Affordable Care Act

12 Months Ended

Dec. 31, 2024

The ACA established risk spreading premium stabilization programs as well as a minimum annual MLR and CSRs.

The Company's net receivables (payables) for each of the programs are as follows ($ in millions):


	December 31, 2024		December 31, 2023
Risk adjustment receivable	$	1,434	$	893
Risk adjustment payable	(1,605)		(2,553)

Minimum medical loss ratio	(688)		(164)
Cost sharing reduction receivable	305		—
Cost sharing reduction payable	(74)		(114)

In July 2024, CMS announced the final risk adjustment transfers for the 2023 benefit year. As a result of the announcement, the risk adjustment net payable was decreased by $1,475 million in the twelve months ended December 31, 2024. After consideration of minimum MLR and other related impacts, which includes the effect to the 2024 benefit year, the net pre-tax benefit recognized was $853 million for the year ended December 31, 2024.

In October 2017, the Trump Administration issued an executive order that immediately ceased payments of CSRs to issuers, and beginning in 2018, premium rates for Health Insurance Marketplace were set without factoring in the cost sharing subsidy payments from the federal government. In 2024, the Company reached an agreement with the federal government to retroactively compensate the Company $299 million (gross) for the difference between its actual CSR experience and its pricing assumptions for 2018 through 2020.