Molina Healthcare Inc (MOH) 2024 Q4 法說會逐字稿

Good day, and welcome to the Molina Healthcare fourth-quarter 2024 earnings conference call. (Operator Instructions). This event is being recorded.

大家好，歡迎參加 Molina Healthcare 2024 年第四季財報電話會議。（操作員指令）。正在記錄此事件。

I would now like to turn the conference over to your host today, Jeffrey Geyer. Please go ahead.

現在，我想將會議交給今天的主持人 Jeffrey Geyer。請繼續。

Good morning, and welcome to Molina Healthcare's fourth quarter and full year 2024 earnings call. Joining me today are Molina's President and CEO, Joe Zubretsky; and our CFO, Mark Keim. A press release announcing our fourth quarter and full year 2024 earnings was distributed after the market closed yesterday and is available on our Investor Relations website.

早上好，歡迎參加 Molina Healthcare 2024 年第四季和全年財報電話會議。今天與我一起參加的是 Molina 總裁兼執行長 Joe Zubretsky；以及我們的財務長馬克·凱姆（Mark Keim）。我們在昨天市場收盤後發布了一份新聞稿，宣布第四季度和 2024 年全年收益，可在我們投資者關係網站上查閱。

Shortly after the conclusion of this call, a replay will be available for 30 days. The numbers to access the replay are in the earnings release. For those of you who listen to the rebroadcast of this presentation, we remind you that all of the remarks made as of today, Thursday, February 6, 2025, and have not been updated subsequent to the initial earnings call.

本次通話結束後不久，重播將保留 30 天。觀看重播的數字可以在收益報告中找到。對於那些收聽本次演示重播的人，我們提醒您，所有評論都是截至今天（2025 年 2 月 6 日星期四）發表的，並且在首次財報電話會議之後尚未更新。

On this call, we will refer to certain non-GAAP measures. A reconciliation of these measures with the most directly comparable GAAP measures can be found in the fourth quarter and full year 2024 earnings release.

在本次電話會議中，我們將參考某些非公認會計準則指標。這些指標與最直接可比較的 GAAP 指標的對帳可以在 2024 年第四季和全年財報中找到。

During the call, we will be making certain forward-looking statements, including, but not limited to, statements regarding our 2025 guidance, the estimated amount of our embedded earnings power and future earnings realization, expected Medicaid rate adjustments and updates, our projected MCR, our recent RFP awards, our acquisitions and M&A activity, revenue growth related to RFPs and M&A activity and our long-term growth strategy.

在電話會議期間，我們將做出某些前瞻性陳述，包括但不限於有關我們 2025 年指引、我們內含盈利能力和未來盈利實現的估計金額、預期的醫療補助費率調整和更新、我們預計的 MCR、我們最近的 RFP 獎勵、我們的收購和併購活動、與 RFP 和併購活動相關的收入增​​長以及我們的長期增長戰略的陳述。

Listeners are cautioned that all of our forward-looking statements are subject to certain risks and uncertainties that could cause our actual results to differ materially from our current expectations. We advise listeners to review the risk factors discussed in our Form 10-K annual report filed with the SEC as well as our risk factors listed in our Form 10-Q and Form 8-K filings with the SEC. After the completion of our prepared remarks, we will open the call to take your questions.

請聽眾注意，我們所有的前瞻性陳述都受一定風險和不確定性的影響，這可能導致我們的實際結果與我們目前的預期有重大差異。我們建議聽眾查看我們向美國證券交易委員會提交的 10-K 表年度報告中討論的風險因素以及我們向美國證券交易委員會提交的 10-Q 表和 8-K 表中列出的風險因素。在我們完成準備好的演講後，我們將開始回答您的問題。

I will now turn the call over to our Chief Executive Officer, Joe Zubretsky. Joe?

現在我將電話轉給我們的執行長喬·祖布雷茨基 (Joe Zubretsky)。喬？

Thank you, Jeff, and good morning. Today, I will discuss several topics. Our reported financial results for the fourth quarter and full year 2024, our growth initiatives and related increases to embedded earnings and our full year 2025 premium revenue and earnings guidance.

謝謝你，傑夫，早安。今天，我將討論幾個主題。我們報告的 2024 年第四季和全年財務業績、我們的成長計畫和相關內含收益成長以及我們的 2025 年全年保費收入和獲利指引。

Let me start with our fourth quarter performance. Last night, we reported adjusted earnings per share of $5.5 on $10 billion of premium revenue. Our fourth quarter results and performance metrics did not meet our expectations, but we did demonstrate a continued ability to maintain operating discipline while navigating industry-wide headwinds.

讓我先從我們第四季的表現開始。昨晚，我們報告稱，調整後每股收益為 5.5 美元，保費收入為 100 億美元。我們的第四季業績和績效指標未達到我們的預期，但我們確實展示了在應對整個行業逆風的同時持續保持營運紀律的能力。

Our 90.2% consolidated MCR was higher than expected due to medical cost pressure in our Medicaid and Medicare segments. In Medicaid, our fourth quarter 2024 guidance assumed a moderate increase in trend of an elevated cost base line from the third quarter.

由於醫療補助和醫療保險部門的醫療成本壓力，我們的 90.2% 合併 MCR 高於預期。在醫療補助方面，我們對 2024 年第四季的指導假設是成本基線從第三季開始呈現適度上升趨勢。

However, the medical cost pressure experienced in the fourth quarter was higher than anticipated, with risk corridors providing no material benefit. Medicare continued to experience higher medical costs, consistent with prior quarters and Marketplace performed very well despite the late in year medical cost seasonality we typically experience.

然而，第四季的醫療成本壓力高於預期，風險走廊並未帶來實質效益。與前幾季一樣，醫療保險的醫療費用持續上漲，儘管我們通常在年底經歷醫療費用的季節性，但市場表現仍然非常好。

For the full year 2024, we reported adjusted earnings per share of $22.65, representing 8.5% year-over-year growth. Our full year premium revenue of $38.6 billion represents 19% year-over-year growth and our pretax margin of 4.3% was well within our long-term target range.

我們報告 2024 年全年調整後每股收益為 22.65 美元，年增 8.5%。我們全年的保費收入為 386 億美元，年增 19%，稅前利潤率為 4.3%，完全符合我們的長期目標範圍。

While our fourth quarter performance resulted in our full year results, falling below our guidance. We have a solid earnings jump-off point heading into 2025 and continue to be very bullish on the growth opportunities within all of our businesses as evidenced by our increased embedded earnings.

而我們第四季的業績導致全年業績低於我們的預期。邁向 2025 年，我們擁有穩固的獲利起點，並且我們繼續對所有業務的成長機會非常樂觀，這從我們內含盈利的增加就可以看出。

In Medicaid, our flagship business representing nearly 80% of revenue, we reported a 90.3% MCR for the full year or 89.8% when adjusting for the impact of higher MCRs on new stores and the prior year California item.

在我們的旗艦業務醫療補助 (Medicaid) 中，佔總收入的近 80%，我們報告全年 MCR 為 90.3%，在調整新店和去年加州項目較高 MCR 的影響後，MCR 為 89.8%。

With respect to observed medical cost trend in 2024, it was certainly a tale of two halves. In the first half of the year, medical costs trended slightly higher than our initial expectations, primarily due to the acuity shift caused by redeterminations. However, MCRs remained lower in the first half of the year because the acuity shift impact was moderated by our medical cost management risk corridor protection and rate increases.

就 2024 年觀察到的醫療成本趨勢而言，這無疑是兩個部分的故事。今年上半年，醫療成本略高於我們最初的預期，這主要是由於重新確定導致的敏銳度轉變。然而，由於敏銳度轉變的影響受到醫療成本管理風險走廊保護和費率上漲的緩和，因此上半年 MCR 仍然較低。

In the second half of the year, we experienced higher-than-expected utilization among the continuing population. The second half rate increases and risk -- were not sufficient to completely offset the higher medical cost pressure that continued into the fourth quarter. In Medicare, the full year MCR was 89.1%. The business performed as well as we could have expected given some of the dynamics the industry has experienced.

下半年，我們在持續人口中的使用率高於預期。下半年的利率上調和風險不足以完全抵銷持續到第四季的較高醫療成本壓力。在醫療保險方面，全年 MCR 為 89.1%。考慮到該行業所經歷的一些動態，業務表現正如我們預期的那樣好。

In Marketplace, the MCR was 75.4% for the full year and significantly outperformed our long-term target range. This was the second consecutive year Marketplace outperformed its long-term target margins. This outperformance allowed us to reinvest excess margin into 2025 pricing to drive higher growth and sustained mid-single-digit pretax margins. Our G&A ratio performance has been excellent at 6.7% for the full year. We continue to have the discipline to harvest fixed cost leverage, manage our internal resources effectively, increase productivity and negotiate attractive vendor contracts.

在市場上，全年的 MCR 為 75.4%，大大超過了我們的長期目標範圍。這是 Marketplace 連續第二年超越其長期目標利潤率。這種優異的表現使我們能夠將超額利潤重新投資到 2025 年的定價中，以推動更高的成長和持續的中位數稅前利潤率。全年來看，我們的 G&A 比率表現優異，達到 6.7%。我們將繼續嚴格遵守紀律，取得固定成本槓桿，有效管理內部資源，提高生產力，並協商有吸引力的供應商合約。

Turning now to our growth initiatives. 2024 was an extraordinary year for securing future growth on top of the reported 19% premium revenue growth. Starting with recent acquisitions. On February 1, we closed our acquisition of Connecticure from Emblem Health, and this year, expect $1.2 billion of revenue, mostly in marketplace.

現在來談談我們的成長計畫。 2024 年是確保未來成長的非凡一年，在報告的 19% 保費收入成長的基礎上。從最近的收購開始。2 月 1 日，我們完成了對 Emblem Health 旗下 Connecticure 的收購，今年預計營收為 12 億美元，主要來自市場。

With respect to new contract wins, in Georgia, the state announced its intend to award us a Medicaid managed care services contract. This was a significant win with an estimated $2 billion in annual premium revenue based on expected market share.

關於贏得新合同，在喬治亞州，該州宣布打算授予我們一份醫療補助管理式醫療服務合約。這是一個重大的勝利，根據預期的市場份額，預計每年的保費收入將達到 20 億美元。

We also had significant new contract wins in our dual eligible and integrated product businesses. We successfully procured duals contracts that will expand our footprint in Ohio, Michigan, Massachusetts, Idaho. The incremental revenue from these new contracts is over $3 billion, an increase from the prior estimate of $1.8 billion we had shared at our November Investor Day.

我們還在雙重合格和綜合產品業務中贏得了重要的新合約。我們成功獲得了雙重合同，這將擴大我們在俄亥俄州、密西根州、馬薩諸塞州和愛達荷州的業務範圍。這些新合約帶來的增量收入超過 30 億美元，高於我們在 11 月投資者日分享的 18 億美元的預期。

2024 was also a year in which we successfully defended RFPs in key states. We retained traditional Medicaid contracts in our Michigan, Florida and Wisconsin businesses. These contracts represent over $2 billion of renewed premium revenues. While we are disappointed in the Virginia contract loss, this award is under protest and the current contract will extend well into 2025.

2024 年也是我們成功捍衛關鍵州的 RFP 的一年。我們在密西根州、佛羅裡達州和威斯康辛州的業務中保留了傳統的醫療補助合約。這些合約代表著超過20億美元的續保收入。雖然我們對弗吉尼亞州合約的損失感到失望，但該合約受到抗議，目前的合約將延長到 2025 年。

We are very pleased with the execution of our 2024 growth initiatives. And in that context, we further now when all of the aforementioned contracts are in force, we are well on our way to meeting our target of $46 billion of premium revenue in 2026 and at least $52 billion in 2027.

我們對 2024 年成長計畫的執行感到非常滿意。在此背景下，當上述所有合約都生效時，我們將有望實現 2026 年 460 億美元保費收入、2027 年至少 520 億美元的保費收入目標。

With our current footprint contributing its average annual growth and now fully considering all of our recent growth successes, the path to achieve these growth milestones is very clear. And most importantly, all of this recent activity has allowed us to increase our embedded earnings to $7.75 for 2026 and beyond after harvesting $1.50 of embedded earnings in our 2025 guidance.

鑑於我們目前的足跡貢獻了其年均成長，並充分考慮到我們最近的所有成長成功，實現這些成長里程碑的道路非常清晰。最重要的是，所有這些最近的活動使我們能夠在 2025 年指引中獲得 1.50 美元的內含收益後，將內含收益提高到 2026 年及以後的 7.75 美元。

Having embedded earnings of at least 20% to 25% of run rate EPS is an attractive benchmark to support future EPS growth. Now at approximately 30%, we are very well positioned to meet our long-term targets. In short, we are solidly on track to achieve the growth outlook we projected at our recent Investor Day.

內含收益至少達到每股收益運行率的 20% 至 25% 是支持未來每股收益成長的一個有吸引力的基準。現在我們的佔比已達到約 30%，並且非常有希望實現我們的長期目標。簡而言之，我們正穩步實現我們在最近的投資者日預測的成長前景。

Turning now to our 2025 guidance. We project 2025 premium revenue of approximately $42 billion and adjusted earnings per share of at least $24.50, which is approximately 8% year-over-year growth, highlighted by an 88.7% consolidated MCR and a 4.1% pretax margin.

現在來談談我們 2025 年的指導。我們預計 2025 年保費收入約為 420 億美元，調整後每股收益至少為 24.50 美元，年增約 8%，其中合併 MCR 為 88.7%，稅前利潤率為 4.1%。

Similar to the situation we encountered in 2023, this $24.50 EPS guidance is burdened with $1 of contract implementation costs related to yet another significant future revenue growth cycle we secured this year. These are complex programs with a new contract in Georgia and fully integrated duals product launches in at least four states. These are not speculative investments, but investments that have near-term and certain realizable value.

與我們在 2023 年遇到的情況類似，24.50 美元的每股盈餘指引承擔了 1 美元的合約實施成本，這與我們今年確保的另一個重要的未來營收成長週期有關。這些都是複雜的項目，包括在喬治亞州簽訂的新合同，以及在至少四個州推出完全一體化的雙重產品。這些不是投機性投資，而是具有近期和確定可實現價值的投資。

Mark will take you through the detailed earnings guidance build in a few minutes, but let me offer some high-level segment commentary. First, in Medicaid. Medicaid is projected to be nearly back to performing within our target ranges with an 89.9% MCR.

馬克將在幾分鐘內向您介紹詳細的盈利預測，但請允許我提供一些高級的細分評論。首先，在醫療補助方面。預計醫療補助將幾乎恢復到我們的目標範圍內，MCR 為 89.9%。

For 2025, we project a continuing elevated medical cost trend during the year. Our 2025 Medicaid rates, most of which are known, are expected to be sufficient to capture this elevated trend. Whichever 2024 MCR you observed, Q4 at 90.2%, second half at 89.9%, full year at 89.8% or our 2025 guidance at 89.9%, our flagship business is hovering around the 90% mark, merely 100 basis points off our long-term MCR target.

我們預計 2025 年醫療費用將持續上升。我們的 2025 年醫療補助率（其中大部分是已知的）預計足以反映這一上升趨勢。無論您觀察到的 2024 年 MCR 是哪一種，第四季度為 90.2%，下半年為 89.9%，全年為 89.8%，還是我們的 2025 年指引為 89.9%，我們的旗艦業務都徘徊在 90% 左右，僅比我們的長期 MCR 目標低點 100 個基點。

The business is expected to produce an excellent pretax margin of 4.3%. When the broader market receives the rates, it needs to bring itself back into balance, we expect to be operating well within our long-term ranges, and we believe that will be in the very near future.

預計該業務將實現 4.3% 的優異稅前利潤率。當大盤接收到利率時，它需要恢復平衡，我們預計將在長期範圍內良好運行，並且我們相信這將是在不久的將來。

Next, in Medicare, we would characterize 2025 as a year of transition and some early growing [plans], as the business transforms to serve the increasingly integrated and high-growth dual-eligible population. We expect our 2025 Medicare MCR to be slightly above our target range for three reasons.

接下來，在醫療保險方面，我們將把 2025 年描述為過渡年和一些早期增長[計劃]，因為業務將轉型以服務日益融合和高增長的雙重合格人口。我們預計 2025 年醫療保險 MCR 將略高於我們的目標範圍，原因有三。

First, utilization pressure from the second half of 2024 is expected to continue into 2025. Second, recent rates have not kept pace with trend. And finally, while our long-term outlook for Bright's earnings accretion is unchanged. We expect that it will be slightly below breakeven in 2025.

首先，預計 2024 年下半年的使用率壓力將持續到 2025 年。其次，近期利率並未跟上趨勢。最後，我們對 Bright 獲利成長的長期前景保持不變。我們預計 2025 年數字將略低於損益平衡點。

Finally, in Marketplace. We are projecting to grow premium at 60% in total, half of which is organic. Two consecutive years of exceeding target margins have allowed us to reinvest several hundred basis points of excess margin into pricing in order to grow. Our product is competitively positioned for this year, and we are very pleased with our early enrollment results. We expect the business to produce an MCR and in the middle of our target range and a solid pretax margin of 6% in 2025, while continuing to sustain mid-single-digit pretax margins over the long term.

最後，在市場上。我們預計保費總成長率將達到 60%，其中一半是有機成長。連續兩年超出目標利潤率使我們能夠將數百個基點的超額利潤重新投資到定價中，從而實現成長。我們的產品今年具有很強的競爭力，我們對早期的招生結果非常滿意。我們預計，到 2025 年，該業務的 MCR 將處於我們的目標範圍的中間位置，稅前利潤率將穩定在 6%，同時在長期內繼續維持中等個位數的稅前利潤率。

Our businesses are positioned to produce an earnings per share outlook of $25.50 in 2025. This is a meaningful measure of underlying performance and represents 13% growth on full year 2024 results. When we include the new contract implementation costs of $1, our adjusted EPS guidance for 2025 is at least $24.50 per share. This is a solid foundation off of which to grow and realize the embedded earnings power of the opportunities we have already secured.

我們的業務預計 2025 年每股收益為 25.50 美元。這是衡量基礎績效的一個有意義的指標，代表 2024 年全年業績成長 13%。當我們包括 1 美元的新合約實施成本時，我們對 2025 年的調整後每股收益預期至少為每股 24.50 美元。這是一個堅實的基礎，在此基礎上我們可以實現成長，並實現已獲得的機會所蘊含的獲利能力。

Turning now to the political and legislative landscape. The facts are the Republicans control Congress was a very narrow majority and have the [White House], two budget reconciliation bills are likely to be passed in 2025, and political parties and state legislatures and the governor's offices did not change materially in the last cycle and the states will weigh in heavily on any policy changes.

現在來談談政治和立法情勢。事實是，共和黨以微弱優勢控制國會並擁有[白宮]，兩項預算協調法案很可能在 2025 年獲得通過，而政黨、州立法機構和州長辦公室在上一周期內沒有發生實質性變化，各州將對任何政策變化產生重大影響。

The question, and it is a question that has been posed and remains, is whether cuts to Medicaid funding will be part of these legislative packages. We continue to believe that any changes to the Medicaid program as we know it today will be marginal, Neither side of the aisle wants to see an increase in the number of insured, a reduction in benefits for those relying on government assistance or the related impact to providers.

問題在於，這是一個已經提出並且仍然存在的問題，即削減醫療補助資金是否會成為這些立法方案的一部分。我們仍然相信，對我們今天所知的醫療補助計劃的任何改變都將是微不足道的，兩黨都不希望看到投保人數增加、依賴政府援助的人的福利減少或對提供者產生相關影響。

While our fourth quarter results fell short of our expectations, I am pleased with our team's ability to manage through the many industry-wide headwinds in all of 2024. Our revenue growth has exceeded our long-term targets. We have produced a consolidated pretax margin within our long-term target range, and embedded earnings has reached a new high.

雖然我們第四季的業績未能達到我們的預期，但我對我們的團隊能夠克服 2024 年全年產業面臨的許多不利因素感到滿意。我們的收入成長已經超過了我們的長期目標。我們已達成綜合稅前利潤率處於長期目標範圍內，內含收益也創下新高。

The 2025 earnings profile is solid and perhaps industry-leading and managed Medicaid. All of this allows us to remain very confident in our ability to achieve the long-term targets that we shared with you at our November Investor Day.

2025 年的獲利狀況穩健，或許是業界領先並管理醫療補助。所有這些都使我們對自己實現在 11 月投資者日與大家分享的長期目標的能力充滿信心。

Finally, I want to thank our 18,500 dedicated associates who work tirelessly on behalf of our members and our stakeholders. Their day-to-day efforts, particularly in the face of difficulty, danger and natural disasters are an award heroic.

最後，我要感謝我們 18,500 位敬業的同事，他們為我們的會員和利害關係人不知疲倦地工作。他們每天的努力，特別是在面臨困難、危險和天災時的努力，都堪稱英雄。

With that, I will turn the call over to Mark for some additional color on the financials. Mark?

說完這些，我將把電話轉給馬克，讓他對財務狀況有更多的了解。標記？

Thanks, Joe, and good morning, everyone. Today, I'll discuss some additional details on our fourth quarter and the full year performance. The balance sheet and our 2025 guidance. Beginning with our fourth quarter and full year 2024 results, for the quarter, we reported approximately $10.5 billion in total revenue and $10 billion of premium revenue. With adjusted EPS of $5.05.

謝謝，喬，大家早安。今天，我將討論有關我們第四季度和全年業績的一些更多細節。資產負債表和我們的2025年指引。從我們的第四季和 2024 年全年業績開始，本季我們報告的總收入約為 105 億美元，保費收入為 100 億美元。調整後每股收益為 5.05 美元。

On a consolidated basis, our fourth quarter MCR was 90.2% and our full year MCR was $89.1 million reflecting higher-than-expected medical costs in the second half of the year in both Medicaid and Medicare.

從綜合來看，我們第四季的 MCR 為 90.2%，全年 MCR 為 8,910 萬美元，這反映了下半年醫療補助和醫療保險的醫療費用高於預期。

In Medicaid, our fourth quarter MCR was $90.2. Consistent with the third quarter, the Medicaid MCR reflected higher utilization, particularly for LTSS, pharmacy and behavioral health services. We previously expected 50 basis points of trend in the fourth quarter of what we considered to be an inflated baseline in the third quarter.

在醫療補助方面，我們第四季的 MCR 為 90.2 美元。與第三季一致，醫療補助 MCR 反映出更高的利用率，特別是對於 LTSS、藥房和行為健康服務。我們先前預期第四季的趨勢將為第三季基線膨脹的 50 個基點。

However, fourth quarter net trend was approximately 1.2% and we saw no material benefit from risk corridors. For the full year, the reported Medicaid MCR was 90.3%, which restates the $89.8 million when adjusting for the prior year California [retro] item and the impact of new store businesses.

然而，第四季的淨趨勢約為 1.2%，我們沒有看到風險走廊帶來的任何實質利益。就全年而言，報​​告的醫療補助 MCR 為 90.3%，在根據去年加州[追溯]項目和新店業務的影響進行調整後，重申了 8,980 萬美元的水平。

Given the unprecedented challenges of rates and trends in the year, we demonstrated strong operating performance with that MCR just 80 basis points above our long-term range. In Medicare, our fourth quarter MCR was 93.8% and our full year MCR on was 89.1%, both above our long-term range.

鑑於今年利率和趨勢面臨的前所未有的挑戰，我們仍表現出強勁的營運業績，MCR 僅比我們的長期範圍高出 80 個基點。在醫療保險方面，我們第四季的 MCR 為 93.8%，全年 MCR 為 89.1%，均高於我們的長期範圍。

Higher medical costs in the quarter reflected continued higher utilization of LTSS and pharmacy as well as higher outpatient utilization within our D-SNP population. The fourth quarter also reflects the seasonal impact of CMS annual facility fee schedule increases and the revenue recognition of certain risk adjustment items.

本季醫療成本的上升反映了 LTSS 和藥房的利用率持續上升以及 D-SNP 族群中門診利用率的上升。第四季度也反映了 CMS 年度設施費用表成長的季節性影響以及某些風險調整項目的收入確認。

As Joe mentioned, we remain confident in our 2025 bids and believe our pricing strategy was conservative enough to protect against higher medical cost trend that occurred in the second half of 2024 and is expected to continue in 2025.

正如喬所提到的，我們對 2025 年的投標仍然充滿信心，並相信我們的定價策略足夠保守，可以抵禦 2024 年下半年出現並預計在 2025 年持續的醫療成本上漲趨勢。

In Marketplace, our fourth quarter MCR was 83.3%, reflecting normal late year seasonality. Our full year Marketplace MCR was 75.4% and well below our long-term target range for the second consecutive year. This allowed us to reinvest excess margin into pricing to achieve significant growth for 2025. Our adjusted G&A ratio for the quarter was 6.3%, and our full year adjusted G&A ratio was 6.7.

在市場上，我們第四季的 MCR 為 83.3%，反映了正常的年底季節性。我們全年的市場 MCR 為 75.4%，連續第二年遠低於我們的長期目標範圍。這使我們能夠將超額利潤重新投資到定價中，以實現 2025 年的顯著成長。我們本季調整後的 G&A 比率為 6.3%，全年調整後的 G&A 比率為 6.7。

This was the second consecutive quarter we benefited from renegotiated vendor contracts and several onetime items. We are very pleased with the disciplined cost management, productivity and leverage we continue to demonstrate.

這是我們連續第二個季度受益於重新談判的供應商合約和幾個一次性項目。我們對我們繼續展現出的嚴謹的成本管理、生產力和槓桿作用感到非常滿意。

Turning to the balance sheet. Our capital foundation remains strong. In the quarter, we harvested approximately $327 million of subsidiary dividends. Our parent company cash balance was approximately $445 million at the end of the quarter, a portion of which was used to fund the Connecticure acquisition, which just closed earlier this week.

轉向資產負債表。我們的資本基礎依然強勁。本季度，我們獲得了約 3.27 億美元的子公司股息。截至本季末，我們母公司的現金餘額約為 4.45 億美元，其中一部分用於資助本週稍早剛完成的 Connecticure 收購。

During the quarter, we repurchased 1.7 million shares at a total cost of $500 million. In November, we closed a bond offering of $750 million of senior notes due in 2033. Debt at the end of the quarter was 1.7 times trailing 12-month EBITDA. The with our debt-to-cap ratio at about 41%. We continue to have ample cash and access to capital to fuel our growth initiatives. Days in claims payable at the end of the quarter was 48, consistent with the third quarter and well within our normal range. We remain confident in the strength of our reserves.

本季度，我們回購了 170 萬股，總成本為 5 億美元。11 月份，我們完成了價值 7.5 億美元的、將於 2033 年到期的優先票據的發行。本季末的債務是過去 12 個月 EBITDA 的 1.7 倍。我們的債務與資本比率約為41%。我們繼續擁有充足的現金和資本來推動我們的成長計劃。本季末的理賠應付天數為 48 天，與第三季一致，且在我們的正常範圍內。我們對我們的儲備實力仍然充滿信心。

Our operating cash flow for the full year 2024 was $644 million. This was lower than 2023 and primarily reflects the impact of risk corridor payments made in 2024. Recall that earlier this year, we made several large corridor settlements related at the prior years.

我們 2024 年全年的營運現金流為 6.44 億美元。這低於 2023 年，主要反映了 2024 年風險走廊支付的影響。回想一下，今年早些時候，我們達成了幾個與前幾年相關的大型走廊協議。

Now some additional details on our 2025 guidance beginning with membership. In Medicaid, we expect new membership growth from recent contract wins and growth in our current footprint to add over 100,000 members. We expect 2025 year-end membership of approximately 5 million members.

現在從會員資格開始介紹我們的 2025 年指導方針的一些更多詳細資訊。在醫療補助方面，我們預計最近贏得的合約將帶來新會員的成長，並且我們目前的業務範圍將擴大，新增會員人數將超過 10 萬名。我們預計 2025 年底會員人數約 500 萬人。

In Medicare, we expect to begin 2025 with approximately 217,000 members based on strong open enrollment in our D-SNP product, somewhat offset by our exit from MAPD in 13 states for 2025. The acquisition of ConnectiCare, adds 39,000 members.

在醫療保險方面，我們預計到 2025 年初將擁有約 217,000 名會員，這得益於我們 D-SNP 產品的強勁開放註冊，但這在一定程度上因我們 2025 年退出 13 個州的 MAPD 而得到抵消。收購 ConnectiCare，增加 39,000 名會員。

Combined with organic growth in our Medicare business, we expect to end 2025 with approximately 250,000 Medicare members. In Marketplace, based on very strong open enrollment, we began 2025 with approximately 546,000 members, representing 35% growth in our legacy business.

結合我們醫療保險業務的有機成長，我們預計到 2025 年底醫療保險會員人數將達到約 25 萬名。在 Marketplace，基於非常強勁的開放註冊，我們在 2025 年開始時擁有約 546,000 名會員，這代表我們傳統業務增長了 35%。

To that, we had the acquisition of Connecticure with approximately 66,000 members. Effectuation rates among renewing members were in line with prior years, while the effectuation rates on our new members are stronger than in recent years. We expect smaller levels of SEP growth throughout the year compared to 2024 and forecast the year to end with approximately 580,000 members, almost 50% growth year-over-year.

為此，我們收購了擁有約 66,000 名會員的 Connecticure。續約會員的效果率與往年持平，而新會員的效果率比近年來更高。我們預計，與 2024 年相比，全年的 SEP 成長率將有所降低，並預測今年年底的會員人數將達到約 58 萬人，年成長近 50%。

Our 2025 premium revenue guidance is approximately $42 billion, representing approximately 9% growth from 2024. Our expected premium revenue growth is comprised of several items, $2.1 billion from growth in our current footprint, $1.2 billion from the acquisition of ConnectiCare, and $600 million of revenue tied to recent RFP wins.

我們預計 2025 年保費收入約為 420 億美元，較 2024 年成長約 9%。我們預期的保費收入成長由幾個項目組成，其中 21 億美元來自我們目前的業務成長，12 億美元來自收購 ConnectiCare，6 億美元的收入與最近的 RFP 勝利有關。

Partially offsetting these growth drivers are minor headwinds due to the annualized impact of last year's Medicaid redeterminations and reduction in our Medicare MAPD footprint. Our 2025 guidance assumes the extension of our Virginia Medicaid contract well into 2025, while we expect the start of Texas start CHIP contract to be delayed to 2026.

由於去年醫療補助重新確定和醫療保險 MAPD 足跡減少的年度影響，部分抵消了這些成長動力。我們的 2025 年指引假設我們的維吉尼亞州醫療補助合約將延長至 2025 年，而我們預計德州兒童健康保險計畫 (CHIP) 合約的開始時間將推遲到 2026 年。

Moving on to earnings guidance. We expect 2025 full year adjusted earnings of at least $24.50 per share. Our EPS guidance reflects approximately $1.50 for the underlying organic growth in our legacy footprint, realization of $1.50 of new store embedded earnings, and $0.90 benefit from lower average share count in 2025.

繼續討論獲利指引。我們預計 2025 年全年調整後每股盈餘至少為 24.50 美元。我們的每股盈餘預期反映了我們傳統業務的潛在有機成長約 1.50 美元、新店內含收益實現 1.50 美元以及 2025 年平均股數下降帶來的 0.90 美元收益。

These items are partially offset by approximately $1 due to higher interest expense driven by the bond offering we completed in November as well as lower net investment income. These components put our earnings outlook at $25.50 a share, an increase of 13% over 2024 full year. When we include the contract implementation costs of $1 for the recent Georgia and Medicare Dual contract wins, our adjusted EPS guidance for 2025 is at least $24.50.

由於我們 11 月完成的債券發行導致利息支出增加以及淨投資收益減少，這些項目部分抵消了約 1 美元。這些因素使我們的獲利預期達到每股 25.50 美元，比 2024 年全年增長 13%。當我們將最近贏得的喬治亞州和醫療保險雙重合約的 1 美元合約實施成本計入時，我們對 2025 年的調整後每股收益預期至少為 24.50 美元。

I will note that these implementation costs are just 1% of the more than $5 billion in revenue we expect to see from the Georgia new contract win and the duals wins in four states.

我要指出的是，這些實施成本僅占我們預計從喬治亞州的新合約勝利和四個州的雙重勝利中獲得的 50 多億美元收入的 1%。

Turning to our 2025 MCR guidance. We expect consolidated MCR of 88.7%. Medicaid MCR at 89.9%, 90 basis points above the high end of our long-term range, due to known and estimated rate increases, just keeping pace with expected trend. This is almost in line with the 2024 normalized MCR of 89.8%, which excludes the impact from new store businesses in the California retro item.

轉向我們的 2025 年 MCR 指導。我們預計合併MCR為88.7％。醫療補助 MCR 為 89.9%，比我們長期範圍的高端高出 90 個基點，這是由於已知和估計的費率增加，剛好與預期趨勢保持一致。這幾乎與 2024 年 89.8% 的標準化 MCR 一致，其中不包括加州復古商品新店業務的影響。

We expect full year rate increases of 4.5% with 75% of our full year premium already known at approximately 5% and the remaining 25% estimated at 2.5%. Our Medicaid MCR guidance includes trend assumption of approximately 4.5% and no impact from risk corridors as they remain constant over the two-year period.

我們預計全年費率將上漲 4.5%，其中 75% 的全年保費已知將上漲約 5%，剩餘 25% 預計將上漲 2.5%。我們的醫療補助 MCR 指導包括約 4.5% 的趨勢假設，並且不受風險走廊的影響，因為它們在兩年內保持不變。

Favorable second half rates versus our conservative estimates, any off-cycle rate adjustments and further moderation and trend present upside to our 2025 guidance. We expect Medicare MCR of 89%. The MCR reflects our conservative approach to 2025 bids and the expectation that utilization experienced in the second half of 2024 will continue into 2025. In Marketplace, we expect MCR of 79% squarely within our long-term target MCR range of 70% to 80%.

與我們的保守估計相比，下半年的利率表現良好，任何非週期利率調整以及進一步的緩和和趨勢都表明，我們的 2025 年指引存在上行空間。我們預計醫療保險 MCR 為 89%。MCR 反映了我們對 2025 年投標的保守態度，以及對 2024 年下半年利用率將持續到 2025 年的預期。在市場上，我們預期 MCR 為 79%，恰好位於我們長期目標 MCR 範圍 70% 至 80% 之內。

Moving on to select P&L guidance metrics. We expect adjusted G&A ratio of 7% and which reflects 20 basis points of new business implementation costs and 20 basis points due to a higher mix of Marketplace membership, partially offset by leverage and increased scale of our business.

繼續選擇損益指引指標。我們預計調整後的 G&A 比率為 7%，其中反映了 20 個基點的新業務實施成本和 20 個基點的市場會員結構提高，但部分被槓桿率和業務規模的擴大所抵消。

Normalizing for these items, our guidance G&A ratio falls to 6.6%, again, demonstrating continued operating leverage year-over-year. In other guidance metrics, we expect effective tax rate of 25.3%, adjusted pretax margin of 4.1% within our long-term range. Weighted average share count of 55.6 million shares and we expect quarterly earnings to be evenly distributed throughout the year.

將這些項目標準化後，我們的指導性 G&A 比率將下降至 6.6%，這再次表明經營槓桿率比去年同期持續上升。在其他指導指標中，我們預計有效稅率為 25.3%，調整後的稅前利潤率為 4.1%，在我們的長期範圍內。加權平均股數為 5,560 萬股，我們預計季度收益將在全年平均分配。

Turning to embedded earnings. At our recent Investor Day we had $6 of new store embedded earnings to this, we had $1.25 for the Georgia Medicaid RFP win, $1 for our additional duals contract wins in four states in the contract implementation costs of $1, leaving us with $9.25 from acquisitions and new contracts. Our 2025 guidance includes the realization of $1.50 in to yield embedded earnings of approximately $7.75 going into 2026, giving us high confidence in our 13% to 15% long-term growth rate.

轉向內含收益。在我們最近的投資者日上，我們有 6 美元的新店嵌入式收益，1.25 美元來自佐治亞州醫療補助 RFP 的勝利，1 美元來自我們在四個州的額外雙重合約勝利，合約執行成本為 1 美元，剩下的 9.25 美元來自收購和新合約。我們的 2025 年指引包括實現 1.50 美元的收入，從而在 2026 年產生約 7.75 美元的內含收益，這使我們對 13% 至 15% 的長期增長率充滿信心。

This concludes our prepared remarks. Operator, we're now ready to take questions.

我們的準備好的演講到此結束。接線員，我們現在可以回答問題了。

We will now begin the question-and-answer session. (Operator Instructions)

我們現在開始問答環節。（操作員指令）

Andrew Mok, Barclays.

巴克萊銀行的 Andrew Mok。

At the Investor Day, I think you gave us an illustration of what's needed to deliver on 89% Medicaid MLR in 2025. Can you give us a little bit more color on the components within that between rates trend and corridors that came in better or worse than expectations resulting in Medicaid MLR 90 basis points above that?

在投資者日，我認為您向我們說明了在 2025 年實現 89% 的醫療補助 MLR 需要什麼。您能否向我們詳細介紹利率趨勢和區間內的組成部分，這些組成部分比預期更好還是更差，導致醫療補助 MLR 高出 90 個基點？

Sure. Andrew, I'll frame it, and then I'll turn it to Mark. The MLR guide 2025 in Medicaid is basically flat with 2024. We have good visibility into rates. We're projecting a 4.5% rate increase and a 4.5% trend off the 2024 baseline. That rate increase, 75% of it is known at 5% and 25% of it is estimated at 2.5% lending to 4.5%.

當然。安德魯，我會把它裝裱起來，然後交給馬克。醫療補助中的 2025 年 MLR 指南基本上與 2024 年持平。我們對利率有很好的了解。我們預計利率將上漲 4.5%，且以 2024 年為基準，成長率將達到 4.5%。此次利率調高中，75%預計為 5%，25%預計為 2.5%，貸款利率上調至 4.5%。

On the trend number, we fully considered the second half pressure as we trended into 2025. All the pressures we saw in the second half of the year continuing into the fourth quarter, we included in our outlook for medical costs in 2025. That puts us only 90 basis points above the high end of our long-term range, which we feel really good that we're maybe a rate action or two, not a rate cycle, but a rate action to away from being at the top end of our long-term range of 89.

在趨勢數字上，我們充分考慮了 2025 年下半年的壓力。我們看到下半年的所有壓力都將持續到第四季度，這些壓力都納入了我們對 2025 年醫療成本的預測。這使我們僅比長期區間的高端高出 90 個基點，我們感覺非常好，我們可能只需要採取一兩次利率行動，不是一個利率週期，而是一個利率行動，就可以遠離長期區間的高端 89。

Mark, any color?

馬克，有什麼顏色嗎？

Yes, I'll just do a quick reconciliation of where we are now versus what we said at IR Day. At IR Day, we were jumping off the second half of the year, and we wound up 60 basis points higher in the second half of the year for the results of the fourth quarter. Per Joe's comment, we also thought that the combination of rates, corridors and trends would give us about 20 bps. They wound up being pretty much breakeven. So we got about zero out of that. So about 60 basis points worse on the jump-off point and pretty much didn't get the rate versus trend of benefit of 20 bps that I was looking for at the Investor Day.

是的，我將快速核對我們現在的情況與我們在 IR Day 上所說的內容。在投資人關係日，我們正邁入下半年，而下半年第四季的業績最終上漲了 60 個基點。根據喬的評論，我們還認為利率、走廊和趨勢的組合將為我們帶來約 20 個基點。他們最終基本上實現了收支平衡。因此，我們的收益幾乎為零。因此，起點大約差了 60 個基點，並且幾乎沒有獲得我在投資者日所期望的 20 個基點的利率與趨勢收益。

Got it. And then in the prepared remarks, I think you said risk corridors didn't provide a material benefit, can you help us understand how the geographic pressure played out such that there was no corridor benefit in the quarter but I think you cited about 100 basis points remaining at the third quarter call?

知道了。然後在準備好的評論中，我認為您說風險走廊沒有提供實質性利益，您能否幫助我們理解地理壓力是如何發揮作用的，以至於本季度沒有走廊利益，但我認為您在第三季度電話會議上提到了剩餘約 100 個基點？

It's a matter of geography. As we've always said, we're almost love to give a number how deep we are in the corridors because while it is a hedge, it's an imperfect hedge. If you have underperformance, it depends where that underperformance happens, whether you get the benefit of the corridor. And in the fourth quarter of this year, while we had forecasted, I believe, 50 basis points of trend pressure absorbed by corridors, it didn't pan out that way. Mark, anything to add?

這是地理問題。正如我們一直所說，我們幾乎喜歡用數字來表示我們在走廊中的深度，因為雖然它是一種對沖，但它是一種不完美的對沖。如果你的表現不佳，那就取決於表現不佳發生在哪裡，以及你是否能從走廊中獲益。而在今年第四季，雖然我們曾預測50個基點的趨勢壓力將被走廊吸收，但結果並非如此。馬克，還有什麼要補充嗎？

That's exactly right. We're in 21 states and the benefit of the corridor is not evenly distributed across 21 states. So what really matters is where does the trend pressure show up versus where is corridor protection remaining and that can either help you significantly or it can leave you no benefit, which is more or less what happened in the fourth quarter.

完全正確。我們分佈在 21 個州，但走廊的利益在 21 個州之間分佈並不均勻。因此，真正重要的是趨勢壓力出現在哪裡，以及走廊保護在哪裡，這可以為您提供極大幫助，也可以給您帶來任何好處，這或多或少就是第四季度發生的情況。

Stephen Baxter, Wells Fargo.

富國銀行的史蒂芬‧巴克斯特。

I appreciate the color on the full year Medicaid MLR and the components impacting it. I was hoping you could give us also the fourth quarter breakdown if there's any lingering impact from new store? Any impact from retros either positive or negative? And then to the extent maybe there was any negative development in the quarter to potentially spike out in Medicaid? Just trying to understand the jump-off point a little bit more clearly think about the achievability of guidance?

我很欣賞全年醫療補助 MLR 及其影響因素的細節。如果新店有任何持續影響，我希望您能給我們第四季度的詳細情況？回顧會帶來什麼正面或負面的影響嗎？那麼本季可能出現任何負面發展，導致醫療補助計劃大幅成長嗎？只是想更清楚地了解起點，思考一下指導的可實現性？

On the Medicaid MCR in the fourth quarter, it actually was merely a case not to oversimplify it, of fourth quarter dates of service trending at 1.2% versus a forecast of 50 basis points. There was no onetime items, there were no retros anticipated or received. It was from an accounting perspective, very, very clean.

關於第四季的醫療補助 MCR，實際上這只是一個不必過度簡化的案例，第四季度的服務日期趨勢為 1.2%，而預測為 50 個基點。沒有一次性物品，也沒有預期或收到的追溯物品。從會計角度來看，它非常非常乾淨。

Trend outpaced our estimate. Quarter protection provided no benefit. The typical suspects higher utilization among the [stairs] population, particularly for LTSS, pharmacy and BH. BH inpatient was all. And look on the pharmacy side, it's not only GLP-1s that are causing the pressure but other high-cost therapies. The trend pressure in the fourth quarter was the same as we experienced in the third quarter and was not muted, benefited or detrimented by any onetime items or artifacts.

趨勢超出了我們的預期。季度保護並沒有任何好處。典型的懷疑是[樓梯]人群的利用率更高，特別是對於 LTSS、藥房和 BH。全部都是BH住院。從藥局角度來看，造成壓力的不僅是 GLP-1，還有其他高成本的療法。第四季的趨勢壓力與我們在第三季經歷的相同，並且沒有因任何一次性項目或人工因素而減弱、受益或受損。

Okay. And then just as a follow-up, would you be able to share the IBNR balance at the end of the year to help us evaluate the reserve picture?

好的。然後作為後續問題，您能否分享年底的 IBNR 餘額以幫助我們評估儲備狀況？

Absolutely. On medical claims payable, you might have seen, we're at $4.6 billion. The DCP, which is an imperfect matter, but I know why you guys use it, was 48. Just to put that in context, over the last three years, DCP averaged 49%. At the low it was 47% one quarter, at the high was 51%, one quarter but averaged 49%. The biggest driver of volatility around DCP and IBNR is how fast cash goes out the door, right, because the actuaries have a very consistent process of accruing liability. Having said that, cash payments are a little bit lumpy. So we're at 48%. That's the same sequentially quarter-over-quarter, well within the middle of our range. I think that's a good proxy for the IBNR.

絕對地。關於醫療索賠應付款項，您可能已經看到，已達到 46 億美元。DCP 是不完美的事物，但我知道你們為什麼要使用它，它是 48。舉例來說，在過去三年中，DCP 平均為 49%。最低時一個季度為47%，最高時為51%，但平均一個季度為49%。DCP 和 IBNR 波動的最大驅動因素是現金的流出速度，對吧，因為精算師有一個非常一致的累積負債流程。話雖如此，現金支付還是有點不平衡。因此我們的比率是 48%。與上一季相比，這一數字相同，遠低於我們的預期範圍的中間值。我認為這是 IBNR 的一個很好的代理。

Josh Raskin, Nephron Research.

喬希‧拉斯金 (Josh Raskin)，腎元研究公司。

It seems like the Marketplace MLR was worse in the fourth quarter. I'm not hearing much commentary around that. So maybe what the specific drivers were there relative to what you guys have put up at Investor Day? And then just back on the Medicare Advantage, maybe if you could give us a little bit more of the specifics on the Medicare Advantage pressures in 4Q, especially in the acquired book from Bright and maybe what changes you made in 2025 to give you confidence in the bids?

看起來第四季的市場 MLR 情況更糟了。我沒有聽到太多關於此的評論。那麼，相對於你們在投資人日提出的內容，具體的驅動因素可能是什麼呢？然後回到醫療保險優勢計劃，您能否向我們詳細介紹一下第四季度醫療保險優勢計劃的壓力，特別是從 Bright 收購的賬簿，以及您在 2025 年做了哪些改變，讓您對投標充滿信心？

I'll turn it to Mark for the Marketplace commentary on Q4, Mark?

我將把話題轉給馬克，請他發表對第四季的市場評論，馬克？

Absolutely. Look, nothing more on the marketplace than normal seasonality. As you know, because of deductibles, co-pact things like that, Marketplace is fairly seasonable and tends to be running hotter later in the year. Look, we were at 83.3%. Maybe it's a little bit higher than we thought, too. But on a full year basis, coming in at 75%, we feel pretty good about the year just chuck it up to a little seasonal noise.

絕對地。你看，市場上除了正常的季節性之外，什麼都沒有。如您所知，由於免賠額、共同協議之類的事情，市場相當季節性，並且往往在一年晚些時候更加火爆。你看，我們已經達到 83.3%了。或許比我們想像的還要高一點。但從全年來看，達到了 75%，我們對這一年感到相當滿意，只是有一些季節性的干擾。

And the only thing I'll add to that is when you're coming in at 75% for the full year, we now have two consecutive years of being able to invest what we call excess margins, margins that came in at 10% pretax into the growth of the product. We're now one or two priced silver and 50% of our geographies as Mark said, ended the year with 400. We're going to start the year with 600, end the year with 580,000 members. It's a great story.

我唯一要補充的是，當全年利潤率達到 75% 時，我們現在有連續兩年的時間可以將所謂的超額利潤（稅前 10% 的利潤）投資於產品的成長。正如馬克所說，我們現在擁有一到兩種定價的白銀，而我們 50％ 的地區到年底的數量達到了 400 家。今年年初我們的會員人數將為 600 人，到年底我們的會員人數將達到 58 萬人。這是一個很棒的故事。

And we believe that given the dampening effect of special enrollment during the year, unlike last year, that it's a very stable book of business, and we have high confidence in the 6% pretax margin and the 79% MCR we're projecting for next year for 2025. The Medicare question, Mark?

我們認為，考慮到今年特殊登記的抑制效應，與去年不同，這是一本非常穩定的業務賬簿，我們對 2025 年預計的 6% 稅前利潤率和 79% MCR 充滿信心。有關醫療保險的問題，馬克？

Yes, absolutely. We reported a 93.8% on Medicare. Part of that is just the industry-wide trend everybody is seeing. Joe mentioned the drivers a trend in Medicare. LTSS, both skilled nursing facility and in home, a variety of pharmaceuticals and then the inpatient and outpatient both have a number of drivers in them. Again, that's not unique to Molina. I think we're seeing that just about everywhere.

是的，絕對是如此。我們報告醫療保險覆蓋率為 93.8%。其中一部分只是每個人都看到的整個行業的趨勢。喬提到了醫療保險的驅動趨勢。LTSS，包括專業護理機構和家庭護理、各種藥物以及住院和門診病人都有許多驅動因素。再說了，這並不是莫利納獨有的。我想我們幾乎隨處都能看到這種現象。

Part of the story too, which compounds the MLR is on the revenue side. we wound up adjusting some of our risk adjustment ultimately. The way risk adjustment works is, obviously, you do a lot of provider in office risk adjustment.

故事的一部分也是，使 MLR 複雜化的是收入面。我們最終調整了一些風險調整。顯然，風險調整的工作方式是，您在辦公室風險調整中做很多提供者的工作。

We also do a lot of in-home assessments, the combination of those. We adjusted our ultimate and took down some of the revenue a little bit. That's kind of a onetime item. The knock-on question, Josh, which I would expect you to ask is, how does that see you up for next year and I think, look, rates aren't great for next year.

我們也進行了很多家庭評估，將這些結合起來。我們調整了我們的終極目標並稍微降低了一些收入。這是一種一次性物品。喬希，我預期你會問的連帶問題是，這對你明年的前景有何影響？

We're pretty conservative on trend based on what we saw in Q3, Q4. So what you're seeing is not a strong move in MLR year-over-year just reflecting a lot of that, you'll see us pretty much a little bit over the top end of our range for guidance. But nonetheless, we feel we're pretty conservative on trend, just given what we saw in Q3, Q4.

根據第三季和第四季的情況，我們對趨勢持相當保守的態度。因此，您所看到的並不是 MLR 同比大幅波動，這只是反映了其中的許多因素，您會看到我們的預期值略高於我們的指導範圍的上限。但儘管如此，根據我們在第三季和第四季看到的情況，我們認為我們對趨勢的判斷還是相當保守的。

The only other comment I'd add on Medicare is the Bright business while we have full confidence in the 13 basis points turnaround to get to the full dollar of accretion. But we're not going to be quite at breakeven this year, it will be slightly lower which is putting a little bit of pressure on the margins.

我對 Medicare 唯一要補充的其他評論是 Bright 業務，同時我們對 13 個基點的扭轉以實現全部美元增值充滿信心。但今年我們不會完全達到收支平衡，收支平衡會略低一些，這會對利潤帶來一點壓力。

But at 89% MCR for next year, a 2.2% pretax margin on nearly $6 billion of revenue, tees us up nicely to take advantage of the growth aspects of the duals and the integrated products. So we're quite bullish on our prospects here in Medicare. And with the early 2026 rate notice, I think we're teed up for margin expansion in 2026 and beyond.

但明年的 MCR 為 89%，近 60 億美元的收入和 2.2% 的稅前利潤率，為我們充分利用雙重和整合產品的成長優勢做好了準備。因此，我們對醫療保險的前景非常樂觀。隨著 2026 年初利率通知的發布，我認為我們已為 2026 年及以後的利潤率擴大做好了準備。

Sarah James, Cantor Fitzgerald.

莎拉詹姆斯 (Sarah James)，費茲傑拉領唱者。

It sounds like you're assuming 4.5% cost trends in '25 down from the 6% you were experiencing in 3Q. What was 4Q cost trend and what's driving your assumption of cost trend lowering in '25?

聽起來你假設 25 年的成本趨勢為 4.5%，低於第三季經歷的 6%。第四季的成本趨勢如何？

Let me do full year-over-year, and then I'll kick it to Mark because it can get quite complicated depending on which period you're comparing. In 2024 in Medicaid, our full -- our cost trend was 6.5%, half of which was the acuity shift due to redetermination and half of which is what we call core utilization, high utilization of the continuing population.

讓我做一下全年同比統計，然後我會把它交給馬克，因為根據你比較的時期，這可能會變得相當複雜。2024 年，在醫療補助方面，我們的全部成本趨勢為 6.5%，其中一半是由於重新確定導致的敏銳度轉變，另一半是我們所說的核心利用率，即持續人口的高利用率。

Comparing that to the 4.5% trend in 2025, the acuity shift doesn't recur. So we're actually projecting a 4.5% core utilization trend in 2025 compared to a 3.5% core utilization trend in 2023, which is 125 basis points higher.

與 2025 年 4.5% 的趨勢相比，這種敏銳度轉變不會再次出現。因此，我們實際上預測 2025 年核心利用率趨勢為 4.5%，而 2023 年核心利用率趨勢為 3.5%，高出 125 個基點。

Now depending on what period you compare. But we think that is a very clean and clear way of looking at it. We considered every nuance of utilization trend in the third and fourth quarters to inform that trend, property by property, DRG by DRG, and we're very confident in that projection. Mark, anything to add?

現在取決於您要比較哪個時期。但我們認為這是一種非常乾淨、清晰的看待問題的方式。我們考慮了第三季和第四季利用率趨勢的每一個細微差別，以了解該趨勢，逐個物業，逐個 DRG，我們對該預測非常有信心。馬克，還有什麼要補充嗎？

I would just repeat that, Joe, because it's a big point. Last year with 6.5% trend, half of it was directly because of mix of redetermination. So the other half was just hot users, the stayers. So 3.25% I'll call it. This year, we're projecting 4.5% trend, which is directly comparable to that 3.25% number last year.

喬，我只想重複這一點，因為這是一個重點。去年的趨勢為 6.5%，其中一半直接是由於重新確定的混合。所以另一半只是熱門用戶，也就是留下來的用戶。因此我稱之為 3.25%。今年，我們預期趨勢為 4.5%，與去年的 3.25% 相當。

So you can see, we've got a pretty strong trend baked into our 2025 outlook. Now I think that's prudent based on where we are, but if the second half of last year was the new normal, that's assuming a pretty strong trend above what we've seen in other kind of normal quote-unquote years. So pretty strong trend at 4.5% and as we've also mentioned, offsetting that trend 4.5% in 2025 is roughly 4.5% of rates.

所以你可以看到，我們在 2025 年的展望中已經看到了相當強勁的趨勢。現在我認為根據我們目前的情況這是謹慎的，但如果去年下半年是新常態，那就意味著我們將看到相當強勁的趨勢，高於我們在其他正常年份所看到的趨勢。因此 4.5% 的趨勢相當強勁，正如我們所提到的，到 2025 年抵消這一趨勢 4.5% 的利率約為 4.5%。

Now when we think about rates, we parse known versus estimated. 75% of our rates are known for 2025 at 5%, 25% we're still estimating, but we feel conservative at those rates at 2.5%. So they weighted average to 4.5%, I know most of them, and I'm pretty conservative on what I'm estimating, but the high-level news for 2025 is 4.5% trend assumption, 4.5% rate, mostly known, some assumed.

現在，當我們考慮利率時，我們會分析已知利率與估計利率。我們已知的 75% 的利率是 2025 年的 5%，25% 的利率我們仍在估計，但我們對 2.5% 的利率持保守態度。因此，他們把加權平均值定為 4.5%，我知道其中的大部分，而且我對我的估計相當保守，但 2025 年的高層新聞是 4.5% 的趨勢假設，4.5% 的利率，大部分是已知的，有些是假設的。

That's helpful. Maybe just one more clarification. If you know 75% of the rates, and you have a pretty good view of our margin play, does that mean that you could get into your long-term goals for Medicaid margins for the whole of 2025? Or would it be more exiting 2025?

這很有幫助。也許還需進一步澄清。如果您了解 75% 的費率，並且對我們的利潤率有相當好的了解，這是否意味著您可以實現 2025 年全年醫療補助利潤的長期目標？還是2025年會更令人興奮？

We would need -- we conservatively estimated the 25% of rates we don't know at 2.5%. And the 75% we do know came in at 5%. Is it conservative? Perhaps. So there could be some upside if we get rate increases north of the 2.5% that we estimated.

我們需要——我們保守估計 25% 的我們不知道的利率為 2.5%。而我們所知的 75% 是 5% 。它是保守的嗎？也許。因此，如果利率上調至預計的 2.5% 以上，則可能存在一些上行空間。

By the way, we never forecast retros and were -- process, which is really robust, advocating for [ashroy] rates in all of our contracts could provide some retroactivity in '25 and '24, but we never forecast it. That would be additional upside if we achieve that.

順便說一句，我們從來沒有預測過追溯和—過程，這是非常強大的，主張我們所有合約中的[ashroy]利率可以在'25和'24提供一些追溯力，但我們從來沒有預測過它。如果我們實現這一目標，將會帶來額外的好處。

Justin Lake, Wolfe Research.

賈斯汀·萊克（Justin Lake），沃爾夫研究公司。

I'll ask another question on [trend] just because you guys have done such a good job of kind of laying it out for us at the Investor Day and today. The -- if I look at the Investor Day deck, you're saying in the third quarter, sequentially, you had a 2.6% increase in trends. Fourth quarter, now you're saying $1.2 million right?

我會再問一個關於[趨勢]的問題，因為你們在投資者日和今天為我們做了很好的闡述。如果我看一下投資者日演示文稿，您會說在第三季度，趨勢環比增長了 2.6%。第四季度，您現在說的是 120 萬美元對嗎？

So just annualizing that back half into the first half of next year, if I'm doing the math in my head correctly, should be like 2% trend trying to just touch up as you annualize. So I'm just trying to think, Joe, like maybe you could talk to us in a similar way that you did, as you did at the Investor Day.

因此，如果我的計算沒有錯誤的話，將下半年的成長率年化到明年上半年，應該會像 2% 的趨勢一樣，在年化時試圖進行觸及。所以我只是在想，喬，也許你可以用類似於在投資者日的方式與我們交談。

And today -- like just like what are you really expecting for quarterly trends. If you think about those little kind of green bars you put at the Investor Day deck. For trend, what would you like -- I would think they might only be 50 basis points a quarter to get to 4.5% because you still got to annualize the back half of this year. Am I thinking of that correctly?

而今天——就像您對季度趨勢真正期待什麼一樣。如果您想想在投資者日平台上放置的那些小綠色條。就趨勢而言，您希望怎樣？我這樣想對嗎？

As I said, when -- you asked your question, it gets really complicated depending on what period you want to use. Obviously, if you use just the second half, the 4.5% trend is a lower number for 2025 than it is for 2024 to oversimplify the case. I'll turn it to Mark because we do have a lot of analysis on the quarterly progression of this. Mark?

正如我所說，當你提出問題時，情況會變得非常複雜，這取決於你想使用什麼時期。顯然，如果只使用下半年，4.5% 的趨勢對於 2025 年來說要低於對於 2024 年來說，這過於簡單化了情況。我將把話題轉給馬克，因為我們確實對該季度的進展進行了大量分析。標記？

Justin, so last year, we mentioned 6.5% trend across the year, full year. But at Investor Day, to your point, we also jumped off a second half of the year for you just because we said, maybe the second half is the new normal, so let the baseline off that.

賈斯汀，去年我們提到了全年 6.5% 的趨勢。但在投資者日，正如您所說，我們也為您開啟了下半年的旅程，因為我們說過，也許下半年是新常態，所以以此為基準。

If you look at our guidance, full year-over-year, we said 4.5% of rates, 4.5% of trend. If you jump up a second half in the framework like we did at Investor Day, it would be more like 2% rates, 2% trend. And now that 2%, you can start to think more like in quarterly increments and you're probably closer to your 50 bps a quarter that you're thinking about.

如果你看我們的指引，全年年比來看，我們說的利率為 4.5%，趨勢為 4.5%。如果您像我們在投資者日所做的那樣，在框架中跳到後半部分，它將更像是 2% 的利率和 2% 的趨勢。現在，您可以開始以 2% 的幅度考慮利率的季度增量，並且很可能更接近您所考慮的每季 50 個基點的利率。

Perfect. And then just a couple of quick numbers questions here. You talked about some onetime benefit in SG&A. Can you give us some more color on that? And then Joe, you said you're not -- rates away, you said your rate actions away in one or two places. Can you tell us like -- can you give us any specificity like -- it sounds like it's a couple of states that you need some rate updates from? Are those larger states or are there smaller states where you need big rates or larger states where you're just waiting for some true-ups there?

完美的。這裡只問幾個簡單的數字問題。您談到了銷售、一般和行政費用中的一些一次性福利。您能給我們更多有關該問題的詳細資訊嗎？然後喬，你說你不是 - 利率偏離，你說你的利率行動在一個或兩個地方偏離。您能否告訴我們——您能否給我們任何具體資訊——聽起來您需要幾個州的利率更新資訊？那些是較大的州，還是有一些較小的州需要較大的利率，或者有一些較大的州只需要等待一些實際利率？

First thing I would say is that the 2.5% that we projected on rates that we don't know about is perhaps conservative. But let me frame it this way. The rate action versus cycle comment was merely to reflect we're operating, no matter which way you cut this second half, Q4, full year or 2025 guidance, we're operating 100 basis points above the high end of our long-term range, 100.

首先我想說的是，我們根據未知的利率預測的 2.5% 可能有些保守。但請讓我這樣表達。利率行動與週期的評論只是為了反映我們的營運情況，無論你如何下調下半年、第四季、全年或 2025 年的指引，我們的營運水準都比長期區間的高端高出 100 個基點。

Based on analysis that we've done, external reports, regulatory filings, we believe that many market participants are operating at two, three, maybe even 400 basis points above an acceptable MCR range. That might take a rate cycle.

根據我們所做的分析、外部報告和監管文件，我們認為許多市場參與者的營運利率都高於可接受的 MCR 範圍 200 個、300 個甚至 400 個基點。這可能需要一個利率週期。

But when you're 100 basis points above the long-term range, maybe a rate action or 2 will get either. That's the point. I don't think this has to cycle through 1 times or 2 times in order to get there. 90 basis points, again, $4 a share on $32 billion of revenue.

但當利率高於長期範圍 100 個基點時，也許就會出現一個或兩個利率行動。這就是重點。我認為不需要循環 1 次或 2 次才能達到目的。 90 個基點，同樣，每股 4 美元，營收 320 億美元。

So if we can get back to the top end of our range, when the market gets the rates it needs to get back into balance, we will comfortably be operating in the high 80s paying into the quarters like we were before all this happened, and that's exactly where we want to be, high 80s and paying into the corridors to provide that 200 basis points of projection.

因此，如果我們能夠回到區間的高端，當市場獲得恢復平衡所需的利率時，我們將可以輕鬆地在 80 年代後期運營，像在所有這一切發生之前一樣支付季度費用，而這正是我們想要的，80 年代後期並支付走廊費用以提供 200 個基點的預測。

A.J. Rice, UBS.

A.J.賴斯、瑞銀。

First, I just wanted to ask about quarterly progression across '25, if there's anything you can do to help us think about that? Obviously, you got the $1 of start-up costs, I assume that's more back-end loaded. You've got the rate updates, which you have been talking about on Medicaid and maybe you would have a positive progression there contributing to EPS.

首先，我只想問一下 25 年季度進展情況，您能做些什麼來幫助我們思考這個問題？顯然，你得到了 1 美元的啟動成本，我認為這是更多的後端負載。您已經獲得了有關醫療補助的費率更新，也許您會在那裡取得積極的進展，從而為 EPS 做出貢獻。

And then you've got more publicly staged business, which is going to exacerbate the fourth quarter it sounds like. Any way you can give us a little bit of flavor for how you think quarterly earnings layout over the course of the year?

然後你會有更多公開上演的業務，這聽起來會加劇第四季的情況。您能否向我們簡單介紹一下您認為全年季度收益佈局的情況？

Sure, I'll turn it to Mark, but you have the items appropriately captured that factor into the seasonality projection of the business. Mark, comment?

當然，我會把它交給馬克，但你已經適當地將這些因素納入了業務的季節性預測中。馬克，有意見嗎？

Yes. So normally, we're a little bit front-end loaded with EPS. And what I'm saying this year is we'll be 50-50, very evenly distributed quarter-to-quarter. So what's different? The first big driver is you've got a specific accounting of where we are on rates within the year, quarter-to-quarter.

是的。因此通常情況下，我們會在前端載入一些 EPS。我想說的是，今年我們的季度成長率將是 50%，各季度之間的分佈非常均勻。那麼有什麼不同呢？第一個重要驅動因素是，你要對我們一年內、每季的利率有一個具體的會計。

We talked about how we know 75% of them, but we also know specifically when they come in. We also have a specific view on that trend number of 4.5%, how it seasonalizes. So you've got that as one of the bigger drivers. Next, you've got just a little bit of carryover from new stores last year. It's not as big a phenomenon as it was last year. So we're not going to call significant attention to it, but you've still got a little bit of that going on.

我們討論了我們如何了解其中的 75%，但我們也具體知道他們何時進來。我們對 4.5% 的趨勢數字以及它的季節性也有具體的看法。因此，這是最大的驅動因素之一。接下來，您將從去年的新店中獲得一點點結轉。這現象並不像去年那麼嚴重。所以我們不會對此太多關注，但你仍然會遇到一些這樣的情況。

So that more or less levels quarter-to-quarter in the year. Now the other thing that's going on is G&A. I heard your statement, but believe it or not, we're front-end loaded on G&A this year with a lot of the initiatives we have. We have on to-go readies January 1, 2026. And a lot of the IT spend, a lot of the upfront investment comes in early, which front ends our G&A.

因此，今年各季度之間的數據大致相同。現在發生的另一件事是 G&A。我聽到了你的聲明，但不管你信不信，今年我們在 G&A 方面已經投入了大量資金，並進行了許多計劃。我們已經準備好 2026 年 1 月 1 日的外賣。很多 IT 支出和前期投資都是早期投入的，這是我們 G&A 的前端。

So those things are a little bit different this year. I take your point on more marketplace, which is typically a little bit back-end loaded on MLR. Yes, that's true. But you put our three businesses together, we've got a pretty even outlook on our margins, and therefore, our EPS.

所以今年的情況有些不同。我接受你關於更多市場的觀點，這通常在 MLR 上有點後端加載。是的，確實如此。但如果你把我們的三項業務放在一起，我們的利潤率前景就相當均衡，因此我們的每股盈餘也是如此。

Okay. All right. That's helpful. And then I just wanted to ask, I know you guys mentioned in the prepared remarks about keeping an eye on what's going on in Washington. Obviously, there's a lot of chatter about potential Medicaid reform. Is it a situation where at this point, you're having some discussions with the states about how they might respond to some of these scenarios and maybe relying on history, does it tend to push the states to put more of the people that they haven't put in Medicaid into managed Medicaid? Is there enough flexibility in the benefit design that if there's pressure on Medicaid funding that they tweak benefits? And how does that impact your business? Any thoughts you can give us along those lines?

好的。好的。這很有幫助。然後我只想問一下，我知道你們在準備好的發言中提到要關注華盛頓發生的事情。顯然，關於潛在的醫療補助改革的討論很多。目前的情況是，您是否正在與各州討論他們可能如何應對這些情況，並且可能根據歷史經驗，這是否會促使各州將更多尚未納入醫療補助計劃的人納入管理式醫療補助計劃？福利設計是否具有足夠的彈性，以便在醫療補助資金面臨壓力時可以調整福利？這對您的業務有何影響？您能就此告訴我們什麼想法嗎？

I can't. I can't give you any of the answers, but I can give you our thinking, and you're absolutely right about the way you're focused on it. Look, the market really focuses on the how. If you come up with a per capita cap scheme, FMAP match for reduction, FMAP match reduction on expansion, block, grants, whatever the mechanism is, the CBO can score it.

我不能。我無法給你任何答案，但我可以告訴你我們的想法，而且你對此的關注方式是完全正確的。你看，市場真正關注的是「如何」。如果你想出一個人均上限方案，FMAP 匹配減量，FMAP 匹配擴張減量，封鎖，補助，不管是什麼機制，CBO 都可以對其進行評分。

That's not the issue. The issue is what are you going to reduce in terms of where the money goes. You've got 25 million people in marketplace, 92% subsidized, 20 million people in expansion, 100% subsidized at 90% and 25 million on insured population, 9.5% of the eligibles. Tell me which number you want to see change? Neither side of the aisle wants to see more uninsured and below 10% eligible for the first time in decades.

這不是問題。問題是，在資金流向方面你要減少什麼。市場上有 2,500 萬人，其中 92% 獲得補貼；擴張期有 2,000 萬人，其中 90% 獲得 100% 補貼；受保人口 2,500 萬人，佔符合條件人口的 9.5%。告訴我你想看到哪個數字的改變？兩黨都不希望看到幾十年來首次出現更多的無保險人口和低於 10% 的符合投保資格的人口。

Reduction in benefits, reduction in enrollment, reduction in payments to providers, or none of the above, and I either have to as a state, decrease my education budget or raise taxes. None of those solutions is politically tenable. That's what they focus on.

減少福利、減少入學人數、減少對服務提供者的付款，或者以上都不做，而我作為一個州，要么減少我的教育預算，要么提高稅收。從政治角度來看，這些解決方案都是站不住腳的。這就是他們關注的重點。

The way to cut a cost is actuarially and financially determinable. Where that would go is where the political tension exists. It's either got to be membership, benefits to existing membership, reductions of payments to providers or higher taxes for the citizens in the state, neither of those approaches is politically tenable. That's why we conclude that any changes to managed Medicaid as we know at would be marginal.

削減成本的方法是精算和財​​務上可確定的。哪裡存在政治緊張局勢，哪裡就會出現這種情況。要么增加會員資格，要么為現有會員提供福利，要么減少對服務提供者的支付，要么提高該州公民的稅收，但這兩種方法在政治上都是站不住腳的。這就是為什麼我們得出結論：對我們所知的管理式醫療補助計劃的任何改變都是微不足道的。

Adam Ron, Bank of America.

美國銀行的亞當‧羅恩 (Adam Ron)。

If I could ask two cleanup questions. First, I think you mentioned in 4Q, you didn't get a lot of benefit from the risk corridors that you talked about in 2024. So if you could update your thinking around that and how -- if you have any cushion for 2025 on risk corridor still and what it would take to realize them?

如果我可以問兩個清理問題。首先，我認為您在第四季度提到，您並沒有從 2024 年談到的風險走廊中獲得太多好處。因此，如果您可以更新您的想法，以及如果您在 2025 年的風險走廊上仍有任何緩衝，以及實現這些緩衝需要什麼？

And then second, if I could just squeeze the second question now. On Medicare, I think you mentioned MLR would be flat year-over-year versus 2024, but you grew membership and Q4 was a little hot in terms of utilization. Then you have United guiding up MLR on presumably Medicare. So curious what gives you comfort there?

第二，我現在是否可以只問第二個問題？關於醫療保險，我認為您提到 MLR 與 2024 年相比將保持平穩，但會員人數有所增加，而且第四季度的利用率有點高。然後，您讓 United 引導 MLR 大概是醫療保險。那麼好奇什麼能帶給你安慰呢？

I'll touch the first question first, and I'll kick it to Mark. On these quarters, what we're saying is the amount of quarter liability we have for year is unchanged. Therefore, it's not providing a benefit or investment in the P&L. And when we're operating 100 basis points above our target range. We're not going to be deep into them, but we are into them in certain places.

我先談第一個問題，然後把它交給馬克。在這些季度中，我們說的是，我們全年的季度負債金額保持不變。因此，它不會在損益表中提供收益或投資。當我們的營運利率高於目標範圍 100 個基點時。我們不會深入研究它們，但我們會在某些地方研究它們。

Now bear in mind, during a year, if you don't have a lot of corridor protection because you're not debit, there actually is at least potential for upside. If you outperform your forecast, you'll get to keep a lot of it or some of it. And so if we're projecting if we're looking at upside during the year, and we're not deep into the corridors in any places and we're in the middle of them, then at least you get some of it to drop through to your bottom line. That's where we are in risk quarters year-over-year.

現在請記住，在一年中，如果您因為沒有借記而沒有太多的走廊保護，那麼實際上至少存在上行的潛力。如果您的表現超出預測，您將可以保留大部分或部分收益。因此，如果我們預測今年會出現上行趨勢，而我們並沒有深入任何地方的走廊，而是處於走廊的中間，那麼至少你可以將其中的一部分降到你的底線。這就是我們每年所處的風險季度的情況。

Mark, do you want to take the Medicare question?

馬克，你想回答有關醫療保險的問題嗎？

Yes, absolutely. So on Medicare, we reported an 89.1% for 2024. Let me walk you through a couple of things to help the thinking on that. The first is, recall, we exited MAPD traditional Medicare Advantage Prescription Drug in 13 states for 2025.

是的，絕對是如此。因此，就醫療保險而言，我們報告 2024 年的比例為 89.1%。讓我向您介紹一些事情來幫助思考這個問題。首先，回想一下，我們在 2025 年退出了 13 個州的 MAPD 傳統醫療保險優勢處方藥。

While the revenue impact was not meaningful, the MLR impact was. So take 40 bps off the 89.1% and normalize the jumping off point to 88.7%. Okay. To that, we've got rates like everybody not that great for 2025, call it, 2.5% for us.

儘管對收入的影響並不大，但對 MLR 的影響卻很大。因此，從 89.1% 中減去 40 個基點，並將起點標準化為 88.7%。好的。對此，我們的利率和其他人的利率一樣，到 2025 年都不太好，對我們來說，也就是 2.5%。

And I've got trend a little warmer than that. Now part of that is mitigated by our bid strategy, part of it is mitigated by our medical cost management, but 2.7-ish on trend, which nets you back to 89. So it's a lot about low rates. It's a lot about us, I think being conservative on trend and that 40 basis points benefit of jumping off helps us. But I think no matter who you talk to next year is a tough year in Medicare advantage.

而且我發現趨勢比這更溫暖一些。現在，部分因素透過我們的競標策略得到了緩解，部分因素透過我們的醫療成本管理得到了緩解，但趨勢還是在 2.7 左右，這使淨利潤回到 89。所以這跟低利率有很大關係。這與我們有很大關係，我認為對趨勢持保守態度，而 40 個基點的起跳收益對我們有幫助。但我認為無論你與誰交談，明年對於醫療保險優勢而言都是艱難的一年。

Ryan Langston, TD Cowen.

瑞安·蘭斯頓（Ryan Langston），TD Cowen。

This is Christian Borgmeyer on for Ryan. Could you remind us what your assumptions are on Marketplace membership attrition? Should APTCs not be extended? And then following that, is there any reason to expect that the marketplace members picked up through this year's open enrollment could be perhaps any more or less sensitive to change in APTC?

這是 Ryan 的 Christian Borgmeyer。您能否提醒我們一下您對市場會員流失的假設是什麼？APTC 是否不應該延長？接下來，是否有理由預期透過今年的公開招生招募的市場成員可能會對 APTC 的變化更加敏感或更不敏感？

We took all the factors into consideration in our marketplace membership projection and whether that's SEP membership during the year, the natural attrition rate, the FTR, all those assumptions factor into a 4% reduction on a fee basis, 4% reduction in membership throughout the year. Mark, anything to add there?

我們在市場會員預測中考慮了所有因素，無論是年度內的 SEP 會員人數、自然流失率還是 FTR，所有這些假設都導致費用減少 4%，全年會員人數減少 4%。馬克，還有什麼要補充嗎？

Yes. I think that's fair. When people talk about the impacts of program integrity changes, they Asian and record lock is largely behind us. FTR, everyone is debating that. But we really believe the quality of our membership because we have a lot of renewals 70% retention rate this year in spite of a huge growth rate on the top line of membership we have a 70% retention in our new renewal book. that and the enhanced integrity around agent of record, we feel very good about the integrity of our membership.

是的。我認為這是公平的。當人們談論程序完整性變化的影響時，亞洲和記錄鎖定基本上已經被拋在身後了。FTR，大家都在爭論這個。但我們確實相信我們的會員質量，因為今年我們的續約會員數量很多，保留率達到 70%，儘管會員人數的增長幅度很大，但我們新續約書中的會員保留率仍達到 70%。憑藉這一點，以及代理人誠信的提高，我們對會員的誠信感到非常滿意。

So while we see a little impact of FTR, maybe. But I don't think it's dramatic. And Joe summarized it best. You've got FTR, you've got effectuation, you've got normal attrition. And don't forget, SEP good guys keep coming. You roll all that together or we're modeling about 4% attrition a month. We feel pretty good about it.

因此，儘管我們看到了 FTR 的一點影響，但也許如此。但我不認為這有什麼戲劇性的。喬對此做出了最好的總結。你有 FTR，你有效果，你有正常損耗。並且請不要忘記，SEP 好人不斷湧現。將所有這些因素綜合起來，我們就能模擬出每月約 4% 的人員流失率。我們對此感覺很好。

Michael Hall, Baird.

麥可霍爾，貝爾德。

With your MA MLR back half pressure, wanted to ask about the risk adjustment true-up first. Like how much did that actually impact your MLR? And then just trying to understand the Monark, you provided great color on the trends on to next year.

由於您的 MA MLR 後半部分壓力，我想先詢問一下風險調整情況。這對您的 MLR 究竟有多大影響？然後只是想了解 Monark，您為明年的趨勢提供了很好的預測。

Just how much [would it cost and it did]? Since you're paring down your MAPD exposure in certain states, conversely increasing your D-SNP. It almost feels like your book now more shifted towards that elevated LTSS application utilization. So I'm just trying to gain overall better comfort in your pricing, your bids and your margins for next year?

到底有多少[會花錢嗎？由於您在某些州減少了 MAPD 曝光，因此反而增加了您的 D-SNP。幾乎感覺您的書現在更多地轉向了提升的 LTSS 應用程式使用率。所以我只是想對您明年的定價、出價和利潤率有更清晰的了解？

Absolutely. So on D-SNP, yes, we're increasing our exposure there a little bit. That's offset by the bright book and now some of the ConnectiCare book. But remember, these trends in D-SNP that we saw were up largely in Q3 and Q4, we've been conservative on our outlook for D-SNP pricing. And I think a lot of competitors in the market have because our competitive positioning among many brokers has not changed.

絕對地。因此對於 D-SNP，是的，我們正在稍微增加我們在那裡的曝光率。這與 Bright Book 以及現在的 ConnectiCare 書的部分內容相抵消。但請記住，我們看到的 D-SNP 趨勢在第三季和第四季大幅上升，我們對 D-SNP 定價的前景持保守態度。我認為市場上的許多競爭對手已經改變了主意，因為我們在眾多經紀商中的競爭定位沒有改變。

So I think a lot of people are dialing back in that way. We believe our benefit design anticipated a lot of this. Again, we've got guidance going to 89% next year. We think we picked up a lot of this trend. And more importantly, that same book of business we have yielding a little bit over 2% pretax. So we think in spite of these headwinds, these are still attractive. And maybe the bigger point, Michael, is these D-SNPs will get by, I believe, with 89% MLR, 2% pretax, are such a big segue though into 2026 when we move into the (inaudible) environment, which just becomes a growth engine for us. with significantly more revenue, significantly bigger footprint. So we like 2025 as a jumping off year into a lot of transition, which I think bodes very well for the future.

所以我認為很多人都在用這種方式迴避。我們相信，我們的福利設計已經預見了這一點。我們再次預測明年這一比例將達到 89%。我們認為我們已經在很大程度上掌握了這種趨勢。更重要的是，我們的同一業務帳簿的稅前收益率略高於 2%。因此，我們認為，儘管存在這些不利因素，但這些仍然具有吸引力。邁克爾，也許更重要的是，我相信這些 D-SNPs 將獲得 89% 的 MLR、2% 的稅前收入，這將在 2026 年帶來巨大的轉變，屆時我們將進入（聽不清楚）環境，而這將成為我們的成長引擎。收入顯著增加，足跡顯著擴大。因此，我們希望 2025 年成為許多轉變的起點，我認為這對未來來說是個好兆頭。

Got it. And just one more on exchange marketplace. It sounds like you're very confident in still achieving mid-single-digit pretax margins. 44% does feel pretty strong, and I know you're investing or reinvesting our excess margin. But was that the level of growth you had been expecting heading in.

知道了。還有一個關於交易市場的問題。聽起來你對於實現中個位數的稅前利潤率非常有信心。 44%確實感覺相當強勁，而且我知道您正在投資或再投資我們的超額保證金。但這是您所期望的成長水平嗎？

And it sounds like you're starting the year at like 612,000 tracking down to $5.80. And I think you mentioned 4% reduction monthly. But specifically related to the FTR recheck, how much of the effectuation rate have you identified and embedded in your guide specifically for like now through April or May when those recheck finish?

聽起來你今年的年初收入好像是 612,000 美元，後來降到 5.80 美元。我記得您提到每月減少 4%。但具體到 FTR 重新檢查，您在指南中確定並嵌入了多少從現在到 4 月或 5 月重新檢查完成的實際發生率？

So whenever we give you numbers, we give it net of our effectuations in other forms of attrition so that you don't have to do additional math and hedge it. We believe we've hedged it with our best judgments on all those items.

因此，每當我們為您提供數字時，我們都會將其減去其他形式的損耗，這樣您就不必進行額外的計算和對沖。我們相信，我們已經對所有這些項目做出了最佳判斷。

Now I heard you mention the 44% statistic. A lot of people are throwing that around. I believe that quarter one versus quarter one, a year ago, and that's a little bit of a dangerous growth number because what happened last year is SEP was so strong through the year that the Q1 number naturally grew dramatically across the year.

現在我聽到您提到 44% 的統計數據。很多人都在談論這個。我認為，與一年前的第一季相比，第一季的成長數字有點危險，因為去年的情況是，SEP 全年表現非常強勁，因此第一季的數位自然在全年大幅成長。

So if you really look at jumping off of Q4, because we grew during the year, with all the SEP gains from redetermination, it's a significantly lower growth number Q4 to Q1. It's still a very nice growth number, but it's not 44. It's more like half that.

因此，如果您真正看一下第四季度，由於我們在這一年中實現了成長，並且由於重新確定帶來了所有 SEP 收益，因此第四季度的成長數字明顯低於第一季度。這仍然是一個非常好的成長數字，但不是44。大概只有一半吧。

Now the good thing is, once again, that's still a lot of growth. But with 70% renewal retention, it's a lot of growth, but it's also a lot of continuity with many of the same members which, as you know, from so many perspectives, gives us more confidence in our margins.

現在好消息是，再次，這仍然有很大的增長。但是，70% 的續約保留率意味著很大的成長，同時也意味著與許多相同會員的很大連續性，正如你所知，從許多角度來看，這讓我們對利潤率更有信心。

So yes, a lot of growth. But if you look at all the growth that we put on Q2, Q3, Q4, not such a big statement and a lot of continuity coming into it with a really good renewal rate. Now we at right now, probably effectuation rates in the mid-80s. We feel really good about that. That's much higher than normal, and I think for two reasons.

是的，成長了很多。但如果你看看我們在第二季、第三季和第四季的成長，你會發現這並不是什麼了不起的成績，而且我們保持了很強的連續性，續約率也非常好。現在，我們的實現率可能在 80 年代中期。我們對此感到非常高興。這比正常水平高得多，我認為有兩個原因。

One, we've got much more renewal retention, which means that [affectation] is going to be higher. But the other thing is, I believe the agent of record lock really created a lot more quality of new membership or (inaudible) membership, so that members knew they were being signed up were very active in the process, you're less likely to have lapses, nonpayment’s, things like that. So I think boding well for this year, both on great effectuation rates, but also great renewal retention rates.

首先，我們的續約保留率更高，這意味著[影響]將會更高。但另一件事是，我相信記錄鎖定代理確實創造了更多高品質的新會員或（聽不清楚）會員，以便會員知道他們正在簽約，並且在整個過程中非常活躍，您不太可能出現失誤、不付款等情況。所以我認為今年是個好兆頭，不僅實施率很高，續約保留率也很高。

Scott Fidel, Stephens.

史考特菲德爾、史蒂芬斯。

I want to just actually just follow back up on the last question. Just still on the exchange margin expectations that -- and I'm not sure if I'm missing something, but maybe you can help us with the bridge because you guys talked about around 70% of the enrollment being from retention and where we saw your rates in terms of your same-store rates, I think they were sort of flat to down in terms of yield for '24 to '25.

我實際上只是想繼續回答最後一個問題。仍然在匯率保證金預期上 - 我不確定我是否遺漏了什麼，但也許你可以幫助我們建立橋樑，因為你們談到了大約 70% 的入學率來自保留，而我們看到你的同店利率，我認為從 24 年到 25 年的收益率來看，它們是持平或下降的。

So just trying to get to sort of the comfort with the 6% margin around sort of the -- I guess, the view on trend that you may have on those retained members or anything else around the product design that would sort of bridge given pretty minimal yield year-over-year on those numbers?

所以只是想讓大家對 6% 左右的利潤率感到滿意——我想，您對這些保留會員的趨勢看法，或者對產品設計的其他看法，這些看法能否彌補這些數字同比相當低的收益？

Well, I'll take it to Mark in a minute, but consciously when you're producing 10% to 11% pretax margins two years in a row, one, you got to remain competitive and, two, if you keep it there, you're going to run into the three year minimum MLR.

好吧，我馬上就把這個問題交給馬克，但當你連續兩年達到 10% 到 11% 的稅前利潤率時，第一，你必須保持競爭力；第二，如果你保持這種狀態，你就會達到三年最低 MLR。

So it makes perfect sense to invest the excess margin and growth. It's a calibration. You try to set your product to be competitive and competitively positioned. As I said, we are number one or two silver priced in 50% of our geographies. We netted 180,000 members in open enrollment. We had, I think, 250,000 ads and 130 terms, which gave us a nice jumping off point.

因此，投資超額利潤和成長是完全合理的。這是一種校準。您嘗試使您的產品具有競爭力並佔據競爭優勢。正如我所說的，在 50% 的地區，我們的白銀價格排名第一或第二。我們透過公開招生吸引了 18 萬名會員。我認為，我們有 25 萬則廣告和 130 條條款，這為我們提供了一個很好的起點。

So we have high confidence in the mid-single-digit margin. The membership, as Mark said, being more stable, higher percentage of it being renewal means that you know the member. You know their clinical history, which gives you higher confidence in obtaining an appropriate risk store.

因此，我們對中等個位數的利潤率充滿信心。正如馬克所說，會員資格越穩定，續約率越高，代表你了解會員。您了解他們的臨床病史，這使您更有信心獲得適當的風險儲備。

So the fact that we have more stability in the book, less special enrollment during the year and consciously invested a double-digit margin into growth makes all the sense in the world, and we believe the strategy is going to work for 2025.

因此，我們的帳面更加穩定，年度內特殊招生減少，並有意識地將兩位數的利潤率投入到增長中，這些事實在世界上都是非常合理的，我們相信這一戰略將在 2025 年發揮作用。

Mark, is there anything to add?

馬克，還有什麼要補充的嗎？

Yes. Scott. So we're coming off of 75% in 2024 MLR. I've got us targeting at 79% for 2025, which means, by definition, we're putting less rate into the market than trend. And that's exactly what's happening. I've got trend a couple of hundred basis points above rate, quite purposeful because, as Joe mentioned, there's a minimum MLR out there. And I'd rather invest back into pricing and drive growth than do rebates. So we're seeing nice growth. We're seeing really good price positioning, and it's quite purposeful putting less rate into the market than we anticipate trend.

是的。斯科特。因此，我們在 2024 年的 MLR 將達到 75%。我的目標是到 2025 年達到 79%，從定義上講，這意味著我們向市場投放的利率低於趨勢利率。而這正是正在發生的事。我得到的趨勢是高於利率幾百個基點，這是有目的的，因為正如喬所提到的，那裡有一個最低 MLR。我寧願將資金重新投入定價和推動成長上，而不是回扣。因此我們看到了良好的成長。我們看到了非常好的價格定位，而且有目的地向市場注入比我們預期趨勢更低的利率是相當合理的。

Okay. And then just on the follow-up. I was hoping to get just two numbers on your -- '25. I don't think we saw investment income in the guide, unless I'm mistaken. So I would love to give us the investment income expectation and then also how you're thinking about operating cash flow up for '25 as well?

好的。然後就是後續行動。我希望得到你的兩個數字——'25。我認為我們沒有在指南中看到投資收益，除非我弄錯了。因此，我很想告訴我們投資收益預期，以及您如何看待 25 年的營運現金流？

Absolutely. So call it about $400 million would be my implied investment income number within guidance. which is a little bit lower than we saw in 2024. But I'm sure you'll understand the drivers of that, given the Fed's actions and this interest rate environment. So a little bit conservative there on investment income. And on operating cash flow, yes, I get this question a lot. On a full year 2024 basis, operating cash flow is down versus 2023. That is true.

絕對地。因此，我預計 4 億美元左右的投資收益將處於指導範圍內。這比 2024 年的水準略低。但考慮到聯準會的行動和利率環境，我相信你會理解其中的驅動因素。因此，在投資收益方面有點保守。關於經營現金流，是的，我常被問到這個問題。從 2024 年全年來看，經營現金流較 2023 年下降。確實如此。

But if you think about it, the vast majority of the explanation is simply the corridors. In 2023, I accrued significant corridors and didn't pay much down in cash. In 2024, we accrued significantly lower corridors. You're all familiar with that story, yet paid down significant prior year corridors with cash. Therefore, that explains the vast majority of my operating cash flow.

但如果你仔細想想，絕大多數的解釋都只是走廊而已。2023 年，我累積了大量貸款，而且並沒有支付太多現金。2024 年，我們累積的走廊明顯較低。你們都熟悉這個故事，卻用現金償還了前幾年的重要債務。因此，這解釋了我絕大部分的經營現金流。

Now for us, a growing company, operating cash flow should always be higher than net income. And what you saw in 2023, it was -- the ratio was 1.4. Last year, operating cash flows below for the reasons I mentioned. And I think you'll see a swing in that back in 2025.

現在對於我們這樣一家成長中的公司來說，經營現金流應該始終高於淨收入。而在 2023 年，這一比例為 1.4。由於我之前提到的原因，去年的營業現金流如下。我認為到 2025 年你會看到這種情況的轉變。

What's more important, though, is cash flow at the parent and we have a really good history of moving cash from the subsidiaries up to the parent, which is where you can really use it. To be clear, operating cash flow isn't usable when it's in the subs. Our track record of dividend to the parent is very efficient. So I feel very good about the cash flow to the parent that I give you and our ability to deploy capital.

但更重要的是母公司的現金流，我們在將現金從子公司轉移到母公司方面有著良好的記錄，這才是真正可以用到現金的地方。需要明確的是，當經營現金流處於訂閱狀態時，它是不可用的。我們派發紅利的記錄給母公司非常有效率。因此，我對母公司給予您的現金流以及我們部署資本的能力感到非常滿意。

And this concludes the question-and-answer session as well as today's event. Thank you for dialing in to today's presentation. You may now disconnect your lines.

問答環節和今天的活動到此結束。感謝您收聽今天的演講。現在您可以斷開線路了。