Molina Healthcare Inc (MOH) 2025 Q4 法說會逐字稿

Good day, and welcome to the Molina Healthcare Fourth Quarter 2025 Conference Call. (Operator Instructions) Please note this event is being recorded.

大家好，歡迎參加 Molina Healthcare 2025 年第四季電話會議。（操作說明）請注意，本次活動正在錄影。

I would now like to turn the conference over to Jeff Geyer, Vice President of Investor Relations. Please go ahead.

現在我將把會議交給投資者關係副總裁傑夫蓋爾。請繼續。

Good morning, and welcome to Molina Healthcare's fourth quarter and full year 2025 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 2025 earnings was distributed after the market closed yesterday and is available on our Investor Relations website.

早安，歡迎參加 Molina Healthcare 2025 年第四季及全年財報電話會議。今天與我一同出席的有 Molina 的總裁兼執行長 Joe Zubretsky；以及我們的財務長 Mark Keim。昨天股市收盤後，我們發布了新聞稿，宣布了 2025 年第四季度和全年收益情況，該新聞稿可在我們的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.

本次通話結束後不久，即可收聽錄音回放，回放有效期為 30 天。觀看重播的號碼已在財報中公佈。

For those of you who listen to the rebroadcast of this presentation, we remind you that all of the remarks are made as of today, Friday, February 6, 2026 and have not been updated subsequent to the initial earnings call. 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 2025 earnings release.

對於收聽本次演講重播的各位，我們提醒您，所有發言均截至 2026 年 2 月 6 日星期五，並且自首次財報電話會議以來未進行任何更新。在本次電話會議中，我們將提及一些非GAAP指標。這些措施與最直接可比較的 GAAP 措施的核對情況，可以在 2025 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 2026 guidance, the medical cost trend and our projected MCRs, Medicaid rate adjustments and updates, our recent Florida CMS RFP win and contract inception, our M&A pipeline and deal activity, upcoming RFPs, our expected future growth, Medicaid, Medicare and Marketplace membership levels, earnings seasonality, the transition to Medicaid, Medicare integrated product designs, our G&A costs, our credit facility and the estimated amount of our embedded earnings power.

在本次電話會議中，我們將發表一些前瞻性聲明，包括但不限於有關我們 2026 年業績指引、醫療成本趨勢和我們預計的醫療費用率 (MCR)、醫療補助費率調整和更新、我們最近贏得佛羅裡達州 CMS RFP 和合約啟動、我們的併購管道和交易活動、即將進行的RFP、我們預期的未來成長、醫療補助、醫療保險和市場會員水準、收益季節性、向醫療補助過渡、醫療保險綜合產品設計、我們的一般及行政費用、我們的信貸額度以及我們估計的內含盈利能力的聲明。

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.

聽眾請注意，我們所有的前瞻性陳述都存在某些風險和不確定性，這些風險和不確定性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在向美國證券交易委員會提交的 10-K 表格年度報告中討論的風險因素，以及我們在向美國證券交易委員會提交的 10-Q 表格和 8-K 表格文件中列出的風險因素。

After the completion of our prepared remarks, we will open the call to take your questions. I will now turn the call over to our Chief Executive Officer, Joe Zubretsky.

我們發言結束後，將開放式提問環節，接受大家的提問。現在我將把電話交給我們的執行長喬祖布雷茨基。

Thank you, Jeff, and good morning. Today, we will provide you with updates on our reported financial results for the fourth quarter and full year 2025. Our top line growth initiatives and our full year 2026 premium revenue and earnings guidance. Let me start with our fourth quarter performance.

謝謝你，傑夫，早安。今天，我們將向您提供我們2025年第四季和全年財務業績的最新資訊。我們的營收成長計畫以及我們對 2026 年全年保費收入和獲利的預期。首先，我想談談我們第四季的業績。

Last night, we reported an adjusted loss per share of $[2.75] on $10.7 billion of premium revenue. Our fourth quarter results fell well below our expectations due to continued strong trend pressure in Medicare and Marketplace and two, retroactive items in Medicaid, which totaled $2 per share. While disappointed in the performance for the quarter, we continue to remain confident in our durable and sustainable operating platform as the rate environment returns to equilibrium.

昨晚，我們公佈了經調整後的每股虧損為 2.75 美元，保費收入為 107 億美元。由於 Medicare 和 Marketplace 持續強勁的趨勢壓力，以及 Medicaid 的兩項追溯性項目（總計每股 2 美元），我們的第四季業績遠低於預期。儘管對本季的業績感到失望，但隨著利率環境恢復平衡，我們仍然對我們持久且可持續的營運平台充滿信心。

In Medicaid, the MCR for the quarter was 93.5% and was impacted by unfavorable and unexpected retroactive premium rate actions taken by the state of California. Adjusting for these retroactive items, we produced a 2% pretax margin and the MCR was favorable to our prior guidance even as we continue to experience higher utilization of professional office visits, behavioral health services, LTSS and high-cost drugs. In Medicare, the MCR for the quarter was 97.5%.

在醫療補助計劃中，本季的最低醫療費用率 (MCR) 為 93.5%，並受到加州採取的不利且出乎意料的追溯性保費率措施的影響。在調整這些追溯項目後，我們實現了 2% 的稅前利潤率，即使我們繼續經歷專業門診就診、行為健康服務、長期服務和高成本藥物使用率的上升，MCR 也優於我們先前的預期。Medicare 的季度 MCR 為 97.5%。

We continue to experience elevated utilization for LTSS and high-cost drugs and slower-than-expected margin improvement in our MAPD product. Finally, in Marketplace, the MCR was 99% which was impacted by elevated utilization and several prior period provider claim settlements. For the full year 2025, we reported premium revenue of $43 billion, representing 11% year-over-year growth.

我們持續面臨長期照護服務和高成本藥物使用率上升的問題，而我們的 MAPD 產品利潤率改善速度低於預期。最後，在 Marketplace 中，MCR 為 99%，這是由於使用率升高和先前幾期供應商索賠結算所致。2025 年全年，我們的保費收入為 430 億美元，年增 11%。

Adjusted earnings per share were $11.03, and our pretax margin was 1.6%, which is below our long-term target range. 2025 was clearly a tale of two halves as the company earned over $11 per share in the first half, largely tracking expectations.

調整後每股盈餘為11.03美元，稅前利潤率為1.6%，低於我們的長期目標範圍。 2025年可謂冰火兩重天，公司上半年每股盈餘超過11美元，基本符合預期。

Trend pressure work against us in each of the third and fourth quarters. Our fourth quarter performance resulted in our full year performance falling below our most recent guidance. As we compare our initial 2025 EPS guidance of $24.50 for our final result of $11.03, nearly half of the underperformance for the year was attributable to the unprecedented trend and increased acuity in our Marketplace segment.

第三季和第四季度，趨勢壓力對我們不利。由於第四季業績不佳，我們全年業績低於先前預期。我們將 2025 年每股收益預期 24.50 美元與最終結果 11.03 美元進行比較，發現今年業績不佳近一半是由於市場部門前所未有的趨勢和日益增長的敏銳度造成的。

A very disproportionate outcome given that the segment is just 10% of our total premium. The rate in trended balance in Medicaid accounted for approximately one third of the underperformance, while the remainder was due to persistent higher utilization in Medicare.

考慮到該細分市場僅占我們總保費的 10%，這樣的結果非常不成比例。醫療補助計劃的趨勢餘額下降率約佔績效不佳的三分之一，其餘部分則歸因於醫療保險計劃持續較高的使用率。

In Medicaid, our flagship business, representing 75% of our total premium revenue, we reported an MCR of 91.8% and pretax margin of 2.8%. Rates increased from 4.5% in our initial guidance to 6% for the year, but medical cost trend continually increased from 4.5% in initial guidance to 7.5%, an unprecedented inflection in such a short period of time. 250 basis points of this 7.5% trend is attributable to the acuity shift from membership declines related to the final stages of redeterminations.

在我們的旗艦業務 Medicaid 中，占我們總保費收入的 75%，我們的 MCR 為 91.8%，稅前利潤率為 2.8%。費率從我們最初預期的4.5%上升至全年的6%，但醫療成本趨勢卻持續攀升，從最初預期的4.5%升至7.5%，在如此短的時間內出現前所未有的大幅增長。這7.5%的成長趨勢中有250個基點歸因於會員人數在重新評估的最後階段下降，導致病情嚴重程度改變。

While we are disappointed in our fourth quarter and full year results, many published reports indicate our Medicaid performance is industry-leading by 300 basis points to 400 basis points in pretax margin. We believe the medical cost trend in 2025 was an aberration, an anomaly by historical standards.

儘管我們對第四季度和全年業績感到失望，但許多已發布的報告表明，我們的醫療補助業務表現領先業界，稅前利潤率比其他業務高出 300 至 400 個基點。我們認為 2025 年的醫療成本趨勢是一種異常現象，以歷史標準來看是一種反常現象。

The important point, which I will get to in a moment, is what all of this means for 2026 and the longer-term outlook for the business. But first, turning to our growth initiatives. Despite the short-term margin challenges, 2025 was another extraordinary year for securing future growth for our flagship Medicaid business.

稍後我會談到重點，那就是這一切對 2026 年以及公司更長遠的發展前景意味著什麼。但首先，讓我們來看看我們的成長計畫。儘管短期內利潤率面臨挑戰，但 2025 年對於確保我們旗艦醫療補助業務的未來成長而言，又是意義非凡的一年。

We continued our successful track record of winning renewal and new RFPs. During the quarter, Molina secured a historic RFP win in Florida where the state awarded Molina, the sole Children's Medical Services or CMS contract.

我們延續了以往在續約和新招標項目中取得成功的記錄。本季度，莫利納在佛羅裡達州贏得了一項歷史性的 RFP 合同，該州將唯一的兒童醫療服務 (CMS) 合約授予了莫利納。

This contract is expected to yield $6 billion in annual run rate premium and is expected to go live late 2026. This award in Florida complements our previously announced contract win in Wisconsin, where we renewed our Wisconsin [MyChoice] LTSS contract in Regions 2 and Regions 7.

該合約預計每年可帶來 60 億美元的保費收入，預計將於 2026 年底生效。佛羅裡達州的這項獎項是對我們先前宣佈在威斯康辛州贏得合約的補充，我們在威斯康辛州續簽了第 2 區和第 7 區的 [MyChoice] 長期服務合約。

The significant win in Florida in our previously announced Georgia and Texas start ship wins represent over $9 billion of Medicaid premium and significantly contribute to our embedded earnings. Since we embarked on this growth strategy, we have achieved an RFP win rate of 90% on renewal contracts, representing $14 billion in retained revenue and 80% on new contracts representing $20 billion of new revenue.

繼先前宣佈在喬治亞州和德克薩斯州贏得啟動計畫之後，我們在佛羅裡達州的重大勝利代表了超過 90 億美元的醫療補助保費，並將對我們的內含收益做出重大貢獻。自從我們開始實施這項成長策略以來，我們在續約合約中實現了 90% 的 RFP 中標率，帶來了 140 億美元的保留收入；在新合約中實現了 80% 的 RFP 中標率，帶來了 200 億美元的新收入。

We are engaged in active RFPs in several states and have an active pipeline of $50 billion of new opportunities over the next few years.

我們正在多個州積極開展招標工作，並且在未來幾年內擁有價值 500 億美元的新機會。

On the M&A side, our acquisition pipeline contains a number of actionable opportunities. The current challenging operating environment is a catalyst for many smaller and less diverse health plans to consider their strategic options.

在併購方面，我們的收購計畫中包含許多可執行的機會。目前充滿挑戰的經營環境促使許多規模較小、業務範圍較窄的醫療保險計劃重新審視其策略性選擇。

We remain opportunistic about deploying capital to accretive acquisitions. In this temporary period of rate and trend in balance, we will work to acquire as much Medicaid revenue as possible, as we have done in the past, manage it to target margins.

我們仍會抓住機會，將資金投入能夠帶來增值收益的收購。在當前利率和趨勢暫時平衡的時期，我們將像過去一樣，努力獲取盡可能多的醫療補助收入，並將其管理到目標利潤率。

Turning now to our 2026 guidance. We project 2026 premium revenue of approximately $42 billion, which is slightly lower than 2025. The premium growth from the new Florida CMS contract in Medicaid and higher revenues in our Medicare segment are more than offset by the planned reduction in the Marketplace segment.

現在來看我們2026年的指導。我們預計 2026 年保費收入約為 420 億美元，略低於 2025 年。佛羅裡達州 CMS 醫療補助新合約帶來的保費成長以及我們在醫療保險領域的收入增加，都被市場領域的計劃削減所抵消。

Our 2026 adjusted earnings per share guidance is at least $5. This guidance is burdened by $1.50 of new contract performance of the landmark Florida CMS contract and dollar due to the underperformance of our traditional MAPD product. We have determined that the MAPD product does not align with our strategic shift to focus exclusively on dual eligible members in Medicare and we will exit the traditional MAPD product for 2027.

我們對 2026 年調整後每股盈餘的預期至少為 5 美元。由於佛羅裡達州 CMS 里程碑合約的新合約履行成本為 1.50 美元，以及由於我們傳統的 MAPD 產品表現不佳而造成的成本增加，本指南的執行成本也隨之增加。我們已經確定 MAPD 產品與我們專注於 Medicare 雙重資格成員的策略轉變不符，我們將於 2027 年退出傳統的 MAPD 產品。

After adjusting for these two items, our 2026 guidance produces underlying earnings of approximately $7.50 per share. There are three aspects of the business that represent significant upside to our guidance. First, our view on Medicaid cost trend could moderate from our initial estimates.

調整這兩個項目後，我們 2026 年的業績預期為每股基本收益約 7.50 美元。這項業務有三個方面可望大幅提升我們的預期。首先，我們對醫療補助成本趨勢的看法可能會比我們最初的估計有所緩和。

Second, Medicaid rates may develop favorably due to on and off-cycle adjustments as they did in 2025. Recall that every 100 basis points on the Medicaid MCR from this current rate and trend relationship, is worth nearly $5 per share.

其次，由於週期內和非週期性調整，醫療補助費率可能會像 2025 年那樣出現有利變化。請記住，根據目前的利率和趨勢關係，Medicaid MCR 每提高 100 個基點，每股價值就增加近 5 美元。

Finally, Medicare and Marketplace are both going through transformations for very different reasons. Our guidance assumes these segments combined for a headwind of $1 per share in 2026, but both contain significant upside as we priced conservatively.

最後，聯邦醫療保險和醫療保險市場都在經歷變革，但原因卻截然不同。我們的預測假設這些業務板塊加起來在 2026 年將面臨每股 1 美元的不利影響，但由於我們定價保守，因此兩者都具有很大的上漲空間。

Mark will take you through the detailed 2026 earnings guidance build in a few minutes, but let me highlight the major assumptions underlying our $5 per share guidance. In Medicaid, 2026 rates are expected to average approximately 4% and will not offset medical cost trend projected at 5%.

Mark 將在幾分鐘內帶您詳細了解 2026 年的獲利預測，但在此我想重點介紹一下我們每股 5 美元預測背後的主要假設。預計 2026 年 Medicaid 的費率平均約為 4%，將無法抵銷預計為 5% 的醫療成本趨勢。

This trend outlook for 2026 is comparable to the 2025 trend without the 250 basis point impact of the redetermination related acuity shift.

2026 年的趨勢展望與 2025 年的趨勢相當，但沒有重新評估相關嚴重程度變化帶來的 250 個基點的影響。

In Medicare, members are transitioning to new integrated product designs, which we expect to produce lower margins in their first year before reaching their full margin potential. Finally, in Marketplace, we made the conscious decision to reduce our exposure and stabilize margins in this highly volatile risk pool, which we expect to yield a 50% decline in our annual marketplace premium. Early enrollment results drove a larger mix of renewal members, which we expect will improve the stability and predictability of our member acuity profile.

在聯邦醫療保險中，會員們正在過渡到新的綜合產品設計，我們預計這些產品在第一年的利潤率會較低，之後才會達到其全部利潤潛力。最後，在 Marketplace 領域，我們做出了有意識的決定，減少我們在這個高度波動風險池中的風險敞口並穩定利潤率，我們預計這將使我們的年度 Marketplace 保費下降 50%。早期註冊結果促使續費會員的比例增加，我們預計這將提高我們會員健康狀況的穩定性和可預測性。

In summary, our 2025 results did not meet our expectations, but I am pleased with our team's focus on managing through these industry headwinds and producing in the fourth quarter a normalized pretax margin in Medicaid of 2%. There is little question that Medicaid rates and medical cost trends are in balance.

總而言之，我們 2025 年的業績沒有達到預期，但我對我們的團隊專注於應對這些行業逆風並於第四季度在醫療補助方面實現 2% 的正常化稅前利潤率感到滿意。毫無疑問，醫療補助費率和醫療成本趨勢是平衡的。

We believe our 2026 forecast for Medicaid is the trough for managed Medicaid margins. In this margin trough, we expect that Molina Medicaid will produce a low single-digit margin, not losses, and that the market is underfunded by 300 basis points to 400 basis points.

我們認為，2026 年的 Medicaid 預測值是管理式 Medicaid 利潤率的最低點。在當前利潤率低迷時期，我們預計 Molina Medicaid 將實現個位數低利潤，而不是虧損，並且市場資金缺口為 300 至 400 個基點。

We are confident in the outlook for this business and that rates and trend will eventually reach equilibrium. Even at this low point in the cycle, we remain optimistic about the future earnings trajectory of the enterprise, which is a function of anticipated rate restoration and future embedded earnings. Of note, we anticipate that actuarial soundness will ultimately prevail as Medicaid rates are restored by state actuarial processes, and that will allow us to achieve target margins.

我們對這項業務的前景充滿信心，並相信利率和趨勢最終會達到平衡。即使在經濟週期的低谷時期，我們仍然對企業的未來獲利前景持樂觀態度，這取決於預期利率的恢復和未來的內在收益。值得注意的是，我們預計隨著各州精算流程恢復醫療補助費率，精算穩健性最終將佔上風，這將使我們能夠實現目標利潤率。

This potential is significant as every 100 basis points on the Medicaid MCR is worth nearly $5 per share. Then our existing new store embedded earnings, which represent future contract revenue at average target margins, are additive to the earnings accretion implied by the rate restoration cycle. Embedded earnings are now greater than $11 per share.

這一潛力非常巨大，因為 Medicaid MCR 每提高 100 個基點，每股價值就增加近 5 美元。然後，我們現有的新店內含收益（代表以平均目標利潤率計算的未來合約收入）將與價格恢復週期所隱含的收益成長相加。目前每股隱含收益已超過 11 美元。

The intrinsic value of our businesses remains unchanged. Modest capital requirements, mid-single-digit pretax target margins, robust parent company cash flow and ample organic and inorganic growth opportunities will combine to yield significant shareholder value. The cycle will turn and these underlying valuation parameters will again become apparent.

我們企業的內在價值保持不變。適度的資本需求、中等個位數的稅前目標利潤率、強勁的母公司現金流以及充足的內生和外延成長機會，將共同為股東創造巨大的價值。週期終會逆轉，這些潛在的估值參數也將再次顯現出來。

Finally, we look forward to updating you on our outlook for sustaining profitable growth at an Investor Day event on Friday, May 8. We will provide you with our long-term goals as well as the detailed playbook for achieving our growth rates and maintaining industry-leading margins.

最後，我們期待在 5 月 8 日星期五的投資者日報上向您報告我們對持續獲利成長的展望。我們將向您提供我們的長期目標，以及實現成長率和保持行業領先利潤率的詳細策略。

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

接下來，我會把電話交給馬克，讓他對財務狀況做一些補充說明。標記？

Thanks, Joe, and good morning, everyone. Today, I'll discuss some additional details on our fourth quarter and full year performance, the balance sheet and our 2026 guidance.

謝謝你，喬，大家早安。今天，我將討論我們第四季和全年業績、資產負債表以及2026年業績指引的一些其他細節。

Beginning with our fourth quarter results. For the quarter, we reported approximately $10.7 billion of premium revenue with an adjusted loss of $2.75 per share. Adjusted earnings were approximately $3 below our expectations with approximately $2 driven by unexpected retroactive premium items in California Medicaid and the remainder due to continued trend pressure in Medicare and Marketplace.

首先，我們來看看第四季的業績。本季度，我們公佈的保費收入約為 107 億美元，調整後每股虧損 2.75 美元。調整後的收益比我們的預期低了約 3 美元，其中約 2 美元是由於加州醫療補助計劃中意外的追溯性保費項目造成的，其餘部分是由於醫療保險和市場持續的趨勢壓力造成的。

In Medicaid, our fourth quarter MCR was 93.5%. As Joe mentioned, this result includes both a retroactive risk corridor and a retro rate reduction in California, totaling 160 basis points. Both were driven by new and unforeseen state actions impacting the full year but introduced late in the fourth quarter. Adjusting for these retroactive items, our reported MCR restated to 92.3% and our pretax margin was 2%, both better than our expectation for the quarter. For the full year, the reported Medicaid MCR was 91.8% and pretax margin was 2.8%.

在醫療補助方面，我們第四季的MCR為93.5%。正如喬所提到的，這一結果包括追溯性風險走廊和加州追溯性利率下調，總計 160 個基點。這兩項措施都是由影響全年的新的、不可預見的政府行動所驅動的，但這些行動是在第四季末才推出的。在調整這些追溯項目後，我們報告的 MCR 重述為 92.3%，稅前利潤率為 2%，均優於我們對該季度的預期。全年報告的 Medicaid MCR 為 91.8%，稅前利潤率為 2.8%。

We take some comfort that even in this unprecedented medical cost trend environment, the stat filings continue to show our Medicaid margins remain best-in-class. Simply put, rates have not kept up with trend over the past six quarters. Looking at the stat filings for all MCOs in our markets, we believe Medicaid plans are underfunded by 300 basis points to 400 basis points. In Medicare, our fourth quarter MCR was 97.5% and our full year MCR was 92.4%. Our results for the year reflected elevated utilization of LTSS and high-cost drugs among our high-acuity dual populations.

即使在當前前所未有的醫療成本趨勢環境下，統計數據仍然顯示我們的醫療補助利潤率仍然是業界最佳，這讓我們感到些許欣慰。簡而言之，過去六個季度利率一直未能跟上趨勢。查看我們市場中所有 MCO 的統計備案，我們認為 Medicaid 計劃資金不足 300 到 400 個基點。在醫療保險方面，我們第四季的MCR為97.5%，全年的MCR為92.4%。我們今年的業績反映出，在重症雙重人口中，長期照護服務和高成本藥物的使用率較高。

Margin recovery in the MAPD product was slower than we expected. In Marketplace, our fourth quarter reported MCR was 99%, and our full year MCR was 90.6%. In the quarter, the MCR reflected elevated utilization across nearly all services, particularly behavioral health, high-cost drugs and professional outpatient visits and several prior period claim settlements with providers. The adjusted G&A ratio for the quarter was 6.9%, and our full year was 6.5%. Our cost management remains disciplined, and we continue to harvest fixed cost leverage as we grow.

MAPD產品的利潤率恢復速度比我們預期的要慢。在 Marketplace，我們在第四季度報告的 MCR 為 99%，全年 MCR 為 90.6%。本季度，MCR 反映出幾乎所有服務的使用率均有所上升，特別是行為健康、高價藥物和專業門診就診，以及與供應商的幾項前期索賠和解。本季調整後的管理費用率為 6.9%，全年為 6.5%。我們維持嚴格的成本管理，並在發展過程中持續利用固定成本優勢。

Recall, the full year G&A ratio reflects added expense for implementation costs in the new integrated tools products, offset by a reduction in management incentive compensation expense. Turning to the balance sheet. Our capital foundation remains strong.

回顧一下，全年一般及行政費用比率反映了新整合工具產品實施成本的增加，但管理層激勵性薪酬支出有所減少，從而抵消了這些增加。接下來看一下資產負債表。我們的資本基礎依然雄厚。

Positive full year earnings continue to add to our capital base and drive parent company cash via dividends. In the quarter, we harvested approximately $337 million of subsidiary dividends and our parent company cash balance was approximately $223 million at the end of the year.RBC ratios, which test the level of capital at the subsidiary level compared to regulatory requirements, are 305% in aggregate, more than 50% above state minimums.

全年獲利持續成長，不斷增加我們的資本基礎，並透過股息為母公司帶來現金流。本季度，我們獲得了約 3.37 億美元的子公司股息，而截至年底，我們的母公司現金餘額約為 2.23 億美元。 RBC 比率（用於測試子公司層級的資本水準與監管要求的比較情況）總計為 305%，比州最低要求高出 50% 以上。

In November, we closed a bond offering of $850 million of senior notes due 2031. The proceeds were used to repay the outstanding term loans and general corporate purposes. Debt at the end of the year was 3.7 times trailing 12 month EBITDA and our debt-to-cap ratio was about 49%. Based on our current guidance, we took action to address any issues with our debt covenants.

11 月，我們完成了 8.5 億美元的 2031 年到期高級票據的債券發行。所得款項用於償還未償還的定期貸款和一般公司用途。年末債務是過去 12 個月 EBITDA 的 3.7 倍，債務資本比率約為 49%。根據我們目前的指導原則，我們採取了行動來解決債務契約中存在的任何問題。

We have secured an agreement with our bank syndicate to appropriately amend these metrics. Our operating cash flow for the full year 2025 was an outflow of $535 million due to the settlement of Medicaid risk corridors, the timing of tax payments and lower operating performance in the second half of the year.

我們已與銀行財團達成協議，對這些指標進行適當修改。由於醫療補助風險走廊的結算、稅款支付的時間以及下半年的營運業績下降，我們 2025 年全年的營運現金流為 5.35 億美元流出。

Turning to reserves. Days in claims payable at the end of the quarter was 47. We remain confident in the strength and consistency of our actuarial process and our reserve position. Even in this period, a sustaining high trend. Moving to guidance. We project 2026 premium revenue of approximately $42 billion, a 0.8% pretax margin and adjusted EPS of at least $5. Our guidance is lower than the $14 per share initial outlook we provided on the third quarter call due to a number of factors. First, in Medicaid, our full year 2026 MCR guidance is 92.9%.

啟用儲備金。截至季末，應付賠款天數為 47 天。我們對精算流程的穩健性和穩定性以及儲備金狀況依然充滿信心。即使在這一時期，也保持了持續的高趨勢。進入指導環節。我們預計 2026 年保費收入約為 420 億美元，稅前利潤率為 0.8%，調整後每股收益至少為 5 美元。由於多種因素，我們的預期低於我們在第三季電話會議上給出的每股 14 美元的初步預期。首先，在醫療補助方面，我們 2026 年全年 MCR 指引值為 92.9%。

That's 140 basis points higher than previously expected, driving $6.50 of the shortfall. The higher MCR results from several items. The fourth quarter retro revenue items in California, which resulted in $2 per share impact will continue in 2026, yielding 40 basis points of margin pressure across the year.

這比之前預期的高出 140 個基點，造成了 6.50 美元的缺口。較高的MCR值是由多個因素造成的。加州第四季追溯性收入項目導致每股收益減少 2 美元，該項目將持續到 2026 年，全年利潤率將面臨 40 個基點的壓力。

Our Florida CMS contract incepting in the fourth quarter will add 30 basis points of full year pressure as that initial quarter will run significantly higher before reaching target margins as new stores typically do. And expected rates for 2026 are approximately 50 basis points lower than our initial outlook.

我們的佛羅裡達州 CMS 合約將於第四季度生效，這將給全年帶來 30 個基點的壓力，因為新店通常會在達到目標利潤率之前，第一個季度的利潤率會明顯高於預期。預計 2026 年的利率將比我們最初的預測低約 50 個基點。

We previously projected rates exceeding expected trend to improve MCR by 50 basis points off the second half of 2025. While our initial discussions with states were encouraging, particularly in the presence of demonstrated underfunding across most of our markets, the rates we finally received fell short, now matching expected trend off second half with no benefit to the MCR.

我們先前預測利率將超過預期趨勢，到 2025 年下半年，MCR 將改善 50 個基點。雖然我們與各州的初步討論令人鼓舞，尤其是在我們的大多數市場都存在資金不足的情況下，但我們最終獲得的費率卻低於預期，與下半年的預期趨勢相符，對MCR沒有任何好處。

Second, in the items driving our lower EPS guidance, underlying performance in our Medicare business deterred by $1 per share, largely due to the MAPD product. And finally, G&A efficiencies only partly offset a higher effective tax rate interest expense and lower volumes, resulting in a headwind of $1.50 per share. As Joe mentioned, upside components to this guidance include moderation in Medicaid cost trends, off-cycle and late 2026 rate adjustments as we sell in 2025 and Medicare and Marketplace performance.

其次，導致我們下調每股盈餘預期的原因之一是，我們的醫療保險業務基本面表現下降了 1 美元/股，這主要是由於 MAPD 產品的影響。最後，一般及行政效率的提高只能部分抵銷較高的實際稅率、利息支出和較低的銷量，導致每股收益下降 1.50 美元。正如喬所提到的，該指導意見的利多因素包括醫療補助成本趨勢的緩和、2026 年末的非週期性費率調整（因為我們在 2025 年進行銷售）以及醫療保險和市場表現。

Now some additional details on our 2026 guidance, beginning with membership. In Medicaid, we expect year-end membership of approximately 4.6 million members to be flat compared with 2025. We expect modest contraction in our current footprint as some states continue to review membership eligibility to be offset by the implementation of the new Florida CMS contract incepting October of 2026.

現在，讓我們來詳細了解我們 2026 年的指導方針，首先是會員資格方面。在醫療補助方面，我們預計年底會員人數約為 460 萬，與 2025 年相比將持平。我們預計，隨著一些州繼續審查會員資格，我們目前的業務規模將略有縮減，但隨著新的佛羅裡達州 CMS 合約於 2026 年 10 月開始實施，這一縮減將被抵消。

In Medicare, we expect to begin and end 2026 with approximately 230,000 members based on open enrollment and transition to our integrated tools products. In Marketplace, we expect approximately 280,000 members at the end of the first quarter, down more than 50% from the end of 2025.

根據開放註冊和向我們的整合工具產品過渡的情況來看，我們預計 Medicare 在 2026 年初和年底將擁有約 230,000 名會員。在 Marketplace，我們預計第一季末會員人數約為 28 萬，比 2025 年底減少 50% 以上。

Recall that we sought to stabilize margins in 2026 and reduce our exposure to the shifting risk pool caused by the expiration of enhanced subsidies and new program integrity initiatives. Our average pricing increased 30% and range from 15% to 45% across our footprint. Renewing members now represent 70% of our current book and retention through the grace periods is less certain than in prior years. We expect to end the year with 220,000 members.

請記住，我們力求在 2026 年穩定利潤率，並降低因強化補貼到期和新的專案誠信措施而導致的風險池變化所帶來的風險敞口。我們的平均價格上漲了 30%，漲幅在 15% 到 45% 之間。續訂會員目前占我們現有會員總數的 70%，但透過寬限期留住會員的幾率不如往年那麼高。我們預計到年底會員人數將達到 22 萬人。

Our 2026 premium revenue guidance is approximately $42 billion. The small decline versus 2025 is driven by several items. Medicaid is up $1.1 billion due to the new Florida CMS contract and the modest rate cycle, partially offset by the Virginia contract loss in 2025 and slight market contraction in our current footprint.

我們預計 2026 年保費收入約為 420 億美元。與 2025 年相比的小幅下降是由幾個因素造成的。由於佛羅裡達州 CMS 新合約和溫和的費率週期，醫療補助計劃增加了 11 億美元，但弗吉尼亞州 2025 年合約的損失以及我們當前業務範圍內的輕微市場萎縮部分抵消了這一增長。

Medicare is up $300 million due to the product mix shift in our Medicare portfolio as members transition to new integrated products, which have a higher average [PMPM]. This is partly offset by a decline in our MAPD product. Finally, Marketplace premium declined $2.3 billion pursuant to the plan to reduce exposure to that segment.

由於會員逐漸過渡到平均收益更高的新型綜合產品，我們醫療保險產品組合的調整導致醫療保險收入增加了 3 億美元。[PMPM]。我們的 MAPD 產品銷售下降，部分抵消了這種影響。最後，根據減少對該領域風險敞口的計劃，市場保費減少了 23 億美元。

Our 2026 premium guidance does not include the Georgia Medicaid and Texas STAR CHIP contracts, which are now expected to go live in 2027. Turning to earnings guidance within our segments. In Medicaid, we expect a pretax margin of 1.2% on $33.4 billion of premium. The MCR of 92.9% includes a 30 basis point headwind due to the new Florida CMS contract. I'll remind you that our Medicaid MCR guidance assumes year-over-year rates of approximately 4% and trend of 5%.

我們 2026 年的保費指導不包括佐治亞州醫療補助計劃和德克薩斯州 STAR CHIP 合同，預計這些合同將於 2027 年生效。接下來，我們來看看各業務板塊的獲利預期。在醫療補助計劃中，我們預計保費收入為 334 億美元，稅前利潤率為 1.2%。92.9% 的 MCR 包含了由於新的佛羅裡達州 CMS 合約而導致的 30 個基點的不利因素。我提醒各位，我們的 Medicaid MCR 指導原則假設年增長率約為 4%，趨勢為 5%。

In Medicare, we expect $6.6 billion of premium revenue with the MCR at 94% and pretax margin of negative 1.7%. Excluding the MAPD product, which we will exit for 2027, the pretax margin is closer to breakeven. Within the segment, margin improvements in the legacy products in the new rate cycle are offset by MMP members transitioning to new integrated products. These integrated products are expected to achieve lower margins in their first year before reaching their full margin potential in years two and years three. In Marketplace, we project a 1.7% pretax margin on $2.2 billion of premium revenue.

在醫療保險方面，我們預計保費收入為 66 億美元，MCR 為 94%，稅前利潤率為 -1.7%。除去我們將於 2027 年退出的 MAPD 產品，稅前利潤率更接近損益平衡點。在該細分市場中，新費率週期內傳統產品的利潤率提高被 MMP 成員向新的綜合產品過渡所抵消。這些一體化產品預計在第一年利潤率較低，然後在第二年和第三年達到其全部利潤潛力。在市場方面，我們預計保費收入為 22 億美元，稅前利潤率為 1.7%。

The MCR of 85.5% reflects continued conservatism given market volatility and risk pool acuity shifts resulting from the expiration of enhanced subsidies. We expect the adjusted G&A ratio at 6.4%. This is slightly lower than 2025 as the tailwind from duals contract implementation costs, cost management discipline and mix within our business is partly offset by the Florida CMS contract implementation costs and the return of management incentive compensation.

85.5% 的最低資本要求反映了市場波動和風險池敏銳度因強化補貼到期而發生的變化，體現了持續的保守主義。我們預計調整後的管理費用比率為 6.4%。這比 2025 年略低，因為雙重合約實施成本、成本管理紀律和我們業務組合帶來的利多因素部分被佛羅裡達州 CMS 合約實施成本和管理層激勵性薪酬的返還所抵消。

Rounding out the other guidance metrics, we expect the effective tax rate at 30% and weighted average share count of 51.1 million shares. Our earnings seasonality is expected to be much more front-end loaded this year with two third of earnings in the first half of the year, reflecting the Medicaid rate cycle and the implementation of Florida CMS in the second half.

其他指導指標方面，我們預計實際稅率為 30%，加權平均股份數為 5,110 萬股。今年我們的收益季節性預計將更加集中在前期，三分之二的收益將在上半年實現，這反映了醫療補助費率週期以及佛羅裡達州醫療保險和醫療補助服務中心（CMS）在下半年的實施。

Our Medicare and Marketplace segments are expected to follow normal seasonal patterns. Turning to embedded earnings. At the end of 2025, we reported $8.65 of new store embedded earnings. Our 2026 guidance harvest $0.60 for Medicare tools implementation costs net of the Virginia contract loss. Updates include the addition of the new Ford CMS contract of $4.50 and a reduction for the MAPD exit.

預計我們的聯邦醫療保險和市場業務部門將遵循正常的季節性規律。轉向內含收益。截至 2025 年底，我們報告了 8.65 美元的新店嵌入式收益。我們 2026 年的指導意見預計，扣除維吉尼亞州合約損失後，Medicare 工具實施成本淨額將為 0.60 美元。更新內容包括新增福特 CMS 新合同，金額為 4.50 美元，以及 MAPD 退出成本的降低。

Embedded earnings now exceed $11 per share and form a compelling view of long-term future earnings power on top of our legacy business rate recovery. We will outline the components and expected realization time line at our May Investor Day.

目前，每股內含收益已超過 11 美元，這為我們未來的長期獲利能力提供了令人信服的前景，而這又建立在我們傳統的商業稅率回收之上。我們將在五月的投資者日上詳細介紹各項組成部分和預期實現時間表。

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

我們的發言稿到此結束。操作員，我們現在可以開始接受提問了。

(Operator Instructions)

（操作說明）

Joshua Raskin, Nephron Research.

Joshua Raskin，腎單位研究。

Sort of a two-parter on the Medicaid side. Is there a large variance that remains across your states with regard to Medicaid margins? And are you at the point in any state where you're contemplating a potential exit? And sort of part b would be, what were the drivers of the negative retro adjustments in California that seems incongruous with what you were seeing in terms of rate increases and margins?

醫療補助方面的情況大致分為兩部分。你們各州在醫療補助利潤率方面是否有較大差異？你是否已經到了考慮退出的地步？第二部分是，加州出現負向追溯調整的原因是什麼？這似乎與你所看到的利率上漲和利潤率不符。

Is California just a market that happen to be running higher than average margins?

加州市場是不是恰好利潤率高於平均？

Josh, on part A of your question, no. Rates are generally underfunded across the universe of our portfolio and there's no state where the regulatory environment is so unfriendly to managed care in the rating environment that we are contemplating an exit.

Josh，關於你問題的A部分，答案是否定的。在我們投資組合的所有項目中，費率普遍資金不足，而且沒有任何一個州的監管環境對評級環境中的管理式醫療過於不友好，以至於我們考慮退出。

We believe, as we've said in our prepared remarks, that these will come back into equilibrium over time for many, many reasons, which I'll cover in a moment. To your second question, the two issues in California were very situational. They were event-driven.

正如我們在準備好的演講稿中所說，我們相信，隨著時間的推移，由於諸多原因，這些因素最終會恢復平衡，我稍後會詳細介紹。關於你的第二個問題，加州的兩個問題都是具體情況不同的。他們是事件驅動型的。

The undocumented population, which we serve, I think, 180,000 members for a lot of (inaudible), which are pretty obvious, did not use services during the year that we're priced to. And therefore, the state decided to, call it, claw back due to the introduction of a retroactive corridor.

我們服務的無證移民群體，我認為有 18 萬名成員，其中很多人（聽不清楚），這很明顯，他們在我們定價的年份裡沒有使用我們的服務。因此，由於引入了追溯性走廊，該州決定進行所謂的「追回」。

And in L.A. County -- separately in L.A. County, there was a dramatic shift of churn in the membership roles during the year, which caused a disequilibrium and risk profile amongst the various carriers -- they did a risk adjustment update at the end of the year, moved money around, and we had to pay it back.

洛杉磯縣——洛杉磯縣的情況比較特殊——會員人數在一年內發生了劇烈的變化，導致各保險公司之間出現失衡和風險狀況——他們在年底進行了風險調整更新，調動了資金，我們不得不把錢還回去。

Mark, anything to add on those two items?

馬克，關於這兩點還有什麼要補充的嗎？

No, Joe, I think that's well summarized. Josh, it's about $135 million between those two items. That's the $2 per share. And they're both pretty unusual in nature. On the corridor from the undocumented immigration status normally, CMS has a rule that they can't put retro corridors in place.

不，喬，我覺得總結得很好。喬什，這兩項加起來大約是 1.35 億美元。那就是每股 2 美元。它們本質上都相當不尋常。對於從無證移民身分開始的過渡，CMS 通常有一條規定，即他們不能設立追溯性過渡通道。

That rule went back in place during the pandemic. However, since this undocumented program in California is state funded, it doesn't -- the CMS restriction doesn't apply. So they were able to put that restriction in place on the corridor on that population. So I don't know of another state where that could happen. On the risk adjustment, risk adjustment data refreshes are common.

疫情期間，這條規定重新生效。然而，由於加州的這項未記錄在案的項目是由州政府資助的，因此它不受 CMS 限制的約束。因此，他們得以對該走廊沿線的人口實施限制。所以我不知道還有哪個州會發生這種事。關於風險調整，風險調整資料更新是常見現象。

We have them all the time. Normally, they're de minimis up or down. In this case, there was enough change in the population in LA, as Joe mentioned, that it was material to us.

我們常有這種情況。通常情況下，它們的上下波動幅度微乎其微。正如喬所提到的那樣，洛杉磯的人口發生了相當大的變化，這對我們來說意義重大。

And one final point, Josh, you didn't ask, but inherent in the movement from our $14 per share outlook and $5 per share guidance, we pulled through that California effect to 2026 because we believe those same situations will apply to the 2026 operation. So we pulled it through a lot of conservatism.

最後還有一點，Josh，你沒問，但我們從每股 14 美元的預期和每股 5 美元的指導調整中，已經考慮到了加州的影響，並將這種影響延續到了 2026 年，因為我們相信同樣的情況也會適用於 2026 年的運營。所以我們克服了許多保守主義的阻力才得以實現。

A.J. Rice, UBS.

A.J. Rice，瑞銀集團。

Just want to think a little bit more about what you're seeing in the Medicaid book. We've heard some of the other companies talk about states working with them to allow them to make adjustments to benefit design in addition to just absolutely hoping for a better rate update.

我想再仔細思考你在醫療補助手冊中看到的內容。我們聽說其他一些公司正在與各州合作，允許他們調整福利設計，此外，他們也絕對希望獲得更好的費率更新。

Are you seeing any of that play out? And you're saying you're going to bottom in Medicaid in 2026 and recover. Obviously, some of the Big Beautiful Bill, work rules, et cetera, kicking in '27. Does that -- you're confident you can overcome that and still show margin improvement in '27 and beyond?

你看到這些情況有發生嗎？你的意思是說，你們會在 2026 年跌至 Medicaid 的谷底，然後東山再起。顯然，一些《大而美麗的法案》、工作規則等等，將於 27 年生效。也就是說——您有信心克服這些困難，並在 2027 年及以後繼續保持利潤率的提高嗎？

A.J., let me answer the second question first, and I'll come back to benefit design. But the context is even in what we consider to be a trough environment in Medicaid, we are operating at low single-digit margins, 2% in the fourth quarter, 1.6% adjusted for [Florida Kids] in 2026.

A.J.，讓我先回答第二個問題，然後再回到福利設計的問題。但即便在我們認為的醫療補助低迷時期，我們的利潤率也只有個位數，第四季為 2%，2026 年經 [佛羅裡達州兒童] 調整後為 1.6%。

By analysis of the regulatory filings and other public company reports, the market appears to be 300 basis points to 400 basis points underfunded. If we get even partially way there, we're back flirting with our target margins in Medicaid, number one. Number two, don't forget that last year, we got 150 basis points of mid-cycle updates.

透過對監管文件和其他上市公司報告的分析，市場似乎資金缺口達 300 至 400 個基點。如果我們能部分實現這個目標，那麼我們就能再次接近我們在醫療補助計劃中的目標利潤率，這是第一點。第二，別忘了去年我們獲得了 150 個基點的週期中期調整。

Now it wasn't enough to offset a 300 basis point increase in trend during the year, but states are recognizing that aspects of this program are underfunded. Next point on rates. Generally speaking, the states are using a 2024 cost baseline.

雖然這不足以抵消年內 300 個基點的成長趨勢，但各州已經意識到該計劃的某些方面資金不足。接下來是關於利率的問題。總的來說，各州採用的是 2024 年的成本基準。

That baseline does not include the full impact of what we're calling the great inflection here over the last two years. When the 2025 cost baseline fully developed begins to be used as the baseline off of which the trend rates will become stronger.

這條基準線並未包含我們稱之為過去兩年來「大轉折點」的全部影響。當 2025 年成本基準完全制定完成後，將開始用作趨勢率的基準，在此基礎上趨勢率將會更加強勁。

Next point, discrete rating factors. LTSS benefits, pharmacy benefits and behavioral, all trending up, and those are very discrete rating components, very transparent. Actuaries can debate and have clinical and actuarial debates over how those costs are being burned into rates in a very transparent way.

接下來是離散評分因子。長期照顧服務福利、藥品福利和行為健康福利都在上升，這些都是非常獨立的評級組成部分，非常透明。精算師可以就這些成本如何以非常透明的方式計入費率進行辯論，並進行臨床和精算的辯論。

And lastly, in 2025, we are experiencing the tail end of the redetermination acuity shift, 250 basis points to our estimation that will not recur in 2026. But to your point, in '27, '28 and '29, we will begin to see the emergence of perhaps a small acuity shift related to [OBBB].

最後，2025 年，我們將經歷重新評估視力敏銳度變化的尾聲，據我們估計，變化幅度為 250 個基點，這種情況在 2026 年不會再次發生。但正如您所說，在 2027 年、2028 年和 2029 年，我們將開始看到與此相關的輕微敏銳度轉變的出現。[OBBB]。

Mark, do you want to take that part?

馬克，你想演那個角色嗎？

I think that's well covered. Across the next three years, we see any place between 2% and 4% annual impact on One Big Beautiful Bill. But that's also before any influx of new members, as you've typically had in the past, or even a recessionary impact as jobs are lost to AI and who knows what else. So the outlook, I think, if there's membership decline over the next three years is rather small.

我覺得這方面已經涵蓋得很全面了。在接下來的三年裡，我們預計「一項偉大的法案」每年將受到 2% 到 4% 的影響。但這還不包括像過去那樣湧入的新成員，也不包括人工智慧和其他因素導致工作流失而造成的經濟衰退影響。所以我認為，如果未來三年會員人數下降，前景相當渺茫。

And as Joe always says, the small changes in membership or cohorts don't really get you because they sort of even out with everything else going on and rates do adequately reflect them.

正如喬常說的那樣，會員或群體的微小變化並不會真正影響到你，因為它們會與其他所有事情相互抵消，而且費率也充分反映了這些變化。

It's the big jumps in population that are problematic like the 20% decline we had in the pandemic with redetermination. So I don't really see a meaningful impact on membership here going forward, either in magnitude or impact on acuity.

人口的大幅成長才是問題所在，例如疫情期間人口因重新評估而下降了 20%。因此，我認為無論從規模或對會員素質的影響來看，未來會員人數都不會受到實質的影響。

A.J., the first part, part of your question was about benefit design. We're seeing some of that. During the pandemic, states really loosened the utilization control requirements on things like behavioral health. They were paying for -- they required us to pay for GLP-1s for weight loss and not accompanied by diabetes diagnosis. Those things are starting to close up.

A.J.，你問題的第一部分是關於福利設計的。我們已經看到了一些這樣的情況。疫情期間，各州大幅放寬了對心理健康等領域的醫療資源使用控制要求。他們要求我們付費購買 GLP-1 類藥物來減肥，但並沒有診斷出糖尿病。這些地方開始關閉了。

States are reintroducing our ability to have tighter utilization control global behavioral. And most of our states, I think, 12 out of 15, now have a diagnosis requirement, diabetes diagnosis requirement for GLP-1s. There's things like that. But I wouldn't say there's a wholesale shift to benefit design. It's on the margin, and it's sporadic from geography to geography.

各國正在重新引入我們對全球行為進行更嚴格利用控制的能力。我認為，我們大多數州（15 個州中有 12 個）現在都有 GLP-1 的診斷要求，即糖尿病診斷要求。諸如此類的事情還有很多。但我不會說福利設計方面已經發生了全面轉變。它處於邊緣地帶，並且在不同的地理位置之間零星分佈。

Justin Lake, Wolfe Research.

賈斯汀·萊克，沃爾夫研究公司。

I wanted to ask Joe about your attrition assumption in 2026. Looks like you're assuming down about 2% membership attrition, and that's offset by, I think, 100,000 members in Florida coming on. Let me know if I'm wrong on that. But 2% versus what it appears some of your peers are talking about mid- to high single digits, it looks like you had some pretty significant attrition just in the last quarter.

我想問喬，你對2026年的人員流失率有什麼假設。看來你預期會員流失率會下降約 2%，但我認為，佛羅裡達州新增的 10 萬會員可以抵銷這項影響。如果我理解有誤，請告訴我。但是，2% 的流失率，而你的一些同業似乎都在談論個位數中高段位的流失率，看來你上個季度的人員流失率相當高。

Why are you assuming that attrition is going to be so modest next year relative to what you're seeing just in the last quarter or two and what some of your peers are talking about?

為什麼你認為明年的員工流動率會比過去一兩個季度以及一些同業所說的要低得多？

And then maybe you could talk about if you do see attrition hire, would we assume that, that would impact risk pool and cost trend?

然後，或許您可以談談，如果您發現人員流失導致招募減少，我們是否可以假設這會影響風險池和成本趨勢？

Sure. Going back a little bit historical here is clinical data. The industry and Molina on a same-store basis, not counting our new store growth, lost 20% membership organically over the past number of years. It is 13% in 2024, 4% in 2025. And now we're projecting it to be 2%.

當然。讓我們稍微回顧一下歷史，這裡有一些臨床數據。過去幾年，產業和 Molina 在同一家門市的基礎上（不計新店成長），會員人數自然減少了 20%。2024年為13%，2025年為4%。現在我們預測這一比例為 2%。

We believe that the redetermination effects are largely over. We're feeling the tail end of that. And now it's just about program integrity. It's about tightening up on -- before [OB3] kicks in, that will kick in for '27 to '28. So we're talking about '26.

我們認為重新選舉的影響基本上已經結束。我們正在感受到那股浪潮的尾聲。現在，一切都關乎程式的完整性。這是為了加強——在[OB3]生效之前，這將在2027年到2028年生效。所以我們說的是26年。

Due to just more rigor around the enrollment process, the redetermination process, we believe that 4% we experienced in 2025, which is exact -- that's the exact number will fall to 2% next year. Now if we're wrong, it ends up being a little higher, Mark -- I'll kick it to Mark here in a minute. We've done an exhaustive analysis of low users. And it depends on what your definition is over what period of time what's a lower-than-average loss ratio.

由於入學流程和重新評估流程更加嚴格，我們相信 2025 年的 4%（準確來說是 4%）明年將降至 2%。如果我們錯了，結果可能會更高一些，馬克——我一會兒把這個問題拋給馬克。我們對低用戶群體進行了詳盡的分析。這取決於你對低於平均的損失率的定義，以及在多長時間內低於平均的損失率才算低於平均。

Everybody doesn't use services at 90% of premium. Some use a lot more, some us a lot less. And so your question you're asking is, if we won about it, is there an acute shift coming and we don't think so.

並非所有人都以90%的優惠價格使用服務。有些人用量很大，有些人用量很小。所以你的問題是，如果我們贏了，是否會出現劇烈的變化，我們認為不會。

Mark, do you want to take that?

馬克，你想拿嗎？

Joe, that's well summarized across the board. So Justin, to your framing question, yes, we're 4.6% roughly flat across the beginning of the year to the end of the year. That's a 2% decline organically offset by Florida. So you got that exactly right. And then to Joe's point, the market is down about 20% since the start of redetermination.

喬，你總結得很好。所以賈斯汀，對於你提出的問題，是的，從年初到年末，我們的成長率大致保持在 4.6% 左右。這相當於2%的自然下降，但佛羅裡達州的成長抵消了這一降幅。你答對了。正如喬所說，自重新評估開始以來，市場已經下跌了約 20%。

We've done exhaustive cohort analysis of who were the joiners, who were the levers. And it's really interesting. Of the people that left since the start-up redetermination we estimate about 5% fewer people in our population are low users or no users.

我們對參與者和推動者進行了詳細的隊列分析。這真的很有意思。自啟動重新評估以來離開的人員中，我們估計我們的人口中低用戶或非用戶減少了約 5%。

So if you look at any given quarter, how many folks didn't use it all, or used very low, say, $200 PMPM, something like that, that population is now 5% smaller within our current population than it was two years ago. That's not the only impact.

所以，如果你看一下任何一個季度，有多少人沒有用完所有額度，或者只用了很少的額度，比如每月 200 美元之類的，那麼這部分人群在我們目前的人口中比兩年前減少了 5%。這並非唯一的影響。

Many of the cohorts changed around, but that's the one that kind of grab your attention. So that's a lot of what's driving trend over the last two years as that mix shift happens, I think Joe referred to it in his prepared remarks. So going forward, most of those people are out now as a result of that. The low users and no users that were on there when redetermination was suspended mostly are gone now.

許多群體都發生了變化，但這個群體最能吸引人們的注意。所以，過去兩年來，隨著這種組合轉變的發生，這在很大程度上推動了趨勢的發展，我認為喬在他的準備好的演講稿中也提到了這一點。因此，接下來，這些人中的大多數都因此而出局了。在重新評估暫停期間，那些用戶很少甚至沒有用戶的用戶大多已經消失了。

So on a go-forward basis, we're estimating 2% attrition across the year organically, which is a relatively small number. Even if it's a little bit bigger -- the big driver of acuity shift or trend is those low users and no users, and those are mostly out of the system now.

因此，展望未來，我們預計全年自然流失率為 2%，這是一個相對較小的數字。即使規模稍大——影響用戶數量或趨勢的主要因素是低用戶和無用戶，而這些人現在大多已經脫離了系統。

Stephen Baxter, Wells Fargo.

史蒂芬‧巴克斯特，富國銀行。

I was hoping if you could update us on the size of your Medicaid expansion enrollment both, I guess, enrollment and premiums would be great. And as we think about dimensioning the attrition that you saw throughout the course of 2025, how much of that came from Medicaid expansion versus other sources, other program types?

我希望您能告知我們貴公司醫療補助計劃擴容的參保人數，包括參保人數和保費情況，那就太好了。當我們思考如何衡量 2025 年期間出現的人員流失情況時，其中有多少是由於醫療補助計劃的擴大，又有多少是由於其他來源、其他類型的計劃造成的？

Just sizing Medicaid expansion, Mark will correct me, but I'll go from memory here. Medicaid expansion population is about 1.3 million members and about $8 billion of the $32 billion of premium. Now when we're talking about [OB3] work requirements, semiannual determination -- semiannual redeterminations, et cetera, we still predict losing about 15% to 20% at the high end of that population, which is only 25% of the total Medicaid book.

我只是在估算醫療補助計畫的擴張規模，馬克會糾正我的，但我這裡憑記憶說的就好。醫療補助計劃擴大覆蓋的人群約 130 萬名成員，保費約佔 320 億美元中的 80 億美元。現在，當我們談到 [OB3] 工作要求、半年一次的確定——半年一次的重新確定等等時，我們仍然預測，在該人群的高端部分，我們將損失大約 15% 到 20% 的份額，而這僅佔醫療補助計劃總人數的 25%。

And as Mark said, when you're trying to calculate or estimate whether that causes a huge acuity shift, the fact that, that cohort is operating closer to the mean of portfolio average is a meaningful statistic. Mark, do you want to talk about the attrition in that population?

正如馬克所說，當你試圖計算或估計這是否會導致巨大的敏銳度變化時，該群體更接近投資組合平均值的均值這一事實是一個有意義的統計數據。馬克，你想談談這個群體的人口流失問題嗎？

Sure. We definitely see more people coming out of expansion due to the OBB, just because that's where the policies are aimed, but that's also where you have more volatility in the population. As Joe mentioned, if you lose 15% to 20% of the folks in expansion, one, it's a quarter of our overall Medicaid population; and two, if it happens over three years, it's even smaller as an impact on the overall book.

當然。由於 OBB 政策，我們看到更多的人從擴張階段退出，因為政策的目標就是擴張階段，但同時擴張階段的人口波動性也更大。正如喬所提到的，如果在擴容期間損失 15% 到 20% 的人，第一，這相當於我們醫療補助計劃總人口的四分之一；第二，如果這種情況在三年內發生，那麼對整體的影響就更小了。

So could be an impact there over time. But annually, I don't think it's meaningful. And again, if all folks are more gathered around the average MLR, the impact shouldn't be meaningful.

所以隨著時間的推移，可能會產生影響。但從年度角度來看，我認為這意義不大。再說一遍，如果所有人的水平都更接近平均MLR，那麼這種影響應該不會有太大意義。

Kevin Fischbeck, Bank of America.

凱文‧菲施貝克，美國銀行。

Great. Just trying to understand a couple of things. First, I guess, in your commentary around 2026 guidance, you listed a number of positive potential levers to upside. There were no negative dynamics that you're thinking of. Obviously, things have been difficult the last couple of years to predict.

偉大的。我只是想弄清楚幾件事。首先，我想，您在 2026 年業績展望的評論中，列出了一些可能帶來上漲的正面因素。你所想到的負面因素並不存在。顯然，在過去幾年裡，事情的發展很難預測。

I was wondering if there's anything that you would highlight as something you were watching? And then just -- if you could just follow up on the commentary around risk pool shifts. Obviously, you said last year was 250 basis points of pressure on 4% membership, and now you're saying 2% membership is zero. So if you could just kind of square that a little bit better?

我想知道你最近有沒有特別想看的節目或影片？然後——如果您能跟進一下關於風險池轉移的評論就好了。顯然，你去年說4%的會員人數面臨250個基點的壓力，現在又說2%的會員人數為零。所以，如果你能把這個問題稍微解釋得更清楚一點就好了？

On the last point, yes, we've been asked that before. It's not linear, and it's not proportional. And the reason is, as Mark just described, it matters how many low and no users you actually have in your population. So if your supposition is it 4% created 250 basis points of pressure, why does it 2% create 125 basis points of pressure because largely speaking -- not largely speaking, the low and no user population as we define it, is down 5%. So people are operating closer to the mean MOR rather than the SKUs.

關於最後一點，是的，我們之前被問過這個問題。它並非線性關係，也不是成比例關係。原因正如馬克剛才所描述的那樣，你的用戶群中實際有多少低活躍用戶和無活躍用戶非常重要。所以，如果你的假設是 4% 的下降造成了 250 個基點的壓力，那麼為什麼 2% 的下降只造成了 125 個基點的壓力呢？因為從總體上來說——或者說從總體上來說——我們定義的低用戶和無用戶群體下降了 5%。因此，人們更傾向於關注平均 MOR 而不是 SKU。

On the 2026 guide, I mean, suffice it to say, anything that is potentially upside is potentially downside. But we believe the rates at 4% of our floor -- we got 150 basis points of release last year and midyear. So we don't think there's downside to rates. We think it's all upside. Now medical costs trended 5%, medical costs is up 20% over the last three-year period, baseline medical costs. And now we're trending in 2026 comparable to 2025 without the acuity shift.

至於 2026 年的指導方針，我的意思是，總而言之，任何可能上漲的因素都可能下跌。但我們相信，4% 的利率是我們最低利率的目標——去年和年中我們獲得了 150 個基點的釋放。所以我們認為利率沒有下行風險。我們認為一切都是利好消息。現在醫療成本趨勢為 5%，過去三年醫療成本上漲了 20%，這是基準醫療成本。現在，我們預期 2026 年的趨勢與 2025 年的趨勢相當，只是沒有出現敏銳度變化。

Same trend number, 5%. Is there downside? Sure, you could (inaudible) about it. But we believe that we have a reasonable -- a reasonably conservative trend assumption. The 4% rate (inaudible), it's all upside from there on midyear on and off-cycle rate increases.

趨勢數值相同，為 5%。有什麼缺點嗎？當然，你可以（聽不清楚）談論這件事。但我們認為我們有一個合理的——一個相當保守的趨勢假設。4%的利率（聽不清楚），從那以後，年中和非週期性利率上漲都將帶來持續的成長。

And the reason we say there's upside to Marketplace and Medicare is because we were priced more conservatively than we're guiding to. Our pricing targets are low single-digit margins. As Mark said, we're expecting a 1.7% negative margin in Medicaid, and I think a positive 1.7% margin in Marketplace. Those could end up being higher. But could they be lower?

我們之所以說市場和醫療保險有上漲空間，是因為我們的定價比我們預期的要保守得多。我們的定價目標是實現個位數低利潤率。正如馬克所說，我們預計醫療補助計劃的利潤率為負 1.7%，而我認為市場計劃的利潤率為正 1.7%。最終結果可能會更高。但價格還能更低嗎？

Mark, anything to add there?

馬克，你還有什麼要補充的嗎？

And just to begin, the 1.7% was Medicare, not Medicaid.

首先要說明的是，這 1.7% 指的是聯邦醫療保險（Medicare），而不是聯邦醫療補助（Medicaid）。

Medicare, sorry. Medicare.

抱歉，聯邦醫療保險（Medicare）。醫療保險。

The only other thing, Kevin, which might have been obvious to you, but the impact of -- on the cohorts of the low users and no users coming out isn't when they come out. It's the subsequent period, right? So if they come out in '24, you'll feel that in your trends in '25 because it's the year-over-year impact. It's not the day they come out.

還有一點，凱文，這可能對你來說很明顯，但——對低用戶群體和無用戶群體的影響，並不在於他們何時出現。是接下來的時期，對吧？所以如果它們在 2024 年推出，你會在 2025 年的趨勢中感受到這一點，因為這是同比的影響。不是他們出獄的日子。

So if you're putting that all together, Joe mentioned it was 4% membership decline in '25 but the much bigger decline in '24 of 13% is would put the pressure on '25. So now that only 4% came out in '25, the implied rollover to '26 is much lower. More to the point, a lot of the low users, no users are already out of the system. So it's really a declining impact.

所以，如果你把所有這些因素綜合起來考慮，喬提到 2025 年會員人數下降了 4%，但 2024 年下降幅度更大，達到 13%，這將給 2025 年帶來壓力。既然 2025 年只有 4% 的人口出生，那麼 2026 年的預期出生率就會低得多。更確切地說，許多低用戶數甚至零用戶數的用戶已經從系統中移除。所以它的影響其實是在下降的。

Ann Hynes, Mizuho.

安海恩斯，瑞穗。

I just want to follow up on your trend assumptions. Obviously, trend has been very difficult, up 7.5% this year. But why do you have confident trend only increasing 5%? Is it a large number? Is there a sort of an area that you already see decreasing?

我只是想就您之前的趨勢假設做個後續說明。顯然，趨勢非常艱難，今年僅上漲了7.5%。但為什麼你們的預測是成長趨勢只有 5%？數字很大嗎？您是否已經觀察到某些領域的成長正在放緩？

Is it more utilization management? Just from our seats, this industry has underwritten all businesses (inaudible) for three years. So when I just see a 5% trend going forward, for me personally, I would like more than just saying like trend has to come down at some point.

這是否屬於利用率管理？僅從我們目前的處境來看，這個行業已經為所有企業（聽不清楚）提供了三年的資金支持。所以，當我看到未來 5% 的趨勢時，就我個人而言，我希望得到的不僅僅是「趨勢總有一天會下降」這樣的說法。

That doesn't make sense to me. So if I could -- if we could have some more detail on specific state actions that utilization management, anything more than -- I personally just like more detail on why you think the rates -- the trend will only grow 5%?

我不明白。所以，如果可以的話——如果我們能得到更多關於具體州政府在利用率管理方面所採取的行動的細節，任何比——我個人只是想知道你為什麼認為利率——這種趨勢只會增長 5% 的細節？

Well, thanks for the question. And of course, it is a key assumption in our outlook through 2026. Context, we had a 7.5% trend in '25 off of '24. With perfect hindsight, 2.5 percentage points of that was related to the redetermination related acuity shift as we've just been describing and a couple of questions that were asked. So core trend is 5%.

謝謝你的提問。當然，這也是我們對2026年展望的關鍵假設。背景：2025 年比 2024 年成長了 7.5%。事後看來，其中 2.5 個百分點與我們剛才描述的重新評估相關的視力變化以及提出的幾個問題有關。所以核心趨勢是5%。

Core trend includes every impact. Supply -- it's a supply and demand economy. It includes the higher acuity of the American population that we serve. It includes any upcoding or aggressive billing from providers. 5% is what we experienced in 2025.

核心趨勢涵蓋所有影響。供給——這是一個供給和需求經濟。這包括我們所服務的美國人口較高的認知能力。這包括醫療服務提供者的任何過度編碼或惡意收費行為。 5%是我們2025年實際經驗的比例。

And again, it's off a cost base that's increased 20% over the past three years. It's 50% higher than historical averages. Medicaid trend over the last 10 years,15 years has been 2% to 3%. We're seeing BH behavioral health services now nearly 20% prevalence -- of BH diagnosis is now 20% prevalent in our population, up from 17% to 18% three years ago. Why is that important?

而且，其成本基數在過去三年成長了 20%。比歷史平均高出50%。過去 10 到 15 年的醫療補助趨勢為 2% 到 3%。我們現在看到 BH 行為健康服務的普及率接近 20%——BH 診斷在我們人群中的普及率現在為 20%，高於三年前的 17% 至 18%。為什麼這很重要？

It's trending at 9%, and the BH services themselves are trending at 18%. Our pharmacy trend, 13%. Top 10 therapeutic classes trending at 36%. These are in the 5% number. LTSS hours, (inaudible) admits, professional office visits up 16% and the number of services, the number of procedures per office is dramatically higher this year than it was in the last two.

它的趨勢是 9%，而 BH 服務本身的趨勢是 18%。我們的藥局趨勢，13%。十大熱門治療類別，使用率達 36%。這些都屬於前5%的範疇。LTSS 小時數、（聽不清楚）入院人數、專業門診就診量增加了 16%，服務數量、每個門診的手術數量今年都比過去兩年大幅增加。

So we believe that the 2025 5% number includes a lot of the phenomenon that industry pundits and commentators talk about, and we believe that's a good number off of which to project. Are we seeing signs of, I call it, aggressive billing, but upcoding?

因此，我們認為 2025 年 5% 的數字包含了許多行業專家和評論員談論的現象，我們認為這是一個可以用來進行預測的良好數字。我們是否看到了我稱之為「激進計費」但實際編碼卻被抬高的跡象？

Level 3 is becoming Level 4, Level 5 service intensity, psychiatric hours going from 30-minute visits to 60-minute visits sure. But that's in the 2025 trend. And that's why we think the 2026 number is fully loaded for all the supply and demand dynamics that are being experienced in the market.

3 級服務強度正在從 4 級、5 級提升，精神科就診時間也從每次 30 分鐘增加到 60 分鐘。但那是2025年的趨勢。因此，我們認為 2026 年的數字已經充分考慮了市場正在經歷的所有供需動態。

Andrew Mok, Barclays.

Andrew Mok，巴克萊銀行。

I'll shift focus to the ACA. I wanted to ask how January open enrollment tracked relative to expectations and what's embedded in your membership assumption for (inaudible) and attrition this year? And if possible, it would be great to share how year-to-date (inaudible) are tracking now versus this time last year?

我將把重點轉移到《平價醫療法案》（ACA）上。我想問一下，1 月份的開放註冊情況與預期相比如何？你們對今年的會員人數（聽不清楚）和流失率有什麼假設？如果可以的話，能否分享一下今年迄今為止（聽不清楚）的數據與去年同期相比的追蹤情況？

Sure. We're in real time. I'll give you a global answer and I'll give it to Mark because we're right in the middle of that process now. But as you recall, we ended the year with 650,000 members. We priced up 30% on average, ranging from 15% to 45%, consciously reduced our number one and number two position from 50% of our counties to 15% and reduced our footprint by 20%, conscious effort as we will not allocate capital to an unstable risk pool.

當然。我們正在進行即時直播。我會給你一個整體的答案，也會告訴馬克，因為我們現在正處於這個過程之中。但您可能還記得，我們​​年底有 65 萬名會員。我們平均將價格上調了 30%，漲幅在 15% 到 45% 之間；我們有意識地將我們排名第一和第二的縣的比例從 50% 降低到 15%；並將我們的業務範圍縮小了 20%；這是我們有意識的努力，因為我們不會將資金分配到不穩定的風險池中。

Our speculation or forecast at the time was we would come down into the 200,000 zone, 200,000 to 300,000 and reduce our revenue to $2.2 billion. As we're right in the middle of that story right now, I'll hand it to Mark to give you the latest (inaudible) what we're forecasting and what's likely to happen with retention and effectuation. Mark?

我們當時的推測或預測是，員工人數將下降到 20 萬到 30 萬之間，收入將減少到 22 億美元。我們現在正處於這個故事的中間，我將把麥克風交給馬克，讓他為大家帶來最新的（聽不清楚）預測，以及在留存率和效果方面可能發生的事情。標記？

Andrew, this year, forecasting marketplace members is a little more difficult than in past years. Big picture to get right to the answer to your question. I'm looking for about 280 at the -- 280,000 at the end of the first quarter, which will decline down to 220,000 at the end. The reason it's a little harder this year is new members are real obvious and clear. It's the renewals that are the wildcard.

Andrew，今年預測市場成員數量比往年困難一些。掌握全局，才能直接找到問題的答案。我預計第一季末的銷量約為 28 萬，到季度末將下降到 22 萬。今年難度稍高的原因是新成員非常明顯。續約才是最大的變數。

Now there's some confusion, I think, in the media, they're saying, gee, marketplace members are still quite high. Everyone thought they were going to come down.

現在媒體上出現了一些混亂，我認為，他們說，哎呀，市場會員數量仍然相當高。大家都以為他們會下來。

And what I think some of the media misses is that they're assuming the renewals all stick. Now as partly or fully subsidized people see what their new premium is in January and February, a lot of passive renewals will not renew. They'll go into grace period, not pay and they'll eventually fall off.

我認為有些媒體忽略的一點是，他們假設所有續約都會成功。現在，隨著部分或全部享受補貼的人們在 1 月和 2 月看到他們的新保費是多少，許多被動續保將不會續保。他們會進入寬限期，無需付款，最終會被取消資格。

That will be much bigger in past years, just given the price dynamics in the market. So right now, I think I'm at 280,000 in the first quarter. As Joe mentioned, we're about 70% renewal, about 30% new members.

考慮到市場價格動態，這個數字比往年大得多。所以現在，我認為我第一季的業績是 28 萬。正如喬所提到的，我們的會員續約約為 70%，新會員約為 30%。

And I think the stats you're looking for is on the new members, the effectuation rate, I think it's 60%. Everything is telling me it's about 60%. Historically, I would have thought 70% to 80%. So effectuation is much lower. But remember, that's new members.

我認為您要查找的統計數據是關於新成員的轉換率，我認為是 60%。種種跡象表明，這個比例大約是 60%。從歷史數據來看，我認為應該是 70% 到 80%。因此，實際效果要低得多。但請記住，這些是新成員。

On renewal, I think my renewal tension is more like 30%, whereas in the past, I would have expected more like 60% and that goes right to the dynamic of people possibly renewing seeing their new premium if they're not fully subsidized, which almost no one has and probably not going through the grace period of making the payments and falling off at some point in the first quarter, which is why I give you a March estimate, not a current estimate.

關於續保，我認為續保壓力大概在 30% 左右，而過去我預計續保率會達到 60% 左右。這直接關係到，如果人們沒有獲得全額補貼（幾乎沒有人獲得全額補貼），他們可能會看到新的保費，並且可能不會經歷寬限期，在第一季的某個時候停止繳費。這就是為什麼我給的是三月的預測，而不是目前的預測。

Sarah James, Cantor Fitzgerald.

莎拉詹姆斯，坎托費茲傑拉。

Sticking on the ACA MCR. Can you help clarify went on in fourth quarter? Was there a pull forward of utilization or any category that was running high? And then how do you think about the slope of the MCR curve for 2026, given the attrition and effectuation that you're assuming? Should we think that the peak to trough swing widens maybe by a few hundred basis points on what you've experienced historically?

堅持使用ACA MCR。你能幫忙解釋一下第四季發生了什麼嗎？是否有提前消耗或某些類別消耗量過高的情況？那麼，考慮到你假設的損耗和影響因素，你如何看待 2026 年 MCR 曲線的斜率？我們是否應該認為，根據您過去的經驗，峰值到谷值的波動幅度可能會擴大數百個基點？

Mark?

標記？

Sarah, it's Mark. A couple of things there. What you're calling pull forward, we don't see it. And I've gotten that question a lot. And just for everyone's benefit, the concept of pull forward might be if subsidies are declining and people might drop or lose their coverage in January, would they increase utilization in the fourth quarter in anticipation of that.

莎拉，我是馬克。有兩件事需要說明。你所說的向前推進，我們並沒有看到。我常被問到這個問題。為了大家的利益，提前購買保險的概念可能是，如果補貼減少，人們可能會在 1 月放棄或失去保險，那麼他們是否會在第四季度增加保險使用量以應對這種情況。

And we're just not seeing it. If you look at my MORs, I'm only slightly up Q4 versus Q3 part of which is normal seasonality and a little bit of which is we talked about the out-of-period provider settlements. So you're just not seeing it in the MCR and I'm not seeing it in the utilization.

而我們卻看不到這一點。如果你看一下我的 MOR，你會發現我第四季的業績只比第三季略有成長，其中一部分是正常的季節性因素，還有一小部分是我們之前討論過的非週期性供應商結算。所以你在MCR中看不到它，我在利用率中也看不到它。

Now on next year's seasonality, we're going to have to see exactly what the membership content looks like when it all settles in March. But I would expect a fairly normal seasonality as we've seen in the past. The only thing that might be a little bit different there is metallic mixes are shifting.

至於明年的季節性安排，我們得等到三月一切塵埃落定後，才能確定會員內容的具體情況。但我預計季節性波動會比較正常，就像我們過去看到的那樣。唯一可能略有不同的是金屬混合物的成分發生了變化。

In past years, we were more 70% silver. This year, we're more 50% silver. So with deductibles, co-pays, things like that, you might see some changes based on metallic mix. But I wouldn't think you'll see something much different seasonality than we normally have.

過去幾年，我們的銀含量超過 70%。今年，我們的白銀佔比超過 50%。因此，根據金屬成分的不同，自付額、共同支付額等費用可能會有所變動。但我認為你不會看到和往常有的季節性變化太大。

The only other point I would make is in 2026, we're projecting a much lower special enrollment period addition for the three quarters. And as you know, special enrollment is an invitation to buy insurance when you need it. They usually come in with very high MLRs until they settle down, and the SEP enrollment during the 2026 is forecasted to be much lower than it was in 2025 (inaudible).

我唯一要補充的是，我們預計 2026 年三個季度的特殊入學期新增人數將大幅減少。如您所知，特殊投保是指在您需要時購買保險的邀請。他們通常會有很高的醫療損失率，直到情況穩定下來，預計 2026 年的 SEP 入學人數將比 2025 年低得多（聽不清楚）。

Scott Fidel, Goldman Sachs.

Scott Fidel，高盛集團。

Just so I'm interested in how you're thinking about, let's call it, maybe sort of underwriting around new business development? And I'm putting it that way because that would maybe include both sort of new contracts organically and then also M&A.

所以我很想知道您是如何考慮，我們姑且稱之為，圍繞新業務開發的某種承保方式的？我這樣說是因為這可能既包括自然產生的新合同，也包括併購。

And just around the downturn and sort of the pressures we're see that -- just maybe curious around -- I'm thinking about Florida, for example, your thoughts on pursuing that contract. And then maybe also just talk about how the overall book of M&A that you've built up over the last couple of years, how has that performed, would you say within the overall enterprise relative to, let's say, more of the ongoing operations?

就在經濟低迷時期以及我們看到的各種壓力之際——只是好奇地想問一下——例如，在佛羅裡達州，您對爭取那份合約有什麼看法。然後或許還可以談談您在過去幾年中建立起來的併購業務的整體表現如何，您認為它在整個企業中相對於正在進行的業務而言表現如何？

Scott, first on the new business, we are still actively pursuing new contracts. Our win rate is 80%. $20 billion of run rate revenue over the past number of years, including the Florida Kids contract, which we believe is a very valuable contract. We have proven over time that we expertly handle high acuity, low-income lines, and these are very high acuity situations for young adult, young children in the state of Florida. So we've worked hard for this contract.

史考特，首先說說新業務，我們仍在積極爭取新合約。我們的勝率是 80%。過去幾年，我們的年化收入達到了 200 億美元，其中包括我們認為非常有價值的佛羅裡達兒童合約。隨著時間的推移，我們已經證明我們能夠熟練地處理高風險、低收入家庭的案件，而這些案件對於佛羅裡達州的年輕成年人和幼兒來說，都是非常危急的情況。所以，我們為了這份合約付出了很多努力。

We believe it's accretive. We wouldn't have put $3 of ultimate run rate into our embedded earnings if that wasn't the case.

我們認為它是增值的。如果不是這樣，我們就不會把最終運行率的 3 美元計入我們的嵌入式收益中。

And I want to clarify the start-up here. The fact that there is a $1.50 drag on 2026. The reason is you have to spend money before any revenue ever shows up. You got to hire people, number one. Number two, new programs, whether it's Nebraska, Iowa, or Florida Kids, a new program or a new entrant always runs higher as people get used to systems and business processes, et cetera.

我想在這裡澄清一下創業過程。2026 年將出現 1.50 美元的拖累。原因在於，你必須先投入資金，才能獲得收入。首先，你得招人。第二，新項目，無論是內布拉斯加州、愛荷華州還是佛羅裡達州的兒童項目，新項目或新參與者的收費總是更高，因為人們需要時間來適應系統和業務流程等等。

And third, as Mark would like to talk about, there is a financial implication of building reserves in the early years. So that $1.50 drag is not symptomatic or emblematic of the power, the earnings power of that business. We added a $3 run rate to our embedded earnings for the ultimate attainment of a target margin.

第三，正如馬克所想談到的，在早期建立儲備金具有財務意義。因此，1.50 美元的股價下跌並不能反映或像徵這家企業的實力或獲利能力。為了最終實現目標利潤率，我們在預期收益中增加了 3 美元的運行率。

Mark, anything to add on Florida?

馬克，關於佛羅裡達州還有什麼要補充的嗎？

Joe, I think there's some important distinctions there that you point out. One, the MOR always runs hot on a new property. And typically, we say it's a two year path to target margins. We have one quarter of performance of Florida which means these margins we put on top of our normal picks, which are onetime items, really exaggerate the performance in the first quarter. So Florida will run a hot MLR in its first quarter, but a lot of it is new property getting everything settled and these margins we put on day one, which are part of our normal actuarial policy.

喬，我認為你指出的這些差異非常重要。第一，新房產的市場反應總是很強烈。通常情況下，我們認為實現目標利潤率需要兩年時間。我們有佛羅裡達州一個季度的業績，這意味著我們在正常選股（一次性項目）之外增加的這些利潤率，確實誇大了第一季的業績。因此，佛羅裡達州第一季的 MLR 將會很高，但其中許多是新房產，所有手續都已辦妥，而這些利潤率是我們第一天就設定的，這是我們正常精算政策的一部分。

The other part of the $1.50 is the business doesn't just start on the fourth quarter. We've got two quarters, three quarters here of prep, where we're hiring people in advance of revenue, incurring expenses. Obviously, that's not part of the run rate. So the $1.50 isn't meant to be -- this is an extrapolation of how it is. It's kind of an anomaly of one quarter of new business and a lot of G&A prep.

1.50 美元的另一部分原因是，業務並非從第四季才開始。我們有兩到三個季度的準備時間，包括提前招聘人員、提前支付費用等，以備不時之需。顯然，這不屬於運行率的一部分。所以 1.50 美元並不是它的實際價格——這只是對它實際價格的一種推斷。這是一種反常現象，四分之一的業務是新業務，而大量的行政準備工作卻是其他事務。

Yes, $6 billion of revenue, which to us is, you're adding 15% of revenue with one contract. And we never measure our acquisitions or contracts on contribution margin. But in this case, it's entirely appropriate. The contribution margin of this contract is going to be significant. To your question on M&A.

是的，60億美元的收入，對我們來說，這意味著一份合約就能增加15%的收入。我們從來不以貢獻毛利率來衡量我們的收購或合約。但就此而言，這樣做完全適合。該合約的貢獻利潤率將非常可觀。關於您提出的併購問題。

This is the perfect environment to be exploring M&A and we have. Our pipeline is as actionable opportunities in it. Many of them are what I'll call challenging situations for single state, single geography payers who are in the same rate environment that everybody else is in and they're eroding capital. Without naming names or states, we've tried to action two or three of these in the past six months. And they were so troubled.

這是探索併購的絕佳環境，而我們也確實這麼做了。我們的銷售管道中蘊藏著可執行的機會。其中許多情況，我稱之為對單一州、單一地理的付款方而言的挑戰性局面，他們與其他所有人一樣，處於相同的費率環境中，並且正在消耗資本。我們不點名批評，但在過去六個月裡，我們已經嘗試對其中兩到三個案例採取行動。他們非常苦惱。

They had to kind of seek other alternatives rather than to be acquired. But this is a great time to acquire revenue. At the (inaudible) of margin entertainment, we are still acquiring things at just over 20% of revenue which means very little goodwill value, you're mostly exchanging cash for regulatory capital.

他們不得不尋找其他出路，而不是被收購。但現在正是獲取收入的好時機。在（聽不清楚）利潤娛樂領域，我們仍然以略高於 20% 的收入收購資產，這意味著幾乎沒有商譽價值，你主要是在用現金換取監管資本。

Now in this environment, Mark and I say, give me a property at book value, and I'm good to go, and we'll get it to target margins in our two year to three year period.

現在在這種環境下，我和馬克會說，給我一個帳面價值的房產，我就可以開始了，我們會在兩到三年內實現目標利潤率。

So this is the perfect time. We believe long term in the veracity of this business and its margin potential, and this is the perfect time to responsibly purchase long-dated revenue streams with stable membership in states where we want to do business, either states that we're already in and are underrepresented in market share or states that we're not in and want to create a foot.

所以現在正是時候。我們相信這項業務的真實性和利潤潛力，並且現在是負責任地購買長期收入來源和穩定會員數量的好時機，這些收入來源位於我們想要開展業務的州，無論是我們已經進入但市場份額不足的州，還是我們尚未進入並想要立足的州。

Ryan Langston, TD Cowen.

Ryan Langston，TD Cowen。

Maybe within the cost trend assumption of 5%, maybe give us a little sense on some of the components within that assumption, maybe cost categories, you assumed higher, lower and maybe any sort of swing factors with the widest range is positive or negative?

假設成本趨勢為 5%，能否讓我們稍微了解一下該假設中的一些組成部分，例如成本類別，您假設的成本是高還是低，以及任何波動範圍最大的因素是正還是負？

Sure. Sure, Ryan. I covered a few of these before. Behavioral health services are the cohort of Medicaid patients with a behavioral condition trends at 9%. We did reduce that at all, and the behavioral services themselves are trending at 18%, not only due to the prevalence of behavioral conditions, but let's face it, providers are using their judgment on diagnosis and treatment protocols.

當然。當然可以，瑞恩。我之前介紹過其中一些。行為健康服務是指 9% 的患有行為疾病的 Medicaid 患者群體。我們確實減少了這部分支出，行為服務本身的趨勢是 18%，這不僅是因為行為問題的普遍性，而且說實話，服務提供者在診斷和治療方案方面運用了自己的判斷。

The pharmacy trend globally is 13%, the top 10 therapeutic classes are trending at 35% antiretrovirals, anti-psoriatics, GLP-1s, all the things you read about. Cancer diagnosis are prevalent. We did not soften any of the current trends that we're experiencing in 2025. As I said, now that the baseline, the cost base line is 20% higher today than it was three years ago. LTSS, skilled nursing facility admits are up.

全球藥局趨勢為 13%，前 10 個治療類別趨勢為 35%：抗愛滋病毒藥物、抗乾癬藥物、GLP-1 類藥物，以及你所讀到的所有藥物。癌症診斷十分普遍。2025年，我們並沒有減弱任何我們正在經歷的當前趨勢。正如我所說，現在的基準線，也就是成本基準線，比三年前高出 20%。長期照護服務（LTSS）和專業照護機構的入院人數增加。

LTSS hours, home service hours are creeping up, didn't reduce any of our trend assumptions there. And professional office visits is the one that doesn't get a lot of airtime, but that's trending at -- it trended at 16% in 2025 off '24. And one of the reasons it's not that the number of office visits is necessarily up per 1,000. But the number of procedures per diagnosis per visit is up significantly.

長期照顧服務時間、家庭服務時間都在緩慢增加，但這並沒有減少我們對這方面的任何趨勢假設。專業辦公室訪問量雖然沒有得到太多關注，但其趨勢是——2025 年比 2024 年增長了 16%。其中一個原因並不是每千人門診次數一定增加。但每次就診每次診斷所需的手術數量顯著增加。

One diagnosis code, 3 CPT codes in the past, maybe there's now 4 CPT codes. So we didn't soften any of what we experienced in '25 and '25 was, again, a year of medical cost inflection off '24, and we kept all those trends rolling through the 2026 numbers. There's probably others that are missing, but those are the big ones.

過去一個診斷代碼對應 3 個 CPT 代碼，現在可能有 4 個 CPT 代碼了。因此，我們沒有緩和 2025 年經歷的任何事情，而 2025 年又是醫療成本相對於 2024 年出現拐點的一年，我們將所有這些趨勢延續到了 2026 年的數據中。可能還有其他遺漏，但這些是主要的。

Mark, did I miss anything?

馬克，我漏掉了什麼嗎？

No. I think that's good. So once the acuity shift is behind us, the 7.5 is now 5 in our projections. Joe, you hit the big ones, pharmacy, professional office visits and BH continued to be high considered within our 5% outlook.

不。我覺得這樣很好。因此，一旦視力敏銳度的變化過去，我們預測的 7.5 就變成了 5。Joe，你說的都是重點，藥局、專業辦公室就診和 BH 仍然在我們 5% 的預期範圍內被高度重視。

Michael Ha, Baird.

Michael Ha，貝爾德。

I appreciate your exhaustive cohort analysis commentary. But what assumption is currently embedded in your '26 guide relating to possible (inaudible) more and more (inaudible) budgetary pressures (inaudible) more stringent eligibility requirements. And if this prompt spike (inaudible) sort of procedure this enrollment, is there a range of outcomes embedded in your guide? And because there are states reactively (inaudible).

我非常感謝您詳盡的隊列分析評論。但是，您 '26 指南中目前隱含的假設是關於可能（聽不清楚）越來越多的（聽不清楚）預算壓力（聽不清楚）更嚴格的資格要求。如果這種快速成長（聽不清楚）之類的程序是本次註冊的，那麼你的指南中是否包含了一系列結果？因為存在反應性狀態（聽不清楚）

Where we're seeing pretty alarming procedural (inaudible) rates, come up to 90%. And a lot of those trends are beginning to spike in more recent months, which is -- its impact is felt typically next year, it concerns us -- I know they might not be 0% utilizers, but I know these (inaudible) are typically healthier overall.

我們看到一些非常令人擔憂的程序性（聽不清楚）發生率高達 90%。近幾個月來，許多這樣的趨勢開始激增，這意味著——其影響通常會在明年顯現，這讓我們感到擔憂——我知道他們可能不是 0% 的使用者，但我知道這些（聽不清楚）總體上通常更健康。

So stepping back, I know you're very confident given the much lower presence overall lower utilized in your book. But I just wanted to ask again how should we think about the achievability of your guide if more states were to tighten eligibility?

所以退一步講，我知道你非常有信心，因為在你的書中，整體使用率要低得多。但我還是想再問一下，如果更多州收緊資格標準，我們該如何看待你們指南的可行性？

We have confidence in it. And I will tell you this, Michael. We don't -- I mean we do top down. Everybody uses global assumptions to testing theories. This is all bottoms up.

我們對此充滿信心。邁克爾，我還要告訴你一件事。我們不——我的意思是，我們是自上而下地做事。每個人都使用全局假設來檢驗理論。一切都從頭開始。

This is about (inaudible) actuaries and our local resources, talking to our state customer on what they're up to and what they're all about and what they're going to do. And it's with every state customers, it's in all their best interest to tell us exactly what to expect, so we can resource appropriately. So this is all bottoms up.

這是關於（聽不清楚）精算師和我們當地的資源，與我們州的客戶談論他們正在做什麼、他們的宗旨是什麼以及他們將要做什麼。對於每個州的客戶來說，告訴我們他們希望得到什麼，以便我們可以合理地調配資源，這對他們來說才是最有利的。所以，一切都從頭開始。

We forecast in some states to (inaudible) higher than others, but this all bottoms up based on what the state is telling us they intend to do, either with just more strict enrollment, eligibility requirements, et cetera, before the [OB3] impacts of work requirements, (inaudible) and all that kicks in for 2027.

我們預測某些州的（聽不清楚）會高於其他州，但這完全取決於各州告訴我們他們打算怎麼做，要么只是在工作要求的影響（聽不清楚）以及所有這些在 2027 年生效之前，採取更嚴格的入學、資格要求等措施。

So we're pretty confident in the 2%. And as we said, if we are wrong, we're very confident that a lot of the -- what we call low and no users have left the portfolio during the redetermination shift. And therefore, if we won by a percent they're closer to the portfolio average likely and therefore, a volume impact, for sure, but not a margin shift impact. Important point.

所以我們對2%這個數字相當有信心。正如我們所說，如果我們錯了，我們非常有信心，許多我們稱之為低用戶和無用戶的用戶在重新評估期間已經離開了投資組合。因此，如果我們以百分之一的優勢獲勝，那麼它們就更接近投資組合的平均水平，因此肯定會對交易量產生影響，但不會對利潤率產生影響。重點。

Erin Wright, Morgan Stanley.

艾琳·賴特，摩根士丹利。

Great. So I understand it's early, but what are some of those items that we should be thinking about in terms of the earnings growth profile into 2027? Do you get back to growth algo? Do you add back some of those burdens? I think you were talking about that earlier in terms of what's an anomaly, what's not or what's recurring in nature.

偉大的。我知道現在談論這些還為時過早，但是就2027年的獲利成長前景而言，我們應該考慮哪些因素呢？你會回歸成長演算法嗎？你會把其中一些負擔加回去嗎？我想你之前也談過這個問題，也就是什麼是異常現象，什麼不是異常現象，或是什麼是自然界中反覆出現的現象。

And then is that the right way to think about it? And the $11 in earnings, embedded earnings power, the trajectory to get there, I guess, we'll hear more about it at Investor Day, but just higher level conceptually how we should be thinking about that as well in terms of the time frame from here?

那麼，這種思考方式是否正確呢？至於每股 11 美元的收益、內在盈利能力以及實現這一目標的路徑，我想我們會在投資者日上聽到更多相關信息，但從更高的概念層面來說，我們應該如何看待這個問題，以及從現在開始的時間框架來看？

Sure. On the embedded earnings, yes, thank you for that because we will give a more specific accounting of it at an Investor Day and obviously, not just the accounting of it, what's in it, whether it ends up being slightly higher or slightly lower or different, we'll update that at Investor Day.

當然。關於內含收益，是的，謝謝，因為我們將在投資者日上對此進行更具體的說明。顯然，不僅僅是說明，還包括具體內容，無論是略高、略低還是有所不同，我們都會在投資者日上進行更新。

But to the point, how it rolls out into '27, '28 and '29, will be a key determinant, and we will update that at our Investor Day. Look, as far as '27 to '28 goes, we're not yet predicting because we can't exactly how rate versus trend is going to improve over the next three years. It's a valid question.

但關鍵在於，它在 2027 年、2028 年和 2029 年的實施情況將是一個關鍵決定因素，我們將在投資者日上更新相關資訊。至於 2027 年到 2028 年，我們目前還無法預測，因為我們無法準確預測未來三年利率與趨勢將如何改善。這是一個很合理的問題。

I don't have an answer for you. But again, 100 basis points of MCR improvement in Medicaid is $5 a share. Now imagine an environment where the entire platform across all geographies, improves by 50, 75, 100 basis points a year for the next two or three.

我沒有答案。但話說回來，醫療補助計劃中 MCR 提高 100 個基點，相當於每股增加 5 美元。現在想像一下，在接下來的兩三年裡，整個平台在所有地區每年都能提升 50、75、100 個基點。

But where we're starting from -- in the trough, what people are calling the trough of -- and some people think the trough is 2027, we believe it's '26. We're earning a 1.6% pretax margin, not a loss. Many of our competitors have said they're losing 1.5% to 2%.

但我們現在所處的起點——低谷，人們所說的低谷——有些人認為低谷是 2027 年，我們認為低谷是 2026 年。我們稅前利潤率為 1.6%，而不是虧損。許多競爭對手錶示，他們的損失率為 1.5% 到 2%。

So if the market gets to 300 basis points to 400 basis points, it needs to get back to, call it, respectability, we're again at target margins. I can't give you an exact projection now. We'll update you at Investor Day, but imagine an environment that improves trend rates versus trend is positive by 50 basis points, 75 or 100 basis points a year for the next two or three, recalling that given the leverage effect of $32 billion of revenue on $32 billion of revenue, 100 basis points to the MCR in Medicaid for Molina is $5 a share.

所以如果市場達到 300 個基點到 400 個基點，它就需要恢復到，我們稱之為，體面的水平，我們又回到了目標利潤率。我現在無法給出準確的預測。我們將在投資者日向您報告最新情況，但想像一下，如果未來兩三年內，趨勢率相對於趨勢每年提高 50 個基點、75 個基點或 100 個基點，考慮到 320 億美元的收入對 320 億美元的收入的槓桿效應，Molina 在 Medicaid 中的 MCR 提高相當於 100 個基點。

This concludes our question-and-answer session and concludes the conference call. Thank you for attending today's presentation. You may now disconnect.

問答環節到此結束，電話會議也到此結束。感謝各位參加今天的報告會。您現在可以斷開連線了。