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Segment Information
 12 Months Ended
Dec. 31, 2024
Segment Reporting [Abstract]  
Segment Information Segment Information
The Company operates in four segments: (1) a Medicaid segment, (2) a Medicare segment, (3) a Commercial segment and (4) an Other segment. The Medicaid, Medicare and Commercial segments primarily represent the government-sponsored or subsidized programs under which the Company offers managed healthcare services. The Other segment includes the Company's pharmacy operations, Envolve Benefit Options' vision and dental services, clinical healthcare, behavioral health, international operations and corporate management company, among others. The Company's international businesses, Operose Health and Circle Health, which were included in the Other segment, were divested in December 2023 and January 2024, respectively.

Factors used in determining the reportable business segments include the nature of operating activities, the existence of separate senior management teams and the type of information presented to the Company's chief operating decision-maker (CODM) to evaluate all results of operations. The Company's CODM is its Chief Executive Officer. The Company's CODM focuses primarily on each segment's ability to generate sufficient revenues and manage expenses associated with health benefits and cost of services (including estimated costs incurred). As such, the CODM measures operating performance at the segment level based on gross margin, including evaluation of budget to actual variances, to determine the allocation of financial and capital resources for each segment. The Company does not report total assets by segment since this is not a metric used by the Company's CODM to allocate resources or evaluate segment performance.

Segment information for the year ended December 31, 2024, is as follows ($ in millions):
 MedicaidMedicareCommercialOther/EliminationsConsolidated Total
Premium$83,758 $23,032 $33,699 $1,814 $142,303 
Service93 — 3 3,106 3,202 
Premium and service revenues83,851 23,032 33,702 4,920 145,505 
Premium tax17,566 — — — 17,566 
Total external revenues101,417 23,032 33,702 4,920 163,071 
Internal revenues— — — 16,879 16,879 
Eliminations— — — (16,879)(16,879)
Total revenues$101,417 $23,032 $33,702 $4,920 $163,071 
Medical costs$77,516 $20,437 $26,039 $1,715 $125,707 
Cost of services89 — — 2,640 2,729 
Other operating expenses (1)
31,460 
Other income (expense) (2)
1,082 
Earnings before income tax expense$4,257 
Segment gross margin (3)
$6,246 $2,595 $7,663 $565 $17,069 
(1)
Other operating expenses include selling, general and administrative expenses, depreciation, amortization, premium tax expense and impairment.
(2)
Other income (expense) includes investment and other income, debt extinguishment and interest expense.
(3)
Segment gross margin represents premium and service revenues less medical costs and cost of services.
Segment information for the year ended December 31, 2023, is as follows ($ in millions):
 MedicaidMedicareCommercialOther/EliminationsConsolidated Total
Premium$86,853 $22,261 $24,843 $1,679 $135,636 
Service2 — 2 4,455 4,459 
Premium and service revenues86,855 22,261 24,845 6,134 140,095 
Premium tax13,904 — — — 13,904 
Total external revenues100,759 22,261 24,845 6,134 153,999 
Internal revenues— — — 16,735 16,735 
Eliminations— — — (16,735)(16,735)
Total revenues$100,759 $22,261 $24,845 $6,134 $153,999 
Medical costs$78,210 $19,394 $19,816 $1,474 $118,894 
Cost of services4 — — 3,560 3,564 
Other operating expenses (1)
28,611 
Other income (expense) (2)
668 
Earnings before income tax expense$3,598 
Segment gross margin (3)
$8,641 $2,867 $5,029 $1,100 $17,637 
(1)
Other operating expenses include selling, general and administrative expenses, depreciation, amortization, premium tax expense and impairment.
(2)
Other income (expense) includes investment and other income, debt extinguishment and interest expense.
(3)
Segment gross margin represents premium and service revenues less medical costs and cost of services.

Segment information for the year ended December 31, 2022, is as follows ($ in millions):
 MedicaidMedicareCommercialOther/EliminationsConsolidated Total
Premium$84,084 $22,484 $17,377 $3,186 $127,131 
Service(1)— 3 8,346 8,348 
Premium and service revenues84,083 22,484 17,380 11,532 135,479 
Premium tax9,068 — — — 9,068 
Total external revenues93,151 22,484 17,380 11,532 144,547 
Internal revenues— — — 25,191 25,191 
Eliminations— — — (25,191)(25,191)
Total revenues$93,151 $22,484 $17,380 $11,532 $144,547 
Medical costs$75,298 $19,372 $14,092 $2,767 $111,529 
Cost of services— — — 7,032 7,032 
Other operating expenses (1)
24,668 
Other income (expense) (2)
644 
Earnings before income tax expense$1,962 
Segment gross margin (3)
$8,785 $3,112 $3,288 $1,733 $16,918 
(1)
Other operating expenses include selling, general and administrative expenses, depreciation, amortization, premium tax expense and impairment.
(2)
Other income (expense) includes investment and other income, debt extinguishment and interest expense.
(3)
Segment gross margin represents premium and service revenues less medical costs and cost of services.