Direct Answer
7 SEC filers are classified under the Standard Industrial Classification code that describes the medicaid managed care industry, and their latest annual reports show $857.5 billion of combined revenue and a median operating margin of 1.7%. Investors should still evaluate its revenue model, industry-specific KPIs, valuation framework and the risks that can change the group's economics.
Industry Overview
Medicaid managed care companies contract with states to manage care for low-income members for a monthly payment per member. Growth comes from contract wins and enrollment, and margins are thin and exposed to rate setting. The first numbers to compare across companies here are membership and contract count, medical loss ratio and premium revenue.
Key Industry Metrics
- Membership and contract count: Number of enrolled members and state contracts held. Growth comes from awards and enrollment, and contract count shows diversification across states.
- Medical loss ratio: Share of premium paid out in members' medical care. Because state rates are fixed, small increases in cost reduce a thin margin quickly.
- Premium revenue: Monthly payments from states for covered members. It follows enrollment and rate setting, and changes when eligibility rules change.
- Administrative cost ratio: Share of revenue spent on running plans. Scale and efficient claims handling lower it, and states often limit allowable amounts.
- State rate adequacy: Whether state payments cover members' actual medical costs. Inadequate rates compress margins until they are reset, often with a lag.
Primary Macro Drivers
- State enrollment and redeterminations: States check eligibility and remove people who no longer qualify, so enrollment and premium revenue move with those reviews.
- Rate adequacy and acuity: States pay a set amount per member, so if rates do not match members' health needs, margin falls; watch rate adequacy and acuity.
- Contract awards: States pick which plans serve their members, so winning or losing a contract moves membership and revenue sharply.
- Medical cost trend: Costs per member rise with hospital, drug and long-term care use, so cost trend above rate increases raises the medical loss ratio.
Major Risks
- Rate shortfalls: If a state pays too little for the cost of care, margin turns negative until rates reset; watch the medical loss ratio and state rate announcements.
- Enrollment declines from redeterminations: When fewer members remain eligible, premium revenue falls and the remaining group may be sicker; watch membership and acuity trends.
- Contract losses: A lost state contract removes revenue and members at once; watch contract award and re-procurement dates.
- Policy and political change: State budgets and elections can change coverage, rates and plan selection; watch policy announcements and budget debates.
Industry Characteristics
| Characteristic | Profile |
|---|---|
| Cyclicality | Defensive |
| Capital Intensity | Low |
| Regulatory Intensity | High |
| Industry Maturity | Mature |
| Geographic Importance | U.S. |
Medicaid Managed Care Filers in the SEC Record
7 companies with annual reports in the dataset are classified by the SEC in the Standard Industrial Classification code 6324. Their latest fiscal years end in 2025, and together they reported $857.5 billion of revenue. Median revenue growth over the prior year was 12.5%. Median operating margin was 1.7% and median net margin 0.9%. Median total liabilities were 73% of total assets, and 4 of 7 reported a profit in their latest year.
| Company | Revenue | Growth | Operating margin | Net margin | Year |
|---|---|---|---|---|---|
| Cigna Group | $274.9 billion | 11.2% | 3.3% | 2.2% | FY 2025 |
| Elevance Health, Inc. | $199.1 billion | 12.5% | 3.6% | 2.8% | FY 2025 |
| Centene Corp | $194.8 billion | 19.4% | -3.9% | -3.4% | FY 2025 |
| Humana Inc | $129.7 billion | 10.1% | 2.1% | 0.9% | FY 2025 |
| Molina Healthcare, Inc. | $45.4 billion | 11.7% | 1.7% | 1.0% | FY 2025 |
| Oscar Health, Inc. | $11.7 billion | 27.5% | -3.4% | -3.8% | FY 2025 |
| Clover Health Investments, Corp. | $1.9 billion | 40.3% | -4.4% | -4.4% | FY 2025 |
Source: each company's own annual report as filed with the SEC (XBRL data), figures in U.S. dollars. A company's SIC code reflects its main business as the SEC records it, so it can differ from how an index provider or analyst classifies the company, and a diversified group appears under only one code.
Where to Go Next
The Medicaid Managed Care guide describes how the industry earns money, what to measure and what can go wrong. To see how it compares, read the neighbouring industries in the same sector, then apply the same checks to a specific company.
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Frequently Asked Questions
What are the main KPIs for the Medicaid Managed Care industry?
Key performance indicators for the Medicaid Managed Care industry include: Membership and contract count, Medical loss ratio, Premium revenue, Administrative cost ratio, State rate adequacy. Which matter most depends on the company's model, so compare them across several companies rather than relying on one.
How cyclical is the Medicaid Managed Care industry?
The Medicaid Managed Care industry is generally defensive, meaning demand tends to remain relatively stable regardless of the economic cycle. Companies in this space can provide portfolio stability during recessions, though growth may lag in strong expansions.
What are the biggest risks in the Medicaid Managed Care industry?
The primary risks for Medicaid Managed Care companies include: Rate shortfalls, Enrollment declines from redeterminations, Contract losses, Policy and political change. Investors should assess each company's exposure to these factors and its track record of navigating them.