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Segments
 12 Months Ended
Dec. 31, 2021
Segment Reporting [Abstract]  
Segments Segments
In the first quarter of 2021, we realigned our reportable operating segments to reflect recent changes in our internal operating and reporting structure, which is now organized by government program. The revised reporting structure reflects the reporting and review process used by our chief executive officer (who is our chief operating decision maker) to assess performance and allocate resources, and is consistent with how we currently manage the business and view the markets we serve. These reportable segments consist of: 1) Medicaid; 2) Medicare; 3) Marketplace; and 4) Other.
The Medicaid, Medicare, and Marketplace segments represent the government-funded or sponsored programs under which we offer managed healthcare services. The Other segment, which is insignificant to our consolidated results of operations, includes certain corporate amounts not associated with or allocated to the Medicaid, Medicare, or Marketplace segments. Additionally, the Other segment includes service revenues and service costs associated with the long-term services and supports consultative services we now provide in Wisconsin, as a result of the Magellan Complete Care acquisition on December 31, 2020.
The key metrics used to assess the performance of our Medicaid, Medicare, and Marketplace segments are premium revenue, medical margin and MCR. MCR represents the amount of medical care costs as a percentage of premium revenue. Therefore, the underlying medical margin, or the amount earned by the Medicaid, Medicare, and Marketplace segments after medical costs are deducted from premium revenue, represents the most important measure of earnings reviewed by management, and is used by our chief executive officer to review results, assess performance, and allocate resources. The key metric used to assess the performance of our Other segment is service margin. The service margin is equal to service revenue minus cost of service revenue. We do not report total assets by segment since this is not a metric used to assess segment performance or allocate resources.
For all tables presented below, the prior period disclosures have been recast to conform to the current period segment presentation.
The following table presents total revenue by segment. Inter-segment revenue was insignificant for all periods presented.
Year Ended December 31,
202120202019
(In millions)
Total revenue:
Medicaid$21,231 $15,217 $13,026 
Medicare3,379 2,529 2,265 
Marketplace3,091 1,677 1,538 
Other70 — — 
Consolidated$27,771 $19,423 $16,829 
The following table reconciles margin by segment to consolidated income before income tax expense:
Year Ended December 31,
202120202019
(In millions)
Margin:
Medicaid$2,322 $1,804 $1,496 
Medicare430 351 331 
Marketplace399 324 476 
Other14 — — 
Total margin3,165 2,479 2,303 
Add: other operating revenues (1)
846 1,124 621 
Less: other operating expenses (2)
(2,991)(2,525)(1,880)
Operating income1,020 1,078 1,044 
Less: other expenses, net145 117 72 
Income before income tax expense$875 $961 $972 
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(1)Other operating revenues include premium tax revenue, health insurer fees reimbursed, Marketplace risk corridor judgment, investment income and other revenue.
(2)Other operating expenses include general and administrative expenses, premium tax expenses, health insurer fees, depreciation and amortization, and other costs.