XML 33 R17.htm IDEA: XBRL DOCUMENT v3.25.0.1
Medical Claims Liability
 12 Months Ended
Dec. 31, 2024
Insurance [Abstract]  
Medical Claims Liability Medical Claims Liability
The following table summarizes the change in medical claims liability for the year ended December 31, 2024 ($ in millions):
 MedicaidMedicareCommercialOtherConsolidated Total
Balance, January 1, 2024$10,814 $3,612 $3,460 $114 $18,000 
Less: Reinsurance recoverables5 — 44 — 49 
Balance, January 1, 2024, net10,809 3,612 3,416 114 17,951 
Incurred related to:
Current year78,886 21,170 26,548 1,708 128,312 
Prior years(1,370)(575)(509)7 (2,447)
Total incurred77,516 20,595 26,039 1,715 125,865 
Paid related to:
Current year69,351 18,036 22,547 1,522 111,456 
Prior years8,693 2,655 2,492 119 13,959 
Total paid78,044 20,691 25,039 1,641 125,415 
Plus: Premium deficiency reserve— (158)— — (158)
Balance, December 31, 2024, net
10,281 3,358 4,416 188 18,243 
Plus: Reinsurance recoverables18 — 47 — 65 
Balance, December 31, 2024
$10,299 $3,358 $4,463 $188 $18,308 

The following table summarizes the change in medical claims liability for the year ended December 31, 2023 ($ in millions):
 MedicaidMedicareCommercialOtherConsolidated Total
Balance, January 1, 2023$11,253 $3,431 $1,921 $140 $16,745 
Less: Reinsurance recoverables7 — 19 — 26 
Balance, January 1, 2023, net11,246 3,431 1,902 140 16,719 
Incurred related to:
Current year79,747 19,487 19,966 1,480 120,680 
Prior years(1,537)(343)(150)(6)(2,036)
Total incurred78,210 19,144 19,816 1,474 118,644 
Paid related to:
Current year69,904 16,631 16,823 1,367 104,725 
Prior years8,743 2,582 1,479 133 12,937 
Total paid78,647 19,213 18,302 1,500 117,662 
Plus: Premium deficiency reserve— 250 — — 250 
Balance, December 31, 2023, net
10,809 3,612 3,416 114 17,951 
Plus: Reinsurance recoverables5 — 44 — 49 
Balance, December 31, 2023
$10,814 $3,612 $3,460 $114 $18,000 
The following table summarizes the change in medical claims liability for the year ended December 31, 2022 ($ in millions):
 MedicaidMedicareCommercialOtherConsolidated Total
Balance, January 1, 2022$9,845 $2,286 $2,014 $98 $14,243 
Less: Reinsurance recoverables23 — — — 23 
Balance, January 1, 2022, net9,822 2,286 2,014 98 14,220 
Acquisitions and divestitures— — — 105 105 
Incurred related to:
Current year76,344 19,474 14,296 2,782 112,896 
Prior years(1,046)(102)(204)(15)(1,367)
Total incurred75,298 19,372 14,092 2,767 111,529 
Paid related to:
Current year66,221 16,275 12,556 2,747 97,799 
Prior years7,653 1,952 1,648 83 11,336 
Total paid73,874 18,227 14,204 2,830 109,135 
Balance, December 31, 2022, net
11,246 3,431 1,902 140 16,719 
Plus: Reinsurance recoverables7 — 19 — 26 
Balance, December 31, 2022
$11,253 $3,431 $1,921 $140 $16,745 

Reinsurance recoverables related to medical claims are included in premium and trade receivables. Changes in estimates of incurred claims for prior years were primarily attributable to reserving under moderately adverse conditions, including residual pandemic impacts. Additionally, as a result of minimum MLR and other return of premium programs, the Company recorded approximately $243 million, $382 million and $198 million of the "Incurred related to: Prior years" as a reduction to premium revenues in 2024, 2023 and 2022, respectively. Further, claims processing and coordination of benefits initiatives yielded claim payment recoveries related to dates of service from prior years.

Changes in medical utilization, claims submission patterns, and cost trends and the effect of population health management initiatives may also contribute to changes in medical claim liability estimates. While the Company has evidence that population health management initiatives are effective on a case by case basis, population health management initiatives primarily focus on events and behaviors prior to the incurrence of the medical event and generation of a claim. Accordingly, any change in behavior, leveling of care or coordination of treatment occurs prior to claim generation and as a result, the costs prior to the population health management initiative are not known by the Company. Additionally, certain population health management initiatives are focused on member and provider education with the intent of influencing behavior to appropriately align the medical services provided with the member's acuity. In these cases, determining whether the population health management initiative changed the behavior cannot be determined. Because of the complexity of its business, the number of states in which it operates and the volume of claims that it processes, the Company is unable to practically quantify the impact of these initiatives on its changes in estimates of IBNR.

The Company reviews actual and anticipated experience compared to the assumptions used to establish medical costs. The Company establishes premium deficiency reserves if actual and anticipated experience indicates that existing policy liabilities together with the present value of future gross premiums will not be sufficient to cover the present value of future benefits, settlement and maintenance costs. For purposes of determining premium deficiencies, contracts are grouped in a manner consistent with the method of acquiring, servicing and measuring the profitability of such contracts and expected investment income is excluded. In December 2023, the Company recorded a premium deficiency reserve of $250 million related to the 2024 Medicare Advantage contract year. In December 2024, the Company recorded a premium deficiency reserve of $92 million related to the 2025 Medicare Advantage contract year.
Information about incurred and paid claims development as of December 31, 2024 is included in the table below. The claims development information for all periods preceding the most recent reporting period is considered required supplementary information.

Consolidated incurred and paid claims development as of December 31, 2024 is as follows ($ in millions):
Cumulative Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance
For the Year Ended December 31,
Claim Year
2022 (unaudited)
2023 (unaudited)
2024
2022$112,896 $110,870 $110,394 
2023120,680 118,709 
2024128,312 
Total incurred claims$357,415 
Cumulative Paid Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance
For the Year Ended December 31,
Claim Year2022 (unaudited)2023 (unaudited)2024
2022$97,799 $109,680 $110,097 
2023104,725 117,635 
2024111,456 
Total payment of incurred claims339,188 
All outstanding liabilities prior to 2022, net of reinsurance
174 
Medical claims liability, net of reinsurance$18,401 

Incurred and paid claims development for the Medicaid segment as of December 31, 2024 is as follows ($ in millions):
Cumulative Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance
For the Year Ended December 31,
Claim Year
2022 (unaudited)
2023 (unaudited)
2024
2022$76,344 $74,861 $74,722 
202379,747 78,517 
202478,885 
Total incurred claims$232,124 
Cumulative Paid Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance
For the Year Ended December 31,
Claim Year
2022 (unaudited)
2023 (unaudited)
2024
2022$66,220 $74,125 $74,608 
202369,904 77,952 
202469,351 
Total payment of incurred claims221,911 
All outstanding liabilities prior to 2022, net of reinsurance
68 
Medical claims liability, net of reinsurance$10,281 
Incurred and paid claims development for the Medicare segment as of December 31, 2024 is as follows ($ in millions):
Cumulative Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance
For the Year Ended December 31,
Claim Year
2022 (unaudited)
2023 (unaudited)
2024
2022$19,475 $19,124 $19,027 
202319,487 19,008 
202421,171 
Total incurred claims$59,206 
Cumulative Paid Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance
For the Year Ended December 31,
Claim Year
2022 (unaudited)
2023 (unaudited)
2024
2022$16,276 $18,818 $18,942 
202316,631 18,778 
202418,036 
Total payment of incurred claims55,756 
All outstanding liabilities prior to 2022, net of reinsurance
66 
Medical claims liability, net of reinsurance$3,516 

Incurred and paid claims development for the Commercial segment as of December 31, 2024 is as follows ($ in millions):
Cumulative Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance
For the Year Ended December 31,
Claim Year
2022 (unaudited)
2023 (unaudited)
2024
2022$14,296 $14,110 $13,870 
202319,966 19,698 
202426,548 
Total incurred claims$60,116 
Cumulative Paid Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance
For the Year Ended December 31,
Claim Year
2022 (unaudited)
2023 (unaudited)
2024
2022$12,556 $13,963 $13,773 
202316,823 19,420 
202422,547 
Total payment of incurred claims55,740 
All outstanding liabilities prior to 2022, net of reinsurance
40 
Medical claims liability, net of reinsurance$4,416 

Incurred and paid claims development for the Other segment as of December 31, 2024 is as follows ($ in millions):
Cumulative Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance
For the Year Ended December 31,
Claim Year
2022 (unaudited)
2023 (unaudited)
2024
2022$2,781 $2,775 $2,775 
20231,480 1,486 
20241,708 
Total incurred claims$5,969 
Cumulative Paid Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance
For the Year Ended December 31,
Claim Year
2022 (unaudited)
2023 (unaudited)
2024
2022$2,747 $2,774 $2,774 
20231,367 1,485 
20241,522 
Total payment of incurred claims5,781 
All outstanding liabilities prior to 2022, net of reinsurance
— 
Medical claims liability, net of reinsurance$188 

Incurred claims and allocated claim adjustment expenses, net of reinsurance, total IBNR plus expected development on reported claims and cumulative claims data as of December 31, 2024 are included in the following table. For claims frequency information summarized below, a claim is defined as the financial settlement of a single medical event in which remuneration was paid to the servicing provider. 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. The Company estimates its 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.

Consolidated information is summarized as follows (in millions):
December 31, 2024
Incurred Claims and Allocated Claim
Adjustment Expenses, Net of Reinsurance		Total IBNR Plus Expected
Development on Reported Claims		Cumulative Paid Claims
2022$110,394 $3 638.0 
2023118,709 383 623.6 
2024128,312 12,079 641.3 

Information for the Medicaid segment is summarized as follows (in millions):
December 31, 2024
Incurred Claims and Allocated Claim
Adjustment Expenses, Net of Reinsurance		Total IBNR Plus Expected
Development on Reported Claims		Cumulative Paid Claims
2022$74,722 $3 370.9 
202378,517 218 345.6 
202478,885 6,968 300.1 
Information for the Medicare segment is summarized as follows (in millions):
December 31, 2024
Incurred Claims and Allocated Claim
Adjustment Expenses, Net of Reinsurance		Total IBNR Plus Expected
Development on Reported Claims		Cumulative Paid Claims
2022$19,027 $— 204.8 
202319,008 102 200.6 
202421,171 1,724 253.0 

Information for the Commercial segment is summarized as follows (in millions):
December 31, 2024
Incurred Claims and Allocated Claim
Adjustment Expenses, Net of Reinsurance		Total IBNR Plus Expected
Development on Reported Claims		Cumulative Paid Claims
2022$13,870 $— 57.5 
202319,698 62 72.9 
202426,548 3,211 83.0 

Information for the Other segment is summarized as follows (in millions):
December 31, 2024
Incurred Claims and Allocated Claim
Adjustment Expenses, Net of Reinsurance		Total IBNR Plus Expected
Development on Reported Claims		Cumulative Paid Claims
2022$2,775 $— 4.8 
20231,486 1 4.5 
20241,708 176 5.2