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Segment Information
 3 Months Ended
Mar. 31, 2026
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, vision and dental services, clinical healthcare, behavioral health, and corporate management company, among others.

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 three months ended March 31, 2026, is as follows ($ in millions):
 MedicaidMedicareCommercialOther/EliminationsConsolidated Total
Premium$23,573 $10,326 $9,555 $433 $43,887 
Service23 — 1 744 768 
Premium and service revenues23,596 10,326 9,556 1,177 44,655 
Premium tax5,289 — — — 5,289 
Total external revenues28,885 10,326 9,556 1,177 49,944 
Internal revenues— — — 4,146 4,146 
Eliminations— — — (4,146)(4,146)
Total revenues$28,885 $10,326 $9,556 $1,177 $49,944 
Medical costs$21,955 $8,772 $7,198 $378 $38,303 
Cost of services23 — — 679 702 
Other operating expenses (1)
9,078 
Other income (expense) (2)
238 
Earnings before income tax$2,099 
Segment gross margin (3)
$1,618 $1,554 $2,358 $120 $5,650 
(1)
Other operating expenses include selling, general and administrative expenses, depreciation, amortization, premium tax expense and impairment.
(2)
Other income (expense) includes investment and other income, debt extinguishment and interest expense.
(3)
Segment gross margin represents premium and service revenues less medical costs and cost of services.
Segment information for the three months ended March 31, 2025, is as follows ($ in millions):
 MedicaidMedicareCommercialOther/EliminationsConsolidated Total
Premium$22,275 $8,759 $10,148 $530 $41,712 
Service24 — 1 752 777 
Premium and service revenues22,299 8,759 10,149 1,282 42,489 
Premium tax4,131 — — — 4,131 
Total external revenues26,430 8,759 10,149 1,282 46,620 
Internal revenues— — — 4,164 4,164 
Eliminations— — — (4,164)(4,164)
Total revenues$26,430 $8,759 $10,149 $1,282 $46,620 
Medical costs$20,843 $7,555 $7,607 $498 $36,503 
Cost of services24 — — 674 698 
Other operating expenses (1)
7,885 
Other income (expense) (2)
212 
Earnings before income tax$1,746 
Segment gross margin (3)
$1,432 $1,204 $2,542 $110 $5,288 
(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.