Molina Healthcare Inc (MOH) 2025 Q3 法說會逐字稿

Good morning, and welcome to Molina Healthcare's third quarter 2025 earnings call. (Operator Instructions) Please note this event is being recorded. I would now like to turn the conference over to Jeffrey Geyer, Vice President, Investor Relations at Molina Healthcare. Please go ahead.

早安，歡迎參加 Molina Healthcare 2025 年第三季財報電話會議。（操作員指示）請注意，此事件正在被記錄。現在，我想將會議交給 Molina Healthcare 投資者關係副總裁 Jeffrey Geyer。請繼續。

Good morning, and welcome to Molina Healthcare's third quarter 2025 earnings call. Joining me today are Molina's President and CEO, Joe Zubretsky; and our CFO, Mark Keim. A press release announcing our third quarter 2025 earnings was distributed after the market closed yesterday and is available on our investor relations website. 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 these remarks are made as of today, Thursday, October 23, 2025, and have not been updated subsequent to the initial earnings call.

早安，歡迎參加 Molina Healthcare 2025 年第三季財報電話會議。今天與我一起出席的還有 Molina 總裁兼執行長 Joe Zubretsky 和我們的財務長 Mark Keim。我們在昨日股市收盤後發布了一份新聞稿，宣布了 2025 年第三季的收益，可在我們的投資者關係網站上查閱。本次通話結束後不久，重播將保留 30 天。重播所需的數字可以在收益報告中找到。對於那些收聽本次演講重播的人，我們提醒您，所有這些言論都是截至今天（2025 年 10 月 23 日星期四）做出的，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 third quarter 2025 earnings release. During the call, we will be making certain forward-looking statements, including, but not limited to, statements regarding our 2025 guidance, our preliminary 2026 outlook, the medical cost trend and our projected MCRs, Medicaid rate adjustments and updates, our 2026 marketplace pricing and rate filings, our RFP awards, including our contract wins in Georgia and Texas as well as our M&A pipeline and activity, revenue growth related to RP wins, and M&A activity, the recently enacted big Beautiful Bill and expected Medicaid, Medicare, and Marketplace program changes, our expected future growth in both our existing footprint and in the new products and markets and the estimated amount of our embedded earnings power.

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 2025 年第三季的收益報告中找到。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 年的指導、我們對 2026 年的初步展望、醫療成本趨勢和我們預計的 MCR、醫療補助費率調整和更新、我們 2026 年的市場定價和費率備案、我們的 RFP 獎項（包括我們在德克薩斯州和德克薩斯州的活動勝利相關的收入成長以及併購活動、最近頒布的《美麗法案》和預期的醫療補助、醫療保險和市場計劃變化、我們現有業務以及新產品和市場的未來成長預期以及我們內含盈利能力的估計數額。

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到某種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?

現在我將把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, we will provide you with updates on our reported financial results for the third quarter, an update on our full year 2025 guidance, our outlook for 2026, and our growth initiatives. Let me start with our third-quarter performance. Last night, we reported adjusted earnings per share of $1.84 on $10.8 billion of premium revenue, below our expectations. Our 92.6% consolidated MCR reflects the continuation of a very challenging medical cost environment in the third quarter.

謝謝你，傑夫，早安。今天，我們將向您提供我們第三季報告的財務業績更新、2025 年全年指引更新、2026 年展望以及我們的成長計畫。讓我先介紹一下我們第三季的業績。昨晚，我們報告稱，調整後的每股收益為 1.84 美元，保費收入為 108 億美元，低於我們的預期。我們 92.6% 的合併 MCR 反映了第三季醫療成本環境的持續嚴峻性。

We produced an adjusted pretax margin of 1%. The headline for the quarter is that approximately half of our underperformance is driven by the Marketplace business and that Medicaid while experiencing some pressure, it's still producing strong margins. Year-to-date, our consolidated MCR is 90.8%, and our adjusted pretax margin is 2.7%.

我們的調整後稅前利潤率為 1%。本季的頭條新聞是，我們大約一半的業績不佳是由市場業務造成的，而醫療補助雖然面臨一些壓力，但仍產生了強勁的利潤率。年初至今，我們的合併 MCR 為 90.8%，調整後的稅前利潤率為 2.7%。

Some color on the quarter. In Medicaid, our flagship business, representing 75% of our total premium revenue, we reported an MCR of 92% and an adjusted pretax margin of 2.6%. Medical cost trend was higher than expected and driven by utilization of behavioral health, pharmacy, LTSS, and inpatient care, largely consistent with what we observed throughout the year. A few positive rate updates were not enough to offset the elevated trend, and our risk corridor protection is now very limited.

四分之一處有一些顏色。在我們的旗艦業務醫療補助 (Medicaid) 中，占我們總保費收入的 75%，我們報告的 MCR 為 92%，調整後的稅前利潤率為 2.6%。醫療成本趨勢高於預期，受行為健康、藥房、LTSS 和住院護理的利用推動，與我們全年觀察到的情況基本一致。一些積極的利率更新不足以抵消上升趨勢，我們的風險走廊保護現在非常有限。

While our Medicaid performance did not meet our expectations for the quarter, many would characterize these results as best-in-class in this environment. In Medicare, we reported a third-quarter MCR of 93.6%. We continue to experience higher utilization in this high-acuity population, particularly related to LTSS and high-cost drugs. In Marketplace, the third-quarter MCR at 95.6% was significantly higher than expected. We continue to experience much higher utilization relative to risk adjustment revenue. Our third quarter adjusted G&A ratio of 6.3% was very strong, reflecting our continued operating discipline.

雖然我們的醫療補助表現沒有達到本季的預期，但許多人認為這些結果在這種環境下是同類最佳的。在醫療保險方面，我們報告第三季的 MCR 為 93.6%。我們繼續看到這群高敏感度族群的使用率更高，特別是與 LTSS 和高成本藥物相關的使用率。在 Marketplace 中，第三季的 MCR 為 95.6%，明顯高於預期。相對於風險調整收入，我們的利用率持續大幅提高。我們第三季調整後的 G&A 比率為 6.3%，非常強勁，反映了我們持續的經營紀律。

Turning now to our 2025 guidance. Our full-year premium revenue increases to approximately $42.5 billion. Our full year 2025 adjusted earnings per share guidance is now expected to be approximately $14 per share, which is $5 below our prior guidance of $19 per share. This revised guidance reflects a consolidated MCR of 91.3% and a pretax margin of 2.1%. As we recount our original EPS guidance of $24.50 and a $10.50 revision to $14, we note that half of this revision emerges from the unprecedented utilization trend in Marketplace, which represents nearly 10% of our business. Only one-third emerges from the rate and trend imbalance in Medicaid, which is 75% of our business and the remainder for Medicare.

現在談談我們的 2025 年指導。我們的全年保費收入增加至約 425 億美元。我們對 2025 年全年調整後每股收益的預期目前約為每股 14 美元，比我們之前預期的每股 19 美元低 5 美元。此修訂後的指引反映了 91.3% 的合併 MCR 和 2.1% 的稅前利潤率。當我們重新計算最初的每股收益指導價 24.50 美元和 10.50 美元的修訂價至 14 美元時，我們注意到，此次修訂的一半源於 Marketplace 前所未有的利用趨勢，這占我們業務的近 10%。只有三分之一來自醫療補助的費率和趨勢不平衡，這占我們業務的 75%，其餘部分來自醫療保險。

Now some color on the segments related to our revised guidance. In Medicaid, our guidance assumes a full-year MCR of 91.5%, which produces a pretax margin of 3.2%. This Medicaid MCR result is above the high end of our long-term target range, but we evaluate it in the context of this challenging trend environment. Average rates achieved are now expected to be 5.5%, but medical cost trend for the year is now expected to be 7%, which is 100 basis points higher than previous guidance. Our early 2025 rate increases were sufficient at the beginning of the year. But as medical cost trend increase beyond those rates, our MCR increased each quarter. The rate updates we received later in the year and risk corridors did not provide an adequate buffer.

現在對與我們修訂的指南相關的部分進行一些說明。在醫療補助計劃中，我們的指導假設全年 MCR 為 91.5%，產生的稅前利潤率為 3.2%。醫療補助 MCR 的結果高於我們長期目標範圍的高端，但我們是在這種充滿挑戰的趨勢環境下對其進行評估的。目前預計平均利率為 5.5%，但預計全年醫療成本趨勢為 7%，比先前的預期高出 100 個基點。我們在 2025 年初的利率上調在年初已經足夠了。但隨著醫療成本趨勢超過這些比率，我們的 MCR 每季都在增加。我們在今年稍後收到的利率更新和風險走廊沒有提供足夠的緩衝。

In Medicare, our full-year guidance includes an MCR of 91.3% and pretax margin is at break-even. We continue to effectively manage elevated utilization through our cost control protocols. In Marketplace, the full-year guidance NCR of 89.7% produces a negative pretax margin. We expect higher utilization to persist as in past quarters with little to no risk adjustment revenue offset.

在醫療保險方面，我們的全年指導包括 91.3% 的 MCR 和稅前利潤率達到盈虧平衡。我們繼續透過成本控制協議有效地管理提高的利用率。在市場上，全年指導 NCR 為 89.7%，產生負的稅前利潤率。我們預計較高的利用率將像過去幾季一樣持續下去，而風險調整收入抵銷很少甚至沒有。

Our Marketplace business has significantly underperformed our expectations, but its performance appears consistent with industry-wide trends. As noted a moment ago, approximately half the earnings per share reduction from initial guidance and prior guidance is attributable to this business, which represents just 10% of our consolidated revenue. Marketplace was initially projected to produce over $3 of earnings per share, but is now expected to produce a loss of $2 per share, a swing of over $5 of the $10.50 reduction from our initial 2025 guidance.

我們的市場業務表現大大低於我們的預期，但其表現似乎與整個行業的趨勢一致。正如剛才所指出的，每股盈餘較初始指引和先前指引的減少約有一半歸因於這項業務，該業務僅占我們合併收入的 10%。市場最初預計每股收益超過 3 美元，但現在預計每股虧損 2 美元，與我們最初預測的 2025 年每股虧損 10.50 美元相比，虧損幅度超過 5 美元。

Our updated full-year guidance at $14 per share, implies earnings per share of approximately $0.35 in the fourth quarter. Within this fourth quarter EPS guidance, Medicaid is projected to earn $3 per share with a 92.5% MCR and a pretax margin of approximately 2.5%. Medicare and Marketplace are expected to offset the Medicaid performance with a combined $2.65 loss per share. The fourth quarter and second half projected Medicaid performance provides a strong jump-off point for our 2026 outlook.

我們更新的全年預期為每股 14 美元，這意味著第四季度每股收益約為 0.35 美元。在第四季每股盈餘預測中，醫療補助預計每股收益 3 美元，MCR 為 92.5%，稅前利潤率約為 2.5%。預計醫療保險和市場將以每股 2.65 美元的合計虧損抵消醫療補助的表現。第四季和下半年預計的醫療補助表現為我們 2026 年的展望提供了一個強有力的起點。

Now some commentary on our outlook for 2026. While it is far too early to provide formal guidance, we believe a discussion of the 2026 building blocks for both revenue and earnings per share will be helpful. I will lay out the components and Mark will provide further details. Our 2026 premium revenue outlook anticipates growth in our current footprint, consistent with historical levels, significant new Medicaid contracts in Georgia and Texas, and Medicare duals growth in five states through our recent RFP wins and MMP conversions. These items alone would put us on track to meet our target of $46 billion of revenue in 2026. However, our 2026 pricing strategy for Marketplace with the intention and expectation of reducing our exposure will likely be a revenue headwind, although earnings accretive.

現在就我們對 2026 年的展望發表一些評論。雖然現在提供正式指導還為時過早，但我們相信討論 2026 年收入和每股收益的基石將會有所幫助。我將佈置各個組件，馬克將提供進一步的細節。我們對 2026 年保費收入的展望預計，我們目前的業務範圍將保持增長，與歷史水平保持一致，在佐治亞州和德克薩斯州簽訂大量新的醫療補助合同，並通過我們最近的 RFP 勝利和 MMP 轉換在五個州實現醫療保險雙重增長。光是這些項目，我們就有望實現 2026 年 460 億美元收入的目標。然而，我們針對市場制定的 2026 年定價策略旨在減少我們的曝光度，儘管收益會增加，但這可能會對收入造成不利影響。

With respect to our outlook for 2026 earnings per share, there are several items to consider, particularly related to the Medicaid earnings baseline. First, our Medicaid performance in the second half of 2025 is expected to produce a 92.3% MCR and a 2.5% pretax margin. This equates to $6.50 per share in the second half, the annualization of which is an appropriate jumping-off point for 2026.

關於我們對 2026 年每股盈餘的展望，有幾個因素需要考慮，特別是與醫療補助收益基準相關的因素。首先，預計 2025 年下半年我們的醫療補助表現將產生 92.3% 的 MCR 和 2.5% 的稅前利潤率。這相當於下半年每股 6.50 美元，其年化是 2026 年合適的起點。

Second, we note that there is normal rate-related seasonality pressure in Medicaid in the second half of the year. Third, with some early views of our January rate cycle, which comprises 60% of our full-year revenue, we project rates will be modestly in excess of trend. And Medicare and Marketplace are projected to at least break-even, although we are driving to achieve our target margins. This early view of the 2026 earnings per share baseline should provide for an outlook for 2026, which likely approximates this year's updated full-year guidance. However, we further note the following areas of potential upside to this baseline view.

其次，我們注意到下半年醫療補助計劃存在與費率相關的正常季節性壓力。第三，根據我們對 1 月份利率週期的一些早期看法（該週期占我們全年收入的 60%），我們預計利率將略高於趨勢水準。儘管我們正在努力實現目標利潤率，但預計醫療保險和市場至少可以實現收支平衡。對 2026 年每股盈餘基準的早期預測應該可以為 2026 年的前景提供參考，該前景可能與今年更新的全年指引相近。然而，我們進一步注意到這一基線觀點在以下方面具有潛在的優勢。

Medicaid rates, as every 100 basis points of improvement, produces an additional $4.50 per share, performing better than break-even in Medicare and Marketplace as we continue to target low to mid-single-digit pretax margins and harvesting a portion of our $8.65 of embedded earnings. That at a high level is our outlook for 2026. Mark will take you through more detail on this in a moment.

醫療補助率每提高 100 個基點，每股收益就會增加 4.50 美元，表現優於醫療保險和市場盈虧平衡，因為我們繼續以低到中等個位數的稅前利潤率為目標，並收穫了 8.65 美元嵌入式收益的一部分。這是我們對 2026 年的整體展望。馬克稍後會向您詳細介紹這一點。

Finally, turning to our growth initiatives. Despite the short-term margin challenges, we continue to fuel our growth engines and see a clear path to surpass the $50 billion premium revenue mark in the next few years. During the third quarter, we continued our successful track record of winning RFPs with the renewal of our Wisconsin My Choice contract in Regions 2 and 7. We are engaged in active RFPs in several states and have an active pipeline of $54 billion of new opportunities over the next few years.

最後，談談我們的成長計劃。儘管面臨短期利潤率挑戰，我們仍將繼續推動成長引擎，並看到了在未來幾年內突破 500 億美元保費收入大關的明確道路。在第三季度，我們繼續保持成功贏得 RFP 的記錄，並續簽了第 2 區和第 7 區的威斯康辛州 My Choice 合約。我們正在多個州積極參與 RFP，並在未來幾年內擁有價值 540 億美元的新商機。

On the M&A side, our acquisition pipeline contains a growing number of actionable opportunities. This current challenging operating environment has been a catalyst for many smaller and less diverse health plans to consider their strategic options. We remain opportunistic in deploying capital to accretive acquisitions. In this temporary period of rate and trend in balance, we are going to work to acquire as much Medicaid revenue as possible and as we have done in the past, work it up to target margins.

在併購方面，我們的收購管道包含越來越多的可操作機會。當前充滿挑戰的營運環境促使許多規模較小、多樣性較差的健康計畫考慮其策略選擇。我們仍會抓住機會，將資本投入增值性收購。在這個利率和趨勢暫時平衡的時期，我們將努力獲取盡可能多的醫療補助收入，並像我們過去所做的那樣，努力實現目標利潤率。

At our last Investor Day, we characterized this environment as inclement weather rather than climate change, metaphorically, meaning temporary rather than permanent. We continue to believe this to be true. Medicaid is expected to produce a 3.2% pretax margin and contribute approximately $16 per share this year. Rates will come back into balance with medical cost trend and the business will recalibrate to target margins.

在我們上次的投資者日上，我們將這種環境描述為惡劣天氣而不是氣候變化，比喻為暫時的而不是永久的。我們仍然相信這是事實。預計醫療補助今年將產生 3.2% 的稅前利潤，每股貢獻約 16 美元。費率將與醫療成本趨勢恢復平衡，業務將重新調整至目標利潤率。

Medicare is experiencing a rejuvenation aimed at serving the very attractive dual-eligible segment, which we believe is poised for significant profitable growth. And Marketplace is undergoing a rationalization, addition by subtraction as we reduce our exposure, while the risk pool stabilizes. In short, these businesses are well positioned for the long term and sustainable profitable growth.

醫療保險正在經歷一場復興，旨在服務於極具吸引力的雙重合格人群，我們相信該人群將實現顯著的盈利增長。隨著我們減少風險敞口，市場正在經歷合理化，透過減法進行增加，同時風險池趨於穩定。簡而言之，這些企業已做好實現長期可持續獲利成長的準備。

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，讓他對財務狀況做進一步的說明。標記？

Thanks, Joe, and good morning, everyone. Today, I'll discuss some additional details on our third-quarter performance, the balance sheet, our 2025 guidance and the building blocks of our 2026 outlook. Beginning with our third-quarter results. For the quarter, we reported approximately $11 billion in total revenue and $10.8 billion of premium revenue with adjusted EPS of $1.84.

謝謝，喬，大家早安。今天，我將討論有關我們第三季業績、資產負債表、2025 年指引以及 2026 年展望的基石的一些更多細節。從我們的第三季業績開始。本季度，我們的總營收約為 110 億美元，保費收入為 108 億美元，調整後每股收益為 1.84 美元。

Our third-quarter consolidated MCR was 92.6%, reflecting a continued challenging medical trend environment for each of our segments, but was moderated by our consistently effective medical cost management. Half the miss versus our expectations this quarter was due to the significant underperformance in Marketplace. In Medicaid, our third-quarter MCR was 92%, higher than our expectations.

我們第三季的合併 MCR 為 92.6%，反映出我們各部門持續面臨充滿挑戰的醫療趨勢環境，但我們一貫有效的醫療成本管理緩和了這一情況。本季業績未達預期的一半原因是市場表現明顯不佳。在醫療補助方面，我們第三季的 MCR 為 92%，高於我們的預期。

We continue to experience medical cost pressure across many cost categories, particularly for behavioral, pharmacy, and LTSS. The combination of these trends exceeded rate updates received throughout the year. In Medicare, our third-quarter MCR was 93.6%, also higher than our expectations. We experienced higher utilization among our high-acuity duals populations, particularly for LTSS and high-cost pharmacy drugs.

我們繼續面臨許多成本類別的醫療成本壓力，特別是行為、藥局和 LTSS。這些趨勢的綜合變化超過了全年收到的利率更新。在醫療保險方面，我們第三季的 MCR 為 93.6%，也高於我們的預期。我們的高敏銳度雙重人群的利用率更高，特別是對於 LTSS 和高成本藥房藥物。

In Marketplace, our third-quarter reported MCR was 95.6%. Utilization in our membership was significantly elevated compared to our prior guidance. In past years, higher trends have often been offset by risk adjustment benefits. However, since Marketplace risk adjustment is relative to the market, not absolute like Medicare, the higher trend this year across the entire national population mitigates the risk adjustment offset we would have expected to realize.

在 Marketplace 中，我們第三季報告的 MCR 為 95.6%。與我們先前的指導相比，我們的會員利用率顯著提高。過去幾年，較高的趨勢常常被風險調整效益所抵銷。然而，由於市場風險調整是相對於市場的，而不是像醫療保險那樣絕對的，今年全國人口的上升趨勢減輕了我們預期實現的風險調整抵消。

Our adjusted G&A ratio for the quarter was 6.3, reflecting our normal operating discipline. I will note that our effective tax rate in the third quarter dropped significantly, reflecting benefits related to acquired federal tax credits and the impact of lower nondeductible expenses.

本季調整後的 G&A 比率為 6.3，反映了我們正常的營運紀律。我要指出的是，我們第三季的有效稅率大幅下降，反映了與獲得聯邦稅收抵免相關的收益以及較低的不可扣除費用的影響。

Turning to the balance sheet. Our capital foundation remains strong. While margins are lower than our targets, I point out that positive earnings continued to add to our capital base and drive cash flow via dividends to the parent. In the quarter, we harvested approximately $278 million of subsidiary dividends and our parent company cash balance was approximately $108 million at the end of the quarter.

轉向資產負債表。我們的資本基礎依然強勁。儘管利潤率低於我們的目標，但我要指出，正收益繼續增加我們的資本基礎，並透過股息推動母公司的現金流。本季度，我們獲得了約 2.78 億美元的子公司股息，季度末母公司現金餘額約為 1.08 億美元。

RBC ratios, which test the level of capital at the subsidiary level compared to regulatory requirements, are 340% in aggregate and unchanged since the end of 2024. Total subsidiary capital is 70% above state minimums. Our operating cash flow for the first nine months of 2025 was an outflow of $237 million due to the settlement of Medicaid risk corridors and Marketplace risk transfer payments as well as the timing of tax payments and government receivables that offset the normal positive items.

RBC 比率用於測試子公司層級的資本水準是否符合監管要求，該比率總計為 340%，自 2024 年底以來一直沒有變化。子公司總資本比國家最低資本標準高出 70%。由於醫療補助風險走廊和市場風險轉移支付的結算以及抵消正常正項目的稅收和政府應收款的時間，我們 2025 年前九個月的經營現金流出 2.37 億美元。

In the quarter, we have repurchased approximately 2.8 million shares at a cost of $500 million. We see real value in our shares at current market prices, which we believe at this low point in the rate cycle underappreciate the longer-term margin targets of our business. Debt balances at the end of the quarter increased temporarily to fund the share repurchase. Current ratios are 2.5 times trailing 12-month EBITDA and our debt-to-cap ratio is about [48]. We continue to have ample cash and access to capital to fuel our growth initiatives and execute on our capital allocation priorities.

本季度，我們回購了約 280 萬股，耗資 5 億美元。我們認為，以當前市場價格計算，我們的股票具有真正的價值，但我們認為，在利率週期的低點，我們低估了我們業務的長期利潤目標。本季末的債務餘額暫時增加，以資助股票回購。流動比率為過去 12 個月 EBITDA 的 2.5 倍，我們的負債資本比率約為[48]我們繼續擁有充足的現金和資本來推動我們的成長計劃並執行我們的資本配置優先事項。

Turning to reserves. Days in claims payable at the end of the quarter was 46. We remain confident in the strength and consistency of our actuarial process and our reserve position even in this period of sustaining high trend. Next, a few comments on our 2025 guidance. Our full-year premium revenue guidance is slightly higher at $42.5 billion. Our adjusted earnings are now expected to be approximately $14 per share. Within our guidance, the full-year consolidated MCR increases to 91.3%, up 110 basis points from our prior guidance.

轉向儲備。本季末應付理賠天數為 46 天。即使在持續高趨勢的時期，我們仍然對我們的精算流程和儲備狀況的強度和一致性充滿信心。接下來，就我們的 2025 年指導提出幾點評論。我們的全年保費收入預期略高，為 425 億美元。我們目前的調整後收益預計約為每股 14 美元。在我們的指導範圍內，全年合併 MCR 增加至 91.3%，比我們之前的指導高出 110 個基點。

Updated EPS guidance is $5 below our prior guidance of $19 per share, reflecting our higher full-year MCR outlook. The medical margin decline of $6.25 in our guidance is partially offset by $1.25 of favorable G&A and the modest impact of lower average share count. I will note that Marketplace, which comprises just 10% of our total revenue, contributes half of that medical margin-driven EPS shortfall.

更新後的每股盈餘指引比我們先前每股 19 美元的指引低 5 美元，反映了我們對全年 MCR 的更高預期。我們預期的醫療利潤率下降 6.25 美元，但被 1.25 美元的有利 G&A 和較低的平均股數的適度影響部分抵消。我要指出的是，Marketplace 僅占我們總收入的 10%，但卻貢獻了醫療利潤驅動的 EPS 缺口的一半。

In Medicaid, we expect fourth-quarter MCR of 92.5% and full year now at 91.5%. This full-year outlook is up 60 basis points from our prior guidance, reflecting the third-quarter experience and our expectations for higher trend in the fourth quarter. Within those numbers, our full-year Medicaid trend rises from 6% to 7%. Updates in several states increased our full-year rate outlook from 5% to 5.5%. We continue to see a willingness from states to discuss off-cycle and retro rate adjustments as data develops, but we do not include speculative updates in our guidance.

在醫療補助方面，我們預計第四季 MCR 為 92.5%，全年為 91.5%。這項全年預期比我們先前的預測高出 60 個基點，反映了第三季的經驗以及我們對第四季更高趨勢的預期。在這些數字中，我們的全年醫療補助趨勢從 6% 上升到 7%。多個州的更新將我們的全年利率預期從 5% 上調至 5.5%。隨著數據的發展，我們繼續看到各州願意討論非週期和追溯利率調整，但我們的指導中不包括推測性更新。

Even in this challenging operating environment, our Medicaid segment's full-year pretax guidance margin is 3.2 and implied second half margin is 2.5, demonstrating the underlying strength and execution of our main business. In Medicare, we expect fourth-quarter MCR of 93.6%, in line with the third quarter. Our guidance for the full year of Medicare MCR rises to 91.3%, a 130-basis-point increase from our prior guidance, mainly driven by expectation for full-year trend rising from about 4 to 5. The Medicare segment full-year pretax guidance margin is break-even.

即使在這種充滿挑戰的經營環境中，我們的醫療補助部門全年稅前指導利潤率為 3.2，下半年隱含利潤率為 2.5，這證明了我們主要業務的潛在實力和執行力。在醫療保險方面，我們預計第四季的 MCR 為 93.6%，與第三季持平。我們對全年醫療保險 MCR 的預期上升至 91.3%，比我們先前的預期增加了 130 個基點，主要原因是對全年趨勢的預期從約 4 上升到 5。醫療保險部門全年稅前指導利潤率達到損益兩平。

In Marketplace, we expect fourth quarter MCR of 96.2% and full year at 89.7%. Within our marketplace guidance, full-year trend rises from about 11 to 15. We expect the full year G&A ratio to be approximately 6.5%. Due to third quarter share repurchases, our fourth-quarter share count falls to 50.9 million and full year is $53 million.

在市場上，我們預計第四季 MCR 為 96.2%，全年為 89.7%。在我們的市場指導範圍內，全年趨勢從約 11 上升至 15。我們預計全年的一般及行政開支比率約為 6.5%。由於第三季股票回購，我們第四季的股票數量下降至 5,090 萬股，全年為 5,300 萬美元。

Finally, I'll expand on Joe's comments on our initial outlook for 2026. While we're unable to give guidance at this early stage, I would like to further detail our initial views on the premium and EPS building blocks for 2026, which may help shape your perspectives and modeling. A number of known items put us on track to meet our target of $46 billion of revenue in 2026. They include normal growth in our current footprint, the new Medicaid contract wins in Georgia and Texas, and the Medicare duals growth in five states as our MMPs transition to [fighties and hideys].

最後，我將詳細說明喬對 2026 年初步展望的評論。雖然我們無法在早期階段提供指導，但我想進一步詳細說明我們對 2026 年保費和每股盈餘構成要素的初步看法，這可能有助於塑造您的觀點和模型。許多已知項目使我們有望實現 2026 年 460 億美元收入的目標。其中包括我們目前覆蓋範圍的正常增長、在喬治亞州和德克薩斯州贏得的新醫療補助合同，以及隨著我們的 MMP 過渡到五個州的醫療保險雙軌增長[戰鬥和躲藏]。

However, we anticipate two revenue headwinds in 2026, which we are unable to size at this early stage. First, given the lapse of enhanced tax credits or subsidies in marketplace and the significant uncertainty will cause in the risk pool, we are repricing the marketplace book of business to reduce exposure and restore margins. Our 2026 rate increases averaged 30%, ranging from 15% to 45%, and we have exited difficult geographies.

然而，我們預計 2026 年將出現兩大收入逆風，目前我們無法在早期階段確定其規模。首先，鑑於市場上增強的稅收抵免或補貼的失效以及風險池中的巨大不確定性，我們正在重新定價市場業務帳簿，以減少風險敞口並恢復利潤率。我們 2026 年的費率平均上漲了 30%，漲幅從 15% 到 45% 不等，我們已經走出了困難地區。

I will note that for the next year, we have reduced our county footprint by 20% and our number one and number two price position goes from 50% of our footprint in 2025 and to an estimated 10% of our footprint in 2026. Separately, we may see a small impact to Medicaid membership due to the recently passed budget bill, but continue to expect that most of that impact will manifest in 2027 and 2028.

我要指出的是，在接下來的一年裡，我們將把縣的足跡減少 20%，而我們第一和第二的價格位置將從 2025 年足跡的 50% 下降到 2026 年足跡的 10%。另外，我們可能會看到最近通過的預算法案對醫療補助會員資格產生輕微影響，但我們仍然預計大部分影響將在 2027 年和 2028 年顯現。

I'll now run through a similar set of building blocks on the EPS side. As a baseline for 2026, our Medicaid performance in the second half of 2025 is expected to produce a 92.3% MCR, a 2.5% pretax margin and contributed $6.50 per share to earnings. We annualized that to $13 per share for full-year Medicaid baseline for 2026. Next, we adjust that baseline upward to reflect normal seasonality pressure in the second half of the year. Remember, second-half MLR is typically 50 basis points higher for seasonal items in our rate cycle, which implies a 25-basis-point increase to next year's annualized outlook from the second half of 2025.

我現在將介紹 EPS 方面的一組類似的構建塊。作為 2026 年的基準，我們 2025 年下半年的醫療補助表現預計將產生 92.3% 的 MCR、2.5% 的稅前利潤率，並為每股收益貢獻 6.50 美元。我們將 2026 年全年醫療補助基準價格年化為每股 13 美元。接下來，我們向上調整基線以反映下半年的正常季節性壓力。請記住，在我們的利率週期中，下半年的季節性專案 MLR 通常高出 50 個基點，這意味著從 2025 年下半年開始，明年的年化前景將增加 25 個基點。

Then early views of draft rates in our January rate cycle, which comprises 60% of our full-year revenue, now suggest next year's full-year rates could be better than an initial proxy for trend by 50 basis points. While still short of the significant cash up needed in rates more generally, our early data points suggest states are moving in the right direction.

然後，我們一月份利率週期中的草案利率（占我們全年收入的 60%）的早期觀點現在表明，明年的全年利率可能比最初的趨勢指標高出 50 個基點。儘管仍未達到普遍所需的大幅加息水平，但我們的早期數據表明，各州正朝著正確的方向發展。

Next, we anticipate increased G&A expense next year as a return to normal compensation expense levels are only slightly offset by the end of the unusual implementation expenses we recognized in 2025. Lastly, we expect the benefit of lower share count next year to be largely offset by the impact of declining interest rate environment on our interest income. These building blocks will enable a fair outlook for 2026 that likely approximate for this year's updated full-year guidance.

接下來，我們預計明年的 G&A 費用將會增加，因為恢復正常的薪資費用水準只會被我們在 2025 年確認的異常實施費用的結束所略微抵消。最後，我們預計明年股票數量減少的好處將在很大程度上被利率下降對利息收入的影響所抵消。這些基礎數據將為 2026 年的前景提供合理的預測，可能與今年更新的全年預測大致相同。

I will note that this approach inherently assumes that both Medicare and Marketplace are earnings neutral next year. As we build our plan for next year, we see additional potential upsides in three areas. Most significantly, we remain optimistic on the margin improvement potential as state set rates for 2026. Many state programs are underfunded as we are now in the sixth consecutive quarter of abnormally high medical cost trend.

我要指出的是，這種方法本質上假設醫療保險和市場明年的獲利都是中性的。在製定明年計劃時，我們看到三個領域的額外潛在優勢。最重要的是，隨著國家設定 2026 年的利率，我們仍然對利潤率改善潛力持樂觀態度。由於醫療成本連續第六個季度處於異常高位，許多州的專案資金不足。

Published reports and our own internal analysis suggests that the market needs 300 to 500 basis points of rate in excess of trend to break-even. States are listing, becoming more responsive and weighing more heavily on recent medical claims data in the rate setting process. We have very strong rate advocacy efforts working with our state partners to restore rates to appropriate levels.

已發布的報告和我們自己的內部分析表明，市場需要超過趨勢 300 到 500 個基點的利率才能實現收支平衡。各州正在列出清單，變得更加敏感，並在費率制定過程中更加重視最近的醫療索賠數據。我們與州合作夥伴一起大力倡導利率，以將利率恢復到適當水平。

Rate increases beyond our initial assumptions create significant earnings upside as each 100 basis points of MLR yields, $4.50 of earnings per share. Separately, as noted, this 2026 outlook also conservatively assumes Medicare and Marketplace will break-even. In Medicare, we remain strategically focused on our dual-eligible population and improving pretax margins. Each 100 basis points of MLR yields $0.80 of earnings per share.

利率上升超出了我們最初的假設，從而創造了顯著的收益上升空間，因為每 100 個基點的 MLR 收益率將帶來每股 4.50 美元的收益。另外，如上所述，2026 年的展望也保守地假設醫療保險和市場將達到收支平衡。在醫療保險方面，我們仍然從策略上關注雙重合格人群並提高稅前利潤。MLR 每 100 個基點產生每股 0.80 美元的收益。

In Marketplace, any positive margins are also upside to our building blocks even on declining revenues. A final source of upside is our embedded earnings, which accounts for the estimated accretion from new contract wins and recent acquisitions. We will harvest some portion of the $8.65 per share in 2026.

在市場上，即使收入下降，任何正利潤率也對我們的基石有利。最後一個上行來源是我們的內含收益，它解釋了新合約的簽訂和近期收購帶來的預期成長。我們將在 2026 年收穫每股 8.65 美元的部分收益。

This concludes our prepared remarks. Operator, we are 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。

(Operator Instructions) Andrew Mok, Barclays.

（操作員指示）巴克萊銀行的 Andrew Mok。

Hi. Good morning. Can you elaborate on the drivers of ACA MLR pressure in the quarter? It sounds like there was a negative surprise in the September weekly data. Can you confirm and quantify that for us? And given the timing of the ACA pressure, how confident are you that this most recent utilization and morbidity experience was captured in your 2026 pricing? Thanks.

你好。早安.您能詳細說明本季 ACA MLR 壓力的驅動因素嗎？聽起來九月的周度數據似乎出現了負面意外。您能為我們確認並量化這一點嗎？考慮到 ACA 壓力的時機，您有多大信心認為最新的利用率和發病率經驗已反映在 2026 年的定價中？謝謝。

I'll frame the answer and then hand it to Mark for more detail. The pressure in the quarter was strictly related to increased medical cost trend literally across all categories. We have a higher percentage of special enrollment membership, which usually runs hot initially. It's all medical cost trends. The risk adjustment was not a factor in our trajectory of earnings per share.

我會構思答案，然後將其交給馬克以了解更多詳細資訊。本季的壓力與所有類別的醫療成本成長趨勢密切相關。我們的特殊註冊會員比例較高，這些會員通常在最初會很受歡迎。這都是醫療成本趨勢。風險調整不是我們每股盈餘軌跡的一個因素。

Now for next year, as Mark mentioned in his comments, we don't like to allocate capital to a product in an unstable risk pool. That's why we kept this small, silver, and stable at 10% of revenue. So next year, our rate increases state-by-state range from 15% to 45%, they averaged 30%. We reduced our footprint by 20%, and more importantly than the raw price increase that went into the market is where does your product price sit compared to the other market participants.

對於明年，正如馬克在評論中提到的那樣，我們不喜歡將資金分配給不穩定風險池中的產品。這就是為什麼我們將其保持在小規模、銀色且穩定在收入的 10% 水平。因此，明年，我們各州的稅率將分別上漲 15% 至 45%，平均為 30%。我們將足跡減少了 20%，比進入市場的原始價格上漲更重要的是，與其他市場參與者相比，您的產品價格處於什麼位置。

We were number one or two silver in 50% of our markets last year. And this year, an early read, we don't have all the information, suggests that we're only going to be priced number one or two in 10% of our core markets.

去年，我們在 50% 的市場中排名第一或第二。今年，根據早期的閱讀，我們還沒有掌握全部信息，這表明我們只能在 10% 的核心市場中排名第一或第二。

Mark, anything to add?

馬克，還有什麼要補充的嗎？

Joe, I think that's well summarized. Just to hit that in the third quarter, a number of drivers because certainly, our MLR is up a lot, Q3 over Q2, to your question. In general, it's the same trend pressure that every one of our segments are seeing. Joe mentioned SEP volumes keep coming. Program integrity, the different forms of membership attrition that come out certainly put a little pressure on it. What you'll also see, and I expect you to ask about this is in our IBNR roll forward, you'll see some development that went back to last year on some large-dollar items and some provider-claim settlements.

喬，我認為總結得很好。只是為了在第三季度實現這一目標，有許多驅動因素，因為我們的 MLR 肯定上升了很多，第三季度比第二季度上升了很多，這是您的問題。整體而言，我們每個細分市場都面臨相同的趨勢壓力。喬提到 SEP 數量持續增加。項目完整性、出現的不同形式的會員流失無疑給它帶來了一些壓力。您還會看到，我希望您詢問的是，在我們的 IBNR 滾動中，您會看到一些發展，這些發展可以追溯到去年的一些大額項目和一些提供者索賠結算。

So you put those items all together, it certainly is the driver of a lot of pressure here in the third quarter on Marketplace. Joe hit the key theme for next year exactly. We'll reduce our exposure significantly next year. We're not as competitive in most markets. We're pretty far down the rankings on most prices, which means I think we have enough price in there to jump over any unforeseen in the third and fourth quarters and more importantly, minimize exposure next year.

所以，把這些因素綜合起來，這無疑是第三季市場面臨巨大壓力的因素。喬準確地指出了明年的關鍵主題。明年我們將大幅減少曝光。在大多數市場上，我們的競爭力並不強。在大多數價格上，我們的排名都相當靠後，這意味著我認為我們有足夠的價格來克服第三季和第四季的任何意外情況，更重要的是，最大限度地減少明年的風險。

That initial 2026 outlook only assumed on a reduced revenue base that we get marketplace back to break-even. Well, in our pricing, we certainly targeted mid- to single-digit pretax margins.

最初的 2026 年展望僅假設在減少的收入基礎上，我們能夠讓市場恢復收支平衡。嗯，在我們的定價中，我們當然瞄準中等到個位數的稅前利潤率。

Stephen Baxter, Wells Fargo.

富國銀行的史蒂芬‧巴克斯特。

Hi. Thank you. Just a couple of clarifications on how you're thinking about Medicaid going into next year. In terms of the rates that you're discussing, are you then expecting rates to be in excess of the 7% cost trend that you're seeing right now? And then when you speak to enrollment trends, on one hand, it sounded like you talked to some level of normal enrollment growth, but then also talking about some expected pressure on enrollment. I guess could you just clarify whether you're expecting on a same contract basis in Medicaid for next year, whether enrollment is going to be up, down, or stable? Thank you.

你好。謝謝。我想就您對明年醫療補助計劃的看法做幾點說明。就您所討論的利率而言，您是否預計利率將超過您目前看到的 7% 的成本趨勢？然後，當您談到入學趨勢時，一方面，聽起來您談到了某種程度的正常入學成長，但同時也談到了一些預期的入學壓力。我想您能否澄清一下，您是否預計明年的醫療補助計劃在同樣的合約基礎上，入學人數將會上升、下降還是保持穩定？謝謝。

I'll answer the second question first. In each of the last three quarters, we saw a 1% membership decline in Medicaid, and that's just due to more rigorous and disciplined enrollment activities in each of our states. Now as you know, stayers versus leavers, that usually adds a little bit of acuity shift, which is probably part of the issue of why medical cost trend is increasing. But your first question about rates, there are four reasons why we're optimistic that rates will at least keep pace with trend and probably be slightly in excess of trend.

我先回答第二個問題。在過去三個季度中，我們看到醫療補助計劃的會員人數下降了 1%，這只是因為我們每個州的登記活動更加嚴格和規範。現在，正如您所知，留下的人與離開的人通常會增加一點敏銳度的轉變，這可能是醫療成本趨勢上升的部分原因。但關於利率的第一個問題，我們有四個理由樂觀地認為利率至少會跟上趨勢，甚至可能略高於趨勢。

One is, in the past, over the past year, states have been very responsive, on-cycle, off-cycle, retroactive, prospective, and responding to the increased trend. Two, this cost inflection started in mid-'24 through mid-'25. We have a full-year baseline that includes significant cost increases that can be rated for. So the updated baseline gives us optimism if that's included in the rate projections, then it captures a lot of the cost increase.

一是，在過去的一年裡，各州都做出了積極的反應，無論是週期性的、非週期性的、追溯性的、前瞻性的，或是成長趨勢的因應。第二，成本變動始於 2024 年中期至 2025 年中期。我們有一個全年基準，其中包括可以評估的顯著成本成長。因此，如果將其納入費率預測中，更新後的基線將為我們帶來樂觀，因為它將涵蓋大部分成本增長。

Third, three of the cost categories that are increasing pressure on our results, LTSS, pharmacy, and behavioral are discrete rating cells in the rating process, very visible, very prominent, gives you great visibility into those cost components, and they can be rated for adequately.

第三，對我們的結果造成越來越大壓力的三個成本類別，即 LTSS、藥房和行為，是評級過程中離散的評級單元，非常明顯、非常突出，讓您能夠很好地了解這些成本組成部分，並且可以對它們進行充分的評級。

And lastly, an early glimpse, very early glimpse at the 1-1 cycle where 60% of our revenue renews gives us some optimism that rates will be slightly ahead of trend and including rate updates for the full year in 2026, be slightly in excess of trend.

最後，透過早期的一瞥，非常早期的一瞥 1-1 週期，其中我們的 60% 的收入來自更新，這讓我們樂觀地認為利率將略高於趨勢，並且包括 2026 年全年的利率更新，將略高於趨勢。

Mark, did I miss anything?

馬克，我遺漏了什麼嗎？

No, Joe, I think it's well summarized. Stephen, it's indisputable that managed Medicaid rates are 3 to 400 basis points underfunded, and our state partners are recognizing that. We understand there's budget pressures out there, but with the development of data, as Joe mentioned, that's indisputable. And our early outlook for next year is that rates will be at least somewhat better-than-expected trend. But as you can imagine, we're feeling our way through both of those right now, and we'll have more as guidance develops.

不，喬，我認為總結得很好。史蒂芬，無可爭辯的是，管理的醫療補助率資金不足 3 至 400 個基點，我們的州合作夥伴也認識到了這一點。我們理解存在預算壓力，但隨著數據的發展，正如喬所提到的，這是無可爭議的。我們對明年的早期預測是，利率至少會比預期趨勢好一些。但正如你所想像的，我們現在正在摸索著解決這兩個問題，隨著指導的製定，我們將會有更多發現。

AJ Rice, UBS.

瑞銀的 AJ Rice。

Thanks. Hi, everybody. I appreciate the early comments about next year. Thinking about what you're assuming on the public exchanges, there are a lot of different scenarios on the table now with respect to subsidies, enhanced subsidies, et cetera. How does that affect -- what have you assumed embedded in the comment about breakeven? And how much of a variability might there be depending on the various ways this could play out?

謝謝。大家好。我很感謝大家對明年的早期評論。想想你對公共交易所的假設，現在有很多不同的方案，涉及補貼、加強補貼等等。這會產生什麼影響—您對損益兩平的評論有何假設？根據不同的結果，變化性會有多大？

Well, we gave you the rate increases ranging from 15% to 45% averaging 30%. And I won't go through the discrete components. I'll describe them qualitatively. You were underwater this year. We're going to have a 3% negative margin. So you put in a catch-up to get you back to target margins. You put in an estimate of trend, which we believe is very conservative. And then, of course, you have to estimate the impact of the acuity shift as the membership roles reduced due to the enhanced subsidy expiration.

好吧，我們給你的利率漲幅從 15% 到 45% 不等，平均為 30%。我不會詳細討論分立元件。我將定性地描述它們。今年你被淹沒了。我們的負利潤率將為 3%。因此，您需要採取追趕措施，以回到目標利潤率。您輸入了一個趨勢估計，我們認為這是非常保守的。然後，當然，你必須估計敏銳度轉變的影響，因為由於補貼到期而導致會員角色減少。

We believe we conservatively priced for all those three elements. But again, the more important point is where does the product sit on the shelf compared to your competitors. And the fact that it's not one or two in most of our markets gives us a view that volume will be reduced next year. I can't tell you how much right now, but it will be reduced. And our assumption is that on that reduced volume, we can at least get this back to break-even. But those conservative pricing assumptions did target mid-single-digit margins. Anything to add, Mark?

我們認為我們對這三個要素的定價都是保守的。但同樣，更重要的一點是與競爭對手相比，該產品在貨架上的位置如何。事實上，在我們的大多數市場中，這樣的情況並不止一兩次，這讓我們認為明年的銷售量將會減少。我現在無法告訴你減少多少，但肯定會減少。我們的假設是，在減少產量的情況下，我們至少可以恢復到收支平衡。但這些保守的定價假設確實瞄準了中等個位數的利潤率。還有什麼要補充的嗎，馬克？

The only thing to add, AJ, is right now, we're priced for the expiration of subsidies, which is the base case on the table. I think inherent in your question might be, well, what if the rules on subsidies change? If the rules on subsidies change, then pricing changes as well. Our objective, as Joe said, would be the same, which is to break-even or be better. But if the outlook and the regulation on subsidies changes, then the rates need to change as well.

AJ，唯一需要補充的是，目前，我們的定價是針對補貼到期而言的，這是基本情況。我認為你的問題本質上可能是，如果補貼規則改變怎麼辦？如果補貼規則發生變化，那麼定價也會改變。正如喬所說，我們的目標是相同的，那就是實現收支平衡或做得更好。但如果補貼前景和監管發生變化，那麼補貼率也需要改變。

Josh Raskin, Nephron Research.

Josh Raskin，腎元研究。

Great, thanks. Hey, good morning. When you look at that early view of 2026 being similar to the $14 this year, would you characterize that as a new baseline from which you grow and realize your embedded earnings going forward? Or do you view that as abnormally depressed still and we should expect above-average growth for a couple of years as margins get back to targets in all three segments?

太好了，謝謝。嘿，早安。當您看到 2026 年的早期預期與今年的 14 美元相似時，您是否會將其視為未來成長和實現內含收益的新基準？或者您認為這仍然處於異常低迷狀態，並且隨著三個部門的利潤率恢復到目標水平，我們應該預計未來幾年會出現高於平均水平的增長？

Whether we're taking the full year of 2025 in Medicaid at $16 or an annualization of the second half at $13, with the items of upside we mentioned, we certainly believe that rates will come back into balance with medical cost trend over time. Now the question everybody asks is, well, how much time will that take? We don't know, and we're not forecasting that. But next year, we are assuming that rates are in excess of trend, modestly in excess of trend, and that's a good jumping off point. But we do believe we have not changed our long-term outlook on the margins for this business.

無論我們將 2025 年全年的醫療補助定為 16 美元，還是將下半年的年化費用定為 13 美元，考慮到我們提到的上漲因素，我們確信，隨著時間的推移，費率將與醫療成本趨勢恢復平衡。現在每個人都會問的問題是，這需要多長時間？我們不知道，而且我們也不會預測這一點。但明年，我們假設利率將超過趨勢，並且略微超過趨勢，這是一個很好的起點。但我們確實相信，我們並沒有改變對該業務利潤率的長期展望。

In the first half of the year, we had a 3.8% pretax margin. And that -- even that was below our long-term target of about 4.5% for the business. We believe, over time, these things come back to target margins. The market in Medicaid needs 3 to 500 basis points to break even, just to breakeven. We've consistently operated 2 to 300 basis points better than the competitors in all of our markets. We only need a fraction of what the market needs in order to get back to target margins. Mark?

今年上半年，我們的稅前利潤率為3.8%。但這仍低於我們 4.5% 左右的長期業務目標。我們相信，隨著時間的推移，這些都會回到目標利潤率。醫療補助市場需要 3 到 500 個基點才能達到收支平衡，僅達到收支平衡。在所有市場中，我們的營運表現始終比競爭對手高出 2 至 300 個基點。我們只需要市場需求的一小部分就能恢復到目標利潤率。標記？

And Josh, just to build on that, I noticed overnight, some of you did the math on our initial outlook, the building blocks to $14 and a few of you got pretty close. It sort of implies next year that the whole company would run about a 2% pretax margin and maybe a 2.5% on Medicaid. Which, in both cases, is significantly below our longer outlook of 4% to 5% pretax for the whole company or 4.5% at the midpoint. So it certainly implies that next year margins are reduced with a lot of growth potential as this rate cycle normalizes.

喬希，在此基礎上，我注意到，昨晚你們中的一些人計算了我們最初的預期，將基石定為 14 美元，其中有幾個人的計算結果非常接近。這多少意味著明年整個公司的稅前利潤率約為 2%，醫療補助利潤率約為 2.5%。在這兩種情況下，這都大大低於我們對整個公司稅前 4% 至 5% 或中間值 4.5% 的長期預期。因此，這肯定意味著，隨著利率週期的正常化，明年的利潤率將會下降，但成長潛力很大。

Justin Lake, Wolfe Research.

賈斯汀·萊克，沃爾夫研究公司。

Thanks. Good morning. I was hoping I could get you to share where you think exchange revenue would be for next year, given all those moving parts you talked about versus the $4.5 billion run rate this year. And then maybe you talked about SG&A be a little pressured year-over-year given bonuses returning. Can you -- anything you could share with us in terms of where you think that SG&A ratio will shake out year over year?

謝謝。早安.我希望我能請您分享一下，考慮到您談到的所有變動因素以及今年 45 億美元的運行率，您認為明年的交易收入將會是多少。然後也許您談到了由於獎金的回歸，銷售、一般和行政費用同比會有點壓力。您能否與我們分享您認為銷售、一般和行政費用比率將如何逐年變化？

I'll answer the exchange revenue question first and then kick it to Mark for the G&A color. We have various scenarios. And of course, what you're doing is you're looking at your price position versus the price positions of other players and looking at your competitive position and trying to forecast how much volume will you keep and how much volume will you get.

我將首先回答有關交換收入的問題，然後將其交給馬克來決定 G&A 顏色。我們有各種各樣的場景。當然，您要做的就是查看您的價格位置與其他參與者的價格位置，查看您的競爭地位，並試圖預測您將保持多少銷量以及您將獲得多少銷量。

We don't believe we'll get a lot of new membership, but we believe we'll hold on to some renewal membership. We have scenarios that indicate that revenue could come down from $4 billion to $2 billion or even slightly less than that at $1.5 billion -- in either case, we are 100% comfortable of at least breaking even in that line of business next year. But our pricing models, even at that reduced volume, were priced to produce mid-single-digit target margins.

我們不相信我們會獲得很多新會員，但我們相信我們會保留一些續訂會員。我們的預測表明，收入可能會從 40 億美元降至 20 億美元，甚至略低於 15 億美元——無論哪種情況，我們 100% 有信心明年該業務至少實現收支平衡。但我們的定價模型即使在銷售減少的情況下也能產生中等個位數的目標利潤率。

Mark, do you want to take the G&A question?

馬克，你想回答一般及行政問題嗎？

Yeah, Joe, just to build on the Marketplace one, a lot of the consensus views out there are that Marketplace could shrink nationally 30% to 50% next year. I think what Joe is suggesting is it wouldn't be out of line to think we would as well with some of the numbers Joe mentioned. On the G&A ratio, we'll probably come in at a 6.5% this year within our guidance. That is low for the reasons you mentioned, compensation and a few other items, probably targeting roughly about a 6%, 8%-ish is the right way to go for next year, at least to start your modeling.

是的，喬，僅就市場而言，許多人的共識是，明年市場在全國範圍內可能會萎縮 30% 到 50%。我認為喬的建議是，根據喬提到的一些數字，我們也會這麼認為，這並不奇怪。就 G&A 比率而言，我們今年的指導值可能為 6.5%。由於您提到的原因、補償和其他一些項目，這個數字很低，大概目標大約是 6% 到 8% 左右，這是明年的正確方向，至少對於開始建模來說是這樣。

On the -- another point on the G&A question is really important because when we talk about target margins in Medicaid. One of the facts that is usually missed is that we operate just north of 5% of a G&A ratio in that line of business, which we believe is best-in-class. So if we get 2 to 300 basis -- 100 basis points of rates, which is equal to $4.50 a share and continue to operate just north of 5% on the G&A line in Medicaid, then we're well on our way back to target margins.

關於 G&A 問題的另一點非常重要，因為當我們談論醫療補助的目標利潤時。人們常常忽略的一個事實是，我們在該業務領域的一般及行政開支比率略高於 5%，我們認為這是同類中最好的。因此，如果我們獲得 2 至 300 個基點（即 100 個基點）的利率，相當於每股 4.50 美元，並繼續在醫療補助的 G&A 線上以略高於 5% 的水平運營，那麼我們就很有可能回到目標利潤率。

Kevin Fischbeck, Bank of America.

凱文‧菲施貝克，美國銀行。

Great, thanks. I guess I appreciate with the guidance that you basically are only signaling potential areas of upside. It really seems like the market is much more focused on potential areas of downside. You have some peers who are thinking that margins trough next year rather than are slightly better in Medicaid. Obviously, the exchanges are unknown.

太好了，謝謝。我想我很欣賞你的指導，因為你基本上只是在暗示潛在的上升空間。看起來市場確實更關注潛在的下行領域。有些同業認為醫療補助的利潤率明年會跌至低谷，而不是略有改善。顯然，這些交易都是未知的。

So I would just love to hear your view on where you think the downside risk to the numbers are. You said that this year, trends matched -- rates matched trend, but then trend got worse as the year went on. It's not clear to me why you have confidence that today, when you say rates look like they're going to be slightly above, why you'd have confidence that by the end of the year, that would still be the case. And then with your embedded earnings comment with, I guess, the business underperforming, how do we think about the embedded earnings? I guess, in the past, you've kind of talked about the trajectory of realizing them. Is that all pushed out a year? Like how should we be thinking about that part of the equation? Thanks.

因此，我很想聽聽您的看法，您認為這些數字的下行風險在哪裡。您說今年的趨勢是一致的——利率與趨勢一致，但隨著時間的推移，趨勢變得更糟。我不明白為什麼您今天有信心，當您說利率看起來會略高時，為什麼您會有信心到今年年底，情況仍然會如此。然後，根據您對內含收益的評論，我想，業務表現不佳，我們如何看待內含收益？我想，過去您曾談論過實現這些目標的軌跡。這一切都要推遲一年嗎？例如，我們該如何思考這個等式的這一部分？謝謝。

Well, on the margin question or the MCR question in Medicaid, when you produce a 91% MCR in the first half of the year, 92% in the second, averaging 91.5% and your pretax margins at 3.2%. It depends what you mean at trough from. I mean these are the lowest point of our margins because we started at 4.5% to 5%. So I think we have to -- when comparing our results to others, you have to look at the starting point. We started at 4.5% to 5%.

好吧，關於醫療補助中的利潤率問題或 MCR 問題，當您在上半年產生 91% 的 MCR，下半年產生 92% 的 MCR，平均為 91.5%，稅前利潤率為 3.2%。這取決於你所說的「低谷」是什麼意思。我的意思是，這是我們利潤率的最低點，因為我們的起價是 4.5% 到 5%。所以我認為我們必須——在將我們的結果與其他人的結果進行比較時，你必須看起點。我們從 4.5% 到 5% 開始。

It was just a year ago, we were 200 basis points into the corridors. One of the reasons why the cost inflection that began in mid-2024 didn't hit us as much is we were 200 basis points into the corridors late in '24, which buffered a lot of that medical cost pressure. So we're operating the way we want to operate. We believe we'll get back to target margins and even back into the corridors. And we're -- I articulated the early view of rates for our guidance, past-state rate updates, the '24-'25 baseline already including a lot of the cost inflection, three rating components that are very discrete and highly prominent, and an early glimpse at 1-1-26.

就在一年前，我們的利率還處於 200 個基點的區間。2024 年中期開始的成本變化之所以沒有給我們帶來太大影響，原因之一是我們在 2024 年末就進入了 200 個基點的區間，這緩解了很大一部分醫療成本壓力。因此，我們正在按照我們想要的方式運作。我們相信我們將回到目標利潤率，甚至回到走廊。而且我們 - 我闡明了我們對指導利率的早期看法、過去的利率更新、'24-'25 基線已經包括了很多成本變化、三個非常離散和非常突出的評級組成部分，以及對 1-1-26 的早期預測。

So we think the Medicaid business, which is the earnings basket of the company, 75% of our revenue, producing a 3.2% pretax margin at $16 a share this year is going to continue to perform. Is there downside? Any business has downside on medical cost trends. And there's no question that in all of our businesses with a 7% cost trend in Medicaid, a 5% cost trend in Medicare and a 15% cost trend in Marketplace, it's all about cost trend and where that settles in, in 2026. But our view is the appointment logs are filled in doctors' offices, the beds are filled in the hospitals. And at some point in time, capacity has to level out and trend levels out on this highly increased cost base. If trend just levels, costs are still up 15%, 20% of where they were two years ago.

因此，我們認為醫療補助業務（該公司的獲利來源，占我們收入的 75%）今年將繼續表現良好，每股收益為 16 美元，稅前利潤率為 3.2%。有缺點嗎？任何企業都會受到醫療成本趨勢的影響。毫無疑問，在我們所有的業務中，醫療補助的成本趨勢為 7%，醫療保險的成本趨勢為 5%，市場的成本趨勢為 15%，這一切都與成本趨勢以及 2026 年的成本趨勢有關。但我們的觀點是，預約記錄是在醫生辦公室填寫的，床位是在醫院填寫的。在某個時間點，產能必須趨於平穩，趨勢也必須在這個大幅增加的成本基礎上趨於平穩。如果趨勢只是保持穩定，成本仍比兩年前上漲 15% 到 20%。

Again, if you got -- go ahead.

再說一次，如果你有——那就繼續吧。

Mark, embedded earnings?

馬克，內含收益？

Yes, Kevin, the second part of your question was on embedded earnings. As we said in our prepared remarks, we've got $8.65 now. And remember what that is, that's earnings on top of what we're currently guiding to in the current year, things that will emerge in future years. We're at $8.65. We had previously signaled we thought about one-third would come out into earnings in 2026. We're not ready to give a more specific number. Joe and I certainly will when we give guidance after the fourth quarter.

是的，凱文，你問題的第二部分是關於內含收益的。正如我們在準備好的演講中所說的那樣，我們現在有 8.65 美元。請記住，這是我們目前指導的今年收益之上的收益，也是未來幾年將會出現的東西。我們現在的股價是8.65美元。我們先前曾暗示，預計其中約三分之一將在2026年轉化為收益。我們還沒準備好給出更具體的數字。當我們在第四季度之後給出指導時，喬和我肯定會這樣做。

But what you can think about is within that $8.65, remember, we were carrying $1 of implementation costs, which depressed our earnings in 2025. That just goes away. That was the preparation for the [FIDEs and HIDEs]. We'll kick those into gear January 1. So that kind of headwind goes away for next year.

但你可以想想，在這 8.65 美元中​​，請記住，我們承擔了 1 美元的實施成本，這降低了我們 2025 年的收益。那一切就都消失了。這是為[FIDE 和 HIDE]。我們將從 1 月 1 日起開始實施這些措施。因此，明年這種不利因素將會消失。

The other small component was we were expecting a little bit of a loss on -- from the Virginia contract going away. That was a $0.40 item. So that falls out. So you get the dollar next year. You have to recognize the $0.40 headwind from Virginia, but net, you're up at least $0.60 just on things that are money in the bank. The rest we'll update as Joe and I have a better view on trend-in rates next year, but you'll get some portion of that $8.65.

另一個小因素是我們預期維吉尼亞合約的終止會帶來一點損失。那是一件價值 0.40 美元的商品。所以結果就是這樣。所以你明年就能得到美元。你必須認識到來自維吉尼亞州的 0.40 美元的逆風，但淨值而言，僅從銀行的錢來看，你就至少賺了 0.60 美元。其餘部分我們將在喬和我對明年的趨勢利率有更好的了解後進行更新，但您將獲得 8.65 美元的一部分。

The only thing I would add is embedded earnings is what we call an ultimate concept, meaning that you get to your ultimate target margins over a period of time. Now given where margins have settled recently, could that then take longer to get to ultimate? Sure. But we have not changed our view of the ultimate target margins in those businesses, but the timing of emergence is certainly something we'll update you on when we give 2026 guidance in February.

我唯一想補充的是，內含收益是我們所說的最終概念，這意味著你會在一段時間內達到最終的目標利潤率。現在考慮到利潤率最近已經穩定下來，是否需要更長的時間才能達到最終目標？當然。但我們並沒有改變對這些業務最終目標利潤率的看法，但我們肯定會在 2 月提供 2026 年指導時向您通報出現的時間。

(Operator Instructions) Scott Fidel, Goldman Sachs.

（操作員指示）高盛的斯科特·菲德爾。

Hi, thanks. Good morning. Maybe switching over -- let's switch back over to Medicare a little bit. And interested maybe if you can break down for us around the performance for this year, breaking it down between, let's say, the traditional MOH, D-SNP-focused book of business. And then the acquisition of the bright assets in California and how each of those have built into the performance this year. And that -- then looking out to next year as well, how each of those two categories influence your view on Medicare and so that, I think, sort of breakeven margin view that you have for next year?

你好，謝謝。早安.也許可以轉換一下——讓我們稍微轉回醫療保險。也許您可以為我們分析今年的表現，將其細分為傳統的衛生部和以 D-SNP 為重點的業務。然後是加州優質資產的收購，以及這些資產如何影響今年的業績。那麼展望明年，這兩個類別會如何影響您對醫療保險的看法，因此，我認為您對明年的損益平衡點有何看法？

Well, I'll tee it up, and I'll hand to Mark. The Medicare business, as I said in my prepared remarks, is sort of going through a rejuvenation, and that is because it is -- it was always aimed at the dual-eligible segment. But now with the MMPs, the $2 billion, 44,000 members, $2 billion of revenue converting to FIDEs and HIDEs, we're really well positioned, particularly with the sweep of Illinois, Ohio, and Michigan and the D-SNP RFP process.

好吧，我先開球，然後交給馬克。正如我在準備好的演講中所說，醫療保險業務正在經歷復興，這是因為它一直針對的是雙重合格人群。但現在有了 MMP，20 億美元、44,000 名成員、20 億美元的收入都轉化為 FIDE 和 HIDE，我們確實處於非常有利的地位，特別是在伊利諾伊州、俄亥俄州和密西根州的席捲以及 D-SNP RFP 流程之後。

So as we look year-over-year, this year versus next, the Bright acquisition will be what, the third full year of ownership, and that was coming from a very low-margin position, and we're building it up. That will provide some improvement. But as we convert these 44,000 members and by the way, add 20,000 due to the service-area extension and the MMP conversions, we're being a little cautious. They're the same members are in the same geographies, but it is a different product chassis. So we're being a little cautious with the margins in that product.

因此，當我們回顧今年與明年的同比情況時，Bright 的收購將是我們擁有該公司的第三個完整年度，而這源於我們利潤率非常低的狀況，而且我們正在不斷累積。這將帶來一些改進。但是，當我們轉換這 44,000 名會員時，順便說一下，由於服務區域擴展和 MMP 轉換而增加了 20,000 名會員，我們有點謹慎。他們的成員相同，位於相同的地理位置，但產品底盤不同。因此，我們對該產品的利潤率持謹慎態度。

So break-even to break-even, Bright does better than the third year of ownership, and we're a little bit cautious on the profitability of the MMP conversions until we have one year of experience.

因此，從收支平衡到收支平衡，Bright 的表現比我們擁有的第三年要好，而且在我們擁有一年的經驗之前，我們對 MMP 轉換的盈利能力持謹慎態度。

Mark, do you want to add anything? .

馬克，你還有什麼要補充嗎？。

Joe, that's well summarized. Within our $6 billion of Medicare, it's about one-third MAPD, about one-third MNP and about one-third D-SNP. As we look to next year, those MMPs will translate to FIDEs and HIDEs given all of the RFPs that we won. Ao I think you'll see slight margin erosion as you go from MMPs into FIDEs and HIDEs, and that's one, just us being cautious about a new product; and two, recognizing that the second half of the year was higher than we thought this year. That slight margin erosion though, I think, is offset as on the MAPD side, Bright, ConnectiCare come back up to closer to where they should be on target margin. You put that all together, we're starting off at least margin neutral for next year.

喬，總結得很好。在我們 60 億美元的醫療保險中，大約三分之一是 MAPD，大約三分之一是 MNP，大約三分之一是 D-SNP。展望明年，鑑於我們贏得的所有 RFP，這些 MMP 將轉化為 FIDE 和 HIDE。噢，我認為，當你從 MMP 轉向 FIDE 和 HIDE 時，你會看到利潤率略有下降，這是因為我們對新產品持謹慎態度；其次，我們認識到今年下半年的利潤率高於我們的預期。不過，我認為，利潤率略有下降，但隨著 MAPD 方面 Bright 和 ConnectiCare 的利潤率回升至更接近其目標水平，利潤率的輕微下降得到了抵消。綜合考慮這些因素，我們明年的利潤率至少會保持中立。

John Stansel, JPMorgan.

摩根大通的約翰·斯坦塞爾。

On the M&A pipeline, since Investor Day last year, you spent a fair amount of time talking about the opportunities you see with smaller and regional players. And I think we've heard a fair amount of commentary across the space about potentially negative margins in Medicaid -- and to contrast that with the significant share repurchase done in the quarter, can you just talk through how you're thinking about capital allocation priorities from here, capacity and how developed that pipeline is in the coming quarters? .

在併購管道方面，自去年投資者日以來，您花了相當多的時間談論您看到的與規模較小和區域性參與者合作的機會。我認為我們已經聽到了相當多關於醫療補助計劃可能出現負利潤率的評論——為了與本季度進行的大量股票回購形成對比，您能否談談您如何考慮從現在開始的資本配置優先事項、產能以及未來幾個季度該渠道的發展情況？。

Sure. Our capital priorities have not changed. The order priority, organic growth, inorganic growth and returning capital to shareholders very share repurchase, that haven't changed, and we have ample capital, as Mark said, we're still producing earnings. You throw leverage on top of earnings. We're producing $1.5 billion of capital capacity a year even at these compressed margins. On the M&A pipeline, -- if you look at our history of purchasing, what, $11 billion of revenue over seven or eight deals and only acting capital equal to 22% of purchase revenue, half of which is regulatory capital, hard capital we barely paid any goodwill value for the acquisitions.

當然。我們的資本重點沒有改變。訂單優先順序、有機成長、無機成長和向股東返還資本以及股票回購，這些都沒有改變，而且我們擁有充足的資本，正如馬克所說，我們仍在創造盈利。你在收益之上施加槓桿。即使利潤率較低，我們每年仍能創造 15 億美元的資本產能。在併購管道上，如果你看一下我們的收購歷史，你會發現，七、八筆交易的收入為 110 億美元，而代理資本僅相當於收購收入的 22%，其中一半是監管資本、硬資本，我們幾乎沒有為收購支付任何商譽價值。

In this period of cyclically low margins, we're going to be very disciplined about prices paid for revenue streams. If you can buy a revenue stream, from a struggling local health plan at or about book value, it's just as good as winning a new contract, no goodwill capital. All the capital was hard capital and regulatory capital. So the number of local not-for-profit health plans in Medicaid that have experienced prolonged operating difficulties and therefore, profitability and capital problems has been a catalyst for the pipeline being replenished in very full, very full of actionable opportunities. And if you can action them at or around book value is as good or even better than winning a new contract. Mark, anything on capital allocation? .

在這個週期性低利潤率的時期，我們將非常嚴格地控制收入流的價格。如果您能以帳面價值或接近帳面價值的價格從陷入困境的當地健康計劃中購買收入流，那麼這就相當於贏得一份新合同，無需商譽資本。全部資本都是硬資本和監管資本。因此，醫療補助計劃中許多地方非營利醫療計劃經歷了長期的營運困難，因此出現了盈利能力和資本問題，這成為管道中充滿可操作機會的催化劑。如果您能夠按照帳面價值或帳面價值左右採取行動，那麼這與贏得新合約一樣好，甚至更好。馬克，關於資本配置有問題嗎？。

On capital allocation, Joe mentioned the prioritization, we always prefer to grow organically. But these M&A situations, when you buy them so close to book, almost feel organic. If the industry is 3 to 400 basis points underfunded, you can imagine some of these smaller players are starting to really struggle, which is why we feel good about the opportunities to do some M&A here and drive additional value from that perspective. On the capital side, we remain in a really good spot with our financial ratios. And again, with the earnings power of the business, even at these lower levels, we just continue to build book value and therefore, debt capacity. So we feel pretty good about on the opportunities and to our capital position.

在資本配置方面，喬提到了優先順序，我們始終傾向於有機成長。但這些併購情況，當你在如此接近帳面價值的時候，幾乎感覺很自然。如果該行業資金不足 3 到 400 個基點，你可以想像其中一些小型企業將開始真正陷入困境，這就是為什麼我們對在這裡進行一些併購並從這個角度創造額外價值的機會感到高興。在資本方面，我們的財務比率仍然處於良好狀態。而且，憑藉企業的獲利能力，即使在這些較低的水平上，我們仍會繼續建立帳面價值，從而提高債務能力。因此，我們對這些機會和資本狀況感到非常滿意。

Ryan Langston, TD. Cowen.

瑞安·蘭斯頓，TD。考恩。

Great. I appreciate all the details for 2026. It sounds like you see states moving in the right direction in terms of rates. But I'm wondering, is there any other type of relief that states are offering just above and beyond. I think you got the second quarter in utilization management was range sort of allow those services. Are you seeing any signaling some states this could change over time?

偉大的。我感謝 2026 年的所有細節。聽起來您看到各州在利率方面正朝著正確的方向發展。但我想知道，各州是否也提供其他類型的救濟。我認為您在利用率管理方面獲得的第二季度是允許這些服務的範圍。您是否看到任何跡象表明這種情況可能會隨著時間而改變？

With -- I think what you're describing is the construction of the program. Look, as states are pressured on budgets. They have a variety of things they can do. They can change the program, reduce benefits, reduce eligibility. And we've heard other companies talk about this. We've seen this at the margin. Have there been utilization pauses called by various states?

我認為您所描述的是該程式的構造。瞧，各州都面臨預算壓力。他們可以做各種各樣的事情。他們可以改變計劃、減少福利、降低資格。我們也聽到其他公司談論過這個問題。我們已經在邊緣看到了這一點。各州是否已經宣布暫停利用？

Yes, isolated, mostly on behavioral. And what do you think happens when you pause utilization on any component of cost that goes up. Most states are going back to full utilization protocols at this point, but it's not a major phenomenon. Benefit changes, meaning reduction in the size of the program to the benefit changes. We've seen those on the margin in various places, but not significant. So going into next year, program changes, program construction is really not a major phenomenon to consider as we -- in our outlook for 2026.

是的，孤立的，主要是行為上的。當您暫停任何成本上升部分的利用時，您認為會發生什麼情況。目前，大多數州都已恢復全面利用協議，但這並不是一個主要現象。福利變化，意味著計劃規模因福利變化而縮小。我們在各個地方都看過這些邊緣現象，但並不顯著。因此，進入明年，專案變更、專案建設實際上並不是我們在 2026 年展望中需要考慮的主要現象。

It's here, it's there, it's isolated, but it's not a major driver. Now the other component that we are seeing, as I mentioned before, and it shouldn't be ignored, is states even before work requirements are taking enrollment processes more seriously, and we've lost about 1% of membership per quarter for each of the last 3. Levers usually have a lower MCR than stayers. So they're putting a little bit of pressure due to an acuity shift, but most of the pressure Medicaid is higher utilization by the stayers, not the acuity shift by the levers, but continued program integrity is another phenomenon that we're experienced state by state.

它在這裡，它在那裡，它是孤立的，但它並不是一個主要的驅動因素。現在我們看到的另一個因素，正如我之前提到的，它不應該被忽視，那就是即使在工作要求之前，各州也更加重視註冊流程，並且在過去 3 個季度中，我們每個季度都會失去大約 1% 的會員。槓桿的 MCR 通常比固定桿的 MCR 低。因此，由於敏銳度轉變，他們施加了一點壓力，但醫療補助的大部分壓力來自於留守者的更高利用率，而不是槓桿的敏銳度轉變，但持續的項目完整性是我們各州經歷的另一個現象。

Erin Wright, Morgan Stanley.

艾琳·賴特，摩根士丹利。

Just a bigger picture question on the exchange business in light of just the uncertainties, whether it's subsidies or otherwise or the lack of visibility sometimes across that business, and you're taking a conservative approach, but I guess, can you talk about your overall commitment to that business, how you think about that? And at what point would your thinking change on that front in terms of your priorities and the overall mix of your business.

鑑於存在不確定性，無論是補貼還是其他因素，或者有時整個業務缺乏透明度，關於交易所業務的一個更大的問題，您採取了保守的態度，但我想，您能否談談您對該業務的總體承諾，您對此有何看法？就您的優先事項和整體業務組合而言，您的想法什麼時候會改變？

As I mentioned previously, thanks for the question. We will allocate capital to the business as long as we are convinced that the risk pool will continue to be stable. And I look over the past five years, insurtechs coming in with unreasonable pricing, expanding the eligibility for special enrollment. -- enhanced subsidies in enhanced subsidies out. I mean you can go back and look at duration of membership, fast-churn membership, you need risk adjustment, you have a member for 18 months, you don't get risk adjustment.

正如我之前提到的，感謝您的提問。只要我們確信風險池將持續保持穩定，我們就會向該業務分配資金。回顧過去五年，保險科技公司以不合理的定價進入市場，擴大了特殊投保資格。 ——加強補貼，加強補貼。我的意思是，你可以回頭看看會員的期限，快速流失的會員，你需要風險調整，如果你的會員期限為 18 個月，你就沒有風險調整。

So when you look at the inherent what I call inherent volatility of the book, we have no choice in my -- in our capital philosophy of allocating a little capital to an unstable risk pool as we can. However, we did not pull the product. The product is available. It's available in over 300 counties. It's on the shelf. And if we come to the conclusion that the risk pool stabilizes for a period of time, we can allocate more capital, leverage our broker relationships. And while other market participants might consider this product a necessity, we consider it an option. We believe that option is out of the money next year. But when it goes back closer to the money, in the money, we'll exercise it.

因此，當你看到我所說的書中固有的固有波動性時，我們別無選擇——在我們的資本理念中，我們只能盡可能地將少量資本分配給不穩定的風險池。然而，我們並沒有撤下該產品。該產品已上市。它在 300 多個縣都有提供。它在架子上。如果我們得出結論，風險池在一段時間內會穩定下來，我們就可以分配更多的資本，利用我們的經紀人關係。雖然其他市場參與者可能認為該產品是必需品，但我們認為它是一種選擇。我們認為該選擇權明年將失去價值。但當它回到更接近價內水平時，我們就會行使它。

Lance Wilkes, Bernstein.

蘭斯威爾克斯、伯恩斯坦。

Great. Just a couple of clarifications on Medicaid and Marketplace. For the '26 assumptions on trend and rate, are you kind of presuming that rates, given visibility you've got thus far are going to improve up to that trend level? Or do you think that trend level is going to be normalizing down? Could you also talk a little bit about the variability you see contract-to-contract or state to state in your margin performance? And does that present any opportunities for exiting any particular contracts? Or are they all doing kind of comparably well? And then the last question is just on marketplace. If you're seeing any sort of pull forward in activity kind of the uncertainty in the membership there, if they're going to have the program going into next year for some of them. And if you could quantify that?

偉大的。僅對醫療補助和市場做一些澄清。對於趨勢和利率的 26 個假設，您是否假設利率（鑑於您目前所掌握的可見度）將會改善至該趨勢水準？或者您認為趨勢水平將會正常化？您能否也談談您在不同合約之間或不同州之間的利潤表現差異？這是否為退出任何特定合約提供了機會？或者說他們的表現都差不多好？最後一個問題是關於市場的。如果您看到任何形式的活動提前，那麼會員人數就存在不確定性，他們是否會為其中一些實施明年的計劃。您能量化一下嗎？

Mark, do you want to take the Medicaid rate question, the 2026 rate question --

馬克，你想回答醫療補助率的問題嗎？ 2026 年的費率問題--

Absolutely. Lance, on the Medicaid rates versus trend, again, the industry is 300 to 400 basis points underfunded right now. And while states might have budget pressures and be reluctant to completely address that, it's inevitable they need to. And so our view into early next year and what we're seeing from our state partners, is that the trend in rate imbalance can't perpetuate.

絕對地。蘭斯，關於醫療補助率與趨勢，我再說一遍，目前該行業資金短缺 300 至 400 個基點。儘管各州可能面臨預算壓力，並且不願意完全解決這個問題，但他們不可避免地需要這樣做。因此，我們對明年年初的看法以及我們從州合作夥伴那裡看到的情況是，利率不平衡的趨勢不會持續下去。

We're faring up into at least six quarters into it, that the trailing data is catching up with it. And our assumption is that extremely high trends as we've seen don't continue that they moderate somewhat. But more importantly, that states are recognizing with the trailing data that they need to catch up. It may take them many quarters to catch up, but they are starting to recognize that and catch up. And remember, if the industry is 3 to 400 basis points underfunded, the stat filings show that Molina is still performs 2 to 250 basis points better than the industry.

我們已經進入了至少六個季度，落後數據正在趕上它。我們的假設是，我們所看到的極高的趨勢不會持續下去，而是會有所緩和。但更重要的是，各州意識到，他們需要透過落後的數據來迎頭趕上。他們可能需要很多季度才能趕上，但他們已經開始意識到這一點並開始趕上。請記住，如果行業資金不足 3 至 400 個基點，統計文件顯示 Molina 的表現仍然比行業高出 2 至 250 個基點。

So we need half of what the broader industry needs to get to our target margins and the probability of us getting that half sooner than later is probably better than the whole market coming back to stasis. So we feel that some catch-up is appropriate and warranted, and we're expecting, again, if all catch up in our initial outlook here.

因此，我們需要的是整個產業所需利潤的一半，才能達到我們的目標利潤率，而我們儘早獲得這一半的可能性可能比整個市場恢復停滯要好。因此，我們認為採取一些追趕措施是適當且有必要的，並且我們再次期待，如果一切能夠趕上我們最初的展望。

With the question state-by-state, Mark and I spent a lot of time managing what we call the portfolio. and we do not tolerate performance SKUs, everybody's got to deliver. Now things go through cycles and sometimes the state rate will get weaker and then sometimes it gets stronger. But every property in the portfolio is performing at least in excess of its cost of capital. There's a supposition out there that some of the smaller plans can't be doing well because they can't be scaled properly.

對於每個州的問題，馬克和我花了很多時間管理我們所謂的投資組合。我們不容忍性能 SKU，每個人都必須交付。現在事情經歷了周期性變化，有時國家利率會變弱，有時又會變強。但投資組合中每項資產的表現都至少超過了其資本成本。有一種推測認為，一些較小的計劃無法順利實施，因為它們無法適當擴展。

We have $5 billion health plans, and we have $500 million health plans. The margins are not correlated to the size of the plan. They're just not. We can make money in a $500 million to $1 billion health plan, all the shared services, claims, grievances and appeals all those shared services call centers are completely leveraged at an enterprise level. So right now, sure, states go through -- our state properties, go through various cycles of profitability, ebbing and flowing. But no, there is no contemplation of reducing the size of the portfolio. We still have an active pipeline targeting $54 billion of opportunities over the next number of years. We have two active RFPs, two of our bigger states in flight right now. So now we're building the portfolio. And right now, there is no discussion over any underperformance or any state where we're not happy to do business.

我們有 50 億美元的健康計劃，還有 5 億美元的健康計劃。利潤與計劃的大小無關。他們不是。我們可以透過 5 億到 10 億美元的健康計畫賺錢，所有共享服務、索賠、申訴和上訴，所有這些共享服務呼叫中心都在企業層面得到充分利用。所以現在，當然，各州正在經歷——我們的州財產，正在經歷各種盈利週期，有起有落。但沒有，沒有考慮減少投資組合的規模。我們仍有活躍的管道，目標是在未來幾年內實現 540 億美元的商機。我們有兩個活躍的 RFP，其中兩個較大的州目前正在進行飛行。所以現在我們正在建立投資組合。目前，我們還沒有討論任何業績不佳的情況或任何我們不願意開展業務的情況。

George Hill, Deutsche Bank.

德意志銀行的喬治·希爾。

I had a Medicare question. And I guess, Mark, when I think of your portfolio in Medicare, I think you talked about like the LTSS and the dual penetration, I think if you guys as having high duals in a relatively sick book of business. which is why I was surprised at the magnitude of the MLR miss in the quarter. I guess, can you talk about the variable consumption that you guys saw in the Medicare business? And what's driving that because, again, I think the really sick members is constant utilizers of care. So I kind of really like to hear about the marginal -- like what's driving the marginal cost of care in Medicare .

我有一個關於醫療保險的問題。我想，馬克，當我想到你在醫療保險方面的投資組合時，我想你談到了 LTSS 和雙重滲透，我想如果你們在相對糟糕的業務賬簿中擁有高雙重性。這就是為什麼我對本季 MLR 失誤的幅度感到驚訝。我想，您能談談您在醫療保險業務中看到的可變消費嗎？而推動這現象的原因又是什麼呢？因為，我認為真正生病的成員是需要持續照護的人。所以我真的很想聽聽關於邊際成本的問題——例如是什麼推動了醫療保險的邊際成本。

I think you have a variety of things going on. We typically talk about LTSS as being a bigger driver in a high acuity population, and it's certainly a built-in big part of each of these high acuity and dual products. And then on the high-cost drug side, that continues to be a factor across all of our businesses, but with certain cancer treatments with certain other of the therapies that are out there. high-cost drugs continue to be a very big driver of it. And you make an interesting point. That in highly chronic populations, by definition, ABD and Medicaid and Duals, you wouldn't expect to see a cost inflection because they're using services from day 1 to day 365.

我認為你正在做各種各樣的事情。我們通常認為 LTSS 是高敏銳度人群中更大的驅動力，而且它無疑是這些高敏銳度和雙重產品中內建的重要組成部分。然後，在高成本藥物方面，這仍然是我們所有業務的一個因素，但對於某些癌症治療和某些其他現有的療法，高成本藥物仍然是一個非常大的驅動因素。你提出了一個有趣的觀點。根據定義，在高度慢性病族群中，ABD、醫療補助和雙重保險，您不會看到成本變化，因為他們從第 1 天到第 365 天都在使用服務。

And -- but we have seen it. And those are the two cost components in Medicare, LTSS hours and SNF admits and high-cost drugs, which are our Rx trends as a company are about of 16% and 36% in the top 10 therapeutic categories. So they're being used across all our populations, and that is what's putting the cost pressure in Medicare. Even though they're already high acuity chronic populations, utilization is up.

而且——但我們已經看到了。這些是醫療保險中的兩個成本組成部分，即長期照護服務 (LTSS) 小時數和 SNF 入院人數以及高成本藥物，作為一家公司，我們的 Rx 趨勢在前 10 個治療類別中分別約佔 16% 和 36%。因此，它們被廣泛用於我們所有的人口，這就是醫療保險的成本壓力。儘管他們已經是高敏感度慢性病患者群體，但利用率仍在上升。

Michael Ha, Baird.

麥可·哈，貝爾德。

With regard to Medicaid margins and state rate increases, I understand you're strongly advocating for better rate alignment. So I'm wondering how many of your states are actually reflecting recent '25 trends into the reference look back period for the upcoming January rates. Curious because in our conversations with state actuaries, it seems like actuaries at best can only consider a look-back period of 12 to 24 months, just given how difficult it is to shorten it, just given they need a few months ahead of time to submit to CMS for approval, need roughly half a year to run the process and then clean 12-month look back to reflect about three months of claims runoff.

關於醫療補助利潤率和州費率成長，我理解您強烈主張更好的費率調整。所以我想知道有多少州實際上將最近的 25 年趨勢反映到了即將到來的 1 月份利率的參考回顧期內。奇怪的是，在我們與州精算師的對話中，似乎精算師最多只能考慮 12 到 24 個月的回顧期，因為縮短回顧期非常困難，因為他們需要提前幾個月提交給 CMS 批准，需要大約半年的時間來運行該流程，然後清理 12 個月的回顧以反映大約三個月的索賠流失。

So I'm curious, are you seeing states who actually reflecting '25 trends? And also on the Medicaid member attrition this year. I was wondering if you could quickly elaborate on the nature of that enrollment. How many of these lives are rolling off because the procedural or administrative reasons? Just trying to better understand if this might be emblematic at the higher level. of outsized procedural disenrollment that we've been seeing?

所以我很好奇，您是否看到各州實際上反映了“25”趨勢？以及今年醫療補助計劃成員的流失情況。我想知道您是否可以快速詳細說明該招生的性質。其中有多少人因為程序或行政原因而喪生？只是想更好地理解這是否在更高層面上具有像徵意義。我們所看到的超大規模程序性取消註冊？

On the Medicaid rates, and Mark and I, particularly Mark spent a lot of time in this process. the data through -- through June of 2025 is virtually complete. Yes, actuaries like to see data very well seasoned. And this cost inflection did start in mid-'24. So whether they use '24 but include early '25 as a trend factor or used mid-'24, '25 as the baseline and late '25 as a trend factor. As long as they capture the medical cost inflection either in the baseline or trend, we believe we'll be in good shape.

關於醫療補助費率，馬克和我，特別是馬克在這個過程中花了大量時間。截至 2025 年 6 月的數據基本上已經完成。是的，精算師喜歡看到經過充分驗證的數據。而這種成本變化確實始於 2024 年中期。因此，他們是否使用 24 年但將 25 年初作為趨勢因素，或使用 24 年中期、25 年作為基線並將 25 年末作為趨勢因素。只要他們能夠捕捉到基線或趨勢中的醫療成本轉折點，我們相信我們就會處於良好狀態。

So I'm not going to go state by state. The industry's advocacy efforts to fully consider the latest experience are very strong, and we believe are working. Whether the actual baseline period is 12 months older and then they include a generous trend on top of it or more recent period and less generous rent, it mathematically doesn't matter. But we are confident that the latest cost information either in the baseline or in a trend assumption is being contemplated in rates. Mark?

所以我不會逐州去。業界為充分考慮最新經驗所做的倡議工作非常有力，我們相信這是有效的。無論實際基線期是 12 個月前，然後在其基礎上納入慷慨的趨勢，還是最近的時期和不那麼慷慨的租金，從數學上來說都無關緊要。但我們確信，利率中已經考慮了基準或趨勢假設中的最新成本資訊。標記？

And Joe, that's a big point that isn't always well understood. If the look-back period is 6 months or 12 months ago, sure, that makes a difference from one perspective, but that's not the rate you get. The rate you get is that look back starting point plus a fair trend on top of it. Now actuaries can argue over what that fair trend is on top of it. But if that fare trend comes out at an appropriate place, the specific data, the look-back period is less relevant.

喬，這是一個不總是被很好理解的重點。如果回顧期是 6 個月或 12 個月前，當然，從某個角度來看會有所不同，但這不是您獲得的利率。您獲得的利率是回顧起點加上其上的公平趨勢。現在精算師可以爭論公平趨勢到底是什麼。但如果票價趨勢出現在適當的位置，那麼具體數據和回顧期間就沒那麼重要了。

On your membership question, yes, states have just gotten more disciplined on eligibility requirements, and there's no one state or one area, about 1% per quarter for the last three. And I believe in the membership decline in a must be in there as of June 30. So the loss of Virginia, I don't have the number in front of me. Mark might have it. That also accounted for some of the membership loss. That contract rolled off months ago.

關於您的會員資格問題，是的，各州在資格要求方面已經變得更加嚴格，並且沒有一個州或一個地區在過去三個季度中每季度都達到約 1%。我相信，截至 6 月 30 日，會員人數肯定會下降。所以對於弗吉尼亞州的損失，我還沒有確切的數字。馬克可能有它。這也導致部分會員流失。該合約幾個月前就到期了。

Right? And in the third quarter, 120,000 of our Medicaid members fell off due to the transmission number game, right.

正確的？第三季度，由於傳播數位遊戲，我們有 12 萬名醫療補助成員退出了該計畫。

Jason Cassorla, Guggenheim.

傑森·卡索拉，古根漢。

Great. Maybe just piggybacking off of the benefits questions from Medicaid. You noted program construction isn't like a phenomenon for 2026. But as opposed to multiple years of elevated rates, discussion around being 3 to 400 basis points unfunded in Medicaid. What do you believe needs to happen for states to take a deeper look at benefit structures and find areas that they'd be willing to pare back? And what would be like the mechanism or timing around when that could possibly happen? Or do you see a greater honors for states to do that and look at benefit structures?

偉大的。也許只是搭上醫療補助的福利問題。您指出，程式建置並不是 2026 年才出現的現象。但與多年來利率不斷上升相反，圍繞醫療補助計劃資金缺口達到 3 至 400 個基點的討論卻一直持續。您認為各州需要採取哪些措施才能更深入地審視福利結構並找到願意削減的領域？那麼，當這種情況可能發生時，其機製或時間是怎樣的呢？或者您認為各州這樣做並考慮福利結構會獲得更大的榮譽？

Well, they do from time to time, carving out pharmacy, putting pharmacy back in. And the real issue here is while we don't like to see swings in revenue, revenue, we like to see revenue coming in. We certainly don't like to see it leave. The real issue here is if they take out benefits, how much rate do they take out? Do they take out the right amount of rate for the reduced benefit. So it should be margin neutral that and over time, it usually is. But there are value-added benefits in many states.

嗯，他們時不時會這麼做，把藥局分割出來，然後再放回去。真正的問題是，雖然我們不喜歡看到收入波動，但我們希望看到收入增加。我們當然不希望看到它離開。真正的問題是，如果他們領取福利，他們領取的比率是多少？他們是否為減少的福利拿出了正確的金額？因此，它應該是利潤中性的，而且隨著時間的推移，通常也是如此。但許多州都有增值利益。

I mean there's the core essential benefits that you'd always provide, but there are benefits around the edges that are always provided where they could actually cut back. states tended to have a tendency to carve out pharmacy. Some states have done that and found that it increased costs substantially. So we don't see that as a new emerging fan, there's for or five states that already do it. we don't see any more that are inclined to do it.

我的意思是，有一些核心基本福利是你們始終會提供的，但還有一些邊緣福利是他們實際上可以削減的。各州往往傾向於剝離藥房。一些州已經這樣做了，但發現成本大幅增加。因此，我們並不認為這是一個新興的潮流，已經有五個州這樣做了。我們也沒有看到有更多的州傾向於這樣做。

So I think around the edges, they will look at that in order to save money. It will reduce revenue, but as long as the right amount of rate is taken out of the capitated rate, then volume goes down a little -- premium line goes down a little bit, but margins should be neutral and should not be affected.

所以我認為他們會從各個方面考慮這個問題，以節省金錢。這會減少收入，但只要從人頭費率中扣除適當的費用，那麼交易量就會下降一點——保費線會下降一點，但利潤率應該是中性的，不會受到影響。

This concludes our question-and-answer session and Molina Healthcare's third quarter 2025 earnings call. Thank you for participating and attending today's presentation. You may now disconnect.

我們的問答環節和 Molina Healthcare 2025 年第三季財報電話會議到此結束。感謝您參與並出席今天的演講。您現在可以斷開連線。