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Significant Accounting Policies - Consolidated Medical Care Costs (Details) - USD ($)
 12 Months Ended
Dec. 31, 2017
Dec. 31, 2016
Dec. 31, 2015
Medical Care Costs      
Fee-for-service $ 12,682,000,000 $ 10,993,000,000 $ 8,572,000,000
Pharmacy 2,563,000,000 2,213,000,000 1,610,000,000
Capitation 1,360,000,000 1,218,000,000 982,000,000
Direct delivery 73,000,000 78,000,000 128,000,000
Other 395,000,000 272,000,000 502,000,000
Total 17,073,000,000 14,774,000,000 11,794,000,000
Medical Care Costs, PMPM      
Fee-for-service (per member per month) 229.63 217.84 218.35
Pharmacy (per member per month) 46.40 43.84 41.01
Capitation (per member per month) 24.63 24.13 25.02
Direct delivery (per member per month) 1.33 1.55 3.26
Other (per member per month) 7.15 5.39 12.79
Total (per member per month) $ 309.14 $ 292.75 $ 300.43
Medical Care Costs, Percentage      
Percentage of total in Fee for service 74.30% 74.40% 72.70%
Percentage of total in pharmacy 15.00% 15.00% 13.70%
Percentage of total in capitation 8.00% 8.20% 8.30%
Percent of total in direct delivery 0.40% 0.50% 1.10%
Percentage of total in other 2.30% 1.90% 4.20%
Percentage of total 100.00% 100.00% 100.00%