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Segments - Reconciliation of Gross Margin to Consolidated Income (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Segment Reporting Information [Line Items]      
Less: Other operating expenses $ (32,499) $ (30,801) $ (26,751)
Operating income 1,573 1,173 1,020
Less: other expenses, net 109 110 145
Income before income tax expense 1,464 1,063 875
Medicaid      
Segment Reporting Information [Line Items]      
Total margin 2,973 2,981 2,322
Medicare      
Segment Reporting Information [Line Items]      
Total margin 388 437 430
Marketplace      
Segment Reporting Information [Line Items]      
Total margin 499 290 399
Other      
Segment Reporting Information [Line Items]      
Total margin 9 11 14
Operating Segments      
Segment Reporting Information [Line Items]      
Total margin 3,869 3,719 3,165
Other Operating      
Segment Reporting Information [Line Items]      
Add: Other operating revenues 1,467 1,020 846
Less: Other operating expenses $ (3,763) $ (3,566) $ (2,991)