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Medical Claims Liability | 3 Months Ended
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Mar. 31, 2019
Insurance [Abstract] |
Medical Claims Liability | Medical Claims Liability The following table summarizes the change in medical claims liability ($ in millions):
|  | Three Months Ended March 31,
|  | 2019 |  | 2018
Balance, January 1 |  | $ | 6,831 |  |  | $ | 4,286 |
Less: Reinsurance recoverable |  | 27 |  |  | 18 |
Balance, January 1, net |  | 6,804 |  |  | 4,268 |
Acquisitions and purchase accounting adjustments |  | 6 |  |  | — |
Incurred related to: |  |  |  |
Current year |  | 14,376 |  |  | 10,302 |
Prior years |  | (494 | ) |  | (263 | )
Total incurred |  | 13,882 |  |  | 10,039 |
Paid related to: |  |  |  |
Current year |  | 8,771 |  |  | 6,579 |
Prior years |  | 4,560 |  |  | 2,970 |
Total paid |  | 13,331 |  |  | 9,549 |
Balance at March 31, net |  | 7,361 |  |  | 4,758 |
Plus: Reinsurance recoverable |  | 20 |  |  | 13 |
Balance, March 31 |  | $ | 7,381 |  |  | $ | 4,771 |
Reinsurance recoverables related to medical claims are included in premium and related receivables. Changes in estimates of incurred claims for prior years are primarily attributable to reserving under moderately adverse conditions. Additionally, as a result of development within "Incurred related to: Prior years" due to minimum health benefits ratio (HBR) and other return of premium programs, we recorded $8 million as an increase to premium revenues and $13 million as a reduction to premium revenues in the three months ended March 31, 2019 and 2018, respectively. Incurred but not reported (IBNR) plus expected development on reported claims as of March 31, 2019 was $5,569 million. Total IBNR plus expected development on reported claims represents estimates for claims incurred but not reported, development on reported claims, and estimates for the costs necessary to process unpaid claims at the end of each period. We estimate our liability using actuarial methods that are commonly used by health insurance actuaries and meet Actuarial Standards of Practice. These actuarial methods consider factors such as historical data for payment patterns, cost trends, product mix, seasonality, utilization of healthcare services and other relevant factors.

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- Definition The entire disclosure for the types of coverages and products sold, and the assets, obligations, recorded liabilities, revenues and expenses arising therefrom, and the amounts of and methodologies and assumptions used in determining the amounts of such items. + References Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 944 -URI http://asc.fasb.org/topic&trid=2303980 + Details
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