XML 91 R18.htm IDEA: XBRL DOCUMENT v3.25.0.1
Medical Claims and Benefits Payable
 12 Months Ended
Dec. 31, 2024
Insurance [Abstract]  
Medical Claims and Benefits Payable Medical Claims and Benefits Payable
The following table provides the details of our medical claims and benefits payable as of the dates indicated.
December 31,
202420232022
(In millions)
Fee-for-service claims incurred but not paid (“IBNP”)$3,085 $2,901 $2,597 
Pharmacy payable249 202 206 
Capitation payable182 100 94 
Other1,124 1,001 631 
Total$4,640 $4,204 $3,528 
“Other” medical claims and benefits payable mainly includes provider incentives and amounts payable to certain providers for which we act as an intermediary on behalf of various government agencies, including arrangements where we are not assuming financial risk. The receipts and payments related to non-risk arrangements do not impact our consolidated statements of income.
The following tables present the components of the change in our medical claims and benefits payable for the periods indicated.
Year Ended December 31, 2024
Medicaid Medicare MarketplaceConsolidated
 (In millions)
Medical claims and benefits payable, beginning balance$3,444 $532 $228 $4,204 
Components of medical care costs related to:
Current year28,211 5,000 1,892 35,103 
Prior years(611)(61)(3)(675)
Total medical care costs27,600 4,939 1,889 34,428 
Payments for medical care costs related to:
Current year24,950 4,464 1,646 31,060 
Prior years2,258 761 220 3,239 
Total paid27,208 5,225 1,866 34,299 
Acquired balances, net of post-acquisition adjustments— 476 — 476 
Change in non-risk and other provider payables(169)— — (169)
Medical claims and benefits payable, ending balance$3,667 $722 $251 $4,640 
Year Ended December 31, 2023
Medicaid Medicare MarketplaceConsolidated
 (In millions)
Medical claims and benefits payable, beginning balance$2,815 $452 $261 $3,528 
Components of medical care costs related to:
Current year23,749 3,802 1,545 29,096 
Prior years(395)(11)(21)(427)
Total medical care costs23,354 3,791 1,524 28,669 
Payments for medical care costs related to:
Current year20,999 3,293 1,323 25,615 
Prior years2,069 431 234 2,734 
Total paid23,068 3,724 1,557 28,349 
Acquired balances, net of post-acquisition adjustments82 14 — 96 
Change in non-risk and other provider payables261 (1)— 260 
Medical claims and benefits payable, ending balance$3,444 $532 $228 $4,204 
Year Ended December 31, 2022
Medicaid Medicare MarketplaceConsolidated
 (In millions)
Medical claims and benefits payable, beginning balance$2,580 $404 $379 $3,363 
Components of medical care costs related to:
Current year22,097 3,390 1,972 27,459 
Prior years(251)(32)(1)(284)
Total medical care costs21,846 3,358 1,971 27,175 
Payments for medical care costs related to:
Current year19,655 2,944 1,746 24,345 
Prior years1,966 361 343 2,670 
Total paid21,621 3,305 2,089 27,015 
Acquired balances, net of post-acquisition adjustments12 — — 12 
Change in non-risk and other provider payables(2)(5)— (7)
Medical claims and benefits payable, ending balance$2,815 $452 $261 $3,528 
The amounts presented for “Components of medical care costs related to: Prior years” represent the amount by which our original estimate of medical claims and benefits payable at the beginning of the year varied from the actual liabilities, based on information (principally the payment of claims) developed since those liabilities were first reported.
Our estimates of medical claims and benefits payable recorded at December 31, 2023, 2022 and 2021 developed favorably by approximately $675 million, $427 million and $284 million in 2024, 2023 and 2022, respectively. The favorable prior year development recognized in 2024 was primarily due to lower than expected utilization of medical services by our members and improved operating performance, including claim payment recoveries related to prior year dates of service, mainly in the Medicaid segment. Consequently, the ultimate costs recognized in 2024, as claims payments were processed, were lower than our estimates in 2023.
The favorable prior year development recognized in 2023 was primarily due to lower than expected utilization of medical services by our members and improved operating performance, including claim payment recoveries related to prior year dates of service, mainly in the Medicaid segment. Consequently, the ultimate costs recognized in 2023, as claims payments were processed, were lower than our estimates in 2022.
The favorable prior year development recognized in 2022 was primarily due to lower than expected utilization of medical services by our members and improved operating performance, including claim payment recoveries related to prior year dates of service, mainly in the Medicaid segment. Consequently, the ultimate costs recognized in 2022, as claims payments were processed, were lower than our estimates in 2021, which was not discernible until additional information was provided, and as claims payments were processed.
The following tables provide information about our consolidated incurred and paid claims development as of December 31, 2024, as well as cumulative claims frequency and the total of incurred but not paid claims liabilities. The pattern of incurred and paid claims development is consistent across each of our segments. The cumulative claim frequency is measured by claim event, and includes claims covered under capitated arrangements.
Incurred Claims and Allocated Claims Adjustment ExpensesTotal IBNPCumulative number of reported claims
Benefit Year202220232024
(Unaudited)(Unaudited)
(In millions)
2022$27,459 $27,128 $27,036 $13 148 
202329,192 28,634 52 157 
202435,103 3,018 158 
$90,773 $3,083 
Cumulative Paid Claims and Allocated Claims Adjustment Expenses
Benefit Year202220232024
(Unaudited)(Unaudited)
(In millions)
2022$24,345 $27,051 $27,023 
202325,615 28,887 
202431,060 
$86,970 
The following table represents a reconciliation of claims development to the aggregate carrying amount of the liability for medical claims and benefits payable.
2024
(In millions)
Incurred claims and allocated claims adjustment expenses$90,773 
Less: cumulative paid claims and allocated claims adjustment expenses(86,970)
All outstanding liabilities before 20222 
Acquired balances476 
Non-risk and other provider payables359 
Medical claims and benefits payable $4,640