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Medical Claims Liability
 12 Months Ended
Dec. 31, 2025
Insurance [Abstract]  
Medical Claims Liability Medical Claims Liability
The following table summarizes the change in medical claims liability for the year ended December 31, 2025 ($ in millions):
 MedicaidMedicareCommercialOtherConsolidated Total
Balance, January 1, 2025$10,299 $3,358 $4,463 $188 $18,308 
Less: Reinsurance recoverables18 — 47 — 65 
Balance, January 1, 2025, net10,281 3,358 4,416 188 18,243 
Incurred related to:
Current year85,697 34,869 37,397 2,146 160,109 
Prior years(1,247)(550)(495)(23)(2,315)
Total incurred84,450 34,319 36,902 2,123 157,794 
Paid related to:
Current year75,872 30,651 32,213 1,955 140,691 
Prior years8,500 2,533 3,482 162 14,677 
Total paid84,372 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 recoverables16 — 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):
 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 

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 $93 million, $243 million and $382 million of the "Incurred related to: Prior years" as a reduction to premium revenues in 2025, 2024 and 2023, 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. As of December 2025, the Company did not record a premium deficiency reserve related to the 2026 Medicare Advantage contract year.

Information about incurred and paid claims development as of December 31, 2025 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, 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 
2024128,312 126,382 
2025160,109 
Total incurred claims$404,815 
Cumulative Paid Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance
For the Year Ended December 31,
Claim Year2023 (unaudited)2024 (unaudited)2025
2023$104,725 $117,635 $118,114 
2024111,456 125,631 
2025140,691 
Total payment of incurred claims384,436 
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 
202478,885 77,872 
202585,697 
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 
202469,351 77,527 
202575,872 
Total payment of incurred claims231,593 
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 
202421,171 20,798 
202534,869 
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 
202418,036 20,674 
202530,651 
Total payment of incurred claims70,108 
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 
202426,548 26,027 
202537,397 
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 
202422,547 25,748 
202532,213 
Total payment of incurred claims77,611 
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 
20241,708 1,685 
20252,146 
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 
20241,522 1,682 
20251,955 
Total payment of incurred claims5,124 
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 
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, 2025 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, 2025
Claim YearIncurred 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 
2024126,382 347 665.0 
2025160,109 13,125 709.9 

Information for the Medicaid segment is summarized as follows (in millions):
December 31, 2025
Claim YearIncurred 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 
202477,872 155 317.9 
202585,697 7,244 308.1 

Information for the Medicare segment is summarized as follows (in millions):
December 31, 2025
Claim YearIncurred 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 
202420,798 82 255.1 
202534,869 1,567 282.8 

Information for the Commercial segment is summarized as follows (in millions):
December 31, 2025
Claim YearIncurred 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 
202426,027 107 86.4 
202537,397 4,242 112.5 
Information for the Other segment is summarized as follows (in millions):
December 31, 2025
Claim YearIncurred 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 
20241,685 3 5.6 
20252,146 72 6.5