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Medical Costs Payable (Notes)
 12 Months Ended
Dec. 31, 2021
Insurance [Abstract]  
Medical Costs Payable Medical Costs Payable
The following table shows the components of the change in medical costs payable for the years ended December 31:
(in millions)202120202019
Medical costs payable, beginning of period$21,872 $21,690 $19,891 
Acquisitions88 316 679 
Reported medical costs:
Current year188,631 160,276 157,020 
Prior years(1,720)(880)(580)
Total reported medical costs186,911 159,396 156,440 
Medical payments:
Payments for current year
(165,524)(139,974)(137,155)
Payments for prior years(18,864)(19,556)(18,165)
Total medical payments(184,388)(159,530)(155,320)
Medical costs payable, end of period$24,483 $21,872 $21,690 
For the years ended December 31, 2021, 2020 and 2019 medical cost reserve development was primarily driven by lower than expected health system utilization levels. Additionally, medical cost reserve development in the year ended December 31, 2021 was driven by the uncertainty of care patterns due to the disruption of the health care system caused by COVID-19.
Medical costs payable included IBNR of $17.1 billion and $14.8 billion at December 31, 2021 and 2020, respectively. Substantially all of the IBNR balance as of December 31, 2021 relates to the current year. The following is information about incurred and paid medical cost development as of December 31, 2021:
Net Incurred Medical Costs
 (in millions)For the Years Ended December 31,
Year20202021
2020$160,276 $159,140 
2021188,631 
Total$347,771 
Net Cumulative Medical Payments
 (in millions)For the Years Ended December 31,
Year20202021
2020$(139,974)$(158,182)
2021(165,524)
Total(323,706)
Net remaining outstanding liabilities prior to 2020418 
Total medical costs payable$24,483