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Centene, one of the largest insurers offering coverage under the Affordable Care Act marketplaces, reported first-quarter enrollment results Tuesday alongside its first-quarter earnings. The company’s disclosure provides a snapshot of how health insurers and consumers are being affected after Congress and the Trump administration did not renew enhanced subsidies that had reduced out-of-pocket premium costs.
Centene said its enrollment in “marketplace” plans sold under the Ambetter brand fell to 3.58 million at the end of the first quarter, down from 5.54 million at the end of last year and 5.62 million in the year-ago quarter.
Democrats in Congress and health insurance analysts previously said the enrollment decline would follow the failure to extend enhanced tax credits for Obamacare buyers. A KFF analysis released last fall projected that middle-income and low-income Americans would face major premium increases if the enhanced credits were not extended, with some customers reporting premiums doubling or even tripling for the year.
The enhanced subsidies, introduced under the Biden administration and supported by the Democratic-controlled Congress through the Inflation Reduction Act of 2022, made individual-market premiums more affordable and helped ACA enrollment reach record levels. The Trump administration, through the Centers for Medicare & Medicaid Services, said in late January that 23 million consumers had signed up for 2026 individual market coverage through the Marketplaces since the start of the 2026 Open Enrollment Period on November 1, 2025.
Centene’s reported drop also suggests 2026 Obamacare enrollment may be lower than earlier estimates from the Trump White House. UnitedHealth Group’s UnitedHealthcare, one of the first major insurers to report first-quarter results last week, said its Obamacare enrollment fell to 1.4 million from 1.7 million in the prior year period.
Centene reported net income of $1.5 billion, or $3.13 per share, compared with $1.3 billion, or $2.64 per share, in the year-ago quarter. Revenue increased to $49.9 billion from $46.6 billion.
Centene said premium and service revenues increased 5% to $44.7 billion from $42.5 billion in the comparable period of 2025.
In its earnings report, the company said the increase was primarily driven by premium yield and membership growth in its prescription drug plan business, state-directed payments, and rate increases in its Medicaid business, partially offset by lower marketplace and Medicaid membership.
Centene reported that its Medicaid health benefits ratio (HBR) decreased by 50 basis points, primarily driven by rate and revenue increases, continued progress in managing medical costs, and moderate flu costs.
The company also said the consolidated HBR decrease was influenced by an increase to the premium deficiency reserve (PDR) in 2025 versus no PDR in 2026 for its Medicare Advantage business as it progresses toward profitability. Centene added that these decreases were partially offset by the decline in Marketplace membership and the resulting impact on consolidated member mix.
Centene Chief Executive Officer Sarah London said the results show the company is continuing “to make tangible progress in our margin recovery efforts while strengthening the fundamental operations of each of our businesses.”
London said Centene’s strong first-quarter results position the company to increase its full-year 2026 adjusted diluted earnings per share guidance to greater than $3.40. She added that the company remains confident in the long-term earnings power of the enterprise.
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