CNC · 10-Q · 2026Q1 · Full report
Marketplace Pricing and ICHRA Strategy
CENTENE CORP · 2026-04-28 · Importance 60 · Surprise 74
Centene cites expiration of enhanced APTCs and changes from the Final Rule as drivers of higher Marketplace morbidity and reduced membership; in response it implemented corrective pricing actions for 2026 covering 95% of Marketplace membership. Marketplace membership declined significantly (from 5.626M to 3.582M year‑over‑year), and Ambetter remains a primary product, offered in 29 states in 2026. The company is expanding Ambetter off‑exchange ICHRA offerings—operations designed to attract ICHRA membership grew from 6 states in 2025 to 13 states in 2026—as part of a product repositioning to stabilize commercial/Marketplace revenue.
Key facts
- Centene took corrective pricing actions for 2026 covering 95% of Marketplace membership due to expiration of Enhanced APTCs and the Final Rule.
- Commercial total revenues decreased 6% in Q1 2026 compared to Q1 2025.
- Commercial gross margin for Q1 2026: $2,358 million, a decrease of $184 million compared to Q1 2025.
- Ambetter Health Solutions is operating plans designed to attract ICHRA membership in off-exchange plans in 13 states in 2026 compared to 6 states in 2025.
- Ambetter Health is offered in 29 states in 2026.
Impact estimates
| metric | direction | stage | expected | basis |
|---|---|---|---|---|
| revenue | negative | realized | -1.2% | Commercial total revenues decreased 6% in Q1 2026 compared to Q1 2025. |
| operating_income | negative | realized | -0.4% | Commercial gross margin for Q1 2026: $2,358 million, a decrease of $184 million compared to Q1 2025. |
| revenue | positive | committed | — | Centene took corrective pricing actions for 2026 covering 95% of Marketplace membership due to expiration of Enhanced APTCs and the Final… |