Molina Healthcare, Inc. (MOH): Business Model Canvas [Dec-2025 Updated]

You're trying to figure out how a major government payer like Molina Healthcare, Inc. makes money when medical costs are so high. Honestly, after two decades in this game, including my time leading analysis at BlackRock, I see their business model as a masterclass in disciplined expense control. They are built on government capitation payments to cover about 5.6 million members, projecting $42.5 billion in revenue for 2025, but the whole structure hinges on keeping their Medical Care Ratio-the cost of care-down to that tight 92.6% figure in Q3. You'll defintely want to see how their key partnerships and activities are engineered to manage that risk and deliver low-cost coverage to low-income Americans.

Molina Healthcare, Inc. (MOH) - Canvas Business Model: Key Partnerships

You're looking at the core relationships that let Molina Healthcare, Inc. (MOH) actually deliver on its promises to vulnerable populations. These aren't just vendors; these are the entities that provide the care and the funding. It's a complex web, but the numbers tell a clear story about scale and focus.

State and Federal Government Agencies for Contract Awards and Funding

Molina Healthcare, Inc. is fundamentally dependent on government-sponsored programs. These agencies are the source of the vast majority of premium revenue, as Molina operates primarily through Medicaid, Medicare, and state insurance marketplaces.

As of the third quarter of 2025, Molina Healthcare served approximately 5.6 million members in total. The breakdown of this massive membership base highlights the reliance on government contracts:

• Medicaid membership, the core business, was projected to reach 5.1 million by the end of 2025.
• Medicare enrollment was projected to be 250,000 members by year-end 2025.
• The ACA Marketplace enrollment was projected at 580,000 members by year-end 2025.

The operational performance with these partners is tracked closely. For instance, the consolidated Medical Care Ratio (MCR) for the third quarter of 2025 stood at 92.6%. The Medicaid MCR was slightly better at 92.0%. Rate advocacy with state partners is a key activity; each 100 basis points of MCR improvement yields $4.50 of earnings per share. On the contract front, Molina Healthcare announced it was awarded a New Florida Medicaid Contract in November 2025.

Government Partner/Program Type	Latest Member Count (Approximate)	Key Metric/Activity (Late 2025)
Medicaid (e.g., Medi-Cal)	5.1 million (Projected YE 2025)	Q3 2025 MCR: 92.0%
Medicare Advantage	250,000 (Projected YE 2025)	Q3 2025 MCR: 93.6%
State Medicaid Contracts (e.g., Florida)	N/A (Contract Awarded Nov 2025)	Focus on rate updates to restore to appropriate levels

Extensive Network of Hospitals, Physicians, and Ancillary Providers

This is the delivery arm of the business model. Molina Healthcare, Inc. must maintain an adequate network of in-network physicians and providers, as HMO plans generally provide no benefits for out-of-network services, with specific exceptions. Customer satisfaction with the provider network is a metric they watch; as of March 2025, 76% of customers expressed satisfaction with their provider network.

The network includes a wide range of providers, and compliance with directory accuracy is mandated, effective July 1, 2025, requiring public, online searchable directories to include whether a provider offers services via Telehealth.

• Provider types covered under contracts include Physicians (Specialists), Hospitals, Mental health and Substance Use Disorder Providers, and Long Term Supports and Services Providers.
• Molina Healthcare of Michigan conducts an annual Provider Satisfaction Survey administered by PressGaney, with the initial mailing sent on August 6, 2025.

McLaren Physician Partners and Other Large Healthcare Systems (July 2025 Expansion)

The partnership with McLaren Physician Partners (MPP) is a significant, localized strategic alliance. In July 2025, Molina expanded its existing MPP relationship to include Medicaid for all regions. This expansion brought the following McLaren regions under full systemwide participation for active MPP clinicians and hospitals:

• McLaren Central
• McLaren Greater Lansing
• McLaren Lapeer
• McLaren Northern

The contract amendment with Molina was effective June 1, 2025. MPP itself is a joint venture handling the negotiation and administration of managed care contracts for its network of physicians, ancillary facilities, and hospitals. Separately, MPP announced a Clinical Integration (CI) Payment 1 for 2025, based on performance measures, totaling $5.6 million distributed, which was an increase of $2.2 million over the last CI Payment 2 of 2024.

Community-based Organizations (CBOs) for Addressing Social Determinants of Health

While specific financial data on CBO partnerships for Social Determinants of Health (SDOH) is not explicitly detailed in the latest reports, the commitment is clear through technology partnerships aimed at underserved areas. The partnership with Vheda Health, for example, is explicitly aimed at advancing health equity in underserved areas.

Digital Health and Technology Vendors like Vheda Health for Chronic Care Management

Partnerships with technology vendors create a digital extension to care management, particularly for chronic conditions. Molina Healthcare of California partnered with Vheda Health to enhance access for members with conditions like diabetes and hypertension.

The results from this specific vendor partnership demonstrate tangible clinical and financial impacts:

Metric	Result/Value	Context
Member Engagement	84%	Reported by Vheda Health for their chronic care programs
Return on Investment (ROI)	Average 3:1	Reported by Vheda Health
Hypertension Control	76% of users achieved control	Within the first six months of engagement
Diabetes HbA1c Reduction	65% of users showed reduction	Within three months of engagement

This technology use includes telehealth consultations, 24/7 access to care teams, and real-time data integration from devices. Also, in November 2025, Molina Healthcare, Inc. closed an offering of $850 Million of 6.500% Senior Notes due 2031, which is a key financial partnership/transaction.

Molina Healthcare, Inc. (MOH) - Canvas Business Model: Key Activities

You're looking at the core engine of Molina Healthcare, Inc. as of late 2025. The real work here is managing the razor-thin margins inherent in government-sponsored healthcare programs, so every activity has to be executed with precision.

Bidding on and securing government managed care contracts (RFPs)

This is where the growth story is written. Molina Healthcare, Inc. is constantly in the arena for state Medicaid and Medicare Advantage contracts. You saw them land a new Florida Medicaid Contract on November 14, 2025. Back in February 2025, management noted that wins in Georgia's Medicaid program and dual-eligible products across several states were projected to add over $5 billion in incremental annual revenue. To be fair, the Medicaid segment remains the bedrock, representing 75% of total premium revenue in Q3 2025.

Disciplined medical cost management to control the high Medical Care Ratio (MCR)

Controlling the Medical Care Ratio (MCR) is non-negotiable; it's the percentage of premium revenue spent on claims. For Q3 2025, the consolidated MCR was 92.6%, which is up from 89.2% in Q3 2024, showing the pressure points. Still, the company points to its consistently effective medical cost management as a moderating factor. You can see the segment breakdown below, which helps explain where the pressure is coming from:

Segment	Q3 2025 MCR
Consolidated	92.6%
Medicaid	92.0%
Medicare	93.6%
Marketplace	95.6%

The company is driving operational discipline elsewhere, too. The adjusted General and Administrative (G&A) Ratio for Q3 2025 was a very strong 6.3%.

Processing and paying claims for approximately 5.6 million members (Q3 2025)

The scale of operations is massive. As of September 30, 2025, Molina Healthcare, Inc. served approximately 5.6 million members. That's a lot of claims to adjudicate. The efficiency in this area is tracked by Days in Claims Payable, which stood at 46 days at the end of Q3 2025. This is a critical metric for cash management, especially since operating cash flow for the first nine months of 2025 was an outflow of $237 million, partly due to settlement activity.

Strategic Mergers & Acquisitions (M&A) to expand geographic footprint and scale

M&A is a clear growth lever. The most recent major transaction mentioned was the acquisition of ConnectiCare, which closed in February 2025 after being announced in 2024 for $350 million. That deal was expected to add about $1.2 billion in revenue, mostly in the Marketplace segment. The company's overall premium revenue guidance for the full year 2025 was raised to approximately $42.5 billion, reflecting these inorganic growth moves alongside organic wins.

Developing and maintaining proprietary IT and claims processing platforms

While direct dollar figures for IT development aren't always isolated, the focus on operational efficiency, evidenced by the low 6.3% adjusted G&A ratio in Q3 2025, implies heavy investment in proprietary systems. These platforms are what allow Molina Healthcare, Inc. to manage the high utilization trends-like those seen in behavioral health and pharmacy-across its 5.6 million members while keeping administrative costs tight. The ability to process and pay claims efficiently directly impacts that 46 days in claims payable metric.

Finance: draft 13-week cash view by Friday.

Molina Healthcare, Inc. (MOH) - Canvas Business Model: Key Resources

Molina Healthcare, Inc. relies on several core assets to execute its government-focused managed care strategy.

State-specific government managed care contracts and licenses across 21 states

Molina Healthcare, Inc. maintains the necessary state-specific government managed care contracts and licenses to operate its health plans. As of July 2024, Molina Healthcare, Inc. served members across 21 states. The Medicare 2025 plans were accessible in 19 states. Note that Molina Healthcare of Virginia ceased offering Medicare coverage as of June 30, 2025.

• California
• Texas
• New York
• Ohio
• Florida
• Georgia
• Illinois
• Kentucky
• Mississippi
• Nebraska
• Nevada
• New Mexico
• Washington
• Wisconsin
• Idaho
• Iowa
• Massachusetts
• Michigan
• Utah
• Virginia (Medicare non-renewal effective July 1, 2025)

Large, established provider network in key Medicaid and Medicare markets

The scale of the member base directly relates to the required network size. As of September 30, 2025, Molina Healthcare, Inc. served approximately 5.6 million members. This membership is concentrated in the Medicaid segment, which remains the largest. State agencies consider the health plan's provider network a key factor when awarding contracts.

Proprietary technology platform for claims processing and care management

Molina Healthcare, Inc. uses centralized services, including information technology, for claims processing and certain care management services across its subsidiaries. The need to maintain, protect, and enhance these systems is an ongoing commitment of significant resources.

Human capital expertise in government programs, compliance, and medical cost control

The enterprise is supported by a substantial workforce. As of July 2024, the organization had 16,000+ employees. The company's associates drive successes in areas like growing business and integrating acquired health plans. Expertise in government programs, compliance, and medical cost control is critical, especially given the Q3 2025 Medical Care Ratio (MCR) of 92.6%.

Strong balance sheet and liquidity to support growth and share repurchases

Molina Healthcare, Inc. maintains significant financial resources, though liquidity at the parent level can fluctuate due to timing of government settlements. As of September 30, 2025, the consolidated balance sheet showed total assets of approximately $15.698 trillion in total liabilities and stockholders' equity. Long-term debt stood at $3,664 million. The company supported its capital structure with share repurchases, buying back approximately 1.7 million shares for $500 million in the fourth quarter of 2024.

Here is a look at key financial and operational metrics as of late 2025 reporting periods:

Metric	Value (As of/For Period)	Reporting Date/Period
Total Members Served	5.6 million	September 30, 2025
Consolidated Medical Care Ratio (MCR)	92.6%	Q3 2025
Parent Company Cash and Investments	$108 million	September 30, 2025
Consolidated Cash and Cash Equivalents	$4,221 million	September 30, 2025
Consolidated Long-Term Debt	$3,664 million	September 30, 2025
Premium Revenue (Q3)	$10.841 billion	Q3 2025
Full Year 2025 Premium Revenue Guidance	$42.5 billion	Full Year 2025
Full Year 2024 Premium Revenue	$38.6 billion	Full Year 2024
Adjusted Earnings Per Share (EPS) Guidance	$14.00 per diluted share	Full Year 2025

The company's financial health is also reflected in its expense ratios for the third quarter of 2025, with the General and Administrative (G&A) Ratio at 6.4% and the Adjusted G&A Ratio at 6.3%.

Molina Healthcare, Inc. (MOH) - Canvas Business Model: Value Propositions

Molina Healthcare, Inc. focuses its value proposition on delivering accessible, comprehensive, and integrated care to government-sponsored populations, which translates into concrete financial and service metrics for members.

Low or no-cost comprehensive health coverage for low-income populations

Molina Healthcare, Inc. provides managed health care services under the Medicaid and Medicare programs and state insurance marketplaces, aiming to erase inequities in care delivery. As of July 25, 2024, Molina served approximately 5.6 million members across 21 states. The company reaffirmed its full-year 2025 guidance of roughly $42 billion in premium revenue. For specific Marketplace plans, like the Silver 12 150 HMO in Michigan for 2025, the first 4 Primary Care Visits are offered at No Charge. Furthermore, for Molina Medicaid members, virtual care visits are provided at NO COST.

Supplemental benefits (e.g., dental, vision, behavioral health) beyond Original Medicare

Molina Medicare Advantage plans often include extra benefits that Original Medicare does not cover, offering a clear financial advantage over the federal program, which has unpredictable out-of-pocket expenses. For members on specific plans who meet criteria and complete a Health Risk Assessment, Molina Medicare Complete Care plans provide a $150 every month for food and produce allowance. Unused allowance does not carry over to the next month. For behavioral health, one plan offers $0 copay for days 1 - 90 of an inpatient hospital stay, subject to a 190 day lifetime limit for inpatient psychiatric hospital care.

Benefit Category	Molina Medicare 2025 Offering Example	Original Medicare Comparison Point
Food/Produce Allowance	$150 every month (SSBCI)	Not covered
Routine Vision Exam	$0 copay for up to one per calendar year	Not covered
Inpatient Mental Health Days	$0 copay for days 1 - 90 per benefit period	60 lifetime reserve days available after 90 days

Integrated care models for complex and chronic conditions (e.g., D-SNP, MMP)

Molina Healthcare is heavily invested in the Dual Eligible Special Needs Plan (D-SNP) market, which integrates Medicare and Medicaid benefits for complex populations. Overall SNP enrollment grew +21.5% from the prior year, with an average annual growth of +18% over the last five years. As of early 2025, Molina Healthcare served 113,921 members in Special Needs Plans. The company is preparing for future growth, evidenced by the Illinois D-SNP contract win expected to add approximately 73,000 beneficiaries starting in 2026, for which Molina's 2025 guidance includes about $1.00 per diluted share in implementation costs. The consolidated Medical Care Ratio (MCR) for Molina was 89.1% in 2024, with the Medicaid MCR at 90.3%.

Access to virtual care (Teladoc) and 24/7 health support

Molina Healthcare offers access to virtual care through partnerships with providers like Teladoc for adult care and Nemours Children's Health System for pediatric care, enabling 24/7 medical care by phone or video. The company's subsidiary, Care Connections, completed over 250,000 visits across 22 states in 2025, utilizing in-home and telehealth visits from nurse practitioners and social workers to support preventive screenings and chronic disease management. For Marketplace plans, telehealth services are covered at the same cost share as in-person services, and for Medicaid members, these telehealth visits are free.

• Telehealth partners include Teladoc and Nemours Children's Health System.
• Care Connections completed over 250,000 visits in 22 states in 2025.
• Molina Medicaid members receive telehealth services at no cost.
• Telehealth services are covered on the same basis as in-person services.

Community-focused programs addressing social determinants of health

The value proposition includes strategic investment in community health via the MolinaCares Accord to address the root causes of health disparities. Molina supports initiatives targeting essential needs like housing, nutrition, and transportation. For example, the company invested in a doula program, reflecting its commitment to health equity. Molina encourages the use of SDOH screening tools that must, at a minimum, screen for:

• Homelessness/Housing instability
• Transportation Assistance
• Employment Instability
• Justice/Legal Involvement
• Social Isolation/Social Support

Finance: draft 13-week cash view by Friday.

Molina Healthcare, Inc. (MOH) - Canvas Business Model: Customer Relationships

You're looking at how Molina Healthcare, Inc. connects with its members in late 2025, a time defined by significant Medicaid redetermination activity and a push toward digital efficiency. The relationship strategy centers on high-touch support for a complex member base, which, as of September 30, 2025, stood at approximately 5.6 million members across its government-sponsored plans.

High-touch, multi-language Member Services support via phone and TTY

Molina Healthcare maintains a commitment to accessible, direct support channels for its members. This includes dedicated phone and TTY services, which are crucial given the diverse linguistic needs of the Medicaid and Marketplace populations it serves. While specific call center metrics for late 2025 aren't public, the scale of the operation supports millions of members who rely on these immediate touchpoints.

• Member base as of September 30, 2025: approximately 5.6 million.
• Member base as of June 30, 2025: approximately 5.7 million.
• The overall business is heavily reliant on government programs, where personalized service is a key differentiator.

Case managers and care coordinators for complex and high-risk members

For members with higher acuity needs, Molina Healthcare deploys specialized clinical teams. This high-touch approach is necessary because utilization remains a concern, with the consolidated Medical Care Ratio (MCR) hitting 92.6% in the third quarter of 2025. This indicates a significant portion of premium revenue is going toward claims, underscoring the need for proactive management of high-cost utilization areas like behavioral health and pharmacy.

Digital self-service tools through member portals and website

Molina Healthcare is actively shifting administrative processes to digital platforms to streamline interactions for both members and providers. A major step in this direction is the transition to a Digital-Only Prior Authorization (PA) Model, meaning faxes will no longer be accepted after December 31, 2025, requiring all PA requests through the Availity Essentials portal. This move aims for faster turnaround times and greater transparency in authorization tracking for members.

Community engagement and outreach programs (MolinaCares)

The MolinaCares Accord represents tangible, localized investment aimed at addressing Health Related Social Needs (HRSN) and improving community health infrastructure. These are concrete financial commitments designed to build trust and address non-clinical barriers to care.

Initiative/Grant Focus	Amount/Detail	Date/Context
Workforce Development (Nevada AHEC)	$150,000 grant	Announced April 2025
Career/College Readiness (Springfield Project)	$45,000 grant for transportation	Presented March 2025
California Community Reinvestment	Planning started in CY 2025	Activities begin in CY 2026

These community reinvestment activities are designed to align with state goals to improve member health and well-being through locally-driven innovations.

Proactive communication for Medicaid redeterminations and renewals

Managing the Medicaid eligibility redetermination process is a critical, ongoing customer relationship challenge. While the bulk of the disenrollments due to the unwinding occurred earlier, the impact continues to be felt, with Medicaid membership declining 5.2% in the first nine months of 2025. Molina Healthcare previously expected to retain 40% of the membership gained during the pandemic pause. Proactive communication is essential as states continue eligibility checks, directly impacting the ~4.5 million Medicaid members Molina served as of Q3 2025 (estimated from total membership of 5.6 million and other segments).

• Medicaid MCR for Q3 2025 was 92.0%.
• The company is focused on rate adjustments to offset the trend, with 55% of premium re-contracting expected on January 1, 2026.

Finance: draft 13-week cash view by Friday.

Molina Healthcare, Inc. (MOH) - Canvas Business Model: Channels

You're looking at how Molina Healthcare, Inc. (MOH) gets its plans in front of people, which is key since they serve a massive government-sponsored population. It's a multi-pronged approach, but some channels are getting a strategic shake-up as of late 2025.

Direct enrollment through state and federal Health Insurance Marketplaces

Molina Healthcare accepts business directly from consumers for its Marketplace plans. However, the company made a significant channel adjustment by announcing it will not pay agent commissions on new Affordable Care Act (ACA) business in ten states: Florida, New Mexico, Texas, South Carolina, Illinois, Michigan, Wisconsin, Connecticut, Washington, and Ohio. The Marketplace segment has been a tough spot; for Q3 2025, it reported a Medical Care Ratio (MCR) of 95.6%. Looking ahead, the fourth quarter guidance projects Medicare and Marketplace segments will combine for an estimated loss of $2.65 per share against Medicaid's projected earnings.

State-run Medicaid and Medicare enrollment systems

The core of Molina Healthcare's distribution relies on state-run systems for Medicaid and Medicare Advantage enrollment. As of the Q3 2025 report, the Medicaid segment was the powerhouse, accounting for 75% of total premium revenue. The company projects its full-year 2025 premium revenue to hit approximately $42.5 billion. This reliance on government programs means enrollment flows heavily through state eligibility determinations and federal Medicare Advantage plan selection processes. The company served approximately 5.6 million+ members across 21 states as of mid-2024, a base they are actively growing through contract wins.

Independent brokers and agents for Medicare Advantage and Marketplace plans

Brokers and agents remain a vital channel, particularly for Medicare Advantage and Marketplace plans, though Molina Healthcare is adjusting incentives. For new 2025 enrollments effective January 1 or February 1, 2025, Molina offered one-time bonuses to agents based on volume and plan type. Renewal business also saw bonus payouts in July 2025. Here's a look at the one-time bonus structure for new 2025 members:

Total # of New Members	Plan Type	One-Time Bonus Amount per Member (Lower Tier)	One-Time Bonus Amount per Member (Higher Tier)
50 +	Silver Plans	$50	$75
50 +	Bronze Plans	$25	$50
100 +	Silver Plans	$50	$75
100 +	Bronze Plans	$25	$50

To be fair, this structure had specific terms, like requiring members to remain enrolled for 120 days. Also, beginning with 1/01/26 enrollments, new sales commissions will be paused for Molina's CHP MAPD and CHP C-SNP products in California, though renewal commissions will continue.

Direct-to-member communication via mail, email, and digital platforms

Molina Healthcare supports direct enrollment and member engagement through digital and physical outreach. Members can access their Member Portal at MyMolina.com to view benefits, print ID cards, and track claims. The company also offers the Molina Mobile App for on-the-go access. For payments, members can use Molinapayment.com for one-time transactions or sign up for Autopay. Interpreter services are provided at no cost to assist any Member needing language support.

Local community offices and health centers for in-person support

While the primary focus is government-sponsored care delivered through established state systems, Molina Healthcare maintains a physical presence. The company is headquartered in Long Beach, California. In-person support channels are crucial for members navigating complex eligibility or benefit questions, especially within the Medicaid and Medicare populations. For example, in Texas, Molina Healthcare of Florida, Inc. serves specific counties like Broward, Miami-Dade, and Orange.

Finance: draft 13-week cash view by Friday.

Molina Healthcare, Inc. (MOH) - Canvas Business Model: Customer Segments

Molina Healthcare, Inc. focuses its business model on serving government-sponsored healthcare programs. You are looking at a customer base heavily concentrated in public health insurance markets.

As of September 30, 2025, Molina Healthcare, Inc. served approximately 5.6 million total members.

The primary customer groups are segmented by the source of their coverage, which dictates the regulatory and payment structure Molina operates under for each group.

• Medicaid beneficiaries: low-income families, children, pregnant women, and individuals with disabilities
• Medicare beneficiaries: primarily dual-eligible (Medicare-Medicaid Plans - MMPs) and Medicare Advantage members
• Health Insurance Marketplace (ACA) enrollees: individuals and families seeking subsidized coverage

Here's a look at the membership distribution across these core segments based on the latest figures available for the third quarter of 2025.

Customer Segment	Approximate Member Count (as of 9/30/2025)	Segment Premium Revenue (Q3 2025)
Medicaid	More than 4.6 million	$8.02 billion
Health Insurance Marketplace (ACA)	713,000	Not explicitly stated for Q3 2025
Medicare Advantage	266,000	Not explicitly stated for Q3 2025
Total Reported Members	Approximately 5.6 million	$10.8 billion (Consolidated Premium Revenue for Q3 2025)

The Medicaid segment remains the cornerstone of Molina Healthcare, Inc. operations, representing the largest portion of the total membership base. In the third quarter of 2025, this flagship business accounted for approximately 75% of total premium revenue. You can see the financial performance pressures, with the Medicaid Medical Care Ratio (MCR) reported at 92.0% for that quarter.

The Health Insurance Marketplace (ACA) segment experienced significant growth in membership leading up to this period, though it also faced notable utilization challenges. For the third quarter of 2025, the Marketplace MCR was reported at 95.6%. The Medicare segment, which includes dual-eligible plans, also saw higher utilization, posting a third quarter MCR of 93.6%.

Molina Healthcare, Inc. (MOH) - Canvas Business Model: Cost Structure

You're looking at the cost side of Molina Healthcare, Inc.'s (MOH) operations as of late 2025, and frankly, the story is dominated by medical claims. It's where the vast majority of premium revenue goes. For the third quarter of 2025, the consolidated Medical Care Ratio (MCR), which is the percentage of premiums spent on member care, hit 92.6%. That's a significant cost base right there.

The pressure on that MCR is coming from utilization across the board, but it's not evenly distributed. The Marketplace segment, which is a smaller piece of the overall business, is seeing the most acute pressure. The Q3 2025 MCR for Marketplace was 95.6%, driven by much higher utilization than their risk adjustment revenue could cover.

Here's a quick breakdown of the key cost ratios from the third quarter of 2025:

Cost Component	Q3 2025 Ratio	Context/Guidance
Consolidated Medical Care Ratio (MCR)	92.6%	Reported for Q3 2025
Adjusted General and Administrative (G&A) Ratio	6.3%	Reported for Q3 2025
GAAP General and Administrative (G&A) Ratio	6.4%	Reported for Q3 2025
Full Year 2025 Adjusted G&A Guidance	~6.5%	Updated guidance
Depreciation and Amortization Expense Ratio	1.0%	Reported ratio from a financial table

The company is managing its overhead costs well, which is important when medical costs are running so high. The adjusted G&A ratio for Q3 2025 was held to 6.3%, showing continued operating discipline even as premium revenue for the quarter was approximately $10.8 billion.

When you look deeper into the utilization trends that are inflating the MCR, you see specific areas of concern that drive these medical costs:

• Marketplace MCR at 95.6% due to elevated utilization.
• Medicare MCR at 93.6%, reflecting higher utilization in high-acuity members.
• Higher utilization in Medicare is specifically tied to long-term services and supports (LTSS) and pharmacy costs.
• Medicaid MCR was 92.0% for the quarter, which management still characterized as producing strong margins relative to the other segments.

Beyond the direct claims, there are the structural costs. The amortization of intangible assets from strategic acquisitions is a component of the overall cost base, and the closest available figure for a related expense category, the Depreciation and amortization expense ratio, was 1.0% in one reported period. Then you have the ongoing spend for state and federal regulatory compliance and quality improvement costs, which are baked into the G&A structure or other operating expenses, but a specific standalone dollar amount for this category in 2025 isn't explicitly broken out in the primary cost disclosures.

Molina Healthcare, Inc. (MOH) - Canvas Business Model: Revenue Streams

Premium Revenue from government capitation payments (Medicaid, Medicare, Marketplace)

• Medicaid segment produced a Q3 2025 Medical Care Ratio (MCR) of 92.0%.
• Medicare segment produced a Q3 2025 MCR of 93.6%.
• Marketplace segment produced a Q3 2025 MCR of 95.6%.
• Q3 2025 Premium revenue was approximately $10.8 billion.

Full-year 2025 Premium Revenue guidance is approximately $42.5 billion.

Risk adjustment and reinsurance payments from government programs

• Marketplace MCR for Q3 2025 was impacted by higher utilization relative to risk adjustment revenue.
• Marketplace MCR guidance for full year 2025 was raised to 85% in one report, while another noted a Q2 2025 MCR of 85.4% including prior-year true-ups.

Investment income on cash reserves and float (less significant)

• Investment income for the nine months ended September 30, 2025, was $322 million.
• Investment income for the third quarter of 2025 was $108 million.

Here's the quick math on the reported revenue components through Q3 2025:

Revenue Component	Amount (Nine Months Ended Sept 30, 2025, in millions)	Amount (Q3 2025, in millions)
Premium revenue	$32,337	$10,841
Premium tax revenue	$1,325	$506
Investment income	$322	$108

Cash and investments at the parent company were approximately $108 million as of September 30, 2025.