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Significant Accounting Policies (Tables) | 12 Months Ended
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Dec. 31, 2018
Accounting Policies [Abstract] |
Restricted cash and cash equivalents | The restricted cash and cash equivalents presented below are included in “Restricted investments” in the accompanying consolidated balance sheets.
| Year Ended December 31,
| 2018 |  | 2017 |  | 2016
| (In millions)
Cash and cash equivalents | $ | 2,826 |  |  | $ | 3,186 |  |  | $ | 2,819 |
Restricted cash and cash equivalents, non-current | 100 |  |  | 95 |  |  | 93 |
Restricted cash and cash equivalents, current | — |  |  | 9 |  |  | — |
Total cash, cash equivalents, and restricted cash and cash equivalents presented in the consolidated statements of cash flows | $ | 2,926 |  |  | $ | 3,290 |  |  | $ | 2,912 |
Summarized premium revenue | The following table summarizes premium revenue by geography for the periods indicated:
| Year Ended December 31,
| 2018 |  | 2017 |  | 2016
| Amount |  | % of Total |  | Amount |  | % of Total |  | Amount |  | % of Total
| (Dollars in millions)
California | $ | 2,150 |  |  | 12.2 | % |  | $ | 2,701 |  |  | 14.3 | % |  | $ | 2,378 |  |  | 14.4 | %
Florida | 1,790 |  |  | 10.2 |  |  | 2,568 |  |  | 13.6 |  |  | 1,938 |  |  | 11.8 |
Illinois | 793 |  |  | 4.5 |  |  | 593 |  |  | 3.1 |  |  | 603 |  |  | 3.7 |
Michigan | 1,601 |  |  | 9.1 |  |  | 1,596 |  |  | 8.5 |  |  | 1,527 |  |  | 9.3 |
New Mexico | 1,356 |  |  | 7.7 |  |  | 1,368 |  |  | 7.3 |  |  | 1,305 |  |  | 7.9 |
Ohio | 2,388 |  |  | 13.6 |  |  | 2,216 |  |  | 11.8 |  |  | 1,967 |  |  | 12.0 |
Puerto Rico | 696 |  |  | 3.9 |  |  | 732 |  |  | 3.9 |  |  | 726 |  |  | 4.4 |
South Carolina | 495 |  |  | 2.8 |  |  | 445 |  |  | 2.4 |  |  | 378 |  |  | 2.3 |
Texas | 3,244 |  |  | 18.4 |  |  | 2,813 |  |  | 14.9 |  |  | 2,461 |  |  | 15.0 |
Washington | 2,361 |  |  | 13.4 |  |  | 2,608 |  |  | 13.8 |  |  | 2,222 |  |  | 13.5 |
Other (1) | 738 |  |  | 4.2 |  |  | 1,214 |  |  | 6.4 |  |  | 940 |  |  | 5.7 |
| $ | 17,612 |  |  | 100.0 | % |  | $ | 18,854 |  |  | 100.0 | % |  | $ | 16,445 |  |  | 100.0 | %
_______________________
(1) | “Other” includes the Idaho, Mississippi, New York, Utah and Wisconsin health plans, which are not individually significant to our consolidated operating results.
Quality incentive premium revenue recognized | The following table quantifies the quality incentive premium revenue recognized for the periods presented, including the amounts earned in the periods presented and prior periods. Although the reasonably possible effects of a change in estimate related to quality incentive premium revenue as of December 31, 2018 are not known, we have no reason to believe that the adjustments to prior periods noted below are not indicative of the potential future changes in our estimates as of December 31, 2018.
| Year Ended December 31,
| 2018 |  | 2017 |  | 2016
| (In millions)
Maximum available quality incentive premium - current period | $ | 182 |  |  | $ | 150 |  |  | $ | 147 |
Amount of quality incentive premium revenue recognized in current period: |  |  |  |  |
Earned current period | $ | 133 |  |  | $ | 97 |  |  | $ | 104 |
Earned prior periods | 31 |  |  | 10 |  |  | 47 |
Total | $ | 164 |  |  | $ | 107 |  |  | $ | 151 |
Quality incentive premium revenue recognized as a percentage of total premium revenue | 0.9 | % |  | 0.6 | % |  | 0.9 | %
Amounts due to government agencies | A summary of the categories of amounts due government agencies is as follows:
| December 31,
| 2018 |  | 2017
| (In millions)
Medicaid program: |  |  |
Medical cost floors and corridors | $ | 103 |  |  | $ | 135 |
Other amounts due to states | 81 |  |  | 71 |
Marketplace program: |  |  |
Risk adjustment | 466 |  |  | 917 |
Cost sharing reduction | 183 |  |  | 275 |
Other | 134 |  |  | 144 |
| $ | 967 |  |  | $ | 1,542 |
Consolidated medical care costs | The following table provides the details of our consolidated medical care costs for the periods indicated:
| Year Ended December 31,
| 2018 |  | 2017 |  | 2016
| Amount |  | PMPM |  | % of Total |  | Amount |  | PMPM |  | % of Total |  | Amount |  | PMPM |  | % of Total
| (In millions, except PMPM amounts)
Fee-for-service | $ | 11,278 |  |  | $ | 232.15 |  |  | 74.5 | % |  | $ | 12,682 |  |  | $ | 229.63 |  |  | 74.3 | % |  | $ | 10,993 |  |  | $ | 217.84 |  |  | 74.4 | %
Pharmacy | 2,138 |  |  | 44.01 |  |  | 14.1 |  |  | 2,563 |  |  | 46.40 |  |  | 15.0 |  |  | 2,213 |  |  | 43.84 |  |  | 15.0 |
Capitation | 1,184 |  |  | 24.38 |  |  | 7.8 |  |  | 1,360 |  |  | 24.63 |  |  | 8.0 |  |  | 1,218 |  |  | 24.13 |  |  | 8.2 |
Other | 537 |  |  | 11.05 |  |  | 3.6 |  |  | 468 |  |  | 8.48 |  |  | 2.7 |  |  | 350 |  |  | 6.94 |  |  | 2.4 |
Total | $ | 15,137 |  |  | $ | 311.59 |  |  | 100.0 | % |  | $ | 17,073 |  |  | $ | 309.14 |  |  | 100.0 | % |  | $ | 14,774 |  |  | $ | 292.75 |  |  | 100.0 | %

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