Hook / Thesis
Centene has chosen the harder path: reset pricing and cut membership where economics were poor. That choice created visible earnings pain in Q2 2025, but it also materially reduced downside on future medical costs and supports a faster path back to normalized margins. At the current price (last trade around $38.46) the market is under-pricing the combination of steady operating cash flow and a lower-margin tail risk.
Our trade idea: buy Centene on weakness in the $36–$40 range, size the position to risk tolerance, use a disciplined stop below $31, and take profits on a staged target ladder as margins re-normalize and membership stabilizes. This is a position trade (months) that leans on operational fixes already underway rather than near-term membership recovery.
Why the market should care - the fundamental driver
Centene is a government-focused managed care operator serving roughly 22 million medical members as of 12/31/2024, with ~60% of membership in Medicaid, ~20% in the individual exchanges, and ~5% in Medicare. That revenue stream is large and recurring, but also highly sensitive to: (1) membership flows, (2) morbidity and health benefits ratio (medical loss), and (3) regulatory payment rates.
The company's recent operating choice was to re-price and cut business that delivered structurally poor margins. That action shows up in the numbers: Q1 2025 produced operating income of $1.534 billion with net income attributable to parent of $1.311 billion (filing 04/25/2025). By Q2 2025 (period ended 06/30/2025, filing 07/25/2025) the company recorded an operating loss of $458 million and a net loss of $259 million.
Why this matters: benefits costs and expenses jumped from $44.874 billion in Q1 2025 to $48.999 billion in Q2 2025, explaining most of the swing. Management's response - re-pricing and membership pruning - is intended to reduce future medical cost exposure and raise the floor on earnings. Importantly, despite the GAAP loss in Q2, Centene generated positive net cash from operating activities of $1.785 billion in that quarter, which supports liquidity while the actions take hold.
Supporting evidence from recent filings
- Q1 2025 (filing 04/25/2025): Revenues $46.62 billion, operating income $1.534 billion, net income attributable to parent $1.311 billion.
- Q2 2025 (filing 07/25/2025): Revenues $48.742 billion, operating loss $458 million, net loss attributable to parent $253 million, net cash flow from operating activities $1.785 billion.
- Balance sheet snapshot (Q2 2025): Assets $86.395 billion, Equity attributable to parent $27.406 billion, Liabilities $58.892 billion. These figures show substantial scale and capital backing through the reset.
What the numbers imply about valuation
The market snapshot shows a last print near $38.46. Using diluted average shares from Q2 2025 (about 493.548 million shares) implies an approximate market capitalization near $19 billion (price multiplied by diluted shares). That valuation compared to run-rate top-line is compelling: the company is operating at very large revenue scale (quarterly revenue in recent quarters has been in the mid‑$40B range), implying a price-to-revenue multiple well below 0.2x on a run-rate basis.
To be clear: metric cross-checks are noisy here because quarterly revenue and membership swings fluctuate with business mix and the timing of contract changes. Still, a market value near $19B for a company that generates tens of billions of revenue per quarter suggests the market is pricing in continued margin stress and membership decline. That creates an asymmetric trade if management executes on re-pricing and cost control.
Trade plan (actionable)
- Entry zone: Buy into weakness between $36.00 and $40.00. If filled above $40, trim initial size and require stronger conviction (membership/cost signals).
- Stop: $31.00 (roughly 19% below the $38.46 last print). Use the stop to protect capital—this is a volatility-prone operator with binary regulatory and membership risk.
- Targets (scale-out):
- Target 1: $48.00 (first take-profit; ~25% upside). This reflects a partial multiple re-rate as margins stabilize.
- Target 2: $60.00 (larger take; ~55% upside). This assumes visible improvement in medical loss ratio and membership stabilization over 6-12 months.
- Target 3: $75.00 (full exit zone for patient capital; ~95% upside). This is a longer-term outcome if Centene re-establishes a durable margin profile and investor sentiment normalizes.
- Position sizing: Limit exposure such that the distance to stop (in $) represents no more than your pre-determined risk tolerance (e.g., risk 1-2% of portfolio). Re-assess after quarterly updates.
Catalysts that can re-rate the stock
- Evidence of medical loss ratio improvement in sequential quarters (falling benefits costs as a percent of revenue).
- Stabilization or modest rebound in membership trends after re-pricing (news flow and membership disclosures).
- Positive commentary or constructive CMS rate updates for Medicaid/Medicare that lower regulatory tail risk.
- Consistent free cash flow generation and a commitment to disciplined capital allocation (deleveraging, buybacks only after margins normalize).
Risks and counterarguments
There are several clear arguments against this idea. Below I list risks and then present a counterargument to our buy thesis.
- Membership decline risk: The business is scale-sensitive. If Medicaid membership continues to decline materially, revenue and risk pools degrade and the margin fix won’t offset top-line shrinkage. Recent headlines noted membership shrinkage and that remains an overhang.
- Morbidity and health benefits volatility: Unexpectedly high medical utilization (sicker-than-expected claims) can quickly erase any gains from re-pricing. Q2 showed benefits costs rising to $48.999 billion, which demonstrates that medical cost swings are real and fast.
- Regulatory / CMS risk: Changes to federal/state payment rates or risk adjustment methodology could create earnings surprises. The broader Medicare/Medicaid policy environment is unpredictable and can materially impact GOP/LTM results.
- Execution risk: Re-pricing and network pruning are operationally complex. If Centene mis-executes — e.g., churn of better-margin members or failure to control administrative/other operating expenses — the margin recovery could be delayed or reversed.
- Sentiment and multiple compression: Even if fundamentals improve, the market may continue to apply a low multiple due to prior volatility and regulatory complexity, keeping the stock range-bound.
Counterargument: One could argue the market is correctly skeptical. The Q1-to-Q2 swing from profitable to loss-making shows how quickly outcomes can change. Continued membership erosion or worse-than-expected morbidity could leave the company trapped at a lower structural scale, where fixed costs and regulatory complexity make recovery slow. That scenario would justify a lower valuation and argue for staying sidelined until membership stabilizes.
What would change our mind
We will upgrade conviction if we see any two of the following: (1) a sequential decline in benefits costs as a percent of revenue for two consecutive quarters, (2) membership stabilization or growth in core Medicaid/individual markets, and (3) operating cash flow sustainably above the current quarterly run-rate (i.e., consistent positive free cash flow net of capex). Conversely, a fresh round of membership losses, a sustained jump in morbidity, or adverse CMS rate changes would cause us to reduce exposure or flip to neutral/underweight.
Conclusion
Centene’s aggressive re-pricing and cuts were painful in the near term but materially reduced tail risk on future medical spending. The company still generates operating cash, and the balance sheet has scale — equity attributable to the parent was roughly $27.4 billion at the last quarter. With the stock trading near $38.50 and implied market value roughly in the low‑$20 billion range (approx. $19B using diluted average shares), the downside looks more contained than the market presently prices, provided management executes on the plan.
Recommendation: Reiterate Buy with the trade plan above (buy $36–$40, stop $31, staged targets at $48 / $60 / $75). This is a position trade that pays to be patient and disciplined — buy the operational reset, but protect capital until the margin signal confirms.
Note: This write-up uses the company’s most recently filed quarterly results and market prints through 02/08/2026. Trade sizing and stops should be adjusted to individual risk tolerance.