，我們又交出一個非常好的季度表現，包括保費與服務營收 451 億美元，以及調整後稀釋每股盈餘 0.58 美元。這優於我們的預期，因此我們將全年調整後 EPS 指引上調至每股稀釋後大於 5.20 美元。

Similarly, the consolidated HBR at 92.7% was better than our expectations, fueling a full year improvement in our 2026 HBR guidance. Let's go through the drivers that you can think about 2026 progress in the context of 2027 and beyond.

同樣地，合併 HBR 為 92.7%，也優於我們的預期，帶動我們對 2026 年全年 HBR 指引的改善。接下來我們將逐一說明推動因素，讓各位能在 2027 年及更長期的脈絡下思考 2026 年的進展。

In Medicaid, at 93.6% in Q3, we were right on track with our full year forecast of approximately 93.5%. We ended Q3 with 11.9 million members, down 5% year-to-date, and we expect some states to continue to trim Medicaid rolls leading up to OB3 implementation in 2027. So we are holding our full year view of membership down 8% to 9%, along with the 2026 forecasted 93.5% HBR.

在 Medicaid 方面，第三季為 93.6%，與我們全年約 93.5% 的預測基本一致。我們在第三季末共有 1,190 萬名會員，年初至今下降 5%，並預期在 2027 年 OB3 上線前，部分州將持續縮減 Medicaid 名冊。因此，我們維持全年會員數下滑 8% 至 9% 的看法，同時維持 2026 年預測 93.5% 的 HBR。

Our full year view on rates and trend has not changed since our Q2 call and we still see good collaboration and recognition by states for the need to match rates with acuity and trend. We are pleased with the stability of Medicaid and look forward to continued HBR improvement ahead.

我們對全年費率與趨勢的看法自第二季電話會議以來未有改變；我們仍看到各州在需要讓費率與病況嚴重度（acuity）及趨勢相匹配方面，展現良好合作與認同。我們對 Medicaid 的穩定性感到滿意，並期待未來 HBR 能持續改善。

Medicare segment results, including an HBR at 93.8%, were stronger than expected, driven by both Medicare Advantage and PDP with PDP representing the majority of the outperformance. Medicare trend was lower than what we had planned for as we continue to execute on trend management initiatives. As Sarah mentioned, we are pleased to be forecasting to reach Medicare Advantage breakeven in 2026 and a year earlier than our multiyear plan. And PDP continues to perform strongly with the 2026 forecasted pretax margin in the mid- to high 3s zone.

Medicare 事業部的表現（HBR 為 93.8%）優於預期，動能來自 Medicare Advantage 與 PDP，其中 PDP 貢獻了大部分超預期表現。在我們持續推動趨勢管理措施之際，Medicare 的趨勢低於我們原先規劃。如 Sarah 所提，我們很高興目前預測可在 2026 年達成 Medicare Advantage 損益兩平，較我們的多年期計畫提前一年。而 PDP 仍維持強勁表現，2026 年預測稅前利潤率落在 3% 中段至高段區間。

The commercial segment led by Marketplace continues to demonstrate a marvelous turnaround from 2025. In the quarter, we are on track, and we were able to cover both rounds of CMS unauthorized enrollment, as previously anticipated.

以 Marketplace 為主的商業保險事業部，持續展現自 2025 年以來令人驚豔的轉機。本季我們進度符合預期，且如先前所預估，我們已能涵蓋 CMS 兩輪未經授權的投保。

In addition, in Q3, we reflected other program integrity measures as well as continued headwinds from certain providers gaming the system with the independent dispute resolution process prompted by the No Surprises Act. We are working with the administration and Congress on plugging the holes that are prompting this health care system waste and abuse.

此外，在第三季，我們也反映了其他方案完整性（program integrity）措施，以及部分提供者透過《無意外法案》（No Surprises Act）所引發的獨立爭議解決（independent dispute resolution）程序鑽漏洞所帶來的持續逆風。我們正與政府部門及國會合作，補上導致醫療體系浪費與濫用的漏洞。

The strength of our underlying performance in marketplace enabled us to account for these matters without missing a beat. In fact, the underlying strength enabled us to move to the top of our previous 4.5% to 5% pretax range for 2026.

Marketplace 基礎營運表現的強勁，使我們得以在不受影響的情況下吸收上述事項。事實上，這股基礎動能讓我們得以將 2026 年稅前利潤率預期上調至先前 4.5% 至 5% 區間的上緣。

Marketplace membership was slightly down from Q2 with a year-end forecast around 3.2 million members. The improved outlook on Medicare and Commercial segments for 2026 improves our full-year consolidated HBR by 15 basis points at the midpoint.

Marketplace 會員數較第二季略為下降，年末預測約為 320 萬名會員。2026 年 Medicare 與商業保險事業部展望的改善，使我們在中位數情境下，將全年合併 HBR 改善 15 個基點。

Our adjusted SG&A expense ratio was 6.5% in the third quarter compared to 7.0% last year; a little better than our expectations, reflecting continued discipline and execution. With the anticipated Q4 seasonality and spending, we are holding at a full year midpoint of 7.2% for 2026. We are also holding the guidance of approximately $1.5 billion of investment and other income for 2026.

第三季調整後 SG&A 費用率為 6.5%，去年同期為 7.0%；略優於我們預期，反映持續的紀律與執行力。考量第四季季節性與支出，我們維持 2026 年全年中位數為 7.2%。我們也維持 2026 年約 15 億美元投資及其他收益的指引。

We ended the quarter with $175 million of cash available for general corporate use. Since our Q2 call, we repurchased an additional $1.1 billion of senior notes, including the full redemption of our senior notes due 2027 during October. So our total debt as we sit here today is $15.0 billion, down from $18.5 billion at the end of 2024.

本季末，我們可供一般公司用途的現金為 1.75 億美元。自第二季電話會議以來，我們額外回購 11 億美元的優先票據，其中包含於 10 月全額贖回 2027 年到期的優先票據。因此，截至目前我們的總負債為 150 億美元，較 2024 年底的 185 億美元下降。

This not only helps address near-term maturities, it reduces interest expense, including avoiding higher current interest rates and maybe most importantly, creates capacity for growth opportunities down the road.

這不僅有助於因應短期到期債務，也能降低利息費用，包括避免承擔目前較高的利率；或許更重要的是，為未來的成長機會創造資金運用空間。

We ended the quarter with a debt-to-cap ratio of 41.1%. Our 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 2026.

本季末，我們的負債對資本比率（debt-to-cap ratio）為 41.1%。醫療理賠負債合計 215 億美元，相當於 48 天的應付理賠天數，較 2026 年第二季增加 1 天。

During the third quarter, cash flow used by operations was $3.7 billion. As expected and previewed during the Q2 call, we paid out over $3 billion of Medicaid pass-through payments that were sitting on our balance sheet at the end of Q2. Cash flow provided by operations was $4.3 billion year-to-date, driven by net earnings and the timing of claims and other payments.

第三季營運活動使用的現金流為 37 億美元。如預期且在第二季電話會議中已預告，我們支付了超過 30 億美元的 Medicaid pass-through 款項，該款項在第二季末仍列於資產負債表。年初至今營運活動提供的現金流為 43 億美元，主要由淨利以及理賠與其他付款時點所帶動。

Overall, given the strength of the quarter, we now expect greater than $5.20 of adjusted diluted EPS in 2026. This increase from prior guidance of greater than $4.80 is driven by: one, continued strength in our Medicare segment led by PDP; two, moving our marketplace pretax margin expectation up to the top of the prior 4.5% to 5% range; and three, lower interest expense to a midpoint of $610 million.

整體而言，鑑於本季表現強勁，我們目前預期 2026 年調整後稀釋每股盈餘（EPS）將高於 5.20 美元。相較先前「高於 4.80 美元」的指引，本次上調主要來自：第一，Medicare 事業部持續強勁，且以 PDP 為主；第二，將 Marketplace 稅前利潤率預期上調至先前 4.5% 至 5% 區間的上緣；第三，利息費用下降至中位數 6.10 億美元。

We are pleased to be forecasting significant EPS improvement from 2025, and we look forward to showing continued progress of earnings restoration ahead.

我們很高興預測 EPS 將較 2025 年顯著改善，也期待未來持續展現獲利修復的進展。

Now let's review 2026 in the context of 2027, and beyond, starting with our current 2026 adjusted EPS guidance of greater than $5.20. Recalling our discussion on the Q2 call, 2026 earnings includes $0.50 that we wouldn't expect to recur in 2027.

接下來，我們以目前 2026 年調整後 EPS 指引「高於 5.20 美元」為起點，將 2026 放在 2027 及更長期的脈絡下檢視。回顧我們在第二季電話會議的討論，2026 年獲利包含 0.50 美元，我們預期該部分在 2027 年不會重複出現。

As we detailed at the end of July, the $0.50 represented $180 million in marketplace and $160 million in our Medicare segment, largely PDP. Overall, we believe the appropriate jump-off point upon which to apply 2027 tailwinds and headwinds is approximately $4.70 of adjusted EPS. As we sit here today, with still a quarter of 2026 to deliver and other open items such as open enrollment in three of our lines of business and partial visibility on 2027 Medicaid rates, we expect to grow adjusted EPS relative to not only the $4.70 jump off, but also relative to our revised $5.20 2026 adjusted EPS guidance.

如我們在 7 月底所詳述，這 0.50 美元包含 Marketplace 的 1.8 億美元，以及 Medicare 事業部（主要為 PDP）的 1.6 億美元。整體而言，我們認為用以套用 2027 年順風與逆風因素的適當起跳點，約為調整後 EPS 4.70 美元。以目前情況來看，在 2026 年仍有一季需要交付、且仍有其他未決事項（例如我們三條業務線中的三項仍在開放投保期，以及對 2027 年 Medicaid 費率僅有部分能見度）之下，我們預期調整後 EPS 的成長不僅會高於 4.70 美元的起跳點，也會高於我們修訂後的 2026 年調整後 EPS 指引 5.20 美元。

Underneath that, here are some of the 2027 drivers, most of which we have covered heretofore. For selected tailwinds relative to the $4.70 2026 jump-off point, we are currently forecasting continued progress matching Medicaid rates with acuity, though partially offset by OB3 headwinds such that we still expect a slight improvement in the Medicaid HBR.

在此之下，以下是我們目前看到的一些 2027 年驅動因素，其中多數我們先前已談及。就相對於 2026 年 4.70 美元起跳點的部分順風因素而言，我們目前預測 Medicaid 費率與病況嚴重度的匹配將持續取得進展，雖然部分會被 OB3 的逆風抵銷，但我們仍預期 Medicaid 的 HBR 將小幅改善。

Improved marketplace pretax margin, Medicare Advantage moving from breakeven in 2026 to better than breakeven in 2027, PDP membership growth, and an increase in premium yield given the increase in the direct subsidy, and an improved SG&A rate on a consolidated basis.

包括 Marketplace 稅前利潤率改善、Medicare Advantage 由 2026 年損益兩平提升至 2027 年優於損益兩平、PDP 會員數成長、因直接補貼（direct subsidy）增加而帶動保費收益率（premium yield）提升，以及在合併基礎下 SG&A 費用率改善。

For a couple of selected headwinds we are currently forecasting, membership attrition in Medicaid from OB3 and the removal of the unsatisfactory immigration status population from managed care in California, and PDP 2026 pretax margin outperformance resetting at least initially in 2027 to a lower margin.

至於我們目前預測的幾項逆風因素，包括：OB3 導致 Medicaid 會員流失，以及加州將移除移民身分狀態不符合要求的人口不再納入管理式照護；另有 PDP 於 2026 年稅前利潤率超預期的表現，至少在 2027 年初期將重設至較低的利潤率水準。

Hopefully, that gives you some early insight into where we sit here in October of 2026. We have a lot of work to do to finish 2026 strong and construct and finalize a plan for 2027 that will be the basis of initial guidance we intend to provide on our Q4 call.

希望以上能讓各位對我們在 2026 年 10 月的現況有初步了解。我們仍有許多工作要做，才能強勁收官 2026 年，並建構與定案 2027 年計畫；該計畫將作為我們預計在第四季電話會議上提供初步指引的基礎。

Chris Neczypor, our next CFO, has been side-by-side with me and the finance team for the last couple of months, and we both look forward to sharing results with you on the Q4 call in February.

我們下一任 CFO Chris Neczypor 在過去幾個月一直與我及財務團隊並肩合作；我們都期待在 2 月的第四季電話會議上與各位分享成果。

Thank you for your interest in Centene; and Rocco, please open it up for questions.

感謝您對 Centene 的關注；Rocco，請開放提問。

(Operator Instructions) Dave Windley, Jefferies.

(接線員指示) Jefferies 的 Dave Windley。

So you answered a number of the questions -- a number of the topics around Medicaid. I guess I'd be interested in a little more color around the dialogue you're having with states and the prospective rate adjustments that they seem to be -- at least some of them seem to be willing to provide. Can you give us any color on that and the mechanism by which they are doing that given their desire to look back at rates?

你已經回答了不少問題——也涵蓋了許多與 Medicaid 相關的主題。我想更進一步了解你們與各州之間的對話細節，以及他們似乎——至少其中一些州似乎——願意提供的前瞻性費率調整。你能否分享一些相關背景，以及在他們希望回溯檢視費率的前提下，他們是透過什麼機制來進行這些調整？

And then more specifically, what you're expecting for 1/1?

另外更具體地說，你們對 1/1 的預期是什麼？

Yeah. Thanks, Dave, for the question. Obviously, very relevant because we're in flight in those conversations as we look at the 1/1 cohort. It is still early. But I would say that we are seeing positive signal in terms of first of all, a very high engagement rate, really good conversation in data exchange. We have a number of states that have already put explicit provisions in their draft rates, and then we have others that are still evaluating, but it is really consistent with where they are in the drafting process.

好的。Dave，謝謝你的提問。顯然這非常相關，因為我們在檢視 1/1 這一批次（cohort）時，相關對話正在進行中。目前仍屬早期。但我會說，我們看到正面的訊號：首先是參與度非常高，資料交換方面的對話也非常順暢。有一些州已經在其費率草案中加入明確條款，另外一些州仍在評估中，但這與他們在擬定流程中的進度相當一致。

I think what we are seeing is two things: one is the increased benefit of having 2025 come into the baseline period. That's obviously more relative to core trend that we've been battling for the last 18 months. But we're also seeing states acknowledge the need to prospectively account for the acuity shifts of work requirements.

我認為我們看到兩件事：第一是把 2025 年納入基準期間所帶來的效益提升。這顯然更能反映我們過去 18 個月一直在應對的核心趨勢。但我們也看到各州承認需要在前瞻性上把工作要求（work requirements）造成的病況嚴重度（acuity）變化納入考量。

And I think the hypothesis that we had coming into this process that because the Medicaid expansion population is a very discrete population, they're rated in a very specific cell. And actually because a lot of the work the states have done to prepare for the process has required them to go get data, right, to figure out what their [feel to] definition would be to get those codes together to define the community exemption data framework, it means actuaries have more data than we did going into the redetermination process to actually scenario model the impact on the population.

我想我們在進入這個流程前的假設是：由於 Medicaid 擴張族群是一個非常明確的族群，他們在費率上會被歸在非常特定的分組（cell）。而且實際上，因為各州為了準備這個流程所做的許多工作，要求他們去取得資料——也就是要釐清他們對於 [feel to] 定義會是什麼、把那些代碼整理出來，以界定社區豁免（community exemption）的資料框架——這代表精算師在重新認定（redetermination）流程開始前，手上的資料比我們當時更多，因此能夠對族群影響做情境建模（scenario modeling）。

So we saw in that 7/1 cohort, we had a few states that were explicitly stepping into work requirements activity, put those in the rates prospectively. I feel like we're seeing that same trend stepping into the 1/1 cohort. We've got really good verbal dialogue with the states that 7/1 cohort that would come back mid-cycle.

因此在 7/1 這一批次中，我們看到有幾個州明確開始納入工作要求相關活動，並以前瞻性方式把它們放進費率裡。我覺得我們在邁向 1/1 這一批次時，也看到同樣的趨勢。我們也與 7/1 批次的各州有非常良好的口頭對話，這些州會在週期中段（mid-cycle）回來做調整。

And I think we're continuing to see strong support from CMS in terms of the requirement for explicit explanation of revision around work requirement impact in the rates and encouragement around mid-cycle adjustments and the ability to leverage current period as they set those rates rather than requiring the look back as they have on more traditional trends. So early, but positive signals in terms of what we're seeing.

而且我認為我們也持續看到 CMS 的強力支持：要求在費率中就工作要求影響所做的修訂提供明確說明，並鼓勵進行週期中段調整，以及在設定費率時能夠運用當期期間（current period）的資料，而不是像對較傳統的趨勢那樣必須回溯（look back）。所以雖然仍在早期，但我們看到的訊號是正面的。

Justin Lake, Wolfe Research.

Wolfe Research 的 Justin Lake。

Just a couple of quick numbers questions. First, on the exchanges going into 2027. I'm curious on how you expect the market as well as your own growth to shape up. I think the exchange market overall grows in '27.

我有幾個快速的數字問題。首先，關於交易所（exchanges）展望到 2027 年。我想了解你們預期整體市場以及你們自身的成長會如何發展。我認為交易所市場整體在 2027 年會成長。

And then just quickly through on your PDP comments, you talked about a reset margins. Should we expect a reset back to target at or back to where you initially guided 2026 at 2%?

另外很快補充一下關於你們的 PDP 評論：你提到利潤率重置（reset margins）。我們是否應該預期重置回到目標水準，也就是回到你們最初對 2026 年指引的 2%？

Yeah. Thanks, Justin. I'll hit the exchanges and then turn it over to Drew for PDP. I think coming into 2027, our view, and if you think about the changes of 2026, relative to expiration of the eAPTCs. Our view is that there would be the most significant shift in 2026, but some degree of tail into 2027, just in terms of the program integrity measures really sort of readjusting the baseline of membership. So our expectations for market overall are still some degree slight contraction.

好的。謝謝你，Justin。我先回答交易所，然後把 PDP 的部分交給 Drew。談到 2027 年，如果你回想 2026 年的變化，與 eAPTCs 到期相關。我們的看法是：最顯著的變動會發生在 2026 年，但 2027 年仍會有一定程度的尾端效應（tail），主要是因為計畫健全性（program integrity）措施會重新調整會員基礎（baseline of membership）。因此我們對整體市場的預期仍是小幅收縮。

And then our membership TBD, it's a little too early. We need to see the results of open enrollment period. But I would say we feel very good about how the team position the products across our geographies with a focus on driving continued margin expansion in 2027.

至於我們的會員數（membership）仍待定，現在還稍早。我們需要看到開放投保期（open enrollment period）的結果。但我會說，我們對團隊在各地區的產品布局感到非常有信心，並聚焦於在 2027 年推動利潤率持續擴張。

Yeah. Justin, on PDP, we feel good about our positioning. Obviously, we've entered the open enrollment period. And like our positioning, not just in the low-income population but also in the enhanced product as well. So excited to be able to forecast some growth there.

是的。Justin，關於 PDP，我們對自身的定位很有信心。顯然我們已進入開放投保期。我們喜歡目前的定位，不僅是在低收入族群，也包括加值型產品（enhanced product）。因此很期待能在那裡預測到一些成長。

And then to your point, yes, we typically bring back, at least for initial guidance, to a more of a target margin. I'd say in '25 and '26 coming out of the chute that was artificially suppressed because of the Inflation Reduction Act. You'll recall we came out at 1% in 2025, and 2% as our initial targets in 2026. We're past that wear off of the Inflation Reduction Act.

至於你提到的問題，是的，我們通常會在初始指引時把利潤率拉回到較接近目標水準。我會說 2025 與 2026 年一開始之所以被人為壓低，是因為《降低通膨法案》（Inflation Reduction Act）。你會記得我們在 2025 年一開始給的是 1%，而 2026 年初始目標是 2%。我們已經度過《降低通膨法案》影響消退（wear off）的階段。

So -- we still need to get data from open enrollment, but probably somewhere in that 2% to 3% range would be the opening expectation for PDP for the year, and then we would work our tails off to outperform that during the year.

所以——我們仍需要取得開放投保期的資料，但 PDP 全年一開始的預期可能會落在 2% 到 3% 的區間，然後我們會在全年全力以赴，力求表現優於該水準。

Stephen Baxter, Wells Fargo.

Wells Fargo 的 Stephen Baxter。

I appreciate the color on the exchanges. I was wondering if you might be willing to call out, I guess, how much of an issue in the quarter, this IDR catch-up was just we can think about bridging to a reasonable Q4.

感謝你分享交易所的細節。我想請問你是否願意指出，本季這個 IDR 追補（catch-up）到底造成多大影響，讓我們能在推估合理的第四季時做銜接（bridging）。

And then -- if we look at where you're trending for the full year MLR, I guess it looks like it's probably going to exceed the initial guidance that you staked out in February, but you're still talking about achieving the high end of this revised margin that you've laid out. Could you help us just bridge some of these moving pieces and why you're still expecting that level of outperformance? Thank you.

另外——如果我們看你們全年 MLR 的走勢，我想看起來可能會高於你們在二月提出的初始指引，但你們仍在談要達成你們這次修訂後所提出的利潤率區間上緣。你能否協助我們把這些變動因素串起來，並說明為何你們仍預期能有那樣程度的超預期表現？謝謝。

Yeah, Stephen, thanks for the questions. If you step back -- well, first of all, it's good to understand that marketplace is not the only item within the commercial segment. I know it's almost all of the segment, but there's about $4 billion of commercial group business in there, which does weigh on the results for the commercial segment. And as you probably picked up in the press, we have decided to exit the Health Net Commercial group business, largely in California, and that will we'll be able to exit on a very orderly fashion over the next, call it, 18 to 24 months.

好的，Stephen，謝謝你的問題。如果你退一步看——首先，了解一點很重要：Marketplace（交易所）並不是商業（commercial）部門裡唯一的項目。我知道它幾乎占了該部門的大部分，但其中還有約 40 億美元的商業團體（commercial group）業務，這也會影響商業部門的結果。而且如你可能從新聞稿中看到的，我們已決定退出 Health Net 的商業團體業務，主要在加州；我們將能在未來約 18 到 24 個月內以非常有序的方式退出。

So that's part of it. But when I step back and look at the marketplace P&L, we're going from a minus 1% pretax margin last year, as we talked about in '25, to a now 5% forecasted pretax margin. So that 600 basis points of pretax margin improvement and HBR largely tracks with that. So we're hitting -- we're doing better than expected in Marketplace. The underlying fundamentals are good.

所以這是其中一部分。但當我退一步看 Marketplace 的損益表（P&L），我們從去年稅前利潤率負 1%（如我們在 2025 年所談）提升到現在預測的稅前利潤率 5%。因此稅前利潤率改善 600 個基點，而 HBR 大致也與此同步。所以我們在 Marketplace 的表現——優於預期。基本面良好。

And to your point, the underlying fundamentals for the quarter essentially helped pay for bolstering the IDR reserves based upon data we got and took a look back of the run out of 2025, some of the run out of IDR assertions and claims. And then look at other program integrity measures like coordination of benefits to make sure that we don't get stung in the future by any past items.

就您提到的重點而言，本季的基本面表現基本上支應了我們根據取得的數據、並回頭檢視至2025年結束期間的情況後，為強化IDR準備金所需的提列，其中包括部分IDR主張與理賠的尾端發展（run-out）。接著也檢視其他方案健全性措施，例如給付協調（coordination of benefits），以確保未來不會因任何過往項目而受到衝擊。

So we don't expect that bolus to recur in Q4. Hence, the continued execution and underlying strong trend performance in marketplace gets us to the top end of that range so we can produce a 5% pretax margin, which is, I think, in my history in managed care, is an incredible turnaround from what we saw in the summer of 2025.

因此，我們不預期該一次性提列會在第四季再度發生。也因此，市集業務持續的執行力與強勁的基礎趨勢表現，讓我們能達到該區間的上緣，進而實現5%的稅前利潤率；我認為，以我在管理式醫療（managed care）的經驗來看，這相較於我們在2025年夏天所見的情況，是一個令人難以置信的扭轉。

A.J. Rice, UBS.

A.J. Rice，瑞銀（UBS）。

I might just ask you about G&A. That's obviously been part of the performance in the recent quarters. Where are you at with respect to rightsizing? I know that's been part of the driver of improved G&A performance but also any other initiatives and where those stand?

我想請教一下G&A（一般及行政費用）。這顯然是近幾季表現的一部分。就組織規模調整（rightsizing）而言，你們目前進展到哪裡？我知道這是帶動G&A表現改善的因素之一；另外還有哪些措施，以及目前進度如何？

And if I could just tack on one little specific one. Drew mentioned that you've got seasonality impact reflected in 4Q for the public exchanges. Is that normal seasonality? Or is there any reason given the loss of the tax credits, et cetera, to think that there might be more step up in utilization in the fourth quarter this year?

如果可以的話，我再補充一個更具體的小問題。Drew提到，你們在第四季的公開交易所（public exchanges）指引中反映了季節性影響。那是正常的季節性嗎？或者考量到稅額抵免（tax credits）流失等因素，今年第四季是否有任何理由認為使用量（utilization）可能會有更明顯的上升？

Yeah. Thanks, A.J. I'll hit the last one quickly, which is that is normal seasonality, particularly for those businesses that are commission-based that are going through enrollment periods in Q4. So nothing out of normal there.

是的。謝謝你，A.J.。我先快速回應最後一題：那是正常的季節性，特別是對於那些以佣金為基礎、且在第四季經歷投保期（enrollment periods）的業務而言。因此沒有任何異常。

Relative to overall G&A, obviously, it was slightly favorable in the quarter. And as you've heard us talk about, we continue to be focused on optimizing the enterprise, really thinking about how the organization, simplify our processes, all in service of delivering industry-leading health outcomes with an industry-leading cost structure.

至於整體G&A，本季確實略為有利。如同你們聽我們談過的，我們持續專注於優化企業營運，真正思考如何調整組織、簡化流程，所有努力都是為了在具備業界領先成本結構的同時，提供業界領先的健康成果。

And so that has been an ongoing effort. I think there are a number of initiatives around that, everything from streamlining our processes, driving further automation. We've made tremendous progress over the last couple of quarters from a data and context layer standpoint to start to implement ROI-driven AI in order to make our team members smarter and faster at the work they're doing to service members. And so feel good about what we've delivered in '26.

因此這一直是一項持續進行的工作。我認為相關措施很多，從精簡流程、推動更進一步的自動化等。過去幾季我們在資料與情境層（data and context layer）方面取得了巨大進展，開始導入以投資報酬（ROI）為導向的AI，讓團隊成員在服務會員的工作上更聰明、更快速。因此，我們對於在2026年所交付的成果感到滿意。

And as you heard from Drew, we see SG&A as a driver of and a tailwind in 2027. So we continue to believe that we'll build momentum around those efforts and see those materialize in 2027.

而且如同你們從Drew那裡聽到的，我們認為SG&A將成為2027年的驅動因素與順風。因此我們仍相信，這些努力會持續累積動能，並在2027年具體展現成效。

Ann Hynes, Mizuho Securities.

Ann Hynes，瑞穗證券（Mizuho Securities）。

Great. Thank you for the question. I just want to ask about commercial for 2027. How should we think about pricing in 2027 versus 2026? And how should we think about metal mix in 2027 versus 2026? And any major learnings from this mix shift from silver versus gold versus bronze this year going into next? Thanks.

很好。謝謝讓我提問。我想請教2027年的商業保險（commercial）。我們應該如何看待2027年相較於2026年的定價？以及2027年相較於2026年的金屬層級組合（metal mix）？另外，今年從銀級（silver）轉向金級（gold）或銅級（bronze）的組合變化，有哪些主要學習，能帶到明年？謝謝。

Yeah. Thanks, Ann. So the team took, as usual, while we operate in a significant number of states, we actually break that down county by county. So the granularity of the portfolio that we use to construct pricing is pretty significant, and the team did an excellent job thinking about where there would be opportunities for growth, where there are opportunities to harvest additional margin, again, with the net goal of the portfolio to balance both improved margin yet again year-over-year 26% to 27%, also trying to make sure that we are offering affordable products to folks who need insurance coverage in the individual marketplace.

是的，謝謝你，Ann。照例，雖然我們在相當多州營運，但團隊實際上是以郡（county）為單位來拆解分析。因此，我們用來建構定價的投組粒度相當細緻；團隊在思考哪些地方有成長機會、哪些地方有機會收割更多利潤率方面做得非常出色。再次強調，該投組的淨目標是在平衡兩件事：一是利潤率持續年增、從2026年的26%提升到2027年的27%；二是同時確保我們為需要在個人市集（individual marketplace）取得保險保障的人提供可負擔的產品。

So as we thought about year-over-year pricing, obviously, the portfolio saw and the markets increases, not as significant as last year, but trying to incorporate both what we're seeing in terms of trend as well as the expectation for additional acuity shifts as we believe that there will be some of that additional lingering market contraction.

因此，在思考年對年定價時，很明顯地，投組與市場都有調升，但幅度不如去年那麼大；我們試圖同時納入我們所看到的趨勢（trend），以及我們對額外病況嚴重度（acuity）變化的預期，因為我們相信市場仍會有一些額外、持續的收縮（contraction）。

Obviously, 2026 broadly saw a huge shift out of silver and into the bronze metal tier and that are moved in that direction as well, but made a less significant move than our peers, and a lot of that was based on historical experience with the Bronze product and just being really thoughtful about the desire to recover margin in 2026.

顯然，2026年整體出現了從銀級大量轉向銅級金屬層級（bronze metal tier）的巨大變化，我們也朝那個方向移動，但幅度比同業更小；其中很大一部分是基於我們對銅級產品的歷史經驗，以及在2026年回收利潤率的目標上保持非常審慎。

So I don't think you would expect huge shift in our overall metal tier, but we do continue to see bronze as a really important part of the portfolio and took that into account as we constructed the 2027 strategy.

因此，我不認為你會看到我們整體金屬層級出現巨大的轉移，但我們確實持續認為銅級是投組中非常重要的一部分，並在建構2027年策略時將其納入考量。

Andrew Mok. Barclays.

Andrew Mok，巴克萊（Barclays）。

Wanted to follow up on the G&A comments. Last quarter, you called out $480 million of workforce and enterprise optimization costs that would be excluded from results this year. And we saw the severance adjustment increased to $276 million in the quarter. Can you give us a sense of the expected annualized savings from these initiatives? Should we think about it being 1:1 with the cost adjustments or something closer to half that?

我想追問一下關於G&A的評論。上季你們提到有4.8億美元的人力與企業優化成本，將在今年的結果中排除。而我們看到本季的資遣費（severance）調整增加到2.76億美元。你們能否讓我們了解，這些措施預期的年度化節省（annualized savings）大概是多少？我們應該把它視為與成本調整1:1對應，還是更接近其中的一半？

And how should we think about the cadence of those savings across 2026 and 2027? Thank you.

另外，這些節省在2026年與2027年的實現節奏（cadence）應該如何看待？謝謝。

Yeah. You're right on the $480 million, Andrew, and that our -- we took most of that in Q3. There's still some more in Q4, and that will probably trail and some of that gets amortized into service periods, maybe into early '27. That's all outside of adjusted. So the $480 million still stands with respect to the broad workforce and enterprise optimization execution that we're undertaking.

是的，你提到的4.8億美元沒錯，Andrew，而且我們——我們在第三季已經認列了其中大部分。第四季還會有一些，之後可能還會延續；其中一部分會攤銷（amortized）到服務期間，可能延伸到2027年初。這些都在調整後（adjusted）結果之外。因此，就我們正在推動的整體人力與企業優化執行而言，4.8億美元這個數字仍然成立。

And then to your point, that is one of the drivers of the view that a tailwind for next year is that the SG&A rate will come down as -- on a consolidated basis, the percentage will come down. Now some of that might be mix, but a fair amount of that should be like durable improvements in the company. And so we're not prepared yet to map that out quarter-to-quarter, but that will occur throughout the year.

接著回到你提到的重點，這也是我們認為明年的一項順風因素：SG&A費用率會下降——以合併基礎來看，該百分比會下降。其中一部分可能來自組合（mix），但相當一部分應該是公司內部可持續的改善。因此，我們目前還沒準備好按季度逐一對應說明，但這會在全年逐步發生。

Sarah James, Cantor Fitzgerald.

Sarah James，Cantor Fitzgerald。

Thank you. On Medicaid, you said that the 4Q acuity impacts are in guidance with the trend unchanged. So how much of the 50 bps cushion on cost trend, have you absorbed so far versus what's the acuity expected in 4Q?

謝謝。關於Medicaid，你們說第四季的病況嚴重度（acuity）影響已納入指引，且趨勢（trend）不變。那麼，在成本趨勢上50個基點（bps）的緩衝中，你們目前已吸收了多少？以及第四季預期的acuity是多少？

And on HIX, are you able to break out how much of the back half slope is coming from just bronze HIX versus anything else going on in your benefit design or the market? Thanks.

另外在HIX方面，你們能否拆解一下，下半年斜率（slope）有多少是來自銅級HIX（bronze HIX），以及是否還有其他因素，例如你們的給付設計（benefit design）或市場端的其他變化？謝謝。

Sure. Thanks, Sarah. So just a reminder about the 50 bps. So we saw stronger rates in the 7/1 cohort and adjusted our full-year view -- sorry, just the back half view to account for the drop off in membership that we expected sort of going down year-over-year 8% to 9% and the acuity shift that would come with that. And so match that up to the 50 basis points.

當然可以。謝謝你，Sarah。先提醒一下關於那50個基點。我們在7/1批次（cohort）看到更強的費率，因此調整了我們對全年——抱歉，是對下半年的看法，以反映我們預期的會員數下滑（年對年約下降8%到9%）以及隨之而來的病況嚴重度（acuity）轉變。因此把這些與那50個基點做了對應。

What we saw, as I mentioned in my prepared remarks, we saw some of that acuity shift and some of the utilization in Q3 matched up again. So that chewed up some of the 50 basis points. But if you look at just the membership shift, we were down roughly 200,000 members in the quarter, which was in line with expectation. But since we still expect to be down 8% to 9% on year-over-year.

如同我在事先準備的發言中提到的，我們看到部分病情嚴重度（acuity）出現轉移，而且第三季（Q3）的部分醫療利用率也再次與之相符。因此，這消耗了那50個基點中的一部分。但如果只看會員結構的變化，本季我們大約減少了20萬名會員，符合預期。不過，由於我們仍預期年對年將下降8%到9%。

That means we are anticipating a bigger step down in Q4 and would therefore expect the bigger impact of the acuity shift and would have held more of that coverage in Q4.

這表示我們預期第四季（Q4）會出現更大幅度的下滑，因此也預期病情嚴重度轉移的影響會更大，並且原本會在Q4保留更多那部分的保障覆蓋。

So all in all, I think we feel well positioned as we look at Q4 and then again, it is still early, but it is certainly promising to see some of those signals of continued stabilization of core trend in the business in those persistent pockets of behavioral health and home health that we have been working against for the last, call it, six quarters.

總體而言，我認為在展望Q4時我們的定位良好；再者，雖然現在仍偏早，但看到一些訊號顯示，業務的核心趨勢在持續趨於穩定，這相當令人鼓舞——尤其是在我們過去大約六個季度一直面臨壓力的那些持續存在的領域：行為健康與居家健康。

So feeling good about stepping into Q4 and 2027 and sort of our overall goal of continuing to drive HBR improvement despite the fact that we're going to need to work through work requirements. And then relative to HIX and the back half sloping, we are not seeing anything unexpected relative to Bronze membership.

因此，我們對邁入Q4與2027年感到樂觀，也就是在我們整體目標上，即便我們必須因應工作要求（work requirements），仍要持續推動HBR改善。另外，關於HIX以及下半年走勢偏斜（back half sloping），就青銅級（Bronze）會員而言，我們沒有看到任何出乎意料的情況。

Obviously, traditional seasonality expect some higher utilization in Q3 and Q4 for the Bronze membership. But they're really tracking directly in line with our expectation. What we saw in Q3, which is really a continuation of what we saw in Q2 relative to a moderating trend that drove the underlying performance of the business in the quarter and that we expect to continue into Q4 was moderating trend in that high acuity silver membership.

顯然，依照傳統季節性，青銅級會員在Q3與Q4的利用率會較高。但他們的表現確實完全符合我們的預期。我們在Q3看到的情況，其實是延續Q2所見：趨勢正在趨於溫和（moderating trend），這推動了本季業務的基礎表現；而我們也預期這會延續到Q4——也就是在高病情嚴重度的白銀級（Silver）會員中，趨勢正在趨於溫和。

So again, that feels durable and like it will continue, which then drives us up to the top end of the previously guided PTI range from Marketplace.

因此，再次強調，這看起來具有持續性，並且會延續下去，進而推動我們達到先前所指引之Marketplace PTI區間的上緣。

Kevin Fischbeck, Bank of America.

Kevin Fischbeck，美國銀行（Bank of America）。

Great. Maybe just to tie a couple of the previous questions back. The acuity shift that you guys are expecting in Q4. How should we think about that as it pertains to the acuity shift in 2027? Are we expecting that this is going to wipe out a lot of that big shift? Or would we expect the 2027 loss enrollment to have a similar headwind to MLR as this 8% to 9% has had?

很好。也許把前面幾個問題串起來問一下。你們預期Q4會出現的病情嚴重度轉移，我們應該如何把它與2027年的病情嚴重度轉移連結起來理解？我們是否預期這會抵消掉那個很大的轉移幅度中的相當一部分？或者，我們應該預期2027年的投保人數流失（loss enrollment）對MLR的逆風，會與這次8%到9%所造成的逆風類似？

And I'm just really trying to narrow in on that slight improvement in Medicaid margins that you guys are forecasting for next year. Is that slight because you're worried about the acuity shift being potentially relatively large? Or are you worried about rates being a little bit slower than you want them to be to catch up to trend?

另外，我也想更聚焦在你們預測明年Medicaid利潤率會有些微改善這件事。之所以只是「些微」，是因為你們擔心病情嚴重度轉移可能相對較大嗎？還是你們擔心費率（rates）追趕趨勢（trend）的速度會比你們希望的更慢？

Yeah. Thanks, Kevin. I do think, as we've looked at it, that the acuity shifting largely that we've seen in '26 so far and expect to continue into Q4, is really a pull forward of acuity shift that would have otherwise happened as a function of work requirements.

是的。謝謝你，Kevin。我確實認為，從我們的觀察來看，我們在2026年迄今所看到、並預期會延續到Q4的病情嚴重度轉移，在很大程度上其實是把原本會因工作要求而發生的病情嚴重度轉移提前（pull forward）了。

So as we've said before, a lot of this -- not all, but a lot of this is the tightening of eligibility of the baseline cohort for the Medicaid expansion population. And that's, again, consistent with the acuity shifts that we've been seeing. And so the degree to which we can frankly to through that in 2026 is better than it otherwise would have been for trying to chew through that in 2027. So we actually see that as a net positive.

因此，如同我們先前所說，這其中很大一部分——不是全部，但很大一部分——是因為對Medicaid擴張族群的基礎隊列（baseline cohort）收緊了資格認定。而這也再次與我們一直看到的病情嚴重度轉移一致。因此，坦白說，我們在2026年能夠在某種程度上把這些消化掉（work through），會比在2027年才去消化要來得更好。所以我們其實把這視為一個淨正面因素。

And then as we think about the margin trajectory of the business in 2027, I think the biggest thing that is a concern is a dislocation between rate and acuity, because of the fact that we are going to see disenrollments from the implementation of work requirements.

接著，當我們思考2027年業務的利潤率走勢時，我認為最大的疑慮在於費率與病情嚴重度之間可能出現錯位（dislocation），因為我們將會因工作要求的實施而看到退保（disenrollments）。

And so that in mind, I think what we've been paying a lot of attention to are the signals that are coming through the process as we work with states to implement in terms of what might derisk that gap between rate and acuity. So think about -- and as I take a step back, I think about the fact that although it is early, the fact that we are seeing early signals of trends starting to stabilize and in those persistent drivers is a positive thing.

基於此，我認為我們一直非常關注的是：在我們與各州合作推動落實的過程中，所釋出的各種訊號，哪些可能有助於降低費率與病情嚴重度之間落差的風險。因此，退一步來看，雖然仍屬早期，但我們看到趨勢開始穩定的早期訊號，而且是在那些持續性的驅動因素上，這是一件正面的事。

We are seeing strength in base rates. So I think we started 4.5%. We're now at composite 5%. And as we think about the 1/1 cohort, we are seeing the '25 base data more squarely come into the look-back period and that would be supportive of rate construction.

我們看到基礎費率（base rates）表現強勁。我想我們一開始是4.5%，現在綜合（composite）已到5%。而在思考1/1這一批（cohort）時，我們看到2025年的基礎數據更明確地進入回溯期（look-back period），這將有利於費率制定（rate construction）。

We are seeing good momentum from states explicitly putting work requirements, adjustments prospectively into the rates, and that is different, materially different from what we saw during the redeterminations period. So states understanding if they need to account for that ahead of time. And we've got really good data to support that modeling.

我們也看到各州在費率中明確把工作要求的調整以前瞻方式（prospectively）納入，這股動能良好；而這與我們在重新認定（redeterminations）期間所看到的情況有實質上的差異。也就是各州理解到他們需要提前把這些因素納入考量。而我們也有非常好的數據來支持相關模型建置。

We also have, I think, signals that other than the California UIS population, there's not going to be some big bang on 1/1 are taking a more methodical approach. Think about a 60-day notice period that starts 1/1, don't see memberships start to roll off until the end of the first quarter. That stretches that membership shift across multiple rate cycles. So the ability to catch up and again, derisk the idea that there would be a dislocation between rate and acuity.

此外，我們也看到一些訊號：除了加州的UIS族群之外，1/1不太可能出現所謂的「一次性大爆發」（big bang），而是採取更有步驟的方法。例如，考量一個自1/1開始的60天通知期（notice period），我們可能要到第一季末才會看到會員開始流失。這會把會員結構的變化分散到多個費率週期之中。因此，追趕調整的能力提升，也再次降低了費率與病情嚴重度之間可能出現錯位的風險。

And then we continue to have a really robust pipeline of quality and affordability initiatives that we have been executing on and we're seeing the results of, and we have more to go.

另外，我們仍持續擁有非常強健的品質與可負擔性（affordability）倡議管線；我們一直在執行，也已看到成果，而且後續還有更多可做。

So net-net, I think everybody is right to be focused on the potential for a dislocation between rate and acuity. But I would say where we stand today, there are more positive signals than negative probably for the first time in a long while. And so that's really what we are leaning into relative to continuing to drive HBR improvement in 2027 and frankly, derisk exactly what you pointed out, would be the concern of what would create a headwind for otherwise normal margin recovery in Medicaid.

因此，總結來說，我認為大家把焦點放在費率與病情嚴重度可能出現錯位的風險上是正確的。但我會說，以我們今天所處的位置來看，正面訊號多於負面訊號，這可能是很長一段時間以來第一次。因此，這也是我們在2027年持續推動HBR改善時所倚重的重點；坦白說，也是在降低你所指出的那個疑慮——也就是什麼情況會對Medicaid原本正常的利潤率修復（margin recovery）造成逆風。

John Stansel, JPMorgan.

John Stansel，摩根大通（JPMorgan）。

I wanted to follow up on kind of some of those commentary and talk about Nebraska. It seems like some of the renewals have run in the low 90s there. Some of that might be attributed to the higher-than-expected medical reality contribution, but are there any learnings from the implementation, obviously, not a material driver, but what you've taken away from those early months as you look into '27?

我想就你剛才的一些評論追問一下，談談內布拉斯加州（Nebraska）。看起來那裡有些續約率落在90%出頭。其中一部分可能可歸因於高於預期的醫療現實貢獻（medical reality contribution），但在推行層面是否有任何學習？當然它不是重大的驅動因素，但就你們從最初幾個月得到的觀察，對你們展望2027年有何啟示？

Yeah, it's a great question. It's obviously one state and with Medicaid, one is one. But I do think that between what we're seeing in Nebraska, which is largely in line with our expectations in terms of net membership roll off, we are seeing what you called out, which is vast majority of members who bring forward data relative to eligibility are being reenrolled.

是的，這是個很好的問題。顯然這只是一個州；但在Medicaid裡，一就是一。不過我確實認為，從我們在內布拉斯加州看到的情況來看，就淨會員流失（net membership roll off）而言大致符合我們的預期；同時也如你所指出的，絕大多數能夠提供與資格（eligibility）相關資料的會員，都已重新投保（reenrolled）。

I think there is some important signal in there in terms of, again, a broad view that states are approaching this with the idea that members who demonstrate eligibility should continue to have access to Medicaid coverage.

我認為其中有一些重要訊號，也就是說，從更宏觀的角度來看，各州正以這樣的理念來處理：凡是能證明符合資格的成員，應該能持續取得 Medicaid 保障。

And also different from what we saw in redeterminations, there are levers available to states that they are very strongly considering, in some cases, implementing to provide, again, a safety net and a GAAP measure relative to what otherwise would be sort of administrative issue an error that would kick people off the roles to think about the ability to leverage self-attestations for the first year relative to frailty, not concerned that's going to create some secondary drop-off of membership, but rather that it gives folks who are medically frail and are -- have a harder time navigating complex process, a little bit more time to effectively do that.

另外也不同於我們在資格重新認定（redeterminations）時看到的情況，各州手上有一些可用的槓桿，他們正非常認真地評估，在某些情況下甚至會付諸實施，以再次提供安全網，並在 GAAP 衡量上，針對原本可能只是行政流程問題、或錯誤而導致人們被從名冊中剔除的情況，提供緩衝；例如思考在第一年針對虛弱（frailty）採用自我聲明（self-attestation）的可行性。我們不擔心這會造成成員的二次流失，反而是讓醫療上較為虛弱、且更難以應對複雜流程的人，有更多時間能有效完成這些程序。

So I would say on track relative to membership and acuity expectations. I think the bigger -- which is great. I think the bigger takeaway is a broader leaning towards coverage continuity relative to the process, a smarter process, a more prospective process and a more data-driven process. So early, but all leans positive.

所以我會說，在成員數與病情嚴重度（acuity）預期方面仍在軌道上。我認為更大的——這點很好。我認為更大的重點是：相較於流程本身，整體更傾向於保障連續性；也就是更聰明的流程、更具前瞻性的流程，以及更以數據驅動的流程。目前還早，但整體都偏正面。

Lance Wilkes, Bernstein.

Lance Wilkes，Bernstein。

Great, just a couple of follow-up questions on Part D. If you could talk a little bit about retention levels that you've experienced traditionally in that? And any margin differences between new members and retained members? And then maybe the overall G&A level you guys experienced in Part D?

好的，關於 Part D 我有幾個追問。你能談談你們過去在 Part D 傳統上所經歷的留存率（retention levels）嗎？以及新加入成員與留存成員之間的利潤率（margin）差異？另外你們在 Part D 的整體 G&A 水準大概如何？

And then maybe as one tack on as we're about to hit the midterms. If you wanted to give us any perspective on policy levers that you think a Democratic House and/or Senate could try to extract that might have any impacts on One Big Beautiful Bill or any of the Medicaid changes?

再補一題，因為我們即將進入期中選舉。你是否願意分享一下，你認為若民主黨掌控眾議院和／或參議院，可能會嘗試運用哪些政策槓桿（policy levers），而這些槓桿是否可能對「One Big Beautiful Bill」或任何 Medicaid 變更產生影響？

Yeah, Lance, why don't I hit policy quickly, and then I'll let Drew hit the for parter on Part D. From a policy standpoint, I would say the conversations we've had with Democratic leaders, very focused on health care access and affordability. And so I think there's an opportunity to work the same way we do in a bipartisan fashion. I mean these are bipartisan concepts. And so I think really continuing to lean in to make sure that we maximize coverage continuity for vulnerable populations.

好的，Lance，我先快速回應政策面，然後再讓 Drew 回答 Part D 的部分。從政策角度來看，我會說我們與民主黨領袖的對話非常聚焦在醫療可近性（access）與可負擔性（affordability）。因此我認為有機會像我們一向採取的兩黨合作方式一樣來推進。我的意思是，這些概念本身就是跨黨派的。所以我認為，重點是持續投入，確保我們能最大化弱勢族群的保障連續性。

Together, we construct the right levers relative to affordability. I think there is -- I believe that there is absolutely bipartisan support for government programs as a critical safety net and don't think that is going to go away. I think we have the ability to further strengthen those.

我們一起建構與可負擔性相關的正確槓桿。我認為——我相信政府計畫作為關鍵安全網，絕對具有跨黨派支持，而且我不認為這會消失。我認為我們也有能力進一步強化這些計畫。

And then the last thing that I would say that I think is interesting is, as we think about the individual marketplace and affordable coverage for working Americans, really thinking about CHOICE and ICHRA as an opportunity to grow that market. And so those are some of the things, again, in a bipartisan way that we are focused on as we turn out of the midterms.

最後我想補充一點我覺得很有意思的是：當我們思考個人市場（individual marketplace）以及為勞動中的美國人提供可負擔的保障時，確實可以把 CHOICE 與 ICHRA 視為擴大該市場的機會。因此，這些就是我們在期中選舉之後，仍會以跨黨派方式聚焦的一些事項。

Lance, you bring up a couple of good questions on PDP. In fact, one of them -- think about the direct subsidy going from $143 to $200 and now $254. You don't need a whole lot of extra G&A to administer the same members, even though you're taking on more of the risk with the changes of the IRA. So therefore, that SG&A rate has been driven down because of that math to, let's say, low to mid-single-digit percentage.

Lance，你提出了幾個關於 PDP 的好問題。事實上，其中一個——想想直接補貼（direct subsidy）從 143 美元提高到 200 美元，現在又到 254 美元。即使因 IRA 的變更而承擔更多風險，要管理同樣的成員，其實不需要增加太多額外的 G&A。因此，因為這個數學關係，SG&A 比率被拉低到例如低到中個位數百分比（low to mid-single-digit percentage）。

What that does is that pushes up the HBR, because you set a target margin and then you plow the difference into benefits. And so optically that HBR goes up, but you're still -- we're still able to achieve at least in this year, a mid- to high 3s margin. So hopefully, that helps you understand the progression from year-to-year of that dynamic, SG&A going down, HBR going up, but able to drive a really good margin in that business.

這樣的結果會推升 HBR，因為你會先設定目標利潤率（target margin），然後把差額回灌到福利（benefits）裡。所以從表面上看 HBR 會上升，但你仍然——我們今年仍能達成約 3% 中段到高段（mid- to high 3s）的利潤率。希望這能幫助你理解這個動態逐年演進：SG&A 下降、HBR 上升，但仍能在這項業務中推動非常不錯的利潤率。

And we've been pretty good with the cross-section, whether it's the auto-assigns, where we're as we said, I think at the Deutsche conference, we are under the benchmark or within de minimis for all 34 regions. So we're going to have a pickup of some auto-assign membership, they're decent performers. And then the enhanced product as well, we would expect some growth going into 2027. Just like we grew from about 8.1 million members in '25 to 8.9 million or 9 million this year. And the year before that, we grew a little over 1 million members.

而且我們在各類組合上做得相當不錯，不論是自動分配（auto-assign）的部分——如同我們在德意志銀行（Deutsche）會議上所說，我們在 34 個區域全部低於基準（benchmark）或落在極小差異（de minimis）範圍內。因此我們會承接一些自動分配的成員，他們的表現也算不錯。另外在加強型產品（enhanced product）方面，我們也預期在 2027 年前後會有一些成長。就像我們從 2025 年約 810 萬名成員成長到今年的 890 萬或 900 萬名。而在那之前的一年，我們也成長了略高於 100 萬名成員。

And the year before that, we grew a couple of million members. So we're pretty good at balancing the -- and administering the risk balance across a broad distributed portfolio. So we like growth in both the enhanced and the basic products.

再前一年，我們成長了約 200 萬名成員。所以我們在平衡——以及在一個廣泛分散的投資組合中管理風險平衡方面做得相當好。因此我們喜歡加強型與基本型（basic）產品兩邊的成長。

George Hill, Deutsche Bank.

George Hill，德意志銀行。

Speaking of [Deutsche]. I guess two quick questions. Number one, given the comments from your peers, any chance you would comment on the order of magnitude of margin increase expectation in the core MA business for next year?

既然提到[德意志]。我想兩個簡短問題。第一，考量同業的評論，你們是否願意談談明年核心 MA 業務利潤率提升預期的大致量級（order of magnitude）？

And then just given that you've talked about a little bit of margin expansion in Medicaid, just from where we are, could you give us a high-level view of expectation of rate and trend, like what are the assumptions for '27?

第二，既然你們提到 Medicaid 會有一些利潤率擴張，從目前的情況出發，你能否給我們一個對費率（rate）與趨勢（trend）的高層次看法，例如對 2027 年的假設是什麼？

Yeah. Thanks, George. It's still, I think, too early to comment on 2027, but you heard from Drew headwinds and tailwinds. Obviously, very pleased to be reaching breakeven in MA a year early. And that creates a new jump-off point. So we would expect expanded margin in 2027 on a path ultimately over the next couple of years to long-term target margins.

好的，謝謝你，George。我認為現在談 2027 年仍然太早，但你也聽到 Drew 提到的逆風與順風。顯然，我們非常高興 MA 能提前一年達到損益兩平（breakeven）。而這也創造了一個新的起跳點。因此我們預期 2027 年利潤率會擴張，並在接下來幾年最終走向長期目標利潤率（long-term target margins）。

So more to come early in open enrollment, but feel good that we have constructed a strategy to get to that footprint that will allow us to not just be profitable in '27, but in '28 as well and beyond.

更多細節會在開放投保（open enrollment）初期再分享，但我們對已建構的策略感到樂觀；這個布局（footprint）將使我們不僅在 2027 年獲利，也能在 2028 年及之後持續獲利。

And then relative to rate and trend for Medicaid, again, there's a lot that we want to see in terms of how some of the early signals that we're seeing play out in Q4. We are early in the 1/1 cycle. So we have some of those draft rates, not all, nobody sitting in a final state. So a lot of that will be part of the update that we provide in February.

至於 Medicaid 的費率與趨勢，同樣地，我們還想觀察一些目前看到的早期訊號在第四季（Q4）如何發展。我們仍在 1/1 週期的早期階段。因此我們拿到了一些草案費率（draft rates），但不是全部，而且目前沒有人處於最終定案狀態。所以其中很多內容會納入我們在二月提供的更新。

But again, what we're seeing there in terms of really constructive conversations, the benefit of '25 coming inform sort of the base rate data, the willingness to consider the right explicit provision for the acuity shift of work requirements.

不過再說一次，我們目前看到的是一些非常具建設性的對話；以及 2025 年的經驗將回饋並反映在基礎費率數據（base rate data）中；同時也看到各州願意考量針對工作要求（work requirements）所造成的病情嚴重度轉移（acuity shift），納入適當且明確的條款（explicit provision）。

And then probably the biggest thing in terms of what's in our control, is just a very robust pipeline of cost management initiatives that we've, I think, executed really well on over the last 18 months or so. And we still got quite a bit of room to run there.

然後，可能最大的一點、也是我們可控的部分，就是我們有一個非常強健的成本管理（cost management）措施管線；我認為在過去大約 18 個月裡，我們執行得非常好。而且我們在這方面仍有相當大的發揮空間。

So more to come in February, but we feel good about where we're sitting against '27 for both of those products. Obviously, with Medicaid, we're going to have membership reduction. So we're going to need to work our way through that, but continue to be committed to driving some HBR improvement.

因此，2 月還會有更多內容，但就這兩項產品而言，我們對目前相較於 2027 年的定位感到滿意。顯然，在 Medicaid 方面，我們的會員人數將會下降。因此我們需要逐步消化這件事，但仍將致力於推動 HBR 的改善。

Michael Ha, Baird.

Michael Ha，Baird。

As we think about next week's midterm elections and work requirements going live on 1/1, how are you thinking about or factoring in the potential risk that could arise from new state leadership changes, governors, newly appointed Medicaid directors, how could that potential leadership hand off across a number of your states impact or disrupt implementation execution into early '27?

當我們思考下週的期中選舉以及 1/1 起工作要求將正式上路時，你們如何看待或納入可能因各州領導層變動所帶來的潛在風險——例如州長更替、新任命的 Medicaid 主管等？這種在你們多個州之間可能發生的領導交接，會如何影響或干擾到 2027 年初的落地執行？

And I also wanted to ask you for a bit more detail on how do you actually assess state readiness into one on live, like, for example, how many of your states can actually handle things like ex parte renewals at scale?

另外我也想請你更詳細說明：你們實際上如何評估各州在上線前的準備度？例如，你們有多少個州實際上能夠大規模處理像 ex parte（免申請）續保這類事項？

Yeah, it's a good question, Michael. Because the reality is across the 30-state portfolio, states are always going to sit along a continuum in terms of capabilities, but also their approach. And so our strategy has been to make sure that we are at maximum readiness in every state and that we are leaning in as much as possible to gap or support states in areas where they're still working through things.

是的，Michael，這是個好問題。因為現實是，在我們涵蓋 30 個州的組合中，各州在能力以及做法上，永遠會落在一個連續光譜的不同位置。因此，我們的策略一直是確保我們在每一州都達到最高程度的準備度，並且在各州仍在處理相關事項的領域，盡可能投入以彌補缺口或提供支援。

So there are states that are still working on their definition of medically frail, but we've done a lot of work to make sure, again, we're in active dialogue with them, every week getting updates sharing what we've seen as definitions in other states. We've done a lot of data work on our side to be prepared for as soon as we get those definitions, being able to load them, run them, provide data to the states, but also use it on our end to model the impact.

例如，有些州仍在制定其對「醫療脆弱（medically frail）」的定義，但我們已做了大量工作，確保——再次強調——我們與他們保持每週的積極對話，取得最新進度並分享我們在其他州看到的定義做法。我們也在自身端做了大量資料工作，以便一旦取得那些定義，就能夠載入、執行、向各州提供資料，同時也在我們這端用來建模其影響。

So I think big thing is what's the implementation process going to be? Do they have the frailty definition how may they leverage self-attestations, the degree to which MCOs can support member and provider outreach. And so again, every state is a little bit different. They're in the active process right now of formalizing that guidance, but we've been talking to them about that for months.

所以我認為關鍵在於：實施流程會是什麼？他們是否已有脆弱度（frailty）定義？他們會如何運用自我聲明（self-attestations）？以及 MCO 在多大程度上能支援會員與提供者的外展溝通。因此，再次強調，每個州都略有不同。他們目前正積極將相關指引正式化，但我們已就此與他們討論了好幾個月。

And then as we think about work requirements and what 39 gubernatorial elections, obviously, it matters in the expansion states. But we have a long history of working through election transitions, and we've got strong relationships with the Medicaid agencies that are going to be a consistent pillar as administrations change.

接著談到工作要求以及 39 場州長選舉，顯然在擴張州（expansion states）這會更重要。但我們在應對選舉交接方面有很長的經驗，而且我們與 Medicaid 機構建立了穩固關係；即使政府更迭，這些機構仍會是持續一致的支柱。

And so just making sure that we know how -- what's coming, we know what might change being able to be very agile. But I don't know that I see significant disruption just given that it is a federal framework that folks must execute against.

因此，重點是確保我們知道——接下來會發生什麼、哪些可能改變，並能保持高度敏捷。但我不認為會出現顯著的干擾，因為這是一個各方必須依循執行的聯邦框架。

And the reality is that even if what we're seeing is more methodical, as I said, in terms of the approach, I think even if you had states that wanted to get more aggressive, there is a practical reality to just the administrative burden of this. And I think that becomes a control framework for how this ultimately gets rolled out.

而現實是，即便我們看到的是更為循序、如我所說在做法上更為審慎，我認為即使有些州想採取更積極的推進方式，從實務面來看也會受到行政負擔的限制。我認為這最終會成為一個控制框架，影響整體推行的節奏與方式。

Scott Fidel, Goldman Sachs.

Scott Fidel，Goldman Sachs。

Just two pieces to this question about Medicaid. The first, just if you can expand out a little bit more just on that higher utilization comment that you said on Florida, CMS in terms of just I guess, the scope of that increase in the utilization. Obviously, we know that you're going to be exiting that contract, but just curious about that.

關於 Medicaid 這個問題我有兩點。第一點，想請你再多展開一些你提到佛羅里達 CMS（合約）「使用率較高」的評論——我想了解使用率上升的幅度或範圍。我們當然知道你們將退出該合約，但仍想請教這點。

And then the second thing would be one element of recent policy change that CMS made in terms of shifting the 1115 waivers to budget neutral for -- in terms of federal spending and the actuarial test that they'll do around that. How are you thinking about that in terms of the headwinds for the overall Medicaid market?

第二點是，CMS 最近有一項政策變更：將 1115 豁免（waivers）在聯邦支出層面改為要求預算中立（budget neutral），並且他們會就此進行精算測試。你們如何看待這件事對整體 Medicaid 市場可能帶來的逆風？

And just given how much expansion of rates and benefits have been included in the 1115 waivers over the last decade and the fact that it all has around one-third of of federal spending overall in Medicaid? Thanks.

尤其考量過去十年 1115 豁免已納入大量費率與福利的擴張，而且 Medicaid 的聯邦總支出中約有三分之一與此相關？謝謝。

Yeah, sure. So in Florida, we saw a slight uptick at the end of the quarter. So I think September largely, we assume, driven by folks who were anxious relative to the program transition. So not significant and not persisting because we did execute the transition on 10/1.

好的，當然。在佛羅里達，我們在季度末看到使用率小幅上升。因此我認為主要是在 9 月，我們推測是因為民眾對於計畫轉換感到焦慮所致。所以幅度不大，也沒有持續，因為我們已在 10/1 完成轉換。

And then relative to the 1115 waivers, I don't know that we expect a significant impact there. I think states obviously need to be -- will need to be thoughtful or maybe some degree of curbing of innovation in terms of how folks use that vehicle. But I think the Shire was always to have those to a large degree, be budget neutral. This is just more seriously enforcing that. But I don't think we expect a major impact from that.

至於 1115 豁免，我不認為我們預期會有顯著影響。我認為各州顯然需要——將需要更審慎，或在某種程度上抑制創新，因為大家使用這個工具的方式可能會受到約束。但我認為其本意一直是讓這些措施在很大程度上維持預算中立。這只是更嚴格地執行而已。但我們不預期這會帶來重大影響。

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

謝謝。問答環節到此結束。我想把電話會議交回給 Sarah London 作結語。

Thanks, Rocco. Thanks, everyone, for joining. We are obviously pleased with the results that we delivered this morning and with the outlook of the business as we head towards 2027.

謝謝你，Rocco。也謝謝各位的參與。我們顯然對今天上午交出的成果感到滿意，也對業務在邁向 2027 年過程中的前景感到樂觀。

I'd like to close with a shout out to the Centene team. You have worked tirelessly over the last year to prove how strong and resilient this company is. And in doing so, you made sure we've never lost sight of our mission, and I want to thank all of you for your leadership. I hope everyone has a great day.

最後我想向 Centene 團隊致意。過去一年你們不懈努力，證明了這家公司有多麼強大且具韌性。在此過程中，你們也確保我們從未偏離使命；我想感謝各位的領導。祝大家今天愉快。

Thank you. That 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。感謝各位參加今天的簡報。您現在可以掛斷電話線，祝您有美好的一天。