Latest news with #Wakely
Yahoo
7 days ago
- Business
- Yahoo
Bear of the Day: Centene (CNC)
Centene Corporation (CNC), a giant of managed care expected to cross $175 billion in revenues this year, unexpectedly pulled its earnings guidance for 2025 on July 2. This change came after an unexpected shift in the dynamics of the health Insurance Marketplace, which could impact earnings more significantly than what was initially decision followed industry risk adjustment data from the independent actuarial firm Wakely, which analyzed 22 out of Centene's 29 Marketplace states, representing approximately 72% of its Marketplace membership. According to the company, these data showed higher-than-expected overall market morbidity and a slower pace of market is anticipating a shortfall of about $1.8 billion in net risk adjustment revenues, which would mean a $2.75 impact on adjusted diluted EPS for 2025. Although it does not have data from the other seven states, management anticipates a further decline in risk-adjusted revenues due to similar morbidity the revelation, Wall Street analysts slashed their EPS projection for this year, cutting the Zacks profit consensus in half from $7.29 to $3.55 and discounting more of the Good, the Bad, and the UglyDespite headwinds, CNC shared that the final 2024 risk-adjusted results from the Centers for Medicare and Medicaid Services aligned with their expectations, and its Medicare Advantage and Medicare PDP segments are performing better than its expectations in the second quarter of 2025. However, Medicaid is facing challenges due to rising costs in behavioral health, home care and expensive medications, particularly in states like New York and we look toward 2026, Centene is taking proactive steps to adjust its rates, aiming to account for a higher morbidity baseline. This adjustment is seen as a necessary move to help balance out potential losses. The company plans to make these pricing changes in the states where it conducts most of its marketplace business. The early refiling of 2026 rates by CNC suggests a more defensive pricing approach in the of many Wall Street investment banks, Wells Fargo downgraded CNC shares to Equal-Weight and cut their price target from $72 to $30.A close look at second-quarter earnings and data analysis is required to move forward. CNC's second-quarter 2025 results are slated to be released on Friday July 25. Want the latest recommendations from Zacks Investment Research? Today, you can download 7 Best Stocks for the Next 30 Days. Click to get this free report Centene Corporation (CNC) : Free Stock Analysis Report This article originally published on Zacks Investment Research ( Zacks Investment Research 擷取數據時發生錯誤 登入存取你的投資組合 擷取數據時發生錯誤 擷取數據時發生錯誤 擷取數據時發生錯誤 擷取數據時發生錯誤
Yahoo
22-07-2025
- Business
- Yahoo
Oscar Health Announces Preliminary Financial Results for Second Quarter 2025 and Revises 2025 Guidance
NEW YORK, July 22, 2025--(BUSINESS WIRE)--Oscar Health, Inc. ("Oscar" or the "Company") (NYSE: OSCR), a leading healthcare technology company, announced today certain preliminary financial results for the second quarter ended June 30, 2025 and updates to full year 2025 guidance. The Company expects a loss from operations of approximately $230 million and a net loss of approximately $228 million for the second quarter of 2025. The preannouncement is driven by a review of 2025 Marketplace data ("2Q Risk Adjustment Reports") from Wakely, an independent actuarial firm, that analyzes paid claims submissions through April 30, 2025 for most Marketplace insurance carriers. "The individual market is a competitive healthcare marketplace that provides affordable, high-quality coverage for millions of consumers across the country," said Mark Bertolini, CEO of Oscar Health. "We are taking appropriate pricing actions for 2026 that reflect higher acuity in the individual market, and we will continue to take steps to deliver for our members, partners, and shareholders. Oscar has successfully navigated dynamic markets before and we remain committed to our long-term strategy to bring more employees, individuals, and families healthcare choices that fit their needs through the individual market." The analysis of the 2Q Risk Adjustment Reports, covering nearly 100% of Oscar's geographic footprint, shows that overall ACA Marketplace risk scores, a measure of the average morbidity of the market, have increased by more than the Company's prior estimates. Based on the reports, the Company now expects a medical loss ratio of 86.0% to 87.0% for full year 2025. Utilization by Oscar's members remained elevated in the second quarter of 2025, however cost trends moderated as compared to the first quarter of 2025. The revised guidance assumes risk adjustment as a percentage of direct and assumed policy premiums is largely consistent year-over-year, and that elevated trends observed in market risk scores and recent Company utilization patterns persist for the remainder of 2025. The Company expects to resubmit rate filings for 2026 in states covering approximately 98% of current membership to reflect the higher market risk scores in the ACA Marketplace. The 2024 risk adjustment results, released by Centers for Medicare and Medicaid Services, were approximately $23 million favorable to the Company's accruals, as of the first quarter of 2025. Oscar is revising its full year 2025 outlook. For 2025, the Company now anticipates Total Revenue of $12.0 billion to $12.2 billion, a Medical Loss Ratio of 86.0% to 87.0%, a SG&A Expense Ratio of 17.1% to 17.6%, and a Loss from Operations of ($300 million) to ($200 million). The Company expects an Adjusted EBITDA loss of approximately $120 million less than the Loss from Operations. The Company expects to release second quarter 2025 financial results before the market opens on Wednesday, August 6, 2025, and host a conference call to review results beginning at 8:00 AM (ET). Oscar Health, Inc. 2025 Financial Guidance Summary Full Year 2025 Outlook (in thousands, except percentages) Low High Total Revenue (1) $12,000,000 $12,200,000 Medical Loss Ratio (2) 86.0% 87.0% SG&A Expense Ratio (3) 17.1% 17.6% Loss from Operations (4) $(300,000) $(200,000) (1) Total revenue includes Premium revenue, Investment income, and Services and other revenue. We believe Total revenue is an important metric to assess the growth of our business, as well as the earnings potential of our investment portfolio. (2) Medical loss ratio (MLR) is a metric used to calculate medical expenses as a percentage of net premiums before ceded quota share reinsurance. We believe MLR is an important metric to demonstrate the ratio of our costs to pay for healthcare of our members to the net premiums before ceded quota share reinsurance. (3) The Selling, general, and administrative (SG&A) Expense ratio is calculated as selling, general and administrative expenses as a percentage of Total Revenue. We believe the SG&A Expense ratio is a valuable metric to evaluate our ability to manage our overall selling, general, and administrative cost base. (4) Loss from operations is a metric for assessing operating performance. Loss from operations is the Company's Total revenue less Total operating expenses. Non-GAAP Financial InformationThis release presents Adjusted EBITDA, a non-GAAP financial metric, which is provided as a complement to the preliminary results provided in accordance with accounting principles generally accepted in the United States of America ("GAAP"). Adjusted EBITDA is defined as Net income (loss) for the Company and its consolidated subsidiaries before interest expense, income tax expense (benefit), and depreciation and amortization, as further adjusted for stock-based compensation and other items that are considered unusual or not representative of underlying trends of our business, where applicable for the period presented. We present Adjusted EBITDA because we believe it is frequently used by securities analysts, investors, and other interested parties in the evaluation of companies in our industry. Management believes that investors' understanding of our performance is enhanced by including this non-GAAP financial measure as a reasonable basis for comparing our ongoing results of operations. We caution investors that amounts presented in accordance with our definition of Adjusted EBITDA may not be comparable to similar measures disclosed by our competitors, because not all companies and analysts calculate Adjusted EBITDA in the same manner. Oscar has not provided a quantitative reconciliation of forecasted Adjusted EBITDA to forecasted GAAP net income (loss) within this press release because Oscar is unable, without making unreasonable efforts, to calculate certain reconciling items with confidence. These items include, but are not limited to, stock-based compensation expense. These items, which could materially affect the computation of forecasted GAAP net income (loss), are inherently uncertain and depend on various factors, some of which are outside of Oscar's control. As such, any associated estimate and its impact on GAAP net income (loss) could vary materially. Cautionary Note Regarding Forward-Looking StatementsThis press release contains forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. All statements other than statements of historical fact contained herein are forward-looking statements. These statements include, but are not limited to, statements about our preliminary results for the second quarter ended June 30, 2025, our financial outlook and estimates, including Total revenue, Medical Loss Ratio, SG&A Expense Ratio, Loss from Operations, Adjusted EBITDA loss and other financial performance metrics, the assumptions underlying our outlook, including expectations with respect to risk adjustment as a percentage of direct and assumed policy premiums and trends in market risk scores and Company utilization patterns, our planned resubmission of rate filings, our business and financial prospects, potential benefits of participation in the individual market, expectations with respect to ACA Marketplace risk scores, industry and market dynamics and expected trends, and our management's plans and objectives for future operations, expectations and business strategy, including future pricing actions. In some cases, you can identify forward-looking statements by terms such as "may," "will," "should," "expects," "plans," "anticipates," "could," "intends," "targets," "projects," "contemplates," "believes," "estimates," "forecast," "predicts," "potential," or "continues" or the negative of these terms or other similar expressions. Accordingly, we caution you that any such forward-looking statements are not guarantees of future performance and are subject to risks, assumptions, and uncertainties that are difficult to predict and generally beyond our control. Although we believe that the expectations reflected in these forward-looking statements are reasonable as of the date made, there are or will be important factors that could cause our actual results to differ materially from those indicated in these forward-looking statements, including, but not limited to, the following: our ability to execute our strategy and manage our growth effectively (including our ability to successfully integrate strategic acquisitions); our ability to retain and expand our member base; our ability to accurately estimate our incurred medical expenses, including as a result of changes or inaccuracies in our actuarial assumptions, or to effectively manage our medical costs or related administrative costs; our ability to maintain profitability in the future; unanticipated results of or changes to risk adjustment programs; our ability to arrange for the delivery of quality care and maintain good relations with brokers and the physicians, hospitals, and other providers within and outside our provider networks; evolving federal and state laws and regulations (including any changes in the interpretation or enforcement of existing laws and regulations), including changes with respect to the Patient Protection and Affordable Care Act ("ACA") and any regulations enacted thereunder, non-renewal of the enhanced APTCs, the implementation of new program integrity rules or other government actions, such as the imposition of tariffs; our ability to comply with ongoing regulatory requirements, including capital reserve and surplus requirements and applicable performance standards; changes or developments in the health insurance markets in the United States; our, or any of our vendors', ability to comply with laws, regulations, and standards related to the handling of information about individuals or applicable consumer protection laws, including as a result of our participation in government-sponsored programs; heightened competition in the markets in which we participate; our ability to utilize quota share reinsurance to meet our capital and surplus requirements and protect against downside risk on medical claims; unfavorable or otherwise costly outcomes of lawsuits, audits, investigations, and other third party claims; incurrence of data security breaches of our and our partners' information and technology systems; our ability to attract and retain qualified personnel; our ability to detect and prevent material weaknesses or significant control deficiencies in our internal controls over financial reporting or other failure to maintain an effective system of internal controls; adverse publicity or other adverse consequences related to our dual class structure or "controlled company" status; and the other factors set forth under the caption "Risk Factors" in our Annual Report on Form 10-K for the year ended December 31, 2024, filed with the Securities and Exchange Commission ("SEC"), as well as our other filings with the SEC, including our Quarterly Report on Form 10-Q for the quarterly period ended March 31, 2025 filed with the SEC and our Quarterly Report on Form 10-Q for the quarterly period ended June 30, 2025 to be filed with the SEC. You are cautioned not to place undue reliance on any forward-looking statements made in this press release. Any forward-looking statement speaks only as of the date as of which it is made, and, except as otherwise required by law, we do not undertake any obligation to publicly update or review any forward-looking statement, whether as a result of new information, future developments or otherwise. New factors emerge from time to time, and it is not possible for us to predict which will arise. Financial Disclosure AdvisoryAll financial data in this press release is preliminary and represents the most current information available to the Company's management, as financial closing procedures for the quarter ended June 30, 2025 are not yet complete. These estimates are not a comprehensive statement of the Company's financial results for the quarter ended June 30, 2025 and actual results may differ from these estimates as a result of the completion of normal quarter-end accounting procedures and adjustments, as well as the preparation and review of the Company's financial statements for the quarter ended June 30, 2025 and the subsequent occurrence or identification of events prior to the formal issuance of our second quarter financial results. About Oscar HealthOscar Health, Inc. ("Oscar") is a leading healthcare technology company built around a full stack technology platform and a relentless focus on serving our members. We have been challenging the status quo in the healthcare system since our founding in 2012, and are dedicated to making a healthier life accessible and affordable for all. Oscar offers Individual & Family plans and health technology solutions that power the healthcare industry through +Oscar. Our technology drives superior experiences, deep engagement, and high-value clinical care, earning us the trust of approximately 2.0 million members, as of March 31, 2025. View source version on Contacts Investor Contact: Chris PotocharVP of Investor Relationsir@ Media Contact: Kristen PrestanoVP of Communicationspress@ Sign in to access your portfolio
Yahoo
02-07-2025
- Business
- Yahoo
Centene Pulls 2025 Guidance as Marketplace Growth Falters
A leading healthcare company, Centene Corporation CNC, has unexpectedly pulled its earnings guidance for 2025, shaking up the managed care industry. This change comes after an unexpected shift in the dynamics of the health Insurance Marketplace, which could impact earnings more significantly than what was initially forecasted. The decision comes after a thorough look at industry risk adjustment data from the independent actuarial firm Wakely, which analyzed 22 out of Centene's 29 Marketplace states, representing approximately 72% of its Marketplace membership. According to the company, these data show higher-than-expected overall market morbidity and a slower pace of market growth. CNC is anticipating a shortfall of about $1.8 billion in net risk adjustment revenues, which would mean a $2.75 impact on adjusted diluted EPS for 2025. Although it does not have data from the other seven states, management anticipates a further decline in risk-adjusted revenues due to similar morbidity trends. Per the Wall Street Journal, shares of CNC plummeted in after-hours trading following the announcement, showcasing investors' anxiety over shrinking profit margins and the broader implications for managed care organizations. Despite headwinds, CNC shared that the final 2024 risk-adjusted results from the Centers for Medicare and Medicaid Services aligned with their expectations, and its Medicare Advantage and Medicare PDP segments are performing better than its expectations in the second quarter of 2025. However, Medicaid is facing challenges due to rising costs in behavioral health, home care and expensive medications, particularly in states like New York and Florida. As we look toward 2026, Centene is taking proactive steps to adjust its rates, aiming to account for a higher morbidity baseline. This adjustment is seen as a necessary move to help balance out potential losses. The company plans to make these pricing changes in the states where it conducts most of its marketplace business. The early refiling of 2026 rates by CNC suggests a more defensive pricing approach in the future. A close look at second-quarter earnings and data analysis is required to move forward. CNC's second-quarter 2025 results are slated to be released on July 25. Year to date, CNC shares have lost 43.3% compared with the industry's decline of 24.4%. Image Source: Zacks Investment Research CNC currently carries a Zacks Rank #2 (Buy). Some other top-ranked stocks in the Medical space are Clover Health Investments Corp CLOV, Fresenius Medical Care AG & Co. FMS and BrightSpring Health Services, Inc. BTSG, each sporting a Zacks Rank #1 (Strong Buy) at present. You can see the complete list of today's Zacks #1 Rank stocks here. The Zacks Consensus Estimate for Clover Health Investments' current-year earnings of 11 cents per share has witnessed one upward revision in the past 60 days against no movement in the opposite direction. Clover Health Investments beat earnings estimates in each of the trailing four quarters, with the average surprise being 114.6%. The consensus estimate for current-year revenues is pegged at $1.9 billion, indicating 37.7% year-over-year growth. The Zacks Consensus Estimate for Fresenius Medical Care AG & Co.'s current-year earnings of $2.21 per share has witnessed two upward revisions in the past 30 days against no movement in the opposite direction. Fresenius Medical Care AG & Co. beat earnings estimates in three of the trailing four quarters and met once, with the average surprise being 6.6%. The consensus estimate for current-year revenues is pegged at $21.9 billion, implying 4.8% year-over-year growth. The Zacks Consensus Estimate for BrightSpring Health Services' current-year earnings of 87 cents per share has witnessed four upward revisions in the past 60 days against no movement in the opposite direction. BrightSpring Health Services beat earnings estimates in two of the trailing four quarters and missed twice, with an average surprise being 17.5%. The consensus estimate for current-year revenues is pegged at $12.3 billion, indicating 9.1% year-over-year growth. Want the latest recommendations from Zacks Investment Research? Today, you can download 7 Best Stocks for the Next 30 Days. Click to get this free report Fresenius Medical Care AG & Co. KGaA (FMS) : Free Stock Analysis Report Centene Corporation (CNC) : Free Stock Analysis Report Clover Health Investments, Corp. (CLOV) : Free Stock Analysis Report BrightSpring Health Services, Inc. (BTSG) : Free Stock Analysis Report This article originally published on Zacks Investment Research ( Zacks Investment Research
Reuters
01-07-2025
- Business
- Reuters
Centene pulls 2025 earnings forecast after hit to marketplace revenue
July 1 (Reuters) - Centene (CNC.N), opens new tab said on Tuesday it had withdrawn its 2025 earnings forecast after new industry data showed a significant drop in expected revenue from its marketplace health insurance plans. Shares of the U.S. health insurer declined nearly 22% in extended trading. The company said preliminary data from 22 of the 29 U.S. states where Centene offers marketplace plans suggested a $1.8 billion drop in risk adjustment revenue, equivalent to a $2.75 hit to adjusted earnings per share. Centene had previously forecast 2025 adjusted earnings per shares of more than $7.25. The shortfall reflects higher-than-expected patient morbidity, or a sicker population, and slower market growth in those 22 states, which represent about 72% of Centene's marketplace membership, the company said. The data was provided by independent actuarial firm Wakely. The drop in risk adjustment payments, which are meant to balance costs for covering higher-risk patients, is likely to weigh on Centene's earnings this year. The company also reported elevated Medicaid medical costs in states like New York and Florida, particularly in behavioral health, home care and drug spending, and said it expects its second-quarter medical costs to be higher as a result. In the first quarter, the company faced elevated costs in its government-backed Medicaid plans for lower-income groups. Insurers who offer Medicaid plans have seen elevated costs over the past few quarters after the end of a pandemic-era policy. As states re-determined eligibility for the plans, healthier members fell off the rolls, leaving behind those who require more medical services. Industry bellwether UnitedHealth (UNH.N), opens new tab in May also suspended its annual forecast due to surging medical costs. Centene offers insurance plans under the federal Obamacare marketplace. It is the largest marketplace carrier, serving 4.4 million members across 29 states as of December 31 under the brand name Ambetter Health, the company said in an annual filing. Centene plans to report its quarterly results on July 25.
Forbes
01-07-2025
- Business
- Forbes
Facing Slower Growth, Health Insurer Centene Pulls 2025 Profit Outlook
Health insurer Centene, one of the nation's biggest providers of individual coverage under the ... More Affordable Care Act known as Obamacare Tuesday withdrew its 2025 guidance, saying market growth in more than 20 states is lower than expected, the company announced July 1, 2025. In this photo is the building housing Centene Corporation headquarters is seen Thursday, July 2, 2015, in Clayton, Mo. (AP Photo/Jeff Roberson) Health insurer Centene, one of the nation's biggest providers of individual coverage under the Affordable Care Act known as Obamacare, on Tuesday withdrew its 2025 guidance, saying market growth in more than 20 states is lower than expected. In a Tuesday afternoon announcement that jarred investors, Centene said an independent actuarial firm's analysis in 22 states where it sells individual coverage on the ACA's marketplaces showed 'overall market growth' to be 'lower than expected and the implied aggregate market morbidity in those states is significantly higher than, and materially inconsistent with, the Company's assumptions for risk adjustment revenue transfer used in the preparation of its previous 2025 consolidated guidance.' Centene said the analysis by Wakely, an independent actuarial firm, covers 22 of the 29 states where Centene sells individual coverage on the marketplace and represents about 72% of the company's marketplace membership. 'The Company's preliminary analysis of the 22 states results in a reduction to its previous full year net risk adjustment revenue transfer expectation by a preliminary estimate of approximately $1.8 billion which corresponds to an adjusted diluted EPS impact of approximately $2.75,' Centene said in its announcement. 'This preliminary estimate includes a projection of the remaining eight months of 2025 and is based on 2025 paid claims through April 30 from Wakely for the 22 states, as well as the Company's membership estimates and morbidity trend estimates for both its members and the aggregate market, calculated by state.' Centene's enrollment in Obamacare, grew by 29% to 5.6 million members in the first quarter of this year from 4.3 million a year-ago, the company reported in April. That increase of more than 1 million health plan members came after an expansion by the company in new markets for 2025 and helped overcome a decrease of more than 330,000 enrollees in Medicaid coverage for poor Americans that Centene administers. Centene said it does not have information or estimates for the remaining seven states where it sells Obamacare 'but anticipates, due to the morbidity trends observed in the 22 states, an additional reduction to its net risk adjustment revenue transfer expectation with a corresponding adjusted diluted EPS impact.' Tuesday's news from Centene comes on the same day the U.S. Senate passed a budget bill that could also hit the health insurer and other providers of Obamacare hard. The legislation, which still has to be approved by the U.S. House of Representatives, is projected to force 11 million Americans to lose health insurance coverage and most of those people will come from Obamacare plans and Medicaid coverage for low income Americans that is also administered by Centene. Centene said its 'in the process of closing the second quarter and analyzing data, including in Marketplace and Medicaid, and expects to report the second quarter 2025 results and provide additional insights on July 25.'
