The Ledger

Centene opens a three-day run of insurer and hospital earnings on Tuesday carrying a 3.49 million Marketplace book, down from 5.86 million a year ago. The Medicaid and Marketplace insurer reports third-quarter results October 27 at about 6:00 a.m. Eastern, per a finviz copy of the company notice (supplemental; not confirmed on Centene’s investor site). The baseline comes from its second-quarter results release: a health benefits ratio (the share of premiums spent on care) of 89.6%, down from 93.0% a year earlier, Medicaid at 93.9%, adjusted earnings per share of $2.51, and revenue of $53.6 billion. Total at-risk membership was 25.89 million, down from 28.00 million. Centene guided to 2026 adjusted earnings per share above $4.80. Who it hits: state Medicaid agencies, the hospitals and physician groups in Centene’s markets, and exchange-heavy hospital operators reporting the same week. So what: Molina’s Medicaid ratio of 93.0% in its third-quarter filing is the nearest read-across, and the question is whether Centene’s Medicaid ratio stays below it as membership falls. This is a preview; we make no claim about what Centene will report. Confidence: High on the second-quarter figures (company release); Med on the date.

Hospital operators follow: HCA and Universal Health Services on Tuesday, Tenet on Thursday, with one date moved. Universal Health Services shifted its report to after the market close October 27, with its call at 8:00 a.m. Eastern October 28, from an earlier October 26 release, per a finviz copy of its notice (supplemental). HCA Healthcare, which we previewed Saturday, holds its call October 27. Tenet reports October 29, and its second-quarter 8-K raised 2026 adjusted EBITDA guidance to $4.83 billion to $5.03 billion, a $295 million increase at the midpoint, while saying lower exchange admissions were an unfavorable payer mix factor even as its Hospital segment margin rose to 18.0%. HCA’s second-quarter release widened its exchange income headwind to $1.0 billion to $1.2 billion and cut 2026 adjusted EBITDA guidance to $15.4 billion to $16.1 billion. Who it hits: every acute-care operator whose payer mix is shifting from exchange coverage to uninsured volume. So what: Tenet raised guidance and HCA lowered it in the same quarter, so the question is whether the third quarter narrows or widens that gap. Confidence: High on July figures (primary filings); Med on dates.

THE DEAL SHEET

No new transactions spotted in the last 24 hours.

Scan covered company releases, SEC filings and trade press for October 23 to 25, a weekend with no market session. No new health system bankruptcy, rating action, closure, or FTC or DOJ healthcare merger action dated in the window could be confirmed from a primary source. Earlier deals outside the window and not listed as new: Humana’s October 13 joint venture selling the majority of its CenterWell senior primary care clinic ownership to a BlackRock-managed fund in a transaction valued at about $2.8 billion per trade coverage, closing expected in the fourth quarter, per its 8-K; and Chorus Aviation’s $40 million (Canadian) agreement, reported October 19, to buy SkyCare Air Ambulance. Irving Levin Associates’ quarterly data, released October 21 and supplemental, counted 415 healthcare deals in the third quarter, 135 of them private equity, down from 155 in the second quarter. Frontier scan this run: air medical and ground ambulance (CS-8c, CS-8d); only the Chorus deal surfaced, outside the window, so no story ran.