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v3.25.4

Medical Claims Liability (Tables) | 12 Months Ended
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Dec. 31, 2025
Insurance [Abstract] |
Schedule of Change in Medical Claims Liability by Operating Segment | The following table summarizes the change in medical claims liability for the year ended December 31, 2025 ($ in millions):
| Medicaid |  | Medicare |  | Commercial |  | Other |  | Consolidated Total
Balance, January 1, 2025 | $ | 10,299 |  |  | $ | 3,358 |  |  | $ | 4,463 |  |  | $ | 188 |  |  | $ | 18,308 |
Less: Reinsurance recoverables | 18 |  |  | — |  |  | 47 |  |  | — |  |  | 65 |
Balance, January 1, 2025, net | 10,281 |  |  | 3,358 |  |  | 4,416 |  |  | 188 |  |  | 18,243 |
Incurred related to: |  |  |  |  |  |  |  |  |
Current year | 85,697 |  |  | 34,869 |  |  | 37,397 |  |  | 2,146 |  |  | 160,109 |
Prior years | (1,247) |  |  | (550) |  |  | (495) |  |  | (23) |  |  | (2,315) |
Total incurred | 84,450 |  |  | 34,319 |  |  | 36,902 |  |  | 2,123 |  |  | 157,794 |
Paid related to: |  |  |  |  |  |  |  |  |
Current year | 75,872 |  |  | 30,651 |  |  | 32,213 |  |  | 1,955 |  |  | 140,691 |
Prior years | 8,500 |  |  | 2,533 |  |  | 3,482 |  |  | 162 |  |  | 14,677 |
Total paid | 84,372 |  |  | 33,184 |  |  | 35,695 |  |  | 2,117 |  |  | 155,368 |
Plus: Premium deficiency reserve | — |  |  | (92) |  |  | — |  |  | — |  |  | (92) |
Plus: Divestitures | — |  |  | — |  |  | — |  |  | (109) |  |  | (109) |
Balance, December 31, 2025, net | 10,359 |  |  | 4,401 |  |  | 5,623 |  |  | 85 |  |  | 20,468 |
Plus: Reinsurance recoverables | 16 |  |  | — |  |  | 60 |  |  | — |  |  | 76 |
Balance, December 31, 2025 | $ | 10,375 |  |  | $ | 4,401 |  |  | $ | 5,683 |  |  | $ | 85 |  |  | $ | 20,544 |
The following table summarizes the change in medical claims liability for the year ended December 31, 2024 ($ in millions):
| Medicaid |  | Medicare |  | Commercial |  | Other |  | Consolidated Total
Balance, January 1, 2024 | $ | 10,814 |  |  | $ | 3,612 |  |  | $ | 3,460 |  |  | $ | 114 |  |  | $ | 18,000 |
Less: Reinsurance recoverables | 5 |  |  | — |  |  | 44 |  |  | — |  |  | 49 |
Balance, January 1, 2024, net | 10,809 |  |  | 3,612 |  |  | 3,416 |  |  | 114 |  |  | 17,951 |
Incurred related to: |  |  |  |  |  |  |  |  |
Current year | 78,886 |  |  | 21,170 |  |  | 26,548 |  |  | 1,708 |  |  | 128,312 |
Prior years | (1,370) |  |  | (575) |  |  | (509) |  |  | 7 |  |  | (2,447) |
Total incurred | 77,516 |  |  | 20,595 |  |  | 26,039 |  |  | 1,715 |  |  | 125,865 |
Paid related to: |  |  |  |  |  |  |  |  |
Current year | 69,351 |  |  | 18,036 |  |  | 22,547 |  |  | 1,522 |  |  | 111,456 |
Prior years | 8,693 |  |  | 2,655 |  |  | 2,492 |  |  | 119 |  |  | 13,959 |
Total paid | 78,044 |  |  | 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 recoverables | 18 |  |  | — |  |  | 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):
| Medicaid |  | Medicare |  | Commercial |  | Other |  | Consolidated Total
Balance, January 1, 2023 | $ | 11,253 |  |  | $ | 3,431 |  |  | $ | 1,921 |  |  | $ | 140 |  |  | $ | 16,745 |
Less: Reinsurance recoverables | 7 |  |  | — |  |  | 19 |  |  | — |  |  | 26 |
Balance, January 1, 2023, net | 11,246 |  |  | 3,431 |  |  | 1,902 |  |  | 140 |  |  | 16,719 |
Incurred related to: |  |  |  |  |  |  |  |  |
Current year | 79,747 |  |  | 19,487 |  |  | 19,966 |  |  | 1,480 |  |  | 120,680 |
Prior years | (1,537) |  |  | (343) |  |  | (150) |  |  | (6) |  |  | (2,036) |
Total incurred | 78,210 |  |  | 19,144 |  |  | 19,816 |  |  | 1,474 |  |  | 118,644 |
Paid related to: |  |  |  |  |  |  |  |  |
Current year | 69,904 |  |  | 16,631 |  |  | 16,823 |  |  | 1,367 |  |  | 104,725 |
Prior years | 8,743 |  |  | 2,582 |  |  | 1,479 |  |  | 133 |  |  | 12,937 |
Total paid | 78,647 |  |  | 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 recoverables | 5 |  |  | — |  |  | 44 |  |  | — |  |  | 49 |
Balance, December 31, 2023 | $ | 10,814 |  |  | $ | 3,612 |  |  | $ | 3,460 |  |  | $ | 114 |  |  | $ | 18,000 |
Schedule of Consolidated Incurred and Paid Claims Development | Consolidated incurred and paid claims development as of December 31, 2025 is as follows ($ in millions):
Cumulative Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance
For the Year Ended December 31,
Claim Year |  | 2023 (unaudited) |  | 2024 (unaudited) |  | 2025
2023 |  | $ | 120,680 |  |  | $ | 118,709 |  |  | $ | 118,324 |
2024 |  |  |  | 128,312 |  |  | 126,382 |
2025 |  |  |  |  |  | 160,109 |
|  | Total incurred claims |  | $ | 404,815 |
Cumulative Paid Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance
For the Year Ended December 31,
Claim Year |  | 2023 (unaudited) |  | 2024 (unaudited) |  | 2025
2023 |  | $ | 104,725 |  |  | $ | 117,635 |  |  | $ | 118,114 |
2024 |  |  |  | 111,456 |  |  | 125,631 |
2025 |  |  |  |  |  | 140,691 |
|  | Total payment of incurred claims |  | 384,436 |
|  | All outstanding liabilities prior to 2023, net of reinsurance |  | 290 |
|  | Magellan Health medical claims liabilities held for sale |  | (109) |
|  | Medical claims liability, net of reinsurance |  | $ | 20,560 |
Incurred and paid claims development for the Medicaid segment as of December 31, 2025 is as follows ($ in millions):
Cumulative Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance
For the Year Ended December 31,
Claim Year |  | 2023 (unaudited) |  | 2024 (unaudited) |  | 2025
2023 |  | $ | 79,747 |  |  | $ | 78,517 |  |  | $ | 78,282 |
2024 |  |  |  | 78,885 |  |  | 77,872 |
2025 |  |  |  |  |  | 85,697 |
|  | Total incurred claims |  | $ | 241,851 |
Cumulative Paid Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance
For the Year Ended December 31,
Claim Year |  | 2023 (unaudited) |  | 2024 (unaudited) |  | 2025
2023 |  | $ | 69,904 |  |  | $ | 77,952 |  |  | $ | 78,194 |
2024 |  |  |  | 69,351 |  |  | 77,527 |
2025 |  |  |  |  |  | 75,872 |
|  | Total payment of incurred claims |  | 231,593 |
|  | All outstanding liabilities prior to 2023, net of reinsurance |  | 101 |
|  | Medical claims liability, net of reinsurance |  | $ | 10,359 |
Incurred and paid claims development for the Medicare segment as of December 31, 2025 is as follows ($ in millions):
Cumulative Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance
For the Year Ended December 31,
Claim Year |  | 2023 (unaudited) |  | 2024 (unaudited) |  | 2025
2023 |  | $ | 19,487 |  |  | $ | 19,008 |  |  | $ | 18,830 |
2024 |  |  |  | 21,171 |  |  | 20,798 |
2025 |  |  |  |  |  | 34,869 |
|  | Total incurred claims |  | $ | 74,497 |
Cumulative Paid Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance
For the Year Ended December 31,
Claim Year |  | 2023 (unaudited) |  | 2024 (unaudited) |  | 2025
2023 |  | $ | 16,631 |  |  | $ | 18,778 |  |  | $ | 18,783 |
2024 |  |  |  | 18,036 |  |  | 20,674 |
2025 |  |  |  |  |  | 30,651 |
|  | Total payment of incurred claims |  | 70,108 |
|  | All outstanding liabilities prior to 2023, net of reinsurance |  | 104 |
|  | Medical claims liability, net of reinsurance |  | $ | 4,493 |
Incurred and paid claims development for the Commercial segment as of December 31, 2025 is as follows ($ in millions):
Cumulative Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance
For the Year Ended December 31,
Claim Year |  | 2023 (unaudited) |  | 2024 (unaudited) |  | 2025
2023 |  | $ | 19,966 |  |  | $ | 19,698 |  |  | $ | 19,725 |
2024 |  |  |  | 26,548 |  |  | 26,027 |
2025 |  |  |  |  |  | 37,397 |
|  | Total incurred claims |  | $ | 83,149 |
Cumulative Paid Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance
For the Year Ended December 31,
Claim Year |  | 2023 (unaudited) |  | 2024 (unaudited) |  | 2025
2023 |  | $ | 16,823 |  |  | $ | 19,420 |  |  | $ | 19,650 |
2024 |  |  |  | 22,547 |  |  | 25,748 |
2025 |  |  |  |  |  | 32,213 |
|  | Total payment of incurred claims |  | 77,611 |
|  | All outstanding liabilities prior to 2023, net of reinsurance |  | 85 |
|  | Medical claims liability, net of reinsurance |  | $ | 5,623 |
Incurred and paid claims development for the Other segment as of December 31, 2025 is as follows ($ in millions):
Cumulative Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance
For the Year Ended December 31,
Claim Year |  | 2023 (unaudited) |  | 2024 (unaudited) |  | 2025
2023 |  | $ | 1,480 |  |  | $ | 1,486 |  |  | $ | 1,487 |
2024 |  |  |  | 1,708 |  |  | 1,685 |
2025 |  |  |  |  |  | 2,146 |
|  | Total incurred claims |  | $ | 5,318 |
Cumulative Paid Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance
For the Year Ended December 31,
Claim Year |  | 2023 (unaudited) |  | 2024 (unaudited) |  | 2025
2023 |  | $ | 1,367 |  |  | $ | 1,485 |  |  | $ | 1,487 |
2024 |  |  |  | 1,522 |  |  | 1,682 |
2025 |  |  |  |  |  | 1,955 |
|  | Total payment of incurred claims |  | 5,124 |
|  | All outstanding liabilities prior to 2023, net of reinsurance |  | — |
|  | Magellan Health medical claims liabilities held for sale |  | (109) |
|  | Medical claims liability, net of reinsurance |  | $ | 85 |
Consolidated information is summarized as follows (in millions):
|  | December 31, 2025
Claim Year |  | Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance |  | Total IBNR Plus Expected Development on Reported Claims |  | Cumulative Paid Claims
2023 |  | $ | 118,324 |  |  | $ | 4 |  |  | 624.1 |
2024 |  | 126,382 |  |  | 347 |  |  | 665.0 |
2025 |  | 160,109 |  |  | 13,125 |  |  | 709.9 |
Information for the Medicaid segment is summarized as follows (in millions):
|  | December 31, 2025
Claim Year |  | Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance |  | Total IBNR Plus Expected Development on Reported Claims |  | Cumulative Paid Claims
2023 |  | $ | 78,282 |  |  | $ | 4 |  |  | 346.0 |
2024 |  | 77,872 |  |  | 155 |  |  | 317.9 |
2025 |  | 85,697 |  |  | 7,244 |  |  | 308.1 |
Information for the Medicare segment is summarized as follows (in millions):
|  | December 31, 2025
Claim Year |  | Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance |  | Total IBNR Plus Expected Development on Reported Claims |  | Cumulative Paid Claims
2023 |  | $ | 18,830 |  |  | $ | — |  |  | 200.7 |
2024 |  | 20,798 |  |  | 82 |  |  | 255.1 |
2025 |  | 34,869 |  |  | 1,567 |  |  | 282.8 |
Information for the Commercial segment is summarized as follows (in millions):
|  | December 31, 2025
Claim Year |  | Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance |  | Total IBNR Plus Expected Development on Reported Claims |  | Cumulative Paid Claims
2023 |  | $ | 19,725 |  |  | $ | — |  |  | 72.9 |
2024 |  | 26,027 |  |  | 107 |  |  | 86.4 |
2025 |  | 37,397 |  |  | 4,242 |  |  | 112.5 |
Information for the Other segment is summarized as follows (in millions):
|  | December 31, 2025
Claim Year |  | Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance |  | Total IBNR Plus Expected Development on Reported Claims |  | Cumulative Paid Claims
2023 |  | $ | 1,487 |  |  | $ | — |  |  | 4.5 |
2024 |  | 1,685 |  |  | 3 |  |  | 5.6 |
2025 |  | 2,146 |  |  | 72 |  |  | 6.5 |

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- Definition Tabular disclosure of the activity in the reserve for settling insured claims and expenses incurred in the claims settlement process for the period. The estimated liability includes the amount of money that will be required for future payments of (a) claims that have been reported to the insurer, (b) claims related to insured events that have occurred but that have not been reported to the insurer as of the date the liability is estimated, and (c) claim adjustment expenses. Claim adjustment expenses include costs incurred in the claim settlement process such as legal fees; outside adjuster fees; and costs to record, process, and adjust claims. + References Reference 1: http://www.xbrl.org/2003/role/disclosureRef -Topic 944 -SubTopic 40 -Name Accounting Standards Codification -Section 50 -Paragraph 3 -Publisher FASB -URI https://asc.fasb.org/1943274/2147480081/944-40-50-3 + Details
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