Centene (CNC) 10-K 20 Feb 24 2023 FY Annual report Financial data

Cover

Cover - USD ($) shares in Thousands, $ in Billions	12 Months Ended
	Dec. 31, 2023	Feb. 16, 2024	Jun. 30, 2023
Cover [Abstract]
Document Type	10-K
Document Annual Report	true
Document Period End Date	Dec. 31, 2023
Current Fiscal Year End Date	--12-31
Document Transition Report	false
Entity File Number	001-31826
Entity Registrant Name	Centene Corporation
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	42-1406317
Entity Address, Address Line One	7700 Forsyth Boulevard
Entity Address, City or Town	St. Louis,
Entity Address, State or Province	MO
Entity Address, Postal Zip Code	63105
City Area Code	314
Local Phone Number	725-4477
Title of 12(b) Security	Common Stock, $0.001 Par Value
Trading Symbol	CNC
Security Exchange Name	NYSE
Entity Well-known Seasoned Issuer	Yes
Entity Voluntary Filers	No
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Document Financial Statement Error Correction [Flag]	false
Entity Shell Company	false
Public Float			$ 36.8
Entity Common Stock, Shares Outstanding		534,863
Documents Incorporated by Reference	Portions of the Proxy Statement for the registrant's 2024 annual meeting of stockholders are incorporated by reference in Part III, Items 10, 11, 12, 13 and 14.
Entity Central Index Key	0001071739
ICFR Auditor Attestation Flag	true
Document Fiscal Year Focus	2023
Document Fiscal Period Focus	FY
Amendment Flag	false

Audit Information

Audit Information	12 Months Ended
	Dec. 31, 2023
Auditor Information [Abstract]
Auditor Name	KPMG LLP
Auditor Location	St. Louis, MO
Auditor Firm ID	185

CONSOLIDATED BALANCE SHEETS

CONSOLIDATED BALANCE SHEETS - USD ($) $ in Millions	Dec. 31, 2023	Dec. 31, 2022
Current assets:
Cash and cash equivalents	$ 17,193	$ 12,074
Premium and trade receivables	15,532	13,272
Short-term investments	2,459	2,321
Other current assets	5,572	2,461
Total current assets	40,756	30,128
Long-term investments	16,286	14,684
Restricted deposits	1,386	1,217
Property, software and equipment, net	2,019	2,432
Goodwill	17,558	18,812
Intangible assets, net	6,101	6,911
Other long-term assets	535	2,686
Total assets	84,641	76,870
Current liabilities:
Medical claims liability	18,000	16,745
Accounts payable and accrued expenses	16,420	9,525
Return of premium payable	1,462	1,634
Unearned revenue	715	478
Current portion of long-term debt	119	82
Total current liabilities	36,716	28,464
Long-term debt	17,710	17,938
Deferred tax liability	641	615
Other long-term liabilities	3,618	5,616
Total liabilities	58,685	52,633
Commitments and contingencies
Redeemable noncontrolling interests	19	56
Stockholders' equity:
Preferred stock, $0.001 par value; authorized 10,000 shares; no shares issued or outstanding at December 31, 2023 and December 31, 2022	0	0
Common stock, $0.001 par value; authorized 800,000 shares; 615,291 issued and 534,484 outstanding at December 31, 2023, and 607,847 issued and 550,754 outstanding at December 31, 2022	1	1
Additional paid-in capital	20,304	20,060
Accumulated other comprehensive (loss)	(652)	(1,132)
Retained earnings	12,043	9,341
Treasury stock, at cost (80,807 and 57,093 shares, respectively)	(5,856)	(4,213)
Total Centene stockholders' equity	25,840	24,057
Nonredeemable noncontrolling interest	97	124
Total stockholders' equity	25,937	24,181
Total liabilities, redeemable noncontrolling interests and stockholders' equity	$ 84,641	$ 76,870

CONSOLIDATED BALANCE SHEETS (Pa

CONSOLIDATED BALANCE SHEETS (Parenthetical) - $ / shares shares in Thousands	Dec. 31, 2023	Dec. 31, 2022
Stockholders' equity:
Preferred stock, par value (in usd per share)	$ 0.001	$ 0.001
Preferred stock, shares authorized (in shares)	10,000	10,000
Preferred stock, shares issued (in shares)	0	0
Preferred stock, shares outstanding (in shares)	0	0
Common stock, par value (in usd per share)	$ 0.001	$ 0.001
Common stock, shares authorized (in shares)	800,000	800,000
Common stock, shares issued (in shares)	615,291	607,847
Common stock, shares outstanding (in shares)	534,484	550,754
Treasury stock, at cost (in shares)	80,807	57,093

CONSOLIDATED STATEMENTS OF OPER

CONSOLIDATED STATEMENTS OF OPERATIONS - USD ($) shares in Thousands, $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Revenues:
Revenues	$ 140,095	$ 135,479	$ 117,983
Premium tax	13,904	9,068	7,999
Total revenues	153,999	144,547	125,982
Expenses:
Medical costs	118,894	111,529	98,602
Cost of services	3,564	7,032	4,894
Selling, general and administrative expenses	12,563	11,589	9,601
Depreciation expense	575	614	565
Amortization of acquired intangible assets	718	817	770
Premium tax expense	14,226	9,330	8,287
Impairment	529	2,318	229
Legal settlement	0	0	1,250
Total operating expenses	151,069	143,229	124,198
Earnings from operations	2,930	1,318	1,784
Other income (expense):
Investment and other income	1,393	1,279	819
Debt extinguishment	0	30	(125)
Interest expense	(725)	(665)	(665)
Earnings before income tax	3,598	1,962	1,813
Income tax expense	899	760	477
Net earnings	2,699	1,202	1,336
Loss attributable to noncontrolling interests	3	0	11
Net earnings attributable to Centene Corporation	$ 2,702	$ 1,202	$ 1,347
Net earnings per common share attributable to Centene Corporation:
Basic earnings per common share (in usd per share)	$ 4.97	$ 2.09	$ 2.31
Diluted earnings per common share (in usd per share)	$ 4.95	$ 2.07	$ 2.28
Weighted average number of common shares outstanding:
Basic (in shares)	543,319	575,191	582,832
Diluted (in shares)	545,704	582,040	590,516
Premium
Revenues:
Revenues	$ 135,636	$ 127,131	$ 112,319
Service
Revenues:
Revenues	$ 4,459	$ 8,348	$ 5,664

CONSOLIDATED STATEMENTS OF COMP

CONSOLIDATED STATEMENTS OF COMPREHENSIVE EARNINGS (LOSS) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Statement of Comprehensive Income [Abstract]
Net earnings	$ 2,699	$ 1,202	$ 1,336
Change in unrealized gain (loss) on investments	520	(1,475)	(296)
Change in unrealized gain (loss) on investments, tax effect	(128)	349	75
Change in unrealized gain (loss) on investments, net of tax	392	(1,126)	(221)
Reclassification adjustment, net of tax	62	11	(20)
Foreign currency translation adjustments, net of tax	36	(94)	(19)
Net unrealized (loss) on cash flow hedge, net of tax	(10)	0	0
Other comprehensive earnings (loss)	480	(1,209)	(260)
Comprehensive earnings (loss)	3,179	(7)	1,076
Comprehensive loss attributable to noncontrolling interests	3	0	11
Comprehensive loss attributable to noncontrolling interests	$ 3,182	$ (7)	$ 1,087

CONSOLIDATED STATEMENTS OF STOC

CONSOLIDATED STATEMENTS OF STOCKHOLDERS' EQUITY - USD ($) shares in Thousands, $ in Millions	Total	Common Stock	Additional Paid-in Capital	Accumulated Other Comprehensive Earnings (Loss)	Retained Earnings	Treasury Stock	Noncontrolling Interest
Beginning balance (in shares) at Dec. 31, 2020		598,249
Beginning balance at Dec. 31, 2020	$ 25,885	$ 1	$ 19,459	$ 337	$ 6,792	$ (816)	$ 112
Beginning balance, Treasury stock (in shares) at Dec. 31, 2020						16,770
Increase (Decrease) in Stockholders' Equity
Net earnings (loss)	1,326				1,347		(21)
Other comprehensive (loss) earnings, net of tax	(260)			(260)
Common stock issued for employee benefit plans (in shares)		4,781
Common stock issued for employee benefit plans	38		38
Common stock repurchases (in shares)		(326)				(3,455)
Common stock repurchases	(297)		(19)			$ (278)
Stock compensation expense	203		203
Contribution from noncontrolling interest	46						46
Divestiture of noncontrolling interest	(4)		(9)				5
Acquisition resulting in noncontrolling interest	3						3
Ending balance (in shares) at Dec. 31, 2021		602,704
Ending balance at Dec. 31, 2021	26,940	$ 1	19,672	77	8,139	$ (1,094)	145
Ending balance, Treasury stock (in shares) at Dec. 31, 2021						20,225
Increase (Decrease) in Stockholders' Equity
Net earnings (loss)	1,189				1,202		(13)
Other comprehensive (loss) earnings, net of tax	(1,209)			(1,209)
Common stock issued for employee benefit plans (in shares)		5,143
Common stock issued for employee benefit plans	71		71
Fair value of unvested equity awards in connection with acquisition	60		60
Common stock repurchases (in shares)						(36,868)
Common stock repurchases	(3,096)		23			$ (3,119)
Stock compensation expense	234		234
Reclassification to non-redeemable	17						17
Divestiture of noncontrolling interest	(14)						(14)
Dividend to noncontrolling interest	(10)						(10)
Purchase of non-redeemable noncontrolling interest	$ (1)						(1)
Ending balance (in shares) at Dec. 31, 2022	550,754	607,847
Ending balance at Dec. 31, 2022	$ 24,181	$ 1	20,060	(1,132)	9,341	$ (4,213)	124
Ending balance, Treasury stock (in shares) at Dec. 31, 2022	57,093					57,093
Increase (Decrease) in Stockholders' Equity
Net earnings (loss)	$ 2,699				2,702		(3)
Other comprehensive (loss) earnings, net of tax	480			480
Common stock issued for employee benefit plans (in shares)		7,444
Common stock issued for employee benefit plans	44		44
Common stock repurchases (in shares)						(23,714)
Common stock repurchases	(1,643)					$ (1,643)
Stock compensation expense	216		216
Purchase of redeemable noncontrolling interest	(12)		(12)
Purchase of non-redeemable noncontrolling interest	$ (28)		(4)				(24)
Ending balance (in shares) at Dec. 31, 2023	534,484	615,291
Ending balance at Dec. 31, 2023	$ 25,937	$ 1	$ 20,304	$ (652)	$ 12,043	$ (5,856)	$ 97
Ending balance, Treasury stock (in shares) at Dec. 31, 2023	80,807					80,807

CONSOLIDATED STATEMENTS OF ST_2

CONSOLIDATED STATEMENTS OF STOCKHOLDERS' EQUITY (Parenthetical) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Common stock, par value (in usd per share)	$ 0.001	$ 0.001
Other comprehensive (loss) earnings, tax	$ 144	$ (349)	$ (75)
Common Stock
Common stock, par value (in usd per share)	$ 0.001	$ 0.001	$ 0.001	$ 0.001
Treasury Stock
Common stock, par value (in usd per share)	$ 0.001	$ 0.001	$ 0.001	$ 0.001

CONSOLIDATED STATEMENTS OF CASH

CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Cash flows from operating activities:
Net earnings	$ 2,699	$ 1,202	$ 1,336
Adjustments to reconcile net earnings to net cash provided by operating activities
Depreciation and amortization	1,293	1,430	1,335
Stock compensation expense	216	234	203
Impairment	529	2,318	229
(Gain) loss on debt extinguishment	0	(25)	125
(Gain) on acquisition	0	(2)	(309)
Deferred income taxes	(78)	(631)	(132)
(Gain) loss on divestitures, net	(152)	(772)	(88)
Loss on disposal of equipment	0	221	12
Other adjustments, net	172	(31)	(23)
Changes in assets and liabilities
Premium and trade receivables	(2,380)	(1,627)	(2,453)
Other assets	5	128	(99)
Medical claims liabilities	1,261	2,397	1,802
Unearned revenue	238	31	(109)
Accounts payable and accrued expenses	3,398	421	1,141
Other long-term liabilities	856	842	1,093
Other operating activities, net	(4)	125	142
Net cash provided by operating activities	8,053	6,261	4,205
Cash flows from investing activities:
Capital expenditures	(799)	(1,004)	(910)
Purchases of investments	(6,622)	(6,736)	(7,400)
Sales and maturities of investments	5,523	3,802	5,458
Acquisitions, net of cash acquired	0	(1,460)	(534)
Divestiture proceeds, net of divested cash	707	2,477	68
Other investing activities, net	0	0	19
Net cash (used in) provided by investing activities	(1,191)	(2,921)	(3,299)
Cash flows from financing activities:
Proceeds from long-term debt	2,335	360	9,267
Payments and repurchases of long-term debt	(2,316)	(1,490)	(7,434)
Common stock repurchases	(1,633)	(3,096)	(297)
Proceeds from common stock issuances	44	70	35
Payments for debt extinguishment	0	(14)	(157)
Purchase of noncontrolling interest	(88)	0	0
Debt issuance costs	0	0	(72)
Other financing activities, net	0	(27)	20
Net cash (used in) provided by financing activities	(1,658)	(4,197)	1,362
Effect of exchange rate changes on cash, cash equivalents, and restricted cash	(32)	(11)	(11)
Net increase (decrease) in cash, cash equivalents and restricted cash and cash equivalents	5,172	(868)	2,257
Cash and cash equivalents reclassified (to) from held for sale	(50)	(16)	0
Cash, cash equivalents and restricted cash and cash equivalents, beginning of period	12,330	13,214	10,957
Cash, cash equivalents and restricted cash and cash equivalents, end of period	17,452	12,330	13,214
Supplemental disclosures of cash flow information:
Interest paid	688	657	658
Income taxes paid	883	1,222	678
Equity issued in connection with acquisitions	0	60	0
Cash and cash equivalents
Cash and cash equivalents	17,193	12,074	13,118
Restricted cash and cash equivalents, included in restricted deposits	259	256	96
Total cash, cash equivalents, and restricted cash and cash equivalents	$ 17,452	$ 12,330	$ 13,214

Organization and Operations

Organization and Operations	12 Months Ended
	Dec. 31, 2023
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Organization and Operations	Organization and Operations Centene Corporation, or the Company, is a leading provider of government-sponsored healthcare. Centene's focus is on improving health and health care for low-income populations with complex needs. The Company provides access to high-quality healthcare, innovative programs and a wide range of health solutions that help families and individuals get well, stay well and be well. In the first quarter of 2023, and in conjunction with the Company's updated strategic plan, executive leadership realignment and corresponding 2023 divestitures, the Company revised the way it manages the business, evaluates performance and allocates resources, resulting in an updated segment structure comprised of (1) a Medicaid segment, (2) a Medicare segment, (3) a Commercial segment and (4) an Other segment. The Medicaid, Medicare and Commercial segments represent the government-sponsored or subsidized programs under which the Company offers managed healthcare services. Specifically, the Medicaid segment includes the Temporary Assistance for Needy Families (TANF) program, Medicaid Expansion programs, the Aged, Blind or Disabled (ABD) program, the Children's Health Insurance Program (CHIP), Long-Term Services and Supports (LTSS), Foster Care, Medicare-Medicaid Plans (MMP), which cover beneficiaries who are dually eligible for Medicaid and Medicare and other state-based programs. The Medicare segment includes Medicare Advantage, Medicare Supplement, Dual Eligible Special Needs Plans (D-SNPs) and Medicare Prescription Drug Plans (PDPs), also known as Medicare Part D. The Commercial segment includes the Health Insurance Marketplace product along with individual, small group and large group commercial health insurance products. The Other segment includes the Company's pharmacy operations, Envolve Benefit Options' vision and dental services, clinical healthcare, behavioral health, international operations and corporate management company, among others.

Summary of Significant Accounti

Summary of Significant Accounting Policies	12 Months Ended
	Dec. 31, 2023
Accounting Policies [Abstract]
Summary of Significant Accounting Policies	Summary of Significant Accounting Policies Basis of Presentation The accompanying consolidated financial statements include the accounts of Centene Corporation and all majority owned subsidiaries and subsidiaries over which the Company exercises the power and control to direct activities significantly impacting financial performance. All material intercompany balances and transactions have been eliminated. Certain amounts in the consolidated financial statements and notes have been reclassified to conform to the 2023 presentation, including reclassifications related to the Company's new segment reporting structure as outlined in Note 1. Organization and Operations . Additionally, beginning in 2022, the Company included a separate line item for depreciation expense in the Consolidated Statements of Operations, which was previously included in selling, general and administrative (SG&A) expenses. Prior period SG&A expense ratios have also been conformed to the current presentation. These reclassifications have no effect on net earnings, cash flow or stockholders' equity as previously reported. During 2023, the Company completed the divestitures of HealthSmart, Centurion, Magellan Specialty Health, its majority stake in Apixio, and Operose Health Group (Operose Health). Additionally, during the third quarter of 2023, the Company signed a definitive agreement to sell Circle Health Group (Circle Health), which was accounted for as held for sale as of December 31, 2023. On January 12, 2024, the Company completed the divestiture for cash consideration of $931 million. During 2022, the Company acquired all of the issued and outstanding shares of Magellan Health, Inc. (Magellan). The acquisition was accounted for as a business combination. Additionally, during 2022 the Company completed the divestitures of PANTHERx Rare (PANTHERx), its Spanish and Central European businesses and Magellan Rx. See Note 3. Acquisitions and Divestitures for further details. Use of Estimates The preparation of financial statements in conformity with generally accepted accounting principles in the United States (GAAP) requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities, the disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Future events and their effects cannot be predicted with certainty; accordingly, the accounting estimates require the exercise of judgment. The accounting estimates used in the preparation of the consolidated financial statements will change as new events occur, as more experience is acquired, as additional information is obtained, and as the operating environment changes. The Company evaluates and updates its assumptions and estimates on an ongoing basis and may employ outside experts to assist in its evaluation, as considered necessary. Actual results could differ from those estimates. Business Combinations Business combinations are accounted for using the acquisition method of accounting. The Company allocates the fair value of purchase consideration to the assets acquired and liabilities assumed based on their fair values at the acquisition date. The excess of the fair value of consideration transferred over the fair value of the net assets acquired is recorded as goodwill. Goodwill is generally attributable to the value of the synergies between the combined companies and the value of the acquired assembled workforce, neither of which qualifies for recognition as an intangible asset. The Company uses its best estimates and assumptions to value assets acquired and liabilities assumed at the acquisition date; however, these estimates are sometimes preliminary and, in some instances, all information required to value the assets acquired and liabilities assumed may not be available or final as of the end of a reporting period subsequent to the business combination. If the accounting for the business combination is incomplete, provisional amounts are recorded. The provisional amounts are updated during the period determined, up to one year from the acquisition date. The Company includes the results of operations of acquired businesses in the Company's consolidated results prospectively from the date of acquisition. Acquisition related expenses and post-acquisition restructuring costs are recognized separately from the business combination and are expensed as incurred. Cash and Cash Equivalents Investments with original maturities of three months or less are considered to be cash equivalents. Cash equivalents consist of money market funds, bank certificates of deposit and savings accounts. The Company maintains amounts on deposit with various financial institutions, which may exceed federally insured limits. However, management periodically evaluates the credit-worthiness of those institutions, and the Company has not experienced any losses on such deposits. Investments Short-term investments include securities with maturities greater than three months to one year. Long-term investments include securities with maturities greater than one year. Short-term and long-term investments are generally classified as available-for-sale and are carried at fair value. Certain equity investments are recorded using the fair value or equity method. The Company monitors the difference between the carrying value and fair value of its available-for-sale debt investments and whether declines in fair value are credit related. Unrealized gains and losses on debt investments available-for-sale are excluded from earnings and reported in accumulated other comprehensive earnings (loss), a separate component of stockholders' equity, net of income tax effects. If a loss is deemed to be credit related, the Company recognizes an allowance through earnings. For each security in an unrealized loss position, the Company assesses whether it intends to sell the security or if it is more likely than not the Company will be required to sell the security before recovery of the amortized cost basis for reasons such as liquidity, contractual or regulatory purposes. If the security meets this criterion, the decline in fair value is recorded in earnings through investment and other income. Premiums and discounts are amortized or accreted over the life of the related security using the effective interest method. To calculate realized gains and losses on the sale of investments, the Company uses the specific amortized cost of each investment sold. Realized gains and losses are recorded in investment and other income. The Company uses the equity method to account for investments in entities that it does not control but has the ability to exercise significant influence over operating and financial policies. Generally, under the equity method, original investments in these entities are recorded at cost and subsequently adjusted by the Company's share of equity in income or losses after the date of acquisition as well as capital contributions to and distributions from these companies. Restricted Deposits Restricted deposits consist of investments required by various state statutes to be deposited or pledged to state agencies. These investments are classified as long-term, regardless of the contractual maturity date, due to the nature of the states' requirements. The Company is required to annually adjust the amount of the deposit pledged to certain states. Fair Value Measurements In the normal course of business, the Company invests in various financial assets and incurs various financial liabilities. Fair values are disclosed for all financial instruments, whether or not such values are recognized in the Consolidated Balance Sheets. Management obtains quoted market prices and other observable inputs for these disclosures. The carrying amounts reported in the Consolidated Balance Sheets for cash and cash equivalents, premium and trade receivables, medical claims liability, accounts payable and accrued expenses, unearned revenue and certain other current assets and liabilities are carried at cost, which approximates fair value because of their short-term nature. The following methods and assumptions were used to estimate the fair value of each financial instrument: • Available-for-sale investments and restricted deposits: The carrying amount is stated at fair value, based on quoted market prices, where available. For securities not actively traded, fair values were estimated using values obtained from independent pricing services or quoted market prices of comparable instruments. • Senior unsecured notes: Estimated based on third-party quoted market prices for the same or similar issues. • Variable rate debt: The carrying amount of the Company's floating rate debt approximates fair value since the interest rates adjust based on market rate adjustments. • Foreign currency swap: Estimated based on Great British Pound to US Dollar foreign exchange rates. • Contingent consideration: Estimated based on expected achievement of metrics included in the acquisition agreement considering circumstances that exist as of the acquisition date. Property, Software and Equipment Property, software and equipment are stated at cost less accumulated depreciation. Computer hardware and software includes certain costs incurred in the development of internal-use software, including external direct costs of materials and services and payroll costs of team members devoted to specific software development. Depreciation is calculated principally by the straight-line method over estimated useful lives. Leasehold improvements are depreciated using the straight-line method over the shorter of the expected useful life or the remaining term of the lease. Property, software and equipment are depreciated over the following periods: Fixed Asset Depreciation Period Buildings and improvements 5 - 40 years Computer hardware and software 3 - 5 years Furniture and equipment 3 - 10 years Land improvements 10 - 20 years Leasehold improvements 1 - 20 years The carrying amounts of all long-lived assets are evaluated to determine if adjustment to the depreciation and amortization period or to the unamortized balance is warranted. Such evaluation is based principally on the expected utilization of the long-lived assets. The Company retains fully depreciated assets in property and accumulated depreciation accounts until it removes them from service. In the case of sale, retirement or disposal, the asset cost and related accumulated depreciation balance is removed from the respective account, and the resulting net amount, less any proceeds, is included as a component of earnings from operations in the Consolidated Statements of Operations. Goodwill and Intangible Assets Intangible assets represent assets acquired in purchase transactions and consist primarily of purchased contract rights and customer relationships, provider contracts, trade names, developed technologies and goodwill. Intangible assets are amortized using the straight-line method over the following periods: Intangible Asset Amortization Period Purchased contract rights and customer relationships 3 - 21 years Provider contracts 4 - 15 years Trade names 7 - 20 years Developed technologies 2 - 7 years The Company tests for impairment of intangible assets, as well as long-lived assets, whenever events or changes in circumstances indicate that the carrying value of an asset or asset group (hereinafter referred to as "asset group") may not be recoverable by comparing the sum of the estimated undiscounted future cash flows expected to result from use of the asset group and its eventual disposition to the carrying value. Such factors include, but are not limited to, significant changes in membership, state funding, state contracts and provider networks and contracts. If the sum of the estimated undiscounted future cash flows is less than the carrying value, an impairment determination is required. The amount of impairment is calculated by subtracting the fair value of the asset group from the carrying value of the asset group. An impairment charge, if any, is recognized within earnings from operations. In the first quarter of 2023, and in conjunction with the Company's updated strategic plan, executive leadership realignment and corresponding 2023 divestitures, the Company revised the way it manages the business, evaluates performance and allocates resources, resulting in an updated segment structure comprised of (1) a Medicaid segment, (2) a Medicare segment, (3) a Commercial segment and (4) an Other segment. As a result of these changes, the Company reassigned goodwill to the impacted reporting units using a relative fair value allocation approach. The Company tests goodwill for impairment using a fair value approach. The Company is required to test for impairment at least annually, absent a triggering event, which could include a significant decline in operating performance that would require an impairment assessment. Absent any impairment indicators, the Company performs its goodwill impairment testing during the fourth quarter of each year. The Company recognizes an impairment charge for any amount by which the carrying amount of goodwill exceeds its fair value. The Company first assesses qualitative factors to determine whether it is necessary to perform the quantitative goodwill impairment test. The Company generally does not calculate the fair value of a reporting unit unless it determines, based on a qualitative assessment, that it is more likely than not that its fair value is less than its carrying amount. If the quantitative test is deemed necessary, the Company determines an appropriate valuation technique to estimate a reporting unit's fair value as of the testing date. The Company utilizes either the income approach or the market approach, whichever is most appropriate for the respective reporting unit. The income approach is based on an internally developed discounted cash flow model that includes assumptions related to future growth rates, discount factors, future tax rates and other various assumptions. The market approach is based on financial multiples of comparable companies derived from current market data. The Company then compares the fair value of the reporting unit calculated using the income approach or market approach with its carrying amount and recognizes an impairment charge for the amount by which the carrying amount exceeds fair value. The impairment charge is limited to the total amount of goodwill allocated to the reporting unit. Changes in economic and operating conditions impacting assumptions used in the Company's analyses could result in goodwill impairment in future periods. Medical Claims Liability Medical claims liability includes claims reported but not yet paid, or claims inventory, estimates for claims incurred but not reported, or IBNR, and estimates for the costs necessary to process unpaid claims at the end of each period. The Company estimates its medical claims liability using actuarial methods that are commonly used by health insurance actuaries and meet Actuarial Standards of Practice. These actuarial methods consider factors such as historical data for payment patterns, cost trends, product mix, seasonality, utilization of healthcare services and other relevant factors. Actuarial Standards of Practice generally require that the medical claims liability estimates be adequate to cover obligations under moderately adverse conditions. Moderately adverse conditions are situations in which the actual claims are expected to be higher than the otherwise estimated value of such claims at the time of estimate. In many situations, the claims amounts ultimately settled will be different than the estimate that satisfies the Actuarial Standards of Practice. The Company includes in its IBNR an estimate for medical claims liability under moderately adverse conditions which represents the risk of adverse deviation of the estimates in its actuarial method of reserving. The Company uses its judgment to determine the assumptions to be used in the calculation of the required estimates. The assumptions it considers when estimating IBNR include, without limitation, claims receipt and payment experience (and variations in that experience), changes in membership, provider billing practices, healthcare service utilization trends, cost trends, product mix, seasonality, prior authorization of medical services, benefit changes, known outbreaks of disease or increased incidence of illness such as influenza or COVID-19, provider contract changes, changes to fee schedules and the incidence of high-dollar or catastrophic claims. The Company's development of the medical claims liability estimate is a continuous process which it monitors and refines on a monthly basis as additional claims receipts and payment information becomes available. As more complete claims information becomes available, the Company adjusts the amount of the estimates, and includes the changes in estimates in medical costs in the period in which the changes are identified. In every reporting period, the operating results include the effects of more completely developed medical claims liability estimates associated with previously reported periods. The Company consistently applies its reserving methodology from period to period. As additional information becomes known, it adjusts the actuarial model accordingly to establish medical claims liability estimates. The Company reviews actual and anticipated experience compared to the assumptions used to establish medical costs. The Company establishes premium deficiency reserves if actual and anticipated experience indicates that existing policy liabilities together with the present value of future gross premiums will not be sufficient to cover the present value of future benefits, settlement and maintenance costs. For purposes of determining premium deficiencies, contracts are grouped in a manner consistent with the method of acquiring, servicing and measuring the profitability of such contracts and expected investment income is excluded. In December 2023, the Company recorded a premium deficiency reserve of $250 million related to the 2024 Medicare Advantage contract year. Revenue Recognition The Company's health plans generate revenues primarily from premiums received from the states in which it operates health plans, premiums received from its members and the Centers for Medicare and Medicaid Services (CMS) for its Medicare product and premiums from members of its commercial health plans. In addition to member premium payments, its Marketplace contracts also generate revenues from subsidies received from CMS. The Company generally receives a fixed premium per member per month pursuant to its contracts and recognizes premium revenues during the period in which it is obligated to provide services to its members at the amount reasonably estimable. In some instances, the Company's base premiums are subject to an adjustment factor, in the form of a risk score or risk adjustment, based on the acuity of its membership. Generally, the risk score or risk adjustment is determined by the state or CMS analyzing submissions of processed claims and medical record data to determine the acuity of the Company's membership, often relative to the respective program's membership. The Company estimates the amount of risk score and risk adjustment based upon the processed claims and medical record data submitted and expected to be submitted to the state or CMS and records revenues on a risk adjusted basis. Some contracts allow for additional premiums related to certain supplemental services provided such as maternity deliveries. The Company's contracts with states may require it to maintain a minimum health benefits ratio (HBR) or may require it to share cost-savings in excess of certain levels. In certain circumstances, including commercial plans, its plans may be required to return premium to the state or policyholders in the event costs are below established levels. The Company estimates the effect of these programs and recognizes reductions in revenue in the current period. Other states may require us to meet certain performance and quality metrics in order to receive additional or full contractual revenue. For performance-based contracts, the Company does not recognize revenue subject to refund until data is sufficient to measure performance. Revenues are recorded based on membership and eligibility data provided by the states or CMS, which is adjusted on a monthly basis by the states or CMS for retroactive additions or deletions to membership data. These eligibility adjustments are estimated monthly and subsequent adjustments are made in the period known. The Company reviews and updates those estimates as new information becomes available. It is possible that new information could require us to make additional adjustments, which could be significant, to these estimates. The Company's Medicare Advantage contracts are with CMS. CMS deploys a risk adjustment model which apportions premiums paid to all health plans according to health severity and certain demographic factors. The CMS risk adjustment model pays more for members whose medical history would indicate that they are expected to have higher medical costs. Under this risk adjustment methodology, CMS calculates the risk adjusted premium payment using diagnosis data from hospital inpatient, hospital outpatient, physician treatment settings as well as prescription drug events. The Company and the healthcare providers collect, compile and submit the necessary and available diagnosis data to CMS within prescribed deadlines. The Company estimates risk adjustment revenues based upon the diagnosis data submitted and expected to be submitted to CMS and records revenues on a risk adjusted basis. For qualifying low-income prescription drug benefit members, CMS pays for some, or all, of the member's monthly premium. The Company receives certain Part D prospective subsidy payments from CMS for these members as a fixed monthly per member amount, based on the estimated costs of providing prescription drug benefits over the plan year, as reflected in its bids. Approximately nine to ten months subsequent to the end of the plan year, or later in the case of the coverage gap discount subsidy, a settlement payment is made between CMS and the Company's plans based on the difference between the prospective payments and actual claims experience. The Company's specialty companies generate revenues under contracts with state and federal programs, healthcare organizations and other commercial organizations, as well as from its own subsidiaries. Revenues are recognized when the related services are provided, when inventory is shipped, or as ratably earned over the covered period of services. The Company recognizes revenue related to administrative services under the TRICARE government-sponsored Managed Care Support Contract for the DoD's TRICARE program on a straight-line basis over the option period, when the fees become fixed and determinable. The TRICARE contract includes various performance-based measures. For each of the measures, an estimate of the amount that has been earned is made at each interim date, and revenue is recognized accordingly. Some states enact premium taxes, similar assessments and provider pass-through payments, collectively premium taxes, and these taxes are recorded as a separate component of both revenues and operating expenses. For certain products, premium taxes and state assessments are not pass-through payments and are recorded as premium revenue and premium tax expense in the Consolidated Statements of Operations. Some states require state directed payments that have minimal risk, but are administered as a premium adjustment. These payments are recorded as premium revenue and medical costs at close to a 100% HBR. In many instances, the Company has little visibility to the timing of these payments until they are paid by the state. Affordable Care Act The Affordable Care Act (ACA) established risk spreading premium stabilization programs as well as minimum medical loss ratio (MLR) and cost sharing reductions (CSRs). The Company's accounting policies for the programs are as follows: Risk Adjustment The permanent risk adjustment program established by the ACA transfers funds from qualified individual and small group insurance plans with below average risk scores to those plans with above average risk scores within each state. The Company estimates the receivable or payable under the risk adjustment program based on its estimated risk score compared to the state average risk score. The Company may record a receivable or payable as an adjustment to premium revenues to reflect the year-to-date impact of the risk adjustment based on its best estimate. The Company refines its estimate as new information becomes available. Minimum Medical Loss Ratio Additionally, the ACA established a minimum MLR for the Health Insurance Marketplace. The risk adjustment program described above is taken into consideration to determine if the Company's estimated annual medical costs are less than the minimum MLR and require an adjustment to premium revenues to meet the minimum MLR. Cost Sharing Reductions The ACA directs issuers to reduce the Company's members' cost sharing for essential health benefits for individuals with Federal Poverty Levels (FPLs) between 100% and 250% who are enrolled in a silver tier product; eliminate cost sharing for Indians/Alaska Natives with a FPL less than 300% and eliminate cost sharing for Indians/Alaska Natives regardless of FPL when services are provided by an Indian Health Service. In October 2017, the Trump Administration issued an executive order that immediately ceased payments of CSRs to issuers, and beginning in 2018 premium rates for Health Insurance Marketplace were set without factoring in the cost sharing subsidy payments from the federal government. The Company is engaged in active discussions with the government regarding recovery for CSR payments for benefit years 2018 and beyond. Premium and Trade Receivables and Unearned Revenue Premium and service revenues collected in advance are recorded as unearned revenue. For performance-based contracts, the Company does not recognize revenue subject to refund until data is sufficient to measure performance. Premiums and service revenues due to the Company are recorded as premium and trade receivables and are recorded net of an allowance based on historical trends and management's judgment on the collectability of these accounts. As the Company generally receives payments during the month in which services are provided, the allowance is typically not significant in comparison to total revenues and does not have a material impact on the presentation of the financial condition or results of operations. Amounts receivable under federal contracts are comprised primarily of contractually defined billings, accrued contract incentives under the terms of the contract and amounts related to change orders for services not originally specified in the contract. Activity in the allowance for uncollectible accounts is summarized below ($ in millions): Year Ended December 31, 2023 2022 2021 Balance, January 1 $ 130 $ 139 $ 243 Amounts charged to expense 58 70 62 Recoveries — — (43) Write-offs of uncollectible receivables (68) (79) (123) Balance, December 31 $ 120 $ 130 $ 139 Significant Customers The Company receives the majority of its revenues under contracts or subcontracts with state Medicaid managed care programs. Customers where the aggregate annual contract revenues exceeded 10% of total annual revenues included the state of New York, where the percentage of the Company's total revenue was 10% for the year ended December 31, 2021. None of the Company's customers exceeded 10% of total annual revenues for the years ended December 31, 2023 and 2022. Other Income (Expense) Other income (expense) consists routinely of investment income, interest expense and equity method earnings from investments. Investment income is derived from the Company's cash, cash equivalents, restricted deposits and investments. Interest expense relates to borrowings under the senior notes, credit facilities, mortgage and construction loans and capital leases. Further, other income (expense) includes gains or losses on sales of investments, divestitures and acquisitions as well as debt extinguishment costs. Income Taxes Deferred tax assets and liabilities are recorded for the future tax consequences attributable to differences between the financial statement carrying amounts of existing assets and liabilities and their respective tax bases. Deferred tax assets and liabilities are measured using enacted tax rates expected to apply to taxable income in the years in which those temporary differences are expected to be recovered or settled. The effect on deferred tax assets and liabilities of a change in tax law or tax rates is recognized in income in the period that includes the enactment date. Valuation allowances are provided when it is considered more likely than not that deferred tax assets will not be realized. In determining if a deductible temporary difference or net operating loss can be realized, the Company considers future reversals of existing taxable temporary differences, future taxable income, taxable income in prior carryback periods and tax planning strategies. Contingencies The Company accrues for loss contingencies associated with outstanding litigation, claims and assessments for which it has determined it is probable that a loss contingency exists and the amount of loss can be reasonably estimated. The Company expenses professional fees associated with litigation claims and assessments as incurred. Stock Based Compensation Stock based compensation expense is recognized at grant date fair value over the period during which an employee is required to provide service in exchange for the award. Excess tax benefits related to stock compensation are presented as a cash inflow from operating activities. The Company accounts for forfeitures when they occur. Foreign Currency Translation The Company is exposed to foreign currency exchange risk through its international subsidiaries whose functional currencies have historically included the Euro and Great British Pound. The assets and liabilities of the Company's subsidiaries are translated into United States dollars at the balance sheet date. The Company translates its proportionate share of earnings using average rates during the year. The resulting foreign currency translation adjustments are recorded as a separate component of accumulated other comprehensive earnings (loss). Recent Accounting Guidance Not Yet Adopted In November 2023, the Financial Accounting Standards Board (FASB) issued an Accounting Standards Update (ASU) which is intended to improve reportable segment disclosure requirements, primarily through enhanced disclosures about significant expenses. The amendments will require public entities to disclose significant segment expenses that are regularly provided to the chief operating decision maker and included within segment profit and loss. The new standard is effective for annual periods beginning after December 15, 2023, and for interim periods within fiscal years beginning after December 15, 2024. The Company is currently evaluating the effect of the new disclosure requirements. In December 2023, the FASB issued an ASU which includes amendments that further enhance income tax disclosures, primarily through standardization and disaggregation of rate reconciliation categories and income taxes paid by jurisdiction. The new standard is effective for annual periods beginning after December 15, 2024. The Company is currently evaluating the effect of the new disclosure requirements.

Acquisitions and Divestitures

Acquisitions and Divestitures	12 Months Ended
	Dec. 31, 2023
Business Combination and Asset Acquisition [Abstract]
Acquisitions and Divestitures	Acquisitions and Divestitures Magellan Acquisition On January 4, 2022, the Company acquired all of the issued and outstanding shares of Magellan. Total consideration for the acquisition was $2,491 million, consisting of $2,431 million in cash and $60 million related to the fair value of replacement equity awards associated with pre-combination service. The purchase price has been adjusted to reflect the net effective settlement of preexisting relationships between the Company and Magellan of $70 million. The Company recognized $106 million of acquisition related expenses related to Magellan for the year ended December 31, 2022. The Magellan acquisition was accounted for as a business combination using the acquisition method of accounting that requires assets acquired and liabilities assumed to be recognized at fair value as of the acquisition date. The valuation of all assets acquired and liabilities assumed was finalized in the fourth quarter of 2022. The Company's allocation of the fair value of assets acquired and liabilities assumed as of the acquisition date of January 4, 2022 is as follows ($ in millions): Assets acquired and liabilities assumed Cash and cash equivalents $ 995 Premium and related receivables 791 Short-term investments 144 Other current assets 145 Long-term investments 43 Restricted deposits 7 Property, software and equipment 72 Intangible assets (1) 889 Other long-term assets 50 Total assets acquired 3,136 Medical claims liability 194 Accounts payable and accrued expenses 495 Return of premium payable 53 Unearned revenue 8 Current portion of long-term debt 5 Long-term debt (2) 542 Deferred tax liabilities (3) 157 Other long-term liabilities 64 Total liabilities assumed 1,518 Mezzanine equity 32 Total identifiable net assets 1,586 Goodwill (4) 905 Total assets acquired and liabilities assumed $ 2,491 Significant fair value adjustments are noted as follows: (1) The identifiable intangible assets acquired are to be measured at fair value as of the completion of the acquisition. The fair value of intangible assets is determined primarily using variations of the income approach, which is based on the present value of the future after-tax cash flows attributable to each identified intangible asset. Other valuation methods, including the market approach and cost approach, were also considered in estimating the fair value. The identifiable intangible assets include purchased contract rights, provider contracts, developed technologies and trade names. The Company has estimated the fair value of intangible assets to be $889 million with a weighted average life of 12 years. The fair values and weighted average useful lives for identifiable intangible assets acquired are as follows ($ in millions): Fair Value Weighted Average Useful Life in Years Purchased contract rights $ 581 13 Provider contracts 120 15 Developed technologies 101 5 Trade names 87 17 Total intangible assets acquired $ 889 12 (2) Debt is required to be measured at fair value under the acquisition method of accounting. The fair value of Magellan's Senior Notes and Credit Agreement assumed in the acquisition was $535 million. In January 2022, the Company paid off Magellan's debt acquired in the transaction using Magellan's cash on hand. (3) The deferred tax liabilities are presented net of $102 million of deferred tax assets. (4) The acquisition resulted in $905 million of goodwill primarily related to synergies expected from the acquisition and the assembled workforce of Magellan. All of the goodwill was assigned to the Other segment. The majority of the goodwill is not deductible for income tax purposes. PANTHERx Rare Divestiture On July 14, 2022, the Company completed the divestiture of PANTHERx for $1,373 million. The Company recognized a gain of $490 million, or $382 million after-tax, which is included in investment and other income in the Consolidated Statements of Operations. Spanish and Central European Divestiture On November 16, 2022, the Company completed the divestiture of its ownership stakes in its Spanish and Central European businesses, including Ribera Salud, Torrejón Salud and Pro Diagnostics Group. During 2022, the Company recorded an impairment charge primarily related to intangible assets and goodwill associated with the divestiture of $163 million, or $140 million after-tax. In 2023, the Company recognized an additional loss on sale of $13 million, or $10 million after-tax, which is included in investment and other income in the Consolidated Statements of Operations. Magellan Rx Divestiture On December 2, 2022, the Company completed the divestiture of Magellan Rx for $1,337 million. The Company recognized a gain of $269 million, or $99 million after-tax, which is included in investment and other income in the Consolidated Statements of Operations. During 2023, the Company recorded a reduction to the previously reported gain on the divestiture of $22 million, or $10 million after-tax, due to the finalization of working capital adjustments. Magellan Specialty Health Divestiture On November 17, 2022, the Company signed a definitive agreement to divest Magellan Specialty Health. As of December 31, 2022, the assets and liabilities of Magellan Specialty Health were considered held for sale, resulting in $645 million of assets held for sale in other current assets and $87 million of liabilities held for sale in accounts payable and accrued expenses in the Consolidated Balance Sheets. The majority of the of held for sale assets were previously reported as goodwill and intangible assets. On January 20, 2023, the Company completed the divestiture for $646 million in cash and stock, including an estimated working capital adjustment, and recognized a pre-tax gain of $79 million. The stock consideration was subsequently sold in April 2023 for cash proceeds of $245 million. The Company could also receive up to an additional $150 million in cash and stock in 2024 based on certain 2023 performance metrics. The Company will recognize the appropriate amount of contingent consideration related to the $150 million when realized or realizable. Centurion Divestiture On January 10, 2023, the Company signed and closed a definitive agreement to divest Centurion. As of December 31, 2022, the assets and liabilities of Centurion were considered held for sale resulting in $236 million of assets held for sale in other current assets and $198 million of liabilities held for sale in accounts payable and accrued expenses in the Consolidated Balance Sheet. The majority of the held for sale assets were previously reported as premium and trade receivables. The majority of the liabilities were previously reported as medical claims liability and accounts payable and accrued liabilities. During 2022, the Company recorded an impairment charge related to goodwill and other current assets associated with the divestiture of $259 million, or $181 million after-tax. During 2023, the Company recognized a gain of $15 million, or $10 million after-tax, reflecting additional proceeds for contingent consideration, partially offset by net working capital adjustments. The gain is included in investment and other income in the Consolidated Statements of Operations. HealthSmart Divestiture On November 1, 2022, the Company signed a definitive agreement to divest HealthSmart. The divestiture was completed on January 5, 2023. As of December 31, 2022, the assets and liabilities of HealthSmart were considered held for sale resulting in $66 million of assets held for sale in other current assets and $34 million of liabilities held for sale in accounts payable and accrued expenses in the Consolidated Balance Sheets. The majority of the held for sale assets were previously reported as cash and cash equivalents, premium and trade receivables and goodwill. During 2022, the Company recorded an impairment charge related to goodwill associated with the divestiture of $36 million, or $27 million after-tax. Apixio Divestiture On June 13, 2023, the Company completed the divestiture of its majority stake in Apixio. The Company recognized a pre-tax gain of $93 million, or $67 million after-tax, which is included in investment and other income in the Consolidated Statements of Operations. Circle Health Group Divestiture On August 28, 2023, the Company signed a definitive agreement to sell Circle Health, one of the U.K.'s largest independent hospital operators, which is included in the Other segment. As of December 31, 2023, the assets and liabilities of Circle Health were considered held for sale resulting in $3,897 million of assets held for sale in other current assets and $3,094 million of liabilities held for sale in accounts payable and accrued expenses in the Consolidated Balance Sheets. The majority of the held for sale assets were previously reported as other long-term assets, goodwill and property, software and equipment. The majority of the liabilities were previously reported as debt and other long-term liabilities. In accordance with the signed definitive agreement in the third quarter of 2023, and subsequently updated in the fourth quarter of 2023, the Company recorded impairment charges related to goodwill associated with the pending divestiture totaling $292 million, or $258 million after-tax. In order to manage the foreign exchange risk on the sale price associated with the pending divestiture of Circle Health, in August 2023 the Company entered into a foreign currency swap agreement for a notional amount of $931 million, to sell £740 million. The swap agreement was formally designated and qualified as a cash flow hedge. The swap expires on the earlier of the divestiture closing date or March 28, 2024. The gain or loss due to changes in the fair value of the foreign currency swap was recorded in other comprehensive income until the Circle Health divestiture closed, at which time the gain or loss was recorded in earnings to the same line in the Consolidated Statements of Operations as the gain or loss on sale. The fair value of the swap agreement as of December 31, 2023 was $13 million, which was recorded in accounts payable and accrued expenses in the Consolidated Balance Sheets. On January 12, 2024, the Company completed the divestiture for $931 million and settled the foreign currency swap. The Company expects to realize a net tax benefit of $50 million in 2024 on the loss recognized on the divestiture. Operose Health Group Divestiture

Short-term and Long-term Invest

Short-term and Long-term Investments, Restricted Deposits	12 Months Ended
	Dec. 31, 2023
Investments, Debt and Equity Securities [Abstract]
Short-term and Long-term Investments, Restricted Deposits	Short-term and Long-term Investments, Restricted Deposits Short-term and long-term investments and restricted deposits by investment type consist of the following ($ in millions): December 31, 2023 December 31, 2022 Amortized Cost Gross Unrealized Gains Gross Unrealized Losses Fair Value Amortized Cost Gross Unrealized Gains Gross Unrealized Losses Fair Value Debt securities: U.S. Treasury securities and obligations of U.S. government corporations and agencies $ 403 $ — $ (8) $ 395 $ 695 $ — $ (16) $ 679 Corporate securities 9,984 78 (461) 9,601 10,127 12 (778) 9,361 Restricted certificates of deposit 4 — — 4 4 — — 4 Restricted cash equivalents 259 — — 259 256 — — 256 Short-term time deposits 746 — — 746 204 — — 204 Municipal securities 4,135 21 (171) 3,985 4,055 6 (280) 3,781 Asset-backed securities 1,665 8 (35) 1,638 1,396 — (70) 1,326 Residential mortgage-backed securities 1,503 7 (103) 1,407 1,165 2 (121) 1,046 Commercial mortgage-backed securities 1,149 5 (82) 1,072 961 — (99) 862 Equity securities 17 — — 17 17 — — 17 Private equity investments 833 — — 833 529 — — 529 Life insurance contracts 174 — — 174 157 — — 157 Total $ 20,872 $ 119 $ (860) $ 20,131 $ 19,566 $ 20 $ (1,364) $ 18,222 The Company's investments are debt securities classified as available-for-sale with the exception of equity securities, certain private equity investments and life insurance contracts. Private equity investments include direct investments in private equity securities as well as private equity funds. The Company's investment policies are designed to provide liquidity, preserve capital and maximize total return on invested assets with a focus on high credit quality securities. The Company limits the size of investment in any single issuer other than U.S. treasury securities and obligations of U.S. government corporations and agencies. As of December 31, 2023, 99% of the Company's investments in rated securities carry an investment grade rating by nationally recognized statistical rating organizations. At December 31, 2023, the Company held certificates of deposit, equity securities, private equity investments and life insurance contracts, which did not carry a credit rating. Accrued interest income on available-for-sale debt securities was $ 153 million 132 million The Company's residential mortgage-backed securities are primarily issued by the Federal National Mortgage Association, Government National Mortgage Association or Federal Home Loan Mortgage Corporation, which carry implicit or explicit guarantees of the U.S. government. The Company's commercial mortgage-backed securities are primarily senior tranches with a weighted average rating of AA+ and a weighted average duration of 4 years at December 31, 2023. The fair value of available-for-sale debt securities with gross unrealized losses by investment type and length of time that individual securities have been in a continuous unrealized loss position were as follows ($ in millions): December 31, 2023 December 31, 2022 Less Than 12 Months 12 Months or More Less Than 12 Months 12 Months or More Unrealized Losses Fair Value Unrealized Losses Fair Value Unrealized Losses Fair Value Unrealized Losses Fair Value U.S. Treasury securities and obligations of U.S. government corporations and agencies $ — $ 79 $ (8) $ 232 $ (5) $ 342 $ (11) $ 184 Corporate securities (6) 658 (455) 6,260 (340) 5,368 (438) 3,400 Municipal securities (4) 553 (167) 2,237 (142) 2,437 (138) 995 Asset-backed securities (2) 197 (33) 855 (29) 786 (41) 486 Residential mortgage-backed securities (2) 153 (101) 814 (55) 629 (66) 352 Commercial mortgage-backed securities (2) 114 (80) 754 (49) 513 (50) 330 Short-term time deposits — 31 — — — — — — Total $ (16) $ 1,785 $ (844) $ 11,152 $ (620) $ 10,075 $ (744) $ 5,747 As of December 31, 2023, the gross unrealized losses were generated from 5,247 positions out of a total of 6,661 positions. The change in fair value of available-for-sale debt securities is primarily a result of movement in interest rates subsequent to the purchase of the security. For each security in an unrealized loss position, the Company assesses whether it intends to sell the security or if it is more likely than not the Company will be required to sell the security before recovery of the amortized cost basis for reasons such as liquidity, contractual or regulatory purposes. If the security meets this criterion, the decline in fair value is recorded in earnings. The Company does not intend to sell these securities prior to maturity and it is not likely that the Company will be required to sell these securities prior to maturity; therefore, the Company did not record an impairment for these securities. In addition, the Company monitors available-for-sale debt securities for credit losses. Certain investments have experienced a decline in fair value due to changes in credit quality, market interest rates and/or general economic conditions. The Company recognizes an allowance when evidence demonstrates that the decline in fair value is credit related. Evidence of a credit-related loss may include rating agency actions, adverse conditions specifically related to the security or failure of the issuer of the security to make scheduled payments. The contractual maturities of short-term and long-term debt securities and restricted deposits are as follows ($ in millions): December 31, 2023 December 31, 2022 Investments Restricted Deposits Investments Restricted Deposits Amortized Cost Fair Value Amortized Cost Fair Value Amortized Cost Fair Value Amortized Cost Fair Value One year or less $ 2,308 $ 2,284 $ 566 $ 564 $ 2,207 $ 2,179 $ 534 $ 532 One year through five years 7,738 7,431 527 504 7,651 7,147 524 490 Five years through ten years 3,905 3,735 298 283 4,066 3,613 224 195 Greater than ten years 155 154 34 35 135 129 — — Asset-backed securities 4,317 4,117 — — 3,522 3,234 — — Total $ 18,423 $ 17,721 $ 1,425 $ 1,386 $ 17,581 $ 16,302 $ 1,282 $ 1,217 Actual maturities may differ from contractual maturities due to call or prepayment options. Equity securities, private equity investments and life insurance contracts are excluded from the table above because they do not have a contractual maturity. The Company has an option to redeem substantially all of the securities included in the greater than ten years category listed above at amortized cost.

Fair Value Measurements

Fair Value Measurements	12 Months Ended
	Dec. 31, 2023
Fair Value Disclosures [Abstract]
Fair Value Measurements	Fair Value Measurements Assets and liabilities recorded at fair value in the Consolidated Balance Sheets are categorized based upon observable or unobservable inputs used to estimate fair value. Level inputs are as follows: Level Input: Input Definition: Level I Inputs are unadjusted, quoted prices for identical assets or liabilities in active markets at the measurement date. Level II Inputs other than quoted prices included in Level I that are observable for the asset or liability through corroboration with market data at the measurement date. Level III Unobservable inputs that reflect management's best estimate of what market participants would use in pricing the asset or liability at the measurement date. The following table summarizes fair value measurements by level at December 31, 2023, for assets and liabilities measured at fair value on a recurring basis ($ in millions): Level I Level II Level III Total Assets Cash and cash equivalents $ 17,193 $ — $ — $ 17,193 Investments: U.S. Treasury securities and obligations of U.S. government corporations and agencies $ 62 $ — $ — $ 62 Corporate securities — 9,564 — 9,564 Municipal securities — 3,232 — 3,232 Short-term time deposits — 746 — 746 Asset-backed securities — 1,638 — 1,638 Residential mortgage-backed securities — 1,407 — 1,407 Commercial mortgage-backed securities — 1,072 — 1,072 Equity securities 15 2 — 17 Total investments $ 77 $ 17,661 $ — $ 17,738 Restricted deposits: Cash and cash equivalents $ 259 $ — $ — $ 259 U.S. Treasury securities and obligations of U.S. government corporations and agencies 333 — — 333 Corporate securities — 37 — 37 Certificates of deposit — 4 — 4 Municipal securities — 753 — 753 Total restricted deposits $ 592 $ 794 $ — $ 1,386 Total assets at fair value $ 17,862 $ 18,455 $ — $ 36,317 Liabilities Accounts payable and accrued expenses: Foreign currency swap agreement $ — $ 13 $ — $ 13 Total liabilities at fair value $ — $ 13 $ — $ 13 The following table summarizes fair value measurements by level at December 31, 2022, for assets and liabilities measured at fair value on a recurring basis ($ in millions): Level I Level II Level III Total Assets Cash and cash equivalents $ 12,074 $ — $ — $ 12,074 Investments: U.S. Treasury securities and obligations of U.S. government corporations and agencies $ 366 $ 5 $ — $ 371 Corporate securities — 9,328 — 9,328 Municipal securities — 3,165 — 3,165 Short-term time deposits — 204 — 204 Asset-backed securities — 1,326 — 1,326 Residential mortgage-backed securities — 1,046 — 1,046 Commercial mortgage-backed securities — 862 — 862 Equity securities 15 2 — 17 Total investments $ 381 $ 15,938 $ — $ 16,319 Restricted deposits: Cash and cash equivalents $ 256 $ — $ — $ 256 U.S. Treasury securities and obligations of U.S. government corporations and agencies 308 — — 308 Corporate securities — 33 — 33 Certificates of deposit — 4 — 4 Municipal securities — 616 — 616 Total restricted deposits $ 564 $ 653 $ — $ 1,217 Total assets at fair value $ 13,019 $ 16,591 $ — $ 29,610 The Company utilizes matrix pricing services to estimate fair value for securities which are not actively traded on the measurement date. The Company designates these securities as Level II fair value measurements. In addition, the aggregate carrying amount of the Company's private equity investments and life insurance contracts, which approximates fair value, was $1,007 million and $686 million as of December 31, 2023 and December 31, 2022, respectively.

Property, Software and Equipmen

Property, Software and Equipment	12 Months Ended
	Dec. 31, 2023
Property, Plant and Equipment [Abstract]
Property, Software and Equipment	Property, Software and Equipment Property, software and equipment consist of the following ($ in millions): December 31, 2023 December 31, 2022 Computer software $ 2,631 $ 2,224 Computer hardware 542 604 Buildings 534 659 Furniture and office equipment 304 366 Leasehold improvements 252 467 Land 156 178 Property, software and equipment, at cost 4,419 4,498 Less: accumulated depreciation (2,400) (2,066) Property, software and equipment, net $ 2,019 $ 2,432 Depreciation expense for the years ended December 31, 2023, 2022 and 2021 was $575 million, $614 million and $565 million, respectively. The decrease in property, software and equipment in 2023 was primarily driven by divestiture related activity as discussed in Note 3. Acquisitions and Divestitures . Specifically, as of December 31, 2023, Circle Health was considered held for sale, and accordingly, the associated property, software and equipment of $447 million was reclassified to other current assets. During the second quarter of 2022, in connection with the adoption of a more modern, flexible work environment, the Company undertook a real estate optimization initiative to evaluate future real estate needs and downsize its real estate footprint for owned and leased properties. As a result of this evaluation, the Company substantially changed the use or abandoned various properties and assessed for impairment. The Company engaged a third-party real estate specialist to determine the fair value of its owned properties. The valuation primarily considered comparable properties in each market as well as future cash flows. As a result of the optimization, the Company recognized impairment charges related to owned real estate and fixed assets related to leased real estate of $57 million and $1,050 million for the years ended December 31, 2023 and 2022, respectively. The remainder of the $97 million and $1,627 million impairment charges for the years ended December 31, 2023 and 2022, respectively, relate to right-of-use (ROU) asset impairments, which is included within other long-term assets in the Consolidated Balance Sheets, refer to Note 11. Leases.

Goodwill and Intangible Assets

Goodwill and Intangible Assets	12 Months Ended
	Dec. 31, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill and Intangible Assets	Goodwill and Intangible Assets As discussed in Note 1. Organization and Operations, in the first quarter of 2023 the Company updated its segment structure. Prior year information has been adjusted to reflect the change in segment reporting. The following table summarizes the changes in goodwill by operating segment ($ in millions): Medicaid Medicare Commercial Other Consolidated Total Balance, December 31, 2021 $ 10,194 $ 1,592 $ 5,424 $ 2,561 $ 19,771 Acquisition and purchase accounting adjustments — — — 1,077 1,077 Divestitures — — — (1,533) (1,533) Reallocation 4 — — (4) — Impairments — — — (370) (370) Translation impact — — — (133) (133) Balance, December 31, 2022 $ 10,198 $ 1,592 $ 5,424 $ 1,598 $ 18,812 Divestitures — — — (912) (912) Impairments — — — (392) (392) Translation impact — — — 50 50 Balance, December 31, 2023 $ 10,198 $ 1,592 $ 5,424 $ 344 $ 17,558 In 2023, divestiture related activity in goodwill included the completed divestiture of Apixio as well as $760 million of goodwill reclassified to other current assets associated with the divestiture of Circle Health, which was considered held for sale as of December 31, 2023. In 2022, divestiture related activity in goodwill included the completed divestitures of PANTHERx and Magellan Rx, as well as goodwill reclassified to other current assets associated with the divestiture of Magellan Specialty Health, which was considered held for sale as of December 31, 2022. The acquired goodwill in 2022 represents goodwill associated with the Magellan acquisition. The Company's Other segment impairments in 2023 were driven by the Circle Health and Operose Health divestitures. The Company's Other segment impairments in 2022 were driven by the impairment of the Federal Services business, which included $216 million of goodwill, in conjunction with the December 2022 announcement from the DoD that the Company was not awarded a TRICARE Managed Care Support Contract, as well as the divestiture of the Spanish and Central European businesses. Intangible assets at December 31, consist of the following ($ in millions): Weighted Average Useful Life in Years 2023 2022 2023 2022 Purchased contract rights and customer relationships $ 7,845 $ 7,850 13.5 13.4 Trade names 943 983 15.6 15.4 Provider contracts 612 612 14.0 14.0 Developed technologies 298 390 4.4 5.3 Intangible assets 9,698 9,835 13.4 13.4 Less: accumulated amortization Purchased contract rights and customer relationships (2,768) (2,193) Trade names (320) (263) Provider contracts (227) (183) Developed technologies (282) (285) Total accumulated amortization (3,597) (2,924) Intangible assets, net $ 6,101 $ 6,911 The decrease in intangible assets in 2023 was primarily driven by divestiture related activity, which included related impairments, during the year as discussed with goodwill above and in Note 3. Acquisitions and Divestitures. Amortization expense was $718 million, $817 million and $770 million for the years ended December 31, 2023, 2022 and 2021, respectively. Estimated total amortization expense related to the December 31, 2023 intangible assets for each of the five succeeding fiscal years is as follows ($ in millions): Estimated Total Amortization Expense 2024 $ 692 2025 690 2026 673 2027 663 2028 662

Medical Claims Liability

Medical Claims Liability	12 Months Ended
	Dec. 31, 2023
Insurance [Abstract]
Medical Claims Liability	Medical Claims Liability As discussed in Note 1. Organization and Operations, in the first quarter of 2023 the Company updated its segment structure. Prior year information has been adjusted to reflect the change in segment reporting. The following table summarizes the change in medical claims liability for the year ended December 31, 2023 ($ in millions): Medicaid Medicare Commercial Other Consolidated Total Balance, January 1, 2023 $ 11,253 $ 3,431 $ 1,921 $ 140 $ 16,745 Less: Reinsurance recoverables 7 — 19 — 26 Balance, January 1, 2023, net 11,246 3,431 1,902 140 16,719 Incurred related to: Current year 79,747 19,487 19,966 1,480 120,680 Prior years (1,537) (343) (150) (6) (2,036) Total incurred 78,210 19,144 19,816 1,474 118,644 Paid related to: Current year 69,904 16,631 16,823 1,367 104,725 Prior years 8,743 2,582 1,479 133 12,937 Total paid 78,647 19,213 18,302 1,500 117,662 Plus: Premium deficiency reserve — 250 — — 250 Balance, December 31, 2023, net 10,809 3,612 3,416 114 17,951 Plus: Reinsurance recoverables 5 — 44 — 49 Balance, December 31, 2023 $ 10,814 $ 3,612 $ 3,460 $ 114 $ 18,000 The following table summarizes the change in medical claims liability for the year ended December 31, 2022 ($ in millions): Medicaid Medicare Commercial Other Consolidated Total Balance, January 1, 2022 $ 9,845 $ 2,286 $ 2,014 $ 98 $ 14,243 Less: Reinsurance recoverables 23 — — — 23 Balance, January 1, 2022, net 9,822 2,286 2,014 98 14,220 Acquisitions and divestitures — — — 105 105 Incurred related to: Current year 76,344 19,474 14,296 2,782 112,896 Prior years (1,046) (102) (204) (15) (1,367) Total incurred 75,298 19,372 14,092 2,767 111,529 Paid related to: Current year 66,221 16,275 12,556 2,747 97,799 Prior years 7,653 1,952 1,648 83 11,336 Total paid 73,874 18,227 14,204 2,830 109,135 Balance, December 31, 2022, net 11,246 3,431 1,902 140 16,719 Plus: Reinsurance recoverables 7 — 19 — 26 Balance, December 31, 2022 $ 11,253 $ 3,431 $ 1,921 $ 140 $ 16,745 The following table summarizes the change in medical claims liability for the year ended December 31, 2021 ($ in millions): Medicaid Medicare Commercial Other Consolidated Total Balance, January 1, 2021 $ 8,567 $ 2,012 $ 1,801 $ 58 $ 12,438 Less: Reinsurance recoverables 23 — — — 23 Balance, January 1, 2021, net 8,544 2,012 1,801 58 12,415 Incurred related to: Current year 68,720 15,388 14,706 1,571 100,385 Prior years (1,616) (142) (17) (8) (1,783) Total incurred 67,104 15,246 14,689 1,563 98,602 Paid related to: Current year 59,839 13,275 12,839 1,474 87,427 Prior years 5,987 1,697 1,637 49 9,370 Total paid 65,826 14,972 14,476 1,523 96,797 Balance, December 31, 2021, net 9,822 2,286 2,014 98 14,220 Plus: Reinsurance recoverables 23 — — — 23 Balance, December 31, 2021 $ 9,845 $ 2,286 $ 2,014 $ 98 $ 14,243 Reinsurance recoverables related to medical claims are included in premium and trade receivables. Changes in estimates of incurred claims for prior years were primarily attributable to reserving under moderately adverse conditions, including residual pandemic impacts and continued integration activities. Additionally, as a result of minimum HBR and other return of premium programs, the Company recorded approximately $382 million, $198 million and $492 million of the "Incurred related to: Prior years" as a reduction to premium revenues in 2023, 2022 and 2021, respectively. Further, claims processing and coordination of benefits initiatives yielded claim payment recoveries related to dates of service from prior years. Changes in medical utilization and cost trends and the effect of population health management initiatives may also contribute to changes in medical claim liability estimates. While the Company has evidence that population health management initiatives are effective on a case by case basis, population health management initiatives primarily focus on events and behaviors prior to the incurrence of the medical event and generation of a claim. Accordingly, any change in behavior, leveling of care or coordination of treatment occurs prior to claim generation and as a result, the costs prior to the population health management initiative are not known by the Company. Additionally, certain population health management initiatives are focused on member and provider education with the intent of influencing behavior to appropriately align the medical services provided with the member's acuity. In these cases, determining whether the population health management initiative changed the behavior cannot be determined. Because of the complexity of its business, the number of states in which it operates and the volume of claims that it processes, the Company is unable to practically quantify the impact of these initiatives on its changes in estimates of IBNR. The Company reviews actual and anticipated experience compared to the assumptions used to establish medical costs. The Company establishes premium deficiency reserves if actual and anticipated experience indicates that existing policy liabilities together with the present value of future gross premiums will not be sufficient to cover the present value of future benefits, settlement and maintenance costs. Information about incurred and paid claims development as of December 31, 2023 is included in the table below. The claims development information for all periods preceding the most recent reporting period is considered required supplementary information. Consolidated incurred and paid claims development as of December 31, 2023 is as follows ($ in millions): Cumulative Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance For the Year Ended December 31, Claim Year 2021 (unaudited) 2022 (unaudited) 2023 2021 $ 100,385 $ 99,087 $ 99,077 2022 112,896 110,870 2023 120,680 Total incurred claims $ 330,627 Cumulative Paid Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance For the Year Ended December 31, Claim Year 2021 (unaudited) 2022 (unaudited) 2023 2021 $ 87,427 $ 98,024 $ 98,645 2022 97,799 109,680 2023 104,725 Total payment of incurred claims 313,050 All outstanding liabilities prior to 2021, net of reinsurance 124 Medical claims liability, net of reinsurance $ 17,701 Incurred and paid claims development for the Medicaid segment as of December 31, 2023 is as follows ($ in millions): Cumulative Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance For the Year Ended December 31, Claim Year 2021 (unaudited) 2022 (unaudited) 2023 2021 $ 68,720 $ 67,682 $ 67,628 2022 76,344 74,861 2023 79,747 Total incurred claims $ 222,236 Cumulative Paid Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance For the Year Ended December 31, Claim Year 2021 (unaudited) 2022 (unaudited) 2023 2021 $ 59,838 $ 66,903 $ 67,436 2022 66,220 74,125 2023 69,904 Total payment of incurred claims 211,465 All outstanding liabilities prior to 2021, net of reinsurance 38 Medical claims liability, net of reinsurance $ 10,809 Incurred and paid claims development for the Medicare segment as of December 31, 2023 is as follows ($ in millions): Cumulative Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance For the Year Ended December 31, Claim Year 2021 (unaudited) 2022 (unaudited) 2023 2021 $ 15,388 $ 15,330 $ 15,337 2022 19,475 19,124 2023 19,487 Total incurred claims $ 53,948 Cumulative Paid Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance For the Year Ended December 31, Claim Year 2021 (unaudited) 2022 (unaudited) 2023 2021 $ 13,275 $ 15,178 $ 15,187 2022 16,276 18,818 2023 16,631 Total payment of incurred claims 50,636 All outstanding liabilities prior to 2021, net of reinsurance 50 Medical claims liability, net of reinsurance $ 3,362 Incurred and paid claims development for the Commercial segment as of December 31, 2023 is as follows ($ in millions): Cumulative Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance For the Year Ended December 31, Claim Year 2021 (unaudited) 2022 (unaudited) 2023 2021 $ 14,706 $ 14,519 $ 14,556 2022 14,296 14,110 2023 19,966 Total incurred claims $ 48,632 Cumulative Paid Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance For the Year Ended December 31, Claim Year 2021 (unaudited) 2022 (unaudited) 2023 2021 $ 12,840 $ 14,387 $ 14,466 2022 12,556 13,963 2023 16,823 Total payment of incurred claims 45,252 All outstanding liabilities prior to 2021, net of reinsurance 36 Medical claims liability, net of reinsurance $ 3,416 Incurred and paid claims development for the Other segment as of December 31, 2023 is as follows ($ in millions): Cumulative Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance For the Year Ended December 31, Claim Year 2021 (unaudited) 2022 (unaudited) 2023 2021 $ 1,571 $ 1,556 $ 1,556 2022 2,781 2,775 2023 1,480 Total incurred claims $ 5,811 Cumulative Paid Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance For the Year Ended December 31, Claim Year 2021 (unaudited) 2022 (unaudited) 2023 2021 $ 1,474 $ 1,556 $ 1,556 2022 2,747 2,774 2023 1,367 Total payment of incurred claims 5,697 All outstanding liabilities prior to 2021, net of reinsurance — Medical claims liability, net of reinsurance $ 114 Incurred claims and allocated claim adjustment expenses, net of reinsurance, total IBNR plus expected development on reported claims and cumulative claims data as of December 31, 2023 are included in the following table. For claims frequency information summarized below, a claim is defined as the financial settlement of a single medical event in which remuneration was paid to the servicing provider. Total IBNR plus expected development on reported claims represents estimates for claims incurred but not reported, development on reported claims and estimates for the costs necessary to process unpaid claims at the end of each period. The Company estimates its liability using actuarial methods that are commonly used by health insurance actuaries and meet Actuarial Standards of Practice. These actuarial methods consider factors such as historical data for payment patterns, cost trends, product mix, seasonality, utilization of healthcare services and other relevant factors. Consolidated information is summarized as follows (in millions): December 31, 2023 Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance Total IBNR Plus Expected Development Cumulative Paid Claims 2021 $ 99,077 $ 3 624.0 2022 110,870 429 637.5 2023 120,680 11,135 599.3 Information for the Medicaid segment is summarized as follows (in millions): December 31, 2023 Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance Total IBNR Plus Expected Development Cumulative Paid Claims 2021 $ 67,628 $ 3 376.6 2022 74,861 306 370.6 2023 79,747 6,859 327.3 Information for the Medicare segment is summarized as follows (in millions): December 31, 2023 Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance Total IBNR Plus Expected Development Cumulative Paid Claims 2021 $ 15,337 $ — 185.9 2022 19,124 86 204.7 2023 19,487 1,783 198.4 Information for the Commercial segment is summarized as follows (in millions): December 31, 2023 Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance Total IBNR Plus Expected Development Cumulative Paid Claims 2021 $ 14,556 $ — 60.9 2022 14,110 37 57.4 2023 19,966 2,393 69.8 Information for the Other segment is summarized as follows (in millions): December 31, 2023 Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance Total IBNR Plus Expected Development Cumulative Paid Claims 2021 $ 1,556 $ — 0.6 2022 2,775 — 4.8 2023 1,480 100 3.8

Affordable Care Act

Affordable Care Act	12 Months Ended
	Dec. 31, 2023
Affordable Care Act [Abstract]
Affordable Care Act	Affordable Care Act The ACA established risk spreading premium stabilization programs as well as a minimum annual MLR and CSRs. The Company's net receivables (payables) for each of the programs are as follows ($ in millions): December 31, 2023 December 31, 2022 Risk adjustment receivable $ 893 $ 838 Risk adjustment payable (2,553) (780) Minimum medical loss ratio (164) (103) Cost sharing reduction payable (114) (99)

Debt

Debt	12 Months Ended
	Dec. 31, 2023
Debt Disclosure [Abstract]
Debt	Debt Debt consists of the following ($ in millions): December 31, 2023 December 31, 2022 $2,500 million 4.25% Senior Notes, due December 15, 2027 $ 2,395 $ 2,393 $2,300 million 2.45% Senior Notes, due July 15, 2028 2,303 2,303 $3,500 million 4.625% Senior Notes, due December 15, 2029 3,277 3,277 $2,000 million 3.375% Senior Notes, due February 15, 2030 2,000 2,000 $2,200 million 3.00% Senior Notes, due October 15, 2030 2,200 2,200 $2,200 million 2.50% Senior Notes, due March 1, 2031 2,200 2,200 $1,300 million 2.625% Senior Notes, due August 1, 2031 1,300 1,300 Total senior notes 15,675 15,673 Term Loan Facility 2,115 2,183 Revolving Credit Agreement 150 58 Finance leases and other 11 253 Debt issuance costs (122) (147) Total debt 17,829 18,020 Less: current portion (119) (82) Long-term debt $ 17,710 $ 17,938 Senior Notes In connection with the Magellan acquisition in January 2022, the Company paid off Magellan's debt of $535 million acquired in the transaction using Magellan's cash on hand. Specifically, the Company redeemed Magellan's existing outstanding 4.4% Senior Notes due 2024 and paid off the existing Credit Agreement. The Company recognized an immaterial net pre-tax gain on extinguishment including related fees and expenses and the write-off of the unamortized premium. During 2022, the Company utilized a portion of the proceeds from the PANTHERx divestiture to repurchase $95 million of its par value Senior Notes due 2027 and $223 million of its par value Senior Notes due 2029 through the Company's senior note debt repurchase program. The Company recognized a $14 million gain on the redemptions of the notes. The indentures governing the senior notes listed in the table above contain restrictive covenants of Centene Corporation. At December 31, 2023, the Company was in compliance with all covenants. Circle Health Debt Refinancing In May 2022, the Company refinanced certain debt agreements for its Circle Health subsidiary with a new £250 million credit facility maturing in May 2025. The Company recognized a $13 million pre-tax gain on the extinguishment of the existing debt. As of December 31, 2023, £150 million was drawn on the facility, and was included in accounts payable and accrued expenses in the Consolidated Balance Sheets as a liability held for sale. The facility is guaranteed by the Company and has similar borrowing rates and covenants to the Company's Revolving Credit Agreement, except it uses the Sterling Overnight Index Average (SONIA) as the reference rate for the interest rate payable. In January 2024, the Company completed the divestiture of Circle Health and terminated the credit facility. Revolving Credit Facility and Term Loan Credit Facility In May 2023, the Company entered into a first amendment to the Company's Fourth Amended and Restated Credit Agreement. The amendment removed and replaced the interest rate benchmark based on the London Interbank Offered Rate (LIBOR) and related LIBOR-based mechanics applicable to U.S. dollar borrowings under the Amended and Restated Credit Agreement with an interest rate benchmark based on the Secured Overnight Financing Rate (SOFR) (including a customary credit spread adjustment) and related SOFR-based mechanics. Additionally, the amendment removed certain provisions which required the Company to make certain mandatory prepayments of the Term Loan Facility. The Company has (i) unsecured $2,000 million multi-currency revolving credit facility (the Revolving Credit Facility), which includes a $300 million sub-limit for letters of credit and a $200 million sub-limit for swingline loans and (ii) a $2,200 million unsecured delayed-draw term loan facility (the Term Loan Facility, and together with the Revolving Credit Facility, the Company Credit Facility). Borrowings under the Revolving Credit Facility bear interest, at the Company's option, at SOFR, SONIA, Euro Interbank Offered Rate (EURIBOR), Swiss Average Rate Overnight (SARON), Tokyo Interbank Offered Rate (TIBOR), Canadian Dollar Offered Rate (CDOR), Bank Buying Rate (BBR) or base rates plus, in each case, an applicable margin between 1.50% to 1.125%, based on the total debt to EBITDA ratio and type of borrowing. Borrowings under the Term Loan Facility bear interest, at the Company's option, at SOFR or base rates plus, in each case, an applicable margin based on the total debt to EBITDA ratio. The Company has an uncommitted option to increase its Company Credit Facility by an additional $500 million plus certain additional amounts based on its total debt to EBITDA ratio. The Term Loan Facility includes scheduled amortization payments equal to 0% for the first year following closing, 2.5% for the second year following closing and 5% thereafter until maturity. The Company Credit Facility contains financial covenants including maintenance of a minimum fixed charge coverage ratio and a restriction on the Company's maximum total debt to EBITDA ratio not to exceed 4.0 to 1.0. It also contains certain non-financial covenants including: limitations on incurrence of additional indebtedness; restrictions on incurrence of liens; restrictions on dividends and other restricted payments; restrictions on investments, mergers, consolidations and asset sales; and limitations on transactions with affiliates. As of December 31, 2023, the Company was in compliance with all financial and non-financial covenants under the Company Credit Facility. As of December 31, 2023, the Company had $150 million of borrowings outstanding under the Revolving Credit Facility, with an interest rate of the base rate plus 0.25% margin. The Revolving Credit Facility and the Term Loan Facility will mature on August 16, 2026. Senior Note Debt Repurchase Program In June 2022, the Company's Board of Directors authorized a $1,000 million senior note debt repurchase program in preparation for future debt reductions as part of the Company's strategic initiatives. During the year ended December 31, 2022, the Company repurchased $318 million of its par value senior notes, as described above, for $300 million. No repurchases were made during the year ended December 31, 2023. As of December 31, 2023, there was $700 million available under the senior note debt repurchase program. Letters of Credit & Surety Bonds The Company had outstanding letters of credit of $152 million as of December 31, 2023, which were not part of the Revolving Credit Facility. The letters of credit bore interest at 0.7% as of December 31, 2023. The Company had outstanding surety bonds of $856 million as of December 31, 2023. Aggregate maturities for the Company's debt for the years ending December 31, are as follows ($ in millions): Aggregate Maturities 2024 $ 119 2025 113 2026 2,048 2027 2,405 2028 2,300 Thereafter 10,977 Total $ 17,962 The fair value of outstanding debt was approximately $16,322 million and $15,791 million at December 31, 2023 and 2022, respectively.

Leases

Leases	12 Months Ended
	Dec. 31, 2023
Leases [Abstract]
Leases	Leases The Company records ROU assets and lease liabilities for non-cancelable operating leases primarily for real estate and equipment. Leases with an initial term of 12 months or less are not recorded on the balance sheet. Expense related to leases is recorded on a straight-line basis over the lease term, including rent holidays. The Company recognized operating lease expense of $349 million and $429 million during the years ended December 31, 2023 and 2022, respectively. The Company considers the existence of options to extend or terminate leases in its analysis of the lease term for the purposes of measuring its ROU assets and lease liabilities. The renewal options are not included in the measurement of the ROU assets and lease liabilities unless the Company is reasonably certain to exercise the optional renewal periods. The following table sets forth the ROU assets and lease liabilities ($ in millions): December 31, 2023 December 31, 2022 Assets ROU assets (recorded within other long-term assets) $ 396 $ 2,554 Liabilities Short-term (recorded within accounts payable and accrued expenses) $ 168 $ 180 Long-term (recorded within other long-term liabilities) 880 3,133 Total lease liabilities $ 1,048 $ 3,313 The decrease in ROU assets and lease liabilities in 2023 was primarily driven by divestiture related activity as discussed in Note 3. Acquisitions and Divestitures . Specifically, as of December 31, 2023, Circle Health was considered held for sale and accordingly the associated ROU assets of $2,113 million and lease liabilities of $2,197 million were reclassified to other current assets and accounts payable and accrued expenses, respectively, in the Consolidated Balance Sheets. Cash paid for amounts included in the measurement of lease liabilities, recorded as operating cash flows in the Consolidated Statements of Cash Flows, was $378 million and $440 million during the years ended December 31, 2023 and 2022, respectively. New operating leases commenced resulting in the recognition of ROU assets and lease liabilities of $40 million and $60 million during the years ended December 31, 2023 and 2022, respectively. In connection with the acquisition of Magellan in January 2022, the Company acquired $30 million of ROU assets and lease liabilities. As of December 31, 2023, the Company had additional operating leases that have not yet commenced of $1 million. These operating leases will commence in 2024 with lease terms of approximately five years. As part of the real estate optimization initiative as described in Note 6. Property, Software and Equipment , the Company vacated and abandoned various domestic leased properties. As a result, the Company assessed the ROU assets for impairment. The Company engaged a third-party real estate specialist to determine the recoverability of the leased properties. The valuation primarily considered comparable leased properties in each market and the assessment of potential future rental income that could be generated by the ROU assets. As a result of the ongoing real estate optimization initiative, the Company recognized $40 million and $577 million of ROU asset impairments for the years ended December 31, 2023 and 2022, respectively. The remainder of the $97 million and $1,627 million real estate optimization impairment charges for the years ended December 31, 2023 and 2022, respectively, was related to Property, Software and Equipment, refer to Note 6. Property, Software and Equipment . As of December 31, 2023, the weighted average remaining lease term for the Company was 20.5 years. The average remaining lease term of the Circle Health portfolio is 26.3 years. Excluding Circle Health, the average remaining lease term of the Company's portfolio is 8.1 years. The lease liabilities as of December 31, 2023, reflect a weighted average discount rate of 5.8%, or 3.3% excluding Circle Health. Lease payments over the next five years and thereafter are as follows ($ in millions): Lease Payments 2024 $ 198 2025 174 2026 148 2027 132 2028 112 Thereafter 434 Total lease payments 1,198 Less: imputed interest (150) Total lease liabilities $ 1,048

Stockholders' Equity

Stockholders' Equity	12 Months Ended
	Dec. 31, 2023
Equity [Abstract]
Stockholders' Equity	Stockholders' Equity The Company's Board of Directors has authorized a stock repurchase program of the Company's common stock from time to time on the open market or through privately negotiated transactions. In 2023, the Company's Board of Directors authorized an increase under the program of $4,000 million. With these increases, the Company is authorized to repurchase up to $10,000 million, inclusive of past authorizations. As of December 31, 2023, the Company had a remaining amount of $5,229 million available under the Company's stock repurchase program. No duration has been placed on the repurchase program. The Company reserves the right to discontinue the repurchase program at any time. Share repurchases in 2023, 2022 and 2021 were primarily funded through divestiture proceeds and free cash flow generated from operations. The following represents the Company's share repurchase activity ($ in millions, shares in thousands): Year Ended December 31, 2023 2022 (2) 2021 Shares Cost Shares Cost Shares Cost Share buybacks 22,886 $ 1,577 35,655 $ 2,994 2,402 $ 200 Income tax withholding 828 56 1,213 102 1,379 97 Total share repurchases (1) 23,714 $ 1,633 36,868 $ 3,096 3,781 $ 297 (1) Excludes share repurchase excise tax of $10 million accrued as of December 31, 2023. (2) Includes 11.6 million shares delivered as part of an accelerated share repurchase (ASR) agreement with a $1,000 million notional amount. The Company purchased additional shares throughout the year through open market repurchases, including repurchase plans designed to comply with Rule 10b5-1. Shares repurchased for income tax withholding are shares withheld in connection with employee stock plans to meet applicable tax withholding requirements. These shares are typically included in the Company's treasury stock, except for the vesting of certain shares assumed in connection with the WellCare acquisition in 2021, which were withheld rather than repurchased. Although these shares are not issued, they are treated as common stock repurchases as they reduce the number of shares that would have been issued upon vesting. Shares withheld were 326 thousand shares at an aggregate cost of $19 million for the year ended December 31, 2021. No shares were withheld under this method in 2022 or 2023.

Statutory Capital Requirements

Statutory Capital Requirements and Dividend Restrictions	12 Months Ended
	Dec. 31, 2023
Statutory Capital Requirements And Dividend Restrictions [Abstract]
Statutory Capital Requirements and Dividend Restrictions	Statutory Capital Requirements and Dividend Restrictions

Income Taxes

Income Taxes	12 Months Ended
	Dec. 31, 2023
Income Tax Disclosure [Abstract]
Income Taxes	Income Taxes The consolidated income tax expense consists of the following ($ in millions): Year Ended December 31, 2023 2022 2021 Current provision Federal $ 833 $ 1,144 $ 507 State and local 132 261 114 International 1 4 7 Total current provision 966 1,409 628 Deferred provision (67) (649) (151) Total income tax expense $ 899 $ 760 $ 477 The reconciliation of the tax provision at the U.S. federal statutory rate to income tax expense is as follows ($ in millions): Year Ended December 31, 2023 2022 2021 Earnings before income tax expense $ 3,598 $ 1,962 $ 1,813 Loss (earnings) attributable to flow through noncontrolling interest 3 (6) 2 Earnings less noncontrolling interest before income tax expense 3,601 1,956 1,815 Tax provision at the U.S. federal statutory rate 756 411 381 State income taxes, net of federal income tax benefit 75 50 63 Nondeductible compensation 38 49 40 Nondeductible PBM legal settlement — (5) 78 Nontaxable divestiture (gains) losses (4) 111 (95) Deferred taxes for investments in subsidiaries 3 84 — Excess tax benefit on stock awards (59) (13) (3) Valuation allowance 26 (17) 29 Nondeductible goodwill 77 69 — Other, net (13) 21 (16) Income tax expense $ 899 $ 760 $ 477 The tax effects of temporary differences which give rise to deferred tax assets and liabilities are presented below ($ in millions): December 31, 2023 December 31, 2022 Deferred tax assets: Medical claims liability $ 217 $ 132 Nondeductible liabilities 111 202 Net operating loss and tax credit carryforwards 71 341 Compensation accruals 113 96 Premium and trade receivables 94 91 Operating lease liability 269 397 Unrealized loss 179 320 Software development costs 193 209 Other 92 85 Deferred tax assets 1,339 1,873 Valuation allowance (82) (205) Net deferred tax assets $ 1,257 $ 1,668 Deferred tax liabilities: Goodwill and intangible assets $ 1,603 $ 1,724 Fixed assets 127 111 Right-of-use asset 98 285 Other 70 163 Deferred tax liabilities 1,898 2,283 Net deferred tax liabilities $ (641) $ (615) The decrease to the unrealized loss deferred tax asset reflects the change in the fair market value of the Company's investment portfolio. Decreases to deferred taxes for net operating losses, operating lease liabilities and right of use assets are primarily related to balances associated with Circle Health that are included with held for sale assets and liabilities as of December 31, 2023. Valuation allowances are provided when it is considered more likely than not that deferred tax assets will not be realized. The valuation allowances primarily relate to future tax benefits on certain federal and state net operating loss, federal and state capital loss and tax credit carryforwards. The decrease to the valuation allowance is primarily related to balances associated with Circle Health that are included with held for sale assets and liabilities as of December 31, 2023. Federal net operating loss and credit carryforwards of $13 million expire beginning in 2024 through 2043. State net operating loss and tax credit carryforwards of $41 million expire beginning in 2024 through 2043, while the remaining $15 million have indefinite carryforward periods. The Company maintains a reserve for uncertain tax positions that may be challenged by a tax authority. A rollforward of the beginning and ending amount of uncertain tax positions, exclusive of related interest and penalties, is as follows ($ in millions): Year Ended December 31, 2023 2022 Gross unrecognized tax benefits, January 1 $ 410 $ 355 Gross increases: Current year tax positions 19 52 Acquired reserves — 7 Prior year tax positions 29 20 Gross decreases: Settlements (2) (17) Prior year tax positions (10) (3) Statute of limitation lapses (7) (4) Gross unrecognized tax benefits, December 31 $ 439 $ 410 As of December 31, 2023, $314 million of unrecognized tax benefits would impact the Company's effective tax rate in future periods, if recognized. The table above excludes interest and penalties, net of related tax benefits, which are treated as income tax expense (benefit) under the Company's accounting policy. The Company recognized net interest expense and penalties related to uncertain positions of $18 million and $23 million for the years ended December 31, 2023 and 2022, respectively. The Company had $84 million and $66 million of accrued interest and penalties for uncertain tax positions as of December 31, 2023 and 2022, respectively. The Company files federal tax returns as well as returns for numerous state and international tax jurisdictions and is engaged in multiple audit proceedings for its state and foreign filings. Generally, no further state or foreign audit activity is expected for years prior to 2015. As of December 31, 2023, the Company's tax returns are under federal examination for the tax years 2014 through 2017, only with respect to Internal Revenue Service (IRS) proposed adjustments relating to the Company's claims to the Domestic Production Activities Deduction for these years. The Company has appealed the IRS adjustments and the appeals process is expected to be completed within the next 12 months. The Company believes it is reasonably possible that its liability for unrecognized tax benefits will decrease by approximately $124 million within the next 12 months if the Company reaches a satisfactory agreement with the IRS during the appeals process and an additional $2 million decrease as a result of the expiration of statutes of limitations and projected audit settlements in certain jurisdictions.

Stock Incentive Plans

Stock Incentive Plans	12 Months Ended
	Dec. 31, 2023
Share-Based Payment Arrangement [Abstract]
Stock Incentive Plans	Stock Incentive Plans The Company's stock incentive plans allow for the granting of restricted stock or restricted stock unit awards and options to purchase common stock. Both incentive stock options and nonqualified stock options can be awarded under the plans. However, an immaterial amount of options were granted, exercised or outstanding in 2023. The plans have 13 million shares available for future awards. Compensation expense for stock options and restricted stock unit awards is recognized on a straight-line basis over the vesting period, generally three one A summary of the Company's non-vested restricted stock and restricted stock unit shares as of December 31, 2023, and changes during the year ended December 31, 2023, is presented below (shares in thousands): Shares Weighted Average Grant Date Fair Value Non-vested balance, December 31, 2022 6,573 $ 74.20 Granted 4,252 63.40 Vested (2,741) 72.37 Forfeited (622) 71.24 Non-vested balance, December 31, 2023 7,462 $ 68.96 The total fair value of restricted stock and restricted stock units vested during the years ended December 31, 2023, 2022 and 2021, was $185 million, $298 million and $264 million, respectively. As of December 31, 2023, there was $243 million of total unrecognized compensation cost related to non-vested share-based compensation arrangements granted under the plans; that cost is expected to be recognized over a weighted-average period of 1.8 years.

Retirement Plan

Retirement Plan	12 Months Ended
	Dec. 31, 2023
Retirement Benefits [Abstract]
Retirement Plan	Retirement Plan

Contingencies

Contingencies	12 Months Ended
	Dec. 31, 2023
Commitments and Contingencies Disclosure [Abstract]
Contingencies	Contingencies Overview The Company is routinely subjected to legal and regulatory proceedings in the normal course of business. These matters can include, without limitation: • periodic compliance and other reviews and investigations by various federal and state regulatory agencies with respect to requirements applicable to the Company's business, including, without limitation, those related to payment of out-of-network claims, compliance with CMS Medicare and Marketplace regulations, including risk adjustment and broker compensation, compliance with the False Claims Act, the calculation of minimum MLR and rebates related thereto, submissions to state agencies related to payments or state false claims acts, pre-authorization penalties, timely review of grievances and appeals, timely and accurate payment of claims, cybersecurity issues, including those related to the Company's or the Company's third-party vendors' information systems, and the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and other federal and state fraud, waste and abuse laws; • litigation arising out of general business activities, such as tax matters, disputes related to healthcare benefits coverage or reimbursement, putative securities class actions, and medical malpractice, privacy, real estate, intellectual property, vendor disputes and employment-related claims; and • disputes regarding reinsurance arrangements, claims arising out of the acquisition or divestiture of various assets, class actions, and claims relating to the performance of contractual and non-contractual obligations to providers, members, employer groups, vendors and others, including, but not limited to, the alleged failure to properly pay claims and challenges to the manner in which the Company processes claims, claims related to network adequacy and claims alleging that the Company has engaged in unfair business practices. Among other things, these matters may result in awards of damages, fines, or penalties, which could be substantial, and/or could require changes to the Company's business. The Company intends to vigorously defend itself against legal and regulatory proceedings to which it is currently a party; however, these proceedings are subject to many uncertainties. In some of the cases pending against the Company, substantial non-economic or punitive damages are being sought. The Company records reserves and accrues costs for certain legal proceedings and regulatory matters to the extent that it determines an unfavorable outcome is probable and the amount of the loss can be reasonably estimated. While such reserves and accrued costs reflect the Company's best estimate of the probable loss for such matters, the recorded amounts may differ materially from the actual amount of any such losses. In some cases, no estimate of the possible loss or range of loss in excess of amounts accrued, if any, can be made because of the inherently unpredictable nature of legal and regulatory proceedings, which may be exacerbated by various factors, including but not limited to, they may involve indeterminate claims for monetary damages or may involve fines, penalties or punitive damages; present novel legal theories or legal uncertainties; involve disputed facts; represent a shift in regulatory policy; involve a large number of parties, claimants or regulatory bodies; are in the early stages of the proceedings; involve a number of separate proceedings and/or a wide range of potential outcomes; or result in a change of business practices. As of the date of this report, amounts accrued for legal proceedings and regulatory matters were not material, except for the reserve estimate as described below with respect to claims or potential claims involving services provided by Envolve Pharmacy Solutions, Inc. (Envolve), as the Company's pharmacy benefits management (PBM) subsidiary. It is possible that in a particular quarter or annual period the Company's financial condition, results of operations, cash flow, and/or liquidity could be materially adversely affected by an ultimate unfavorable resolution of or development in legal and/or regulatory proceedings, including as described below. Except for the discussion below, the Company believes that the ultimate outcome of any of the regulatory and legal proceedings that are currently pending against it should not have a material adverse effect on financial condition, results of operations, cash flow, or liquidity. Pharmacy Benefits Management Matters On March 11, 2021, the State of Ohio filed a civil action against the Company and the Company's subsidiaries, Buckeye Health Plan Community Solutions, Inc. and Envolve, in Franklin County Court of Common Pleas, captioned as Ohio Department of Medicaid, et al. v. Centene Corporation, et al. The complaint alleged breaches of contract with the Ohio Department of Medicaid relating to the provision of PBM services and violations of Ohio law relating to such contracts, including among other things, by (i) seeking payment for services already reimbursed, (ii) not accurately disclosing to the Ohio Department of Medicaid the true cost of the PBM services and (iii) inflating dispensing fees for prescription drugs. The plaintiffs sought an undisclosed sum of money in damages, penalties, and possible termination of the contract with Buckeye Health Plan. The Company has reached a no-fault settlement with the Ohio Attorney General regarding this matter and the complaint was dismissed. The Company has reached no-fault settlement agreements related to services previously provided by Envolve with the vast majority of states impacted. Such agreements have provided for payment amounts consistent with the initial reserve estimate established in the second quarter of 2021 related to this issue. Additional claims, reviews, or investigations relating to the Company's historical PBM business across products may be brought by other states, the federal government, or shareholder litigants, and there is no guarantee the Company will have the ability to settle such claims with other states within the reserve estimate the Company has recorded and on other acceptable terms, or at all. This matter is subject to many uncertainties, and an adverse outcome in this matter could have an adverse impact on the Company's financial condition, results of operations, and cash flows.

Earnings Per Share

Earnings Per Share	12 Months Ended
	Dec. 31, 2023
Earnings Per Share [Abstract]
Earnings Per Share	Earnings Per Share The following table sets forth the calculation of basic and diluted net earnings per common share ($ in millions, except per share data in dollars and shares in thousands): Year Ended December 31, 2023 2022 2021 Earnings attributable to Centene Corporation $ 2,702 $ 1,202 $ 1,347 Shares used in computing per share amounts: Weighted average number of common shares outstanding 543,319 575,191 582,832 Common stock equivalents (as determined by applying the treasury stock method) 2,385 6,849 7,684 Weighted average number of common shares and potential dilutive common shares outstanding 545,704 582,040 590,516 Net earnings per common share attributable to Centene Corporation: Basic earnings per common share $ 4.97 $ 2.09 $ 2.31 Diluted earnings per common share $ 4.95 $ 2.07 $ 2.28 The calculation of diluted earnings per common share for 2023, 2022 and 2021 excludes the impact of 376 thousand shares, 187 thousand shares and 44 thousand shares, respectively, related to anti-dilutive stock options and restricted stock units.

Segment Information

Segment Information	12 Months Ended
	Dec. 31, 2023
Segment Reporting [Abstract]
Segment Information	Segment Information In the first quarter of 2023, and in conjunction with the Company's updated strategic plan, executive leadership realignment and corresponding 2023 divestitures, the Company revised the way it manages the business, evaluates performance and allocates resources, resulting in an updated segment structure comprised of (1) a Medicaid segment, (2) a Medicare segment, (3) a Commercial segment and (4) an Other segment. Prior year information has been adjusted to reflect the change in segment reporting. The Medicaid, Medicare and Commercial segments represent the government-sponsored or subsidized programs under which the Company offers managed healthcare services. The Other segment includes the Company's pharmacy operations, Envolve Benefit Options' vision and dental services, clinical healthcare, behavioral health, international operations and corporate management company, among others. Factors used in determining the reportable business segments include the nature of operating activities, the existence of separate senior management teams and the type of information presented to the Company's chief operating decision-maker to evaluate all results of operations. The Company does not report total assets by segment since this is not a metric used to allocate resources or evaluate segment performance. Segment information for the year ended December 31, 2023, is as follows ($ in millions): Medicaid Medicare Commercial Other/Eliminations Consolidated Total Premium $ 86,853 $ 22,261 $ 24,843 $ 1,679 $ 135,636 Service 2 — 2 4,455 4,459 Premium and service revenues 86,855 22,261 24,845 6,134 140,095 Premium tax 13,904 — — — 13,904 Total external revenues 100,759 22,261 24,845 6,134 153,999 Internal revenues — — — 16,735 16,735 Eliminations — — — (16,735) (16,735) Total revenues $ 100,759 $ 22,261 $ 24,845 $ 6,134 $ 153,999 Medical costs $ 78,210 $ 19,394 $ 19,816 $ 1,474 $ 118,894 Cost of services $ 4 $ — $ — $ 3,560 $ 3,564 Gross margin (1) $ 8,641 $ 2,867 $ 5,029 $ 1,100 $ 17,637 (1) Gross margin represents premium and service revenues less medical costs and cost of services. Segment information for the year ended December 31, 2022, is as follows ($ in millions): Medicaid Medicare Commercial Other/Eliminations Consolidated Total Premium $ 84,084 $ 22,484 $ 17,377 $ 3,186 $ 127,131 Service (1) — 3 8,346 8,348 Premium and service revenues 84,083 22,484 17,380 11,532 135,479 Premium tax 9,068 — — — 9,068 Total external revenues 93,151 22,484 17,380 11,532 144,547 Internal revenues — — — 25,191 25,191 Eliminations — — — (25,191) (25,191) Total revenues $ 93,151 $ 22,484 $ 17,380 $ 11,532 $ 144,547 Medical costs $ 75,298 $ 19,372 $ 14,092 $ 2,767 $ 111,529 Cost of services $ — $ — $ — $ 7,032 $ 7,032 Gross margin (1) $ 8,785 $ 3,112 $ 3,288 $ 1,733 $ 16,918 (1) Gross margin represents premium and service revenues less medical costs and cost of services. Segment information for the year ended December 31, 2021, is as follows ($ in millions): Medicaid Medicare Commercial Other/Eliminations Consolidated Total Premium $ 76,127 $ 17,512 $ 16,953 $ 1,727 $ 112,319 Service 13 — 3 5,648 5,664 Premium and service revenues 76,140 17,512 16,956 7,375 117,983 Premium tax 7,999 — — — 7,999 Total external revenues 84,139 17,512 16,956 7,375 125,982 Internal revenues — — — 23,654 23,654 Eliminations — — — (23,654) (23,654) Total revenues $ 84,139 $ 17,512 $ 16,956 $ 7,375 $ 125,982 Medical costs $ 67,104 $ 15,246 $ 14,689 $ 1,563 $ 98,602 Cost of services $ — $ — $ — $ 4,894 $ 4,894 Gross margin (1) $ 9,036 $ 2,266 $ 2,267 $ 918 $ 14,487 (1) Gross margin represents premium and service revenues less medical costs and cost of services.

Condensed Financial Information

Condensed Financial Information of Registrant	12 Months Ended
	Dec. 31, 2023
Condensed Financial Information Disclosure [Abstract]
Condensed Financial Information of Registrant	Condensed Financial Information of Registrant Centene Corporation (Parent Company Only) Condensed Balance Sheets (In millions, except shares in thousands and per share data in dollars) December 31, 2023 December 31, 2022 ASSETS Current assets: Cash and cash equivalents $ 7 $ 12 Other current assets 7 6 Total current assets 14 18 Long-term investments 264 66 Investment in subsidiaries 43,853 42,306 Other long-term assets 186 422 Total assets $ 44,317 $ 42,812 LIABILITIES, REDEEMABLE NONCONTROLLING INTERESTS AND STOCKHOLDERS' EQUITY Current liabilities: Current liabilities $ 417 $ 534 Current portion of long-term debt 110 69 Total current liabilities 527 603 Long-term debt 17,708 17,699 Other long-term liabilities 126 273 Total liabilities 18,361 18,575 Commitments and contingencies Redeemable noncontrolling interest 19 56 Stockholders' equity: Preferred stock, $0.001 par value; authorized 10,000 shares; no shares issued or outstanding at December 31, 2023 and December 31, 2022 — — Common stock, $0.001 par value; authorized 800,000 shares; 615,291 issued and 534,484 outstanding at December 31, 2023, and 607,847 issued and 550,754 outstanding at December 31, 2022 1 1 Additional paid-in capital 20,304 20,060 Accumulated other comprehensive (loss) (652) (1,132) Retained earnings 12,043 9,341 Treasury stock, at cost (80,807 and 57,093 shares, respectively) (5,856) (4,213) Total Centene stockholders' equity 25,840 24,057 Nonredeemable noncontrolling interest 97 124 Total stockholders' equity 25,937 24,181 Total liabilities, redeemable noncontrolling interests and stockholders' equity $ 44,317 $ 42,812 See notes to condensed financial information of registrant. Centene Corporation (Parent Company Only) Condensed Statements of Operations (In millions, except per share data in dollars) Year Ended December 31, 2023 2022 2021 Expenses: Selling, general and administrative expenses $ 14 $ 21 $ 9 Legal settlement — 33 1,116 Other income (expense): Investment and other income (47) 55 38 Gain on divestiture 108 13 118 Debt extinguishment — 14 (125) Interest expense (710) (643) (641) (Loss) before income taxes (663) (615) (1,735) Income tax (benefit) (118) (208) (308) Net (loss) before equity in subsidiaries (545) (407) (1,427) Equity in earnings from subsidiaries 3,244 1,609 2,763 Net earnings 2,699 1,202 1,336 Loss attributable to noncontrolling interests 3 — 11 Net earnings attributable to Centene Corporation $ 2,702 $ 1,202 $ 1,347 Net earnings per common share attributable to Centene Corporation: Basic earnings per common share $ 4.97 $ 2.09 $ 2.31 Diluted earnings per common share $ 4.95 $ 2.07 $ 2.28 See notes to condensed financial information of registrant. Centene Corporation (Parent Company Only) Condensed Statements of Cash Flows (In millions) Year Ended December 31, 2023 2022 2021 Cash flows from operating activities: Dividends from subsidiaries, return on investment $ 2,823 $ 1,706 $ 2,194 Payments for legal settlement (326) (282) (298) Other operating activities, net (334) (450) (582) Net cash provided by operating activities 2,163 974 1,314 Cash flows from investing activities: Capital contributions to subsidiaries (443) (880) (1,217) Purchases of investments (202) (2) (723) Sales and maturities of investments — — 66 Dividends from subsidiaries, return of investment 85 10 241 Investments in acquisitions — (2,431) (151) Proceeds from divestitures 325 — 130 Intercompany activities (357) 5,785 (1,709) Other investing activities, net — 3 — Net cash (used in) provided by investing activities (592) 2,485 (3,363) Cash flows from financing activities: Proceeds from common stock issuances 44 70 35 Proceeds from long-term debt 2,305 75 9,066 Payments and repurchases of long-term debt (2,290) (491) (7,207) Common stock repurchases (1,633) (3,096) (297) Payments for debt extinguishment — (14) (157) Debt issuance costs — — (72) Other financing activities, net (2) — 22 Net cash (used in) provided by financing activities (1,576) (3,456) 1,390 Net increase (decrease) in cash and cash equivalents (5) 3 (659) Cash and cash equivalents, beginning of period 12 9 668 Cash and cash equivalents, end of period $ 7 $ 12 $ 9 See notes to condensed financial information of registrant. Notes to Condensed Financial Information of Registrant Note A - Basis of Presentation and Significant Accounting Policies The parent company only financial statements should be read in conjunction with Centene Corporation's audited consolidated financial statements and the notes to consolidated financial statements included in this Form 10-K. The parent company's investment in subsidiaries is stated at cost plus equity in undistributed earnings of the subsidiaries. The parent company's share of net income of its unconsolidated subsidiaries is included in income using the equity method of accounting. Certain unrestricted subsidiaries receive monthly management fees from the Company's restricted subsidiaries. The management and service fees received by its unrestricted subsidiaries are associated with all of the functions required to manage the restricted subsidiaries including, but not limited to, salaries and wages for personnel, rent, utilities, population health management, provider contracting, compliance, member services, claims processing, information technology, cash management, finance and accounting and other services. Beginning in 2023, the management fees are based on a cost basis reimbursement. Due to the Company's centralized cash management function, cash flows generated by its unrestricted subsidiaries are utilized by the parent company to the extent required, primarily to repay borrowings on the parent company's credit facilities, repurchase the parent company's common stock, make acquisitions, fund capital contributions to subsidiaries and fund its operations. Certain amounts presented in the parent company only financial statements are eliminated in the consolidated financial statements of Centene Corporation.

Pay vs Performance Disclosure

Pay vs Performance Disclosure - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Pay vs Performance Disclosure
Net earnings	$ 2,702	$ 1,202	$ 1,347

Insider Trading Arrangements

Insider Trading Arrangements	3 Months Ended
	Dec. 31, 2023
Trading Arrangements, by Individual
Rule 10b5-1 Arrangement Adopted	false
Non-Rule 10b5-1 Arrangement Adopted	false
Rule 10b5-1 Arrangement Terminated	false
Non-Rule 10b5-1 Arrangement Terminated	false

Summary of Significant Accoun_2

Summary of Significant Accounting Policies (Policies)	12 Months Ended
	Dec. 31, 2023
Accounting Policies [Abstract]
Basis of Presentation	Basis of Presentation The accompanying consolidated financial statements include the accounts of Centene Corporation and all majority owned subsidiaries and subsidiaries over which the Company exercises the power and control to direct activities significantly impacting financial performance. All material intercompany balances and transactions have been eliminated. Certain amounts in the consolidated financial statements and notes have been reclassified to conform to the 2023 presentation, including reclassifications related to the Company's new segment reporting structure as outlined in Note 1. Organization and Operations . Additionally, beginning in 2022, the Company included a separate line item for depreciation expense in the Consolidated Statements of Operations, which was previously included in selling, general and administrative (SG&A) expenses. Prior period SG&A expense ratios have also been conformed to the current presentation. These reclassifications have no effect on net earnings, cash flow or stockholders' equity as previously reported. During 2023, the Company completed the divestitures of HealthSmart, Centurion, Magellan Specialty Health, its majority stake in Apixio, and Operose Health Group (Operose Health). Additionally, during the third quarter of 2023, the Company signed a definitive agreement to sell Circle Health Group (Circle Health), which was accounted for as held for sale as of December 31, 2023. On January 12, 2024, the Company completed the divestiture for cash consideration of $931 million. During 2022, the Company acquired all of the issued and outstanding shares of Magellan Health, Inc. (Magellan). The acquisition was accounted for as a business combination. Additionally, during 2022 the Company completed the divestitures of PANTHERx Rare (PANTHERx), its Spanish and Central European businesses and Magellan Rx. See Note 3. Acquisitions and Divestitures for further details.
Use of Estimates	Use of Estimates
Business Combinations	Business Combinations Business combinations are accounted for using the acquisition method of accounting. The Company allocates the fair value of purchase consideration to the assets acquired and liabilities assumed based on their fair values at the acquisition date. The excess of the fair value of consideration transferred over the fair value of the net assets acquired is recorded as goodwill. Goodwill is generally attributable to the value of the synergies between the combined companies and the value of the acquired assembled workforce, neither of which qualifies for recognition as an intangible asset. The Company uses its best estimates and assumptions to value assets acquired and liabilities assumed at the acquisition date; however, these estimates are sometimes preliminary and, in some instances, all information required to value the assets acquired and liabilities assumed may not be available or final as of the end of a reporting period subsequent to the business combination. If the accounting for the business combination is incomplete, provisional amounts are recorded. The provisional amounts are updated during the period determined, up to one year from the acquisition date. The Company includes the results of operations of acquired businesses in the Company's consolidated results prospectively from the date of acquisition. Acquisition related expenses and post-acquisition restructuring costs are recognized separately from the business combination and are expensed as incurred.
Cash and Cash Equivalents	Cash and Cash Equivalents Investments with original maturities of three months or less are considered to be cash equivalents. Cash equivalents consist of money market funds, bank certificates of deposit and savings accounts. The Company maintains amounts on deposit with various financial institutions, which may exceed federally insured limits. However, management periodically evaluates the credit-worthiness of those institutions, and the Company has not experienced any losses on such deposits.
Investments	Investments Short-term investments include securities with maturities greater than three months to one year. Long-term investments include securities with maturities greater than one year. Short-term and long-term investments are generally classified as available-for-sale and are carried at fair value. Certain equity investments are recorded using the fair value or equity method. The Company monitors the difference between the carrying value and fair value of its available-for-sale debt investments and whether declines in fair value are credit related. Unrealized gains and losses on debt investments available-for-sale are excluded from earnings and reported in accumulated other comprehensive earnings (loss), a separate component of stockholders' equity, net of income tax effects. If a loss is deemed to be credit related, the Company recognizes an allowance through earnings. For each security in an unrealized loss position, the Company assesses whether it intends to sell the security or if it is more likely than not the Company will be required to sell the security before recovery of the amortized cost basis for reasons such as liquidity, contractual or regulatory purposes. If the security meets this criterion, the decline in fair value is recorded in earnings through investment and other income. Premiums and discounts are amortized or accreted over the life of the related security using the effective interest method. To calculate realized gains and losses on the sale of investments, the Company uses the specific amortized cost of each investment sold. Realized gains and losses are recorded in investment and other income.
Restricted Deposits	Restricted Deposits Restricted deposits consist of investments required by various state statutes to be deposited or pledged to state agencies. These investments are classified as long-term, regardless of the contractual maturity date, due to the nature of the states' requirements. The Company is required to annually adjust the amount of the deposit pledged to certain states.
Fair Value Measurements	Fair Value Measurements In the normal course of business, the Company invests in various financial assets and incurs various financial liabilities. Fair values are disclosed for all financial instruments, whether or not such values are recognized in the Consolidated Balance Sheets. Management obtains quoted market prices and other observable inputs for these disclosures. The carrying amounts reported in the Consolidated Balance Sheets for cash and cash equivalents, premium and trade receivables, medical claims liability, accounts payable and accrued expenses, unearned revenue and certain other current assets and liabilities are carried at cost, which approximates fair value because of their short-term nature. The following methods and assumptions were used to estimate the fair value of each financial instrument: • Available-for-sale investments and restricted deposits: The carrying amount is stated at fair value, based on quoted market prices, where available. For securities not actively traded, fair values were estimated using values obtained from independent pricing services or quoted market prices of comparable instruments. • Senior unsecured notes: Estimated based on third-party quoted market prices for the same or similar issues. • Variable rate debt: The carrying amount of the Company's floating rate debt approximates fair value since the interest rates adjust based on market rate adjustments. • Foreign currency swap: Estimated based on Great British Pound to US Dollar foreign exchange rates. • Contingent consideration: Estimated based on expected achievement of metrics included in the acquisition agreement considering circumstances that exist as of the acquisition date.
Property, Software and Equipment	Property, Software and Equipment Property, software and equipment are stated at cost less accumulated depreciation. Computer hardware and software includes certain costs incurred in the development of internal-use software, including external direct costs of materials and services and payroll costs of team members devoted to specific software development. Depreciation is calculated principally by the straight-line method over estimated useful lives. Leasehold improvements are depreciated using the straight-line method over the shorter of the expected useful life or the remaining term of the lease. Property, software and equipment are depreciated over the following periods: Fixed Asset Depreciation Period Buildings and improvements 5 - 40 years Computer hardware and software 3 - 5 years Furniture and equipment 3 - 10 years Land improvements 10 - 20 years Leasehold improvements 1 - 20 years The carrying amounts of all long-lived assets are evaluated to determine if adjustment to the depreciation and amortization period or to the unamortized balance is warranted. Such evaluation is based principally on the expected utilization of the long-lived assets.
Goodwill and Intangible Assets	Goodwill and Intangible Assets Intangible assets represent assets acquired in purchase transactions and consist primarily of purchased contract rights and customer relationships, provider contracts, trade names, developed technologies and goodwill. Intangible assets are amortized using the straight-line method over the following periods: Intangible Asset Amortization Period Purchased contract rights and customer relationships 3 - 21 years Provider contracts 4 - 15 years Trade names 7 - 20 years Developed technologies 2 - 7 years The Company tests for impairment of intangible assets, as well as long-lived assets, whenever events or changes in circumstances indicate that the carrying value of an asset or asset group (hereinafter referred to as "asset group") may not be recoverable by comparing the sum of the estimated undiscounted future cash flows expected to result from use of the asset group and its eventual disposition to the carrying value. Such factors include, but are not limited to, significant changes in membership, state funding, state contracts and provider networks and contracts. If the sum of the estimated undiscounted future cash flows is less than the carrying value, an impairment determination is required. The amount of impairment is calculated by subtracting the fair value of the asset group from the carrying value of the asset group. An impairment charge, if any, is recognized within earnings from operations. In the first quarter of 2023, and in conjunction with the Company's updated strategic plan, executive leadership realignment and corresponding 2023 divestitures, the Company revised the way it manages the business, evaluates performance and allocates resources, resulting in an updated segment structure comprised of (1) a Medicaid segment, (2) a Medicare segment, (3) a Commercial segment and (4) an Other segment. As a result of these changes, the Company reassigned goodwill to the impacted reporting units using a relative fair value allocation approach. The Company tests goodwill for impairment using a fair value approach. The Company is required to test for impairment at least annually, absent a triggering event, which could include a significant decline in operating performance that would require an impairment assessment. Absent any impairment indicators, the Company performs its goodwill impairment testing during the fourth quarter of each year. The Company recognizes an impairment charge for any amount by which the carrying amount of goodwill exceeds its fair value. The Company first assesses qualitative factors to determine whether it is necessary to perform the quantitative goodwill impairment test. The Company generally does not calculate the fair value of a reporting unit unless it determines, based on a qualitative assessment, that it is more likely than not that its fair value is less than its carrying amount. If the quantitative test is deemed necessary, the Company determines an appropriate valuation technique to estimate a reporting unit's fair value as of the testing date. The Company utilizes either the income approach or the market approach, whichever is most appropriate for the respective reporting unit. The income approach is based on an internally developed discounted cash flow model that includes assumptions related to future growth rates, discount factors, future tax rates and other various assumptions. The market approach is based on financial multiples of comparable companies derived from current market data. The Company then compares the fair value of the reporting unit calculated using the income approach or market approach with its carrying amount and recognizes an impairment charge for the amount by which the carrying amount exceeds fair value. The impairment charge is limited to the total amount of goodwill allocated to the reporting unit. Changes in economic and operating conditions impacting assumptions used in the Company's analyses could result in goodwill impairment in future periods.
Medical Claims Liability	Medical Claims Liability Medical claims liability includes claims reported but not yet paid, or claims inventory, estimates for claims incurred but not reported, or IBNR, and estimates for the costs necessary to process unpaid claims at the end of each period. The Company estimates its medical claims liability using actuarial methods that are commonly used by health insurance actuaries and meet Actuarial Standards of Practice. These actuarial methods consider factors such as historical data for payment patterns, cost trends, product mix, seasonality, utilization of healthcare services and other relevant factors. Actuarial Standards of Practice generally require that the medical claims liability estimates be adequate to cover obligations under moderately adverse conditions. Moderately adverse conditions are situations in which the actual claims are expected to be higher than the otherwise estimated value of such claims at the time of estimate. In many situations, the claims amounts ultimately settled will be different than the estimate that satisfies the Actuarial Standards of Practice. The Company includes in its IBNR an estimate for medical claims liability under moderately adverse conditions which represents the risk of adverse deviation of the estimates in its actuarial method of reserving. The Company uses its judgment to determine the assumptions to be used in the calculation of the required estimates. The assumptions it considers when estimating IBNR include, without limitation, claims receipt and payment experience (and variations in that experience), changes in membership, provider billing practices, healthcare service utilization trends, cost trends, product mix, seasonality, prior authorization of medical services, benefit changes, known outbreaks of disease or increased incidence of illness such as influenza or COVID-19, provider contract changes, changes to fee schedules and the incidence of high-dollar or catastrophic claims. The Company's development of the medical claims liability estimate is a continuous process which it monitors and refines on a monthly basis as additional claims receipts and payment information becomes available. As more complete claims information becomes available, the Company adjusts the amount of the estimates, and includes the changes in estimates in medical costs in the period in which the changes are identified. In every reporting period, the operating results include the effects of more completely developed medical claims liability estimates associated with previously reported periods. The Company consistently applies its reserving methodology from period to period. As additional information becomes known, it adjusts the actuarial model accordingly to establish medical claims liability estimates. The Company reviews actual and anticipated experience compared to the assumptions used to establish medical costs. The Company establishes premium deficiency reserves if actual and anticipated experience indicates that existing policy liabilities together with the present value of future gross premiums will not be sufficient to cover the present value of future benefits, settlement and maintenance costs. For purposes of determining premium deficiencies, contracts are grouped in a manner consistent with the method of acquiring, servicing and measuring the profitability of such contracts and expected investment income is excluded. In December 2023, the Company recorded a premium deficiency reserve of $250 million related to the 2024 Medicare Advantage contract year.
Revenue Recognition	Revenue Recognition The Company's health plans generate revenues primarily from premiums received from the states in which it operates health plans, premiums received from its members and the Centers for Medicare and Medicaid Services (CMS) for its Medicare product and premiums from members of its commercial health plans. In addition to member premium payments, its Marketplace contracts also generate revenues from subsidies received from CMS. The Company generally receives a fixed premium per member per month pursuant to its contracts and recognizes premium revenues during the period in which it is obligated to provide services to its members at the amount reasonably estimable. In some instances, the Company's base premiums are subject to an adjustment factor, in the form of a risk score or risk adjustment, based on the acuity of its membership. Generally, the risk score or risk adjustment is determined by the state or CMS analyzing submissions of processed claims and medical record data to determine the acuity of the Company's membership, often relative to the respective program's membership. The Company estimates the amount of risk score and risk adjustment based upon the processed claims and medical record data submitted and expected to be submitted to the state or CMS and records revenues on a risk adjusted basis. Some contracts allow for additional premiums related to certain supplemental services provided such as maternity deliveries. The Company's contracts with states may require it to maintain a minimum health benefits ratio (HBR) or may require it to share cost-savings in excess of certain levels. In certain circumstances, including commercial plans, its plans may be required to return premium to the state or policyholders in the event costs are below established levels. The Company estimates the effect of these programs and recognizes reductions in revenue in the current period. Other states may require us to meet certain performance and quality metrics in order to receive additional or full contractual revenue. For performance-based contracts, the Company does not recognize revenue subject to refund until data is sufficient to measure performance. Revenues are recorded based on membership and eligibility data provided by the states or CMS, which is adjusted on a monthly basis by the states or CMS for retroactive additions or deletions to membership data. These eligibility adjustments are estimated monthly and subsequent adjustments are made in the period known. The Company reviews and updates those estimates as new information becomes available. It is possible that new information could require us to make additional adjustments, which could be significant, to these estimates. The Company's Medicare Advantage contracts are with CMS. CMS deploys a risk adjustment model which apportions premiums paid to all health plans according to health severity and certain demographic factors. The CMS risk adjustment model pays more for members whose medical history would indicate that they are expected to have higher medical costs. Under this risk adjustment methodology, CMS calculates the risk adjusted premium payment using diagnosis data from hospital inpatient, hospital outpatient, physician treatment settings as well as prescription drug events. The Company and the healthcare providers collect, compile and submit the necessary and available diagnosis data to CMS within prescribed deadlines. The Company estimates risk adjustment revenues based upon the diagnosis data submitted and expected to be submitted to CMS and records revenues on a risk adjusted basis. For qualifying low-income prescription drug benefit members, CMS pays for some, or all, of the member's monthly premium. The Company receives certain Part D prospective subsidy payments from CMS for these members as a fixed monthly per member amount, based on the estimated costs of providing prescription drug benefits over the plan year, as reflected in its bids. Approximately nine to ten months subsequent to the end of the plan year, or later in the case of the coverage gap discount subsidy, a settlement payment is made between CMS and the Company's plans based on the difference between the prospective payments and actual claims experience. The Company's specialty companies generate revenues under contracts with state and federal programs, healthcare organizations and other commercial organizations, as well as from its own subsidiaries. Revenues are recognized when the related services are provided, when inventory is shipped, or as ratably earned over the covered period of services. The Company recognizes revenue related to administrative services under the TRICARE government-sponsored Managed Care Support Contract for the DoD's TRICARE program on a straight-line basis over the option period, when the fees become fixed and determinable. The TRICARE contract includes various performance-based measures. For each of the measures, an estimate of the amount that has been earned is made at each interim date, and revenue is recognized accordingly. Some states enact premium taxes, similar assessments and provider pass-through payments, collectively premium taxes, and these taxes are recorded as a separate component of both revenues and operating expenses. For certain products, premium taxes and state assessments are not pass-through payments and are recorded as premium revenue and premium tax expense in the Consolidated Statements of Operations.
Affordable Care Act	Affordable Care Act The Affordable Care Act (ACA) established risk spreading premium stabilization programs as well as minimum medical loss ratio (MLR) and cost sharing reductions (CSRs). The Company's accounting policies for the programs are as follows: Risk Adjustment The permanent risk adjustment program established by the ACA transfers funds from qualified individual and small group insurance plans with below average risk scores to those plans with above average risk scores within each state. The Company estimates the receivable or payable under the risk adjustment program based on its estimated risk score compared to the state average risk score. The Company may record a receivable or payable as an adjustment to premium revenues to reflect the year-to-date impact of the risk adjustment based on its best estimate. The Company refines its estimate as new information becomes available. Minimum Medical Loss Ratio Additionally, the ACA established a minimum MLR for the Health Insurance Marketplace. The risk adjustment program described above is taken into consideration to determine if the Company's estimated annual medical costs are less than the minimum MLR and require an adjustment to premium revenues to meet the minimum MLR. Cost Sharing Reductions The ACA directs issuers to reduce the Company's members' cost sharing for essential health benefits for individuals with Federal Poverty Levels (FPLs) between 100% and 250% who are enrolled in a silver tier product; eliminate cost sharing for Indians/Alaska Natives with a FPL less than 300% and eliminate cost sharing for Indians/Alaska Natives regardless of FPL when services are provided by an Indian Health Service. In October 2017, the Trump Administration issued an executive order that immediately ceased payments of CSRs to issuers, and beginning in 2018 premium rates for Health Insurance Marketplace were set without factoring in the cost sharing subsidy payments from the federal government. The Company is engaged in active discussions with the government regarding recovery for CSR payments for benefit years 2018 and beyond.
Premium and Trade Receivables and Unearned Revenue	Premium and Trade Receivables and Unearned Revenue
Significant Customers	Significant Customers The Company receives the majority of its revenues under contracts or subcontracts with state Medicaid managed care programs. Customers where the aggregate annual contract revenues exceeded 10% of total annual revenues included the state of New York, where the percentage of the Company's total revenue was 10% for the year ended December 31, 2021. None of the Company's customers exceeded 10% of total annual revenues for the years ended December 31, 2023 and 2022.
Other Income (Expense)	Other Income (Expense)
Income Taxes	Income Taxes Deferred tax assets and liabilities are recorded for the future tax consequences attributable to differences between the financial statement carrying amounts of existing assets and liabilities and their respective tax bases. Deferred tax assets and liabilities are measured using enacted tax rates expected to apply to taxable income in the years in which those temporary differences are expected to be recovered or settled. The effect on deferred tax assets and liabilities of a change in tax law or tax rates is recognized in income in the period that includes the enactment date. Valuation allowances are provided when it is considered more likely than not that deferred tax assets will not be realized. In determining if a deductible temporary difference or net operating loss can be realized, the Company considers future reversals of existing taxable temporary differences, future taxable income, taxable income in prior carryback periods and tax planning strategies.
Contingencies	Contingencies The Company accrues for loss contingencies associated with outstanding litigation, claims and assessments for which it has determined it is probable that a loss contingency exists and the amount of loss can be reasonably estimated. The Company expenses professional fees associated with litigation claims and assessments as incurred.
Stock Based Compensation	Stock Based Compensation Stock based compensation expense is recognized at grant date fair value over the period during which an employee is required to provide service in exchange for the award. Excess tax benefits related to stock compensation are presented as a cash inflow from operating activities. The Company accounts for forfeitures when they occur.
Foreign Currency Translation	Foreign Currency Translation
Recently Adopted Accounting Guidance and Recent Accounting Guidance Not Yet Adopted	Recent Accounting Guidance Not Yet Adopted In November 2023, the Financial Accounting Standards Board (FASB) issued an Accounting Standards Update (ASU) which is intended to improve reportable segment disclosure requirements, primarily through enhanced disclosures about significant expenses. The amendments will require public entities to disclose significant segment expenses that are regularly provided to the chief operating decision maker and included within segment profit and loss. The new standard is effective for annual periods beginning after December 15, 2023, and for interim periods within fiscal years beginning after December 15, 2024. The Company is currently evaluating the effect of the new disclosure requirements. In December 2023, the FASB issued an ASU which includes amendments that further enhance income tax disclosures, primarily through standardization and disaggregation of rate reconciliation categories and income taxes paid by jurisdiction. The new standard is effective for annual periods beginning after December 15, 2024. The Company is currently evaluating the effect of the new disclosure requirements.

Summary of Significant Accoun_3

Summary of Significant Accounting Policies (Tables)	12 Months Ended
	Dec. 31, 2023
Accounting Policies [Abstract]
Schedule of Property Software and Equipment Depreciation Periods	Property, software and equipment are depreciated over the following periods: Fixed Asset Depreciation Period Buildings and improvements 5 - 40 years Computer hardware and software 3 - 5 years Furniture and equipment 3 - 10 years Land improvements 10 - 20 years Leasehold improvements 1 - 20 years
Schedule of Amortization Period for Intangible Assets	Intangible assets are amortized using the straight-line method over the following periods: Intangible Asset Amortization Period Purchased contract rights and customer relationships 3 - 21 years Provider contracts 4 - 15 years Trade names 7 - 20 years Developed technologies 2 - 7 years
Schedule of Allowance for Uncollectible Accounts	Activity in the allowance for uncollectible accounts is summarized below ($ in millions): Year Ended December 31, 2023 2022 2021 Balance, January 1 $ 130 $ 139 $ 243 Amounts charged to expense 58 70 62 Recoveries — — (43) Write-offs of uncollectible receivables (68) (79) (123) Balance, December 31 $ 120 $ 130 $ 139

Acquisitions and Divestitures (

Acquisitions and Divestitures (Tables)	12 Months Ended
	Dec. 31, 2023
Business Combination and Asset Acquisition [Abstract]
Schedule of Recognized Identified Assets Acquired and Liabilities Assumed	The Company's allocation of the fair value of assets acquired and liabilities assumed as of the acquisition date of January 4, 2022 is as follows ($ in millions): Assets acquired and liabilities assumed Cash and cash equivalents $ 995 Premium and related receivables 791 Short-term investments 144 Other current assets 145 Long-term investments 43 Restricted deposits 7 Property, software and equipment 72 Intangible assets (1) 889 Other long-term assets 50 Total assets acquired 3,136 Medical claims liability 194 Accounts payable and accrued expenses 495 Return of premium payable 53 Unearned revenue 8 Current portion of long-term debt 5 Long-term debt (2) 542 Deferred tax liabilities (3) 157 Other long-term liabilities 64 Total liabilities assumed 1,518 Mezzanine equity 32 Total identifiable net assets 1,586 Goodwill (4) 905 Total assets acquired and liabilities assumed $ 2,491
Schedule of Fair Values and Weighted Average Useful Lives for Identifiable Intangible Assets Acquired	The fair values and weighted average useful lives for identifiable intangible assets acquired are as follows ($ in millions): Fair Value Weighted Average Useful Life in Years Purchased contract rights $ 581 13 Provider contracts 120 15 Developed technologies 101 5 Trade names 87 17 Total intangible assets acquired $ 889 12

Short-term and Long-term Inve_2

Short-term and Long-term Investments, Restricted Deposits (Tables)	12 Months Ended
	Dec. 31, 2023
Investments, Debt and Equity Securities [Abstract]
Short-term and Long-term Investments and Restricted Deposits by Investment Type	Short-term and long-term investments and restricted deposits by investment type consist of the following ($ in millions): December 31, 2023 December 31, 2022 Amortized Cost Gross Unrealized Gains Gross Unrealized Losses Fair Value Amortized Cost Gross Unrealized Gains Gross Unrealized Losses Fair Value Debt securities: U.S. Treasury securities and obligations of U.S. government corporations and agencies $ 403 $ — $ (8) $ 395 $ 695 $ — $ (16) $ 679 Corporate securities 9,984 78 (461) 9,601 10,127 12 (778) 9,361 Restricted certificates of deposit 4 — — 4 4 — — 4 Restricted cash equivalents 259 — — 259 256 — — 256 Short-term time deposits 746 — — 746 204 — — 204 Municipal securities 4,135 21 (171) 3,985 4,055 6 (280) 3,781 Asset-backed securities 1,665 8 (35) 1,638 1,396 — (70) 1,326 Residential mortgage-backed securities 1,503 7 (103) 1,407 1,165 2 (121) 1,046 Commercial mortgage-backed securities 1,149 5 (82) 1,072 961 — (99) 862 Equity securities 17 — — 17 17 — — 17 Private equity investments 833 — — 833 529 — — 529 Life insurance contracts 174 — — 174 157 — — 157 Total $ 20,872 $ 119 $ (860) $ 20,131 $ 19,566 $ 20 $ (1,364) $ 18,222
Schedule of Fair Value of Available-for-sale Debt Securities with Gross Unrealized Losses by Investment Type in a Continuous Unrealized Loss Position	The fair value of available-for-sale debt securities with gross unrealized losses by investment type and length of time that individual securities have been in a continuous unrealized loss position were as follows ($ in millions): December 31, 2023 December 31, 2022 Less Than 12 Months 12 Months or More Less Than 12 Months 12 Months or More Unrealized Losses Fair Value Unrealized Losses Fair Value Unrealized Losses Fair Value Unrealized Losses Fair Value U.S. Treasury securities and obligations of U.S. government corporations and agencies $ — $ 79 $ (8) $ 232 $ (5) $ 342 $ (11) $ 184 Corporate securities (6) 658 (455) 6,260 (340) 5,368 (438) 3,400 Municipal securities (4) 553 (167) 2,237 (142) 2,437 (138) 995 Asset-backed securities (2) 197 (33) 855 (29) 786 (41) 486 Residential mortgage-backed securities (2) 153 (101) 814 (55) 629 (66) 352 Commercial mortgage-backed securities (2) 114 (80) 754 (49) 513 (50) 330 Short-term time deposits — 31 — — — — — — Total $ (16) $ 1,785 $ (844) $ 11,152 $ (620) $ 10,075 $ (744) $ 5,747
Contractual Maturities of Short-term and Long-term Investments and Restricted Deposits	The contractual maturities of short-term and long-term debt securities and restricted deposits are as follows ($ in millions): December 31, 2023 December 31, 2022 Investments Restricted Deposits Investments Restricted Deposits Amortized Cost Fair Value Amortized Cost Fair Value Amortized Cost Fair Value Amortized Cost Fair Value One year or less $ 2,308 $ 2,284 $ 566 $ 564 $ 2,207 $ 2,179 $ 534 $ 532 One year through five years 7,738 7,431 527 504 7,651 7,147 524 490 Five years through ten years 3,905 3,735 298 283 4,066 3,613 224 195 Greater than ten years 155 154 34 35 135 129 — — Asset-backed securities 4,317 4,117 — — 3,522 3,234 — — Total $ 18,423 $ 17,721 $ 1,425 $ 1,386 $ 17,581 $ 16,302 $ 1,282 $ 1,217

Fair Value Measurements (Tables

Fair Value Measurements (Tables)	12 Months Ended
	Dec. 31, 2023
Fair Value Disclosures [Abstract]
Fair Value Level Input and Input Definitions	Level inputs are as follows: Level Input: Input Definition: Level I Inputs are unadjusted, quoted prices for identical assets or liabilities in active markets at the measurement date. Level II Inputs other than quoted prices included in Level I that are observable for the asset or liability through corroboration with market data at the measurement date. Level III Unobservable inputs that reflect management's best estimate of what market participants would use in pricing the asset or liability at the measurement date.
Fair Value Measurements by Level for Assets Measured at Fair Value on a Recurring Basis	The following table summarizes fair value measurements by level at December 31, 2023, for assets and liabilities measured at fair value on a recurring basis ($ in millions): Level I Level II Level III Total Assets Cash and cash equivalents $ 17,193 $ — $ — $ 17,193 Investments: U.S. Treasury securities and obligations of U.S. government corporations and agencies $ 62 $ — $ — $ 62 Corporate securities — 9,564 — 9,564 Municipal securities — 3,232 — 3,232 Short-term time deposits — 746 — 746 Asset-backed securities — 1,638 — 1,638 Residential mortgage-backed securities — 1,407 — 1,407 Commercial mortgage-backed securities — 1,072 — 1,072 Equity securities 15 2 — 17 Total investments $ 77 $ 17,661 $ — $ 17,738 Restricted deposits: Cash and cash equivalents $ 259 $ — $ — $ 259 U.S. Treasury securities and obligations of U.S. government corporations and agencies 333 — — 333 Corporate securities — 37 — 37 Certificates of deposit — 4 — 4 Municipal securities — 753 — 753 Total restricted deposits $ 592 $ 794 $ — $ 1,386 Total assets at fair value $ 17,862 $ 18,455 $ — $ 36,317 Liabilities Accounts payable and accrued expenses: Foreign currency swap agreement $ — $ 13 $ — $ 13 Total liabilities at fair value $ — $ 13 $ — $ 13 The following table summarizes fair value measurements by level at December 31, 2022, for assets and liabilities measured at fair value on a recurring basis ($ in millions): Level I Level II Level III Total Assets Cash and cash equivalents $ 12,074 $ — $ — $ 12,074 Investments: U.S. Treasury securities and obligations of U.S. government corporations and agencies $ 366 $ 5 $ — $ 371 Corporate securities — 9,328 — 9,328 Municipal securities — 3,165 — 3,165 Short-term time deposits — 204 — 204 Asset-backed securities — 1,326 — 1,326 Residential mortgage-backed securities — 1,046 — 1,046 Commercial mortgage-backed securities — 862 — 862 Equity securities 15 2 — 17 Total investments $ 381 $ 15,938 $ — $ 16,319 Restricted deposits: Cash and cash equivalents $ 256 $ — $ — $ 256 U.S. Treasury securities and obligations of U.S. government corporations and agencies 308 — — 308 Corporate securities — 33 — 33 Certificates of deposit — 4 — 4 Municipal securities — 616 — 616 Total restricted deposits $ 564 $ 653 $ — $ 1,217 Total assets at fair value $ 13,019 $ 16,591 $ — $ 29,610

Property, Software and Equipm_2

Property, Software and Equipment (Tables)	12 Months Ended
	Dec. 31, 2023
Property, Plant and Equipment [Abstract]
Property, Software and Equipment	Property, software and equipment consist of the following ($ in millions): December 31, 2023 December 31, 2022 Computer software $ 2,631 $ 2,224 Computer hardware 542 604 Buildings 534 659 Furniture and office equipment 304 366 Leasehold improvements 252 467 Land 156 178 Property, software and equipment, at cost 4,419 4,498 Less: accumulated depreciation (2,400) (2,066) Property, software and equipment, net $ 2,019 $ 2,432

Goodwill and Intangible Assets

Goodwill and Intangible Assets (Tables)	12 Months Ended
	Dec. 31, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule of Changes in Goodwill by Operating Segment	The following table summarizes the changes in goodwill by operating segment ($ in millions): Medicaid Medicare Commercial Other Consolidated Total Balance, December 31, 2021 $ 10,194 $ 1,592 $ 5,424 $ 2,561 $ 19,771 Acquisition and purchase accounting adjustments — — — 1,077 1,077 Divestitures — — — (1,533) (1,533) Reallocation 4 — — (4) — Impairments — — — (370) (370) Translation impact — — — (133) (133) Balance, December 31, 2022 $ 10,198 $ 1,592 $ 5,424 $ 1,598 $ 18,812 Divestitures — — — (912) (912) Impairments — — — (392) (392) Translation impact — — — 50 50 Balance, December 31, 2023 $ 10,198 $ 1,592 $ 5,424 $ 344 $ 17,558
Schedule of Intangible Assets	Intangible assets at December 31, consist of the following ($ in millions): Weighted Average Useful Life in Years 2023 2022 2023 2022 Purchased contract rights and customer relationships $ 7,845 $ 7,850 13.5 13.4 Trade names 943 983 15.6 15.4 Provider contracts 612 612 14.0 14.0 Developed technologies 298 390 4.4 5.3 Intangible assets 9,698 9,835 13.4 13.4 Less: accumulated amortization Purchased contract rights and customer relationships (2,768) (2,193) Trade names (320) (263) Provider contracts (227) (183) Developed technologies (282) (285) Total accumulated amortization (3,597) (2,924) Intangible assets, net $ 6,101 $ 6,911
Schedule of Amortization Expense Related to Intangible Assets	Estimated total amortization expense related to the December 31, 2023 intangible assets for each of the five succeeding fiscal years is as follows ($ in millions): Estimated Total Amortization Expense 2024 $ 692 2025 690 2026 673 2027 663 2028 662

Medical Claims Liability (Table

Medical Claims Liability (Tables)	12 Months Ended
	Dec. 31, 2023
Insurance [Abstract]
Schedule of Change in Medical Claims Liability by Operating Segment	The following table summarizes the change in medical claims liability for the year ended December 31, 2023 ($ in millions): Medicaid Medicare Commercial Other Consolidated Total Balance, January 1, 2023 $ 11,253 $ 3,431 $ 1,921 $ 140 $ 16,745 Less: Reinsurance recoverables 7 — 19 — 26 Balance, January 1, 2023, net 11,246 3,431 1,902 140 16,719 Incurred related to: Current year 79,747 19,487 19,966 1,480 120,680 Prior years (1,537) (343) (150) (6) (2,036) Total incurred 78,210 19,144 19,816 1,474 118,644 Paid related to: Current year 69,904 16,631 16,823 1,367 104,725 Prior years 8,743 2,582 1,479 133 12,937 Total paid 78,647 19,213 18,302 1,500 117,662 Plus: Premium deficiency reserve — 250 — — 250 Balance, December 31, 2023, net 10,809 3,612 3,416 114 17,951 Plus: Reinsurance recoverables 5 — 44 — 49 Balance, December 31, 2023 $ 10,814 $ 3,612 $ 3,460 $ 114 $ 18,000 The following table summarizes the change in medical claims liability for the year ended December 31, 2022 ($ in millions): Medicaid Medicare Commercial Other Consolidated Total Balance, January 1, 2022 $ 9,845 $ 2,286 $ 2,014 $ 98 $ 14,243 Less: Reinsurance recoverables 23 — — — 23 Balance, January 1, 2022, net 9,822 2,286 2,014 98 14,220 Acquisitions and divestitures — — — 105 105 Incurred related to: Current year 76,344 19,474 14,296 2,782 112,896 Prior years (1,046) (102) (204) (15) (1,367) Total incurred 75,298 19,372 14,092 2,767 111,529 Paid related to: Current year 66,221 16,275 12,556 2,747 97,799 Prior years 7,653 1,952 1,648 83 11,336 Total paid 73,874 18,227 14,204 2,830 109,135 Balance, December 31, 2022, net 11,246 3,431 1,902 140 16,719 Plus: Reinsurance recoverables 7 — 19 — 26 Balance, December 31, 2022 $ 11,253 $ 3,431 $ 1,921 $ 140 $ 16,745 The following table summarizes the change in medical claims liability for the year ended December 31, 2021 ($ in millions): Medicaid Medicare Commercial Other Consolidated Total Balance, January 1, 2021 $ 8,567 $ 2,012 $ 1,801 $ 58 $ 12,438 Less: Reinsurance recoverables 23 — — — 23 Balance, January 1, 2021, net 8,544 2,012 1,801 58 12,415 Incurred related to: Current year 68,720 15,388 14,706 1,571 100,385 Prior years (1,616) (142) (17) (8) (1,783) Total incurred 67,104 15,246 14,689 1,563 98,602 Paid related to: Current year 59,839 13,275 12,839 1,474 87,427 Prior years 5,987 1,697 1,637 49 9,370 Total paid 65,826 14,972 14,476 1,523 96,797 Balance, December 31, 2021, net 9,822 2,286 2,014 98 14,220 Plus: Reinsurance recoverables 23 — — — 23 Balance, December 31, 2021 $ 9,845 $ 2,286 $ 2,014 $ 98 $ 14,243
Short-duration Insurance Contracts, Claims Development	Consolidated incurred and paid claims development as of December 31, 2023 is as follows ($ in millions): Cumulative Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance For the Year Ended December 31, Claim Year 2021 (unaudited) 2022 (unaudited) 2023 2021 $ 100,385 $ 99,087 $ 99,077 2022 112,896 110,870 2023 120,680 Total incurred claims $ 330,627 Cumulative Paid Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance For the Year Ended December 31, Claim Year 2021 (unaudited) 2022 (unaudited) 2023 2021 $ 87,427 $ 98,024 $ 98,645 2022 97,799 109,680 2023 104,725 Total payment of incurred claims 313,050 All outstanding liabilities prior to 2021, net of reinsurance 124 Medical claims liability, net of reinsurance $ 17,701 Incurred and paid claims development for the Medicaid segment as of December 31, 2023 is as follows ($ in millions): Cumulative Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance For the Year Ended December 31, Claim Year 2021 (unaudited) 2022 (unaudited) 2023 2021 $ 68,720 $ 67,682 $ 67,628 2022 76,344 74,861 2023 79,747 Total incurred claims $ 222,236 Cumulative Paid Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance For the Year Ended December 31, Claim Year 2021 (unaudited) 2022 (unaudited) 2023 2021 $ 59,838 $ 66,903 $ 67,436 2022 66,220 74,125 2023 69,904 Total payment of incurred claims 211,465 All outstanding liabilities prior to 2021, net of reinsurance 38 Medical claims liability, net of reinsurance $ 10,809 Incurred and paid claims development for the Medicare segment as of December 31, 2023 is as follows ($ in millions): Cumulative Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance For the Year Ended December 31, Claim Year 2021 (unaudited) 2022 (unaudited) 2023 2021 $ 15,388 $ 15,330 $ 15,337 2022 19,475 19,124 2023 19,487 Total incurred claims $ 53,948 Cumulative Paid Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance For the Year Ended December 31, Claim Year 2021 (unaudited) 2022 (unaudited) 2023 2021 $ 13,275 $ 15,178 $ 15,187 2022 16,276 18,818 2023 16,631 Total payment of incurred claims 50,636 All outstanding liabilities prior to 2021, net of reinsurance 50 Medical claims liability, net of reinsurance $ 3,362 Incurred and paid claims development for the Commercial segment as of December 31, 2023 is as follows ($ in millions): Cumulative Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance For the Year Ended December 31, Claim Year 2021 (unaudited) 2022 (unaudited) 2023 2021 $ 14,706 $ 14,519 $ 14,556 2022 14,296 14,110 2023 19,966 Total incurred claims $ 48,632 Cumulative Paid Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance For the Year Ended December 31, Claim Year 2021 (unaudited) 2022 (unaudited) 2023 2021 $ 12,840 $ 14,387 $ 14,466 2022 12,556 13,963 2023 16,823 Total payment of incurred claims 45,252 All outstanding liabilities prior to 2021, net of reinsurance 36 Medical claims liability, net of reinsurance $ 3,416 Incurred and paid claims development for the Other segment as of December 31, 2023 is as follows ($ in millions): Cumulative Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance For the Year Ended December 31, Claim Year 2021 (unaudited) 2022 (unaudited) 2023 2021 $ 1,571 $ 1,556 $ 1,556 2022 2,781 2,775 2023 1,480 Total incurred claims $ 5,811 Cumulative Paid Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance For the Year Ended December 31, Claim Year 2021 (unaudited) 2022 (unaudited) 2023 2021 $ 1,474 $ 1,556 $ 1,556 2022 2,747 2,774 2023 1,367 Total payment of incurred claims 5,697 All outstanding liabilities prior to 2021, net of reinsurance — Medical claims liability, net of reinsurance $ 114 Consolidated information is summarized as follows (in millions): December 31, 2023 Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance Total IBNR Plus Expected Development Cumulative Paid Claims 2021 $ 99,077 $ 3 624.0 2022 110,870 429 637.5 2023 120,680 11,135 599.3 Information for the Medicaid segment is summarized as follows (in millions): December 31, 2023 Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance Total IBNR Plus Expected Development Cumulative Paid Claims 2021 $ 67,628 $ 3 376.6 2022 74,861 306 370.6 2023 79,747 6,859 327.3 Information for the Medicare segment is summarized as follows (in millions): December 31, 2023 Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance Total IBNR Plus Expected Development Cumulative Paid Claims 2021 $ 15,337 $ — 185.9 2022 19,124 86 204.7 2023 19,487 1,783 198.4 Information for the Commercial segment is summarized as follows (in millions): December 31, 2023 Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance Total IBNR Plus Expected Development Cumulative Paid Claims 2021 $ 14,556 $ — 60.9 2022 14,110 37 57.4 2023 19,966 2,393 69.8 Information for the Other segment is summarized as follows (in millions): December 31, 2023 Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance Total IBNR Plus Expected Development Cumulative Paid Claims 2021 $ 1,556 $ — 0.6 2022 2,775 — 4.8 2023 1,480 100 3.8

Affordable Care Act (Tables)

Affordable Care Act (Tables)	12 Months Ended
	Dec. 31, 2023
Affordable Care Act [Abstract]
Schedule of Receivables (Payables) Related to the Health Insurance Marketplace Programs	The Company's net receivables (payables) for each of the programs are as follows ($ in millions): December 31, 2023 December 31, 2022 Risk adjustment receivable $ 893 $ 838 Risk adjustment payable (2,553) (780) Minimum medical loss ratio (164) (103) Cost sharing reduction payable (114) (99)

Debt (Tables)

Debt (Tables)	12 Months Ended
	Dec. 31, 2023
Debt Disclosure [Abstract]
Schedule of Debt	Debt consists of the following ($ in millions): December 31, 2023 December 31, 2022 $2,500 million 4.25% Senior Notes, due December 15, 2027 $ 2,395 $ 2,393 $2,300 million 2.45% Senior Notes, due July 15, 2028 2,303 2,303 $3,500 million 4.625% Senior Notes, due December 15, 2029 3,277 3,277 $2,000 million 3.375% Senior Notes, due February 15, 2030 2,000 2,000 $2,200 million 3.00% Senior Notes, due October 15, 2030 2,200 2,200 $2,200 million 2.50% Senior Notes, due March 1, 2031 2,200 2,200 $1,300 million 2.625% Senior Notes, due August 1, 2031 1,300 1,300 Total senior notes 15,675 15,673 Term Loan Facility 2,115 2,183 Revolving Credit Agreement 150 58 Finance leases and other 11 253 Debt issuance costs (122) (147) Total debt 17,829 18,020 Less: current portion (119) (82) Long-term debt $ 17,710 $ 17,938
Schedule of Aggregate Maturities of Debt	Aggregate maturities for the Company's debt for the years ending December 31, are as follows ($ in millions): Aggregate Maturities 2024 $ 119 2025 113 2026 2,048 2027 2,405 2028 2,300 Thereafter 10,977 Total $ 17,962

Leases (Tables)

Leases (Tables)	12 Months Ended
	Dec. 31, 2023
Leases [Abstract]
ROU Assets and Liabilities	The following table sets forth the ROU assets and lease liabilities ($ in millions): December 31, 2023 December 31, 2022 Assets ROU assets (recorded within other long-term assets) $ 396 $ 2,554 Liabilities Short-term (recorded within accounts payable and accrued expenses) $ 168 $ 180 Long-term (recorded within other long-term liabilities) 880 3,133 Total lease liabilities $ 1,048 $ 3,313
Operating Lease Maturity	Lease payments over the next five years and thereafter are as follows ($ in millions): Lease Payments 2024 $ 198 2025 174 2026 148 2027 132 2028 112 Thereafter 434 Total lease payments 1,198 Less: imputed interest (150) Total lease liabilities $ 1,048

Stockholders' Equity (Tables)

Stockholders' Equity (Tables)	12 Months Ended
	Dec. 31, 2023
Equity [Abstract]
Share Repurchase Activity	The following represents the Company's share repurchase activity ($ in millions, shares in thousands): Year Ended December 31, 2023 2022 (2) 2021 Shares Cost Shares Cost Shares Cost Share buybacks 22,886 $ 1,577 35,655 $ 2,994 2,402 $ 200 Income tax withholding 828 56 1,213 102 1,379 97 Total share repurchases (1) 23,714 $ 1,633 36,868 $ 3,096 3,781 $ 297 (1) Excludes share repurchase excise tax of $10 million accrued as of December 31, 2023. (2) Includes 11.6 million shares delivered as part of an accelerated share repurchase (ASR) agreement with a $1,000 million notional amount. The Company purchased additional shares throughout the year through open market repurchases, including repurchase plans designed to comply with Rule 10b5-1.

Income Taxes (Tables)

Income Taxes (Tables)	12 Months Ended
	Dec. 31, 2023
Income Tax Disclosure [Abstract]
Consolidated Income Tax Expense	The consolidated income tax expense consists of the following ($ in millions): Year Ended December 31, 2023 2022 2021 Current provision Federal $ 833 $ 1,144 $ 507 State and local 132 261 114 International 1 4 7 Total current provision 966 1,409 628 Deferred provision (67) (649) (151) Total income tax expense $ 899 $ 760 $ 477
Reconciliation of Tax Provision at the U.S. Federal Statutory Rate to Income Tax Expense	The reconciliation of the tax provision at the U.S. federal statutory rate to income tax expense is as follows ($ in millions): Year Ended December 31, 2023 2022 2021 Earnings before income tax expense $ 3,598 $ 1,962 $ 1,813 Loss (earnings) attributable to flow through noncontrolling interest 3 (6) 2 Earnings less noncontrolling interest before income tax expense 3,601 1,956 1,815 Tax provision at the U.S. federal statutory rate 756 411 381 State income taxes, net of federal income tax benefit 75 50 63 Nondeductible compensation 38 49 40 Nondeductible PBM legal settlement — (5) 78 Nontaxable divestiture (gains) losses (4) 111 (95) Deferred taxes for investments in subsidiaries 3 84 — Excess tax benefit on stock awards (59) (13) (3) Valuation allowance 26 (17) 29 Nondeductible goodwill 77 69 — Other, net (13) 21 (16) Income tax expense $ 899 $ 760 $ 477
Tax Effects of Temporary Differences Which Give Rise to Deferred Tax Assets and Liabilities	The tax effects of temporary differences which give rise to deferred tax assets and liabilities are presented below ($ in millions): December 31, 2023 December 31, 2022 Deferred tax assets: Medical claims liability $ 217 $ 132 Nondeductible liabilities 111 202 Net operating loss and tax credit carryforwards 71 341 Compensation accruals 113 96 Premium and trade receivables 94 91 Operating lease liability 269 397 Unrealized loss 179 320 Software development costs 193 209 Other 92 85 Deferred tax assets 1,339 1,873 Valuation allowance (82) (205) Net deferred tax assets $ 1,257 $ 1,668 Deferred tax liabilities: Goodwill and intangible assets $ 1,603 $ 1,724 Fixed assets 127 111 Right-of-use asset 98 285 Other 70 163 Deferred tax liabilities 1,898 2,283 Net deferred tax liabilities $ (641) $ (615)
Summary of Reserve for Uncertain Tax Positions	The Company maintains a reserve for uncertain tax positions that may be challenged by a tax authority. A rollforward of the beginning and ending amount of uncertain tax positions, exclusive of related interest and penalties, is as follows ($ in millions): Year Ended December 31, 2023 2022 Gross unrecognized tax benefits, January 1 $ 410 $ 355 Gross increases: Current year tax positions 19 52 Acquired reserves — 7 Prior year tax positions 29 20 Gross decreases: Settlements (2) (17) Prior year tax positions (10) (3) Statute of limitation lapses (7) (4) Gross unrecognized tax benefits, December 31 $ 439 $ 410

Stock Incentive Plans (Tables)

Stock Incentive Plans (Tables)	12 Months Ended
	Dec. 31, 2023
Share-Based Payment Arrangement [Abstract]
Summary of Non-Vested Restricted Stock and Restricted Stock	A summary of the Company's non-vested restricted stock and restricted stock unit shares as of December 31, 2023, and changes during the year ended December 31, 2023, is presented below (shares in thousands): Shares Weighted Average Grant Date Fair Value Non-vested balance, December 31, 2022 6,573 $ 74.20 Granted 4,252 63.40 Vested (2,741) 72.37 Forfeited (622) 71.24 Non-vested balance, December 31, 2023 7,462 $ 68.96

Earnings Per Share (Tables)

Earnings Per Share (Tables)	12 Months Ended
	Dec. 31, 2023
Earnings Per Share [Abstract]
Calculation Of Basic And Diluted Net Earnings Per Common Share	The following table sets forth the calculation of basic and diluted net earnings per common share ($ in millions, except per share data in dollars and shares in thousands): Year Ended December 31, 2023 2022 2021 Earnings attributable to Centene Corporation $ 2,702 $ 1,202 $ 1,347 Shares used in computing per share amounts: Weighted average number of common shares outstanding 543,319 575,191 582,832 Common stock equivalents (as determined by applying the treasury stock method) 2,385 6,849 7,684 Weighted average number of common shares and potential dilutive common shares outstanding 545,704 582,040 590,516 Net earnings per common share attributable to Centene Corporation: Basic earnings per common share $ 4.97 $ 2.09 $ 2.31 Diluted earnings per common share $ 4.95 $ 2.07 $ 2.28

Segment Information (Tables)

Segment Information (Tables)	12 Months Ended
	Dec. 31, 2023
Segment Reporting [Abstract]
Segment Information	Segment information for the year ended December 31, 2023, is as follows ($ in millions): Medicaid Medicare Commercial Other/Eliminations Consolidated Total Premium $ 86,853 $ 22,261 $ 24,843 $ 1,679 $ 135,636 Service 2 — 2 4,455 4,459 Premium and service revenues 86,855 22,261 24,845 6,134 140,095 Premium tax 13,904 — — — 13,904 Total external revenues 100,759 22,261 24,845 6,134 153,999 Internal revenues — — — 16,735 16,735 Eliminations — — — (16,735) (16,735) Total revenues $ 100,759 $ 22,261 $ 24,845 $ 6,134 $ 153,999 Medical costs $ 78,210 $ 19,394 $ 19,816 $ 1,474 $ 118,894 Cost of services $ 4 $ — $ — $ 3,560 $ 3,564 Gross margin (1) $ 8,641 $ 2,867 $ 5,029 $ 1,100 $ 17,637 (1) Gross margin represents premium and service revenues less medical costs and cost of services. Segment information for the year ended December 31, 2022, is as follows ($ in millions): Medicaid Medicare Commercial Other/Eliminations Consolidated Total Premium $ 84,084 $ 22,484 $ 17,377 $ 3,186 $ 127,131 Service (1) — 3 8,346 8,348 Premium and service revenues 84,083 22,484 17,380 11,532 135,479 Premium tax 9,068 — — — 9,068 Total external revenues 93,151 22,484 17,380 11,532 144,547 Internal revenues — — — 25,191 25,191 Eliminations — — — (25,191) (25,191) Total revenues $ 93,151 $ 22,484 $ 17,380 $ 11,532 $ 144,547 Medical costs $ 75,298 $ 19,372 $ 14,092 $ 2,767 $ 111,529 Cost of services $ — $ — $ — $ 7,032 $ 7,032 Gross margin (1) $ 8,785 $ 3,112 $ 3,288 $ 1,733 $ 16,918 (1) Gross margin represents premium and service revenues less medical costs and cost of services. Segment information for the year ended December 31, 2021, is as follows ($ in millions): Medicaid Medicare Commercial Other/Eliminations Consolidated Total Premium $ 76,127 $ 17,512 $ 16,953 $ 1,727 $ 112,319 Service 13 — 3 5,648 5,664 Premium and service revenues 76,140 17,512 16,956 7,375 117,983 Premium tax 7,999 — — — 7,999 Total external revenues 84,139 17,512 16,956 7,375 125,982 Internal revenues — — — 23,654 23,654 Eliminations — — — (23,654) (23,654) Total revenues $ 84,139 $ 17,512 $ 16,956 $ 7,375 $ 125,982 Medical costs $ 67,104 $ 15,246 $ 14,689 $ 1,563 $ 98,602 Cost of services $ — $ — $ — $ 4,894 $ 4,894 Gross margin (1) $ 9,036 $ 2,266 $ 2,267 $ 918 $ 14,487 (1) Gross margin represents premium and service revenues less medical costs and cost of services.

Condensed Financial Informati_2

Condensed Financial Information of Registrant (Tables)	12 Months Ended
	Dec. 31, 2023
Condensed Financial Information Disclosure [Abstract]
Condensed Balance Sheets	Centene Corporation (Parent Company Only) Condensed Balance Sheets (In millions, except shares in thousands and per share data in dollars) December 31, 2023 December 31, 2022 ASSETS Current assets: Cash and cash equivalents $ 7 $ 12 Other current assets 7 6 Total current assets 14 18 Long-term investments 264 66 Investment in subsidiaries 43,853 42,306 Other long-term assets 186 422 Total assets $ 44,317 $ 42,812 LIABILITIES, REDEEMABLE NONCONTROLLING INTERESTS AND STOCKHOLDERS' EQUITY Current liabilities: Current liabilities $ 417 $ 534 Current portion of long-term debt 110 69 Total current liabilities 527 603 Long-term debt 17,708 17,699 Other long-term liabilities 126 273 Total liabilities 18,361 18,575 Commitments and contingencies Redeemable noncontrolling interest 19 56 Stockholders' equity: Preferred stock, $0.001 par value; authorized 10,000 shares; no shares issued or outstanding at December 31, 2023 and December 31, 2022 — — Common stock, $0.001 par value; authorized 800,000 shares; 615,291 issued and 534,484 outstanding at December 31, 2023, and 607,847 issued and 550,754 outstanding at December 31, 2022 1 1 Additional paid-in capital 20,304 20,060 Accumulated other comprehensive (loss) (652) (1,132) Retained earnings 12,043 9,341 Treasury stock, at cost (80,807 and 57,093 shares, respectively) (5,856) (4,213) Total Centene stockholders' equity 25,840 24,057 Nonredeemable noncontrolling interest 97 124 Total stockholders' equity 25,937 24,181 Total liabilities, redeemable noncontrolling interests and stockholders' equity $ 44,317 $ 42,812
Condensed Statements of Operations	Centene Corporation (Parent Company Only) Condensed Statements of Operations (In millions, except per share data in dollars) Year Ended December 31, 2023 2022 2021 Expenses: Selling, general and administrative expenses $ 14 $ 21 $ 9 Legal settlement — 33 1,116 Other income (expense): Investment and other income (47) 55 38 Gain on divestiture 108 13 118 Debt extinguishment — 14 (125) Interest expense (710) (643) (641) (Loss) before income taxes (663) (615) (1,735) Income tax (benefit) (118) (208) (308) Net (loss) before equity in subsidiaries (545) (407) (1,427) Equity in earnings from subsidiaries 3,244 1,609 2,763 Net earnings 2,699 1,202 1,336 Loss attributable to noncontrolling interests 3 — 11 Net earnings attributable to Centene Corporation $ 2,702 $ 1,202 $ 1,347 Net earnings per common share attributable to Centene Corporation: Basic earnings per common share $ 4.97 $ 2.09 $ 2.31 Diluted earnings per common share $ 4.95 $ 2.07 $ 2.28
Condensed Statements of Cash Flows	Centene Corporation (Parent Company Only) Condensed Statements of Cash Flows (In millions) Year Ended December 31, 2023 2022 2021 Cash flows from operating activities: Dividends from subsidiaries, return on investment $ 2,823 $ 1,706 $ 2,194 Payments for legal settlement (326) (282) (298) Other operating activities, net (334) (450) (582) Net cash provided by operating activities 2,163 974 1,314 Cash flows from investing activities: Capital contributions to subsidiaries (443) (880) (1,217) Purchases of investments (202) (2) (723) Sales and maturities of investments — — 66 Dividends from subsidiaries, return of investment 85 10 241 Investments in acquisitions — (2,431) (151) Proceeds from divestitures 325 — 130 Intercompany activities (357) 5,785 (1,709) Other investing activities, net — 3 — Net cash (used in) provided by investing activities (592) 2,485 (3,363) Cash flows from financing activities: Proceeds from common stock issuances 44 70 35 Proceeds from long-term debt 2,305 75 9,066 Payments and repurchases of long-term debt (2,290) (491) (7,207) Common stock repurchases (1,633) (3,096) (297) Payments for debt extinguishment — (14) (157) Debt issuance costs — — (72) Other financing activities, net (2) — 22 Net cash (used in) provided by financing activities (1,576) (3,456) 1,390 Net increase (decrease) in cash and cash equivalents (5) 3 (659) Cash and cash equivalents, beginning of period 12 9 668 Cash and cash equivalents, end of period $ 7 $ 12 $ 9

Summary of Significant Accoun_4

Summary of Significant Accounting Policies - Schedule of Property, Software and Equipment Depreciation Periods (Details)	Dec. 31, 2023
Buildings and improvements | Minimum
Property, Plant and Equipment [Line Items]
Depreciation Period	5 years
Buildings and improvements | Maximum
Property, Plant and Equipment [Line Items]
Depreciation Period	40 years
Computer hardware and software | Minimum
Property, Plant and Equipment [Line Items]
Depreciation Period	3 years
Computer hardware and software | Maximum
Property, Plant and Equipment [Line Items]
Depreciation Period	5 years
Furniture and equipment | Minimum
Property, Plant and Equipment [Line Items]
Depreciation Period	3 years
Furniture and equipment | Maximum
Property, Plant and Equipment [Line Items]
Depreciation Period	10 years
Land improvements | Minimum
Property, Plant and Equipment [Line Items]
Depreciation Period	10 years
Land improvements | Maximum
Property, Plant and Equipment [Line Items]
Depreciation Period	20 years
Leasehold improvements | Minimum
Property, Plant and Equipment [Line Items]
Depreciation Period	1 year
Leasehold improvements | Maximum
Property, Plant and Equipment [Line Items]
Depreciation Period	20 years

Summary of Significant Accoun_5

Summary of Significant Accounting Policies - Schedule of Amortization Period for Intangible Assets (Details)	Dec. 31, 2023	Dec. 31, 2022
Finite-Lived Intangible Assets [Line Items]
Amortization Period	13 years 4 months 24 days	13 years 4 months 24 days
Purchased contract rights and customer relationships
Finite-Lived Intangible Assets [Line Items]
Amortization Period	13 years 6 months	13 years 4 months 24 days
Purchased contract rights and customer relationships | Minimum
Finite-Lived Intangible Assets [Line Items]
Amortization Period	3 years
Purchased contract rights and customer relationships | Maximum
Finite-Lived Intangible Assets [Line Items]
Amortization Period	21 years
Provider contracts
Finite-Lived Intangible Assets [Line Items]
Amortization Period	14 years	14 years
Provider contracts | Minimum
Finite-Lived Intangible Assets [Line Items]
Amortization Period	4 years
Provider contracts | Maximum
Finite-Lived Intangible Assets [Line Items]
Amortization Period	15 years
Developed technologies
Finite-Lived Intangible Assets [Line Items]
Amortization Period	4 years 4 months 24 days	5 years 3 months 18 days
Developed technologies | Minimum
Finite-Lived Intangible Assets [Line Items]
Amortization Period	2 years
Developed technologies | Maximum
Finite-Lived Intangible Assets [Line Items]
Amortization Period	7 years
Trade names
Finite-Lived Intangible Assets [Line Items]
Amortization Period	15 years 7 months 6 days	15 years 4 months 24 days
Trade names | Minimum
Finite-Lived Intangible Assets [Line Items]
Amortization Period	7 years
Trade names | Maximum
Finite-Lived Intangible Assets [Line Items]
Amortization Period	20 years

Summary of Significant Accoun_6

Summary of Significant Accounting Policies - Schedule of Allowance for Uncollectible Accounts (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Accounts Receivable, Allowance for Credit Loss [Roll Forward]
Balance, January 1	$ 130	$ 139	$ 243
Amounts charged to expense	58	70	62
Recoveries	0	0	(43)
Write-offs of uncollectible receivables	(68)	(79)	(123)
Balance, December 31	$ 120	$ 130	$ 139

Summary of Significant Accoun_7

Summary of Significant Accounting Policies - Significant Customers (Details)	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Segment Reporting Information [Line Items]
Percentage of revenues under contracts or subcontracts	0%	0%
NEW YORK
Segment Reporting Information [Line Items]
Percentage of revenues under contracts or subcontracts			10%

Acquisitions and Divestitures -

Acquisitions and Divestitures - Acquisitions Narrative (Details) - Magellan Health - USD ($) $ in Millions		12 Months Ended
	Jan. 04, 2022	Dec. 31, 2022
Business Acquisition [Line Items]
Consideration transferred	$ 2,491
Cash payments to acquire business	2,431
Fair value adjustment to stock based compensation associated with pre-combination service	60
Settlement of pre-existing payables and receivables prior to acquisition	$ (70)
Acquisition related costs		$ 106

Acquisitions and Divestitures_2

Acquisitions and Divestitures - Schedule of Fair Value of Assets Acquired and Liabilities Assumed (Details) - USD ($) $ in Millions	Jan. 04, 2022	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Assets acquired and liabilities assumed
Goodwill		$ 17,558	$ 18,812	$ 19,771
Goodwill		$ 17,558	$ 18,812	$ 19,771
Magellan Health
Assets acquired and liabilities assumed
Cash and cash equivalents	$ 995
Premium and related receivables	791
Short-term investments	144
Other current assets	145
Long-term investments	43
Restricted deposits	7
Property, software and equipment	72
Intangible assets	889
Other long-term assets	50
Total assets acquired	3,136
Medical claims liability	194
Accounts payable and accrued expenses	495
Return of premium payable	53
Unearned revenue	8
Current portion of long-term debt	5
Long-term debt	542
Deferred tax liabilities	157
Other long-term liabilities	64
Total liabilities assumed	1,518
Mezzanine equity	32
Total identifiable net assets	1,586
Goodwill	905
Total assets acquired and liabilities assumed	$ 2,491
Weighted Average Useful Life in Years	12 years
Debt assumed, aggregate principal	$ 535
Deferred tax assets	102
Goodwill	$ 905

Acquisitions and Divestitures_3

Acquisitions and Divestitures - Identifiable Intangible Assets (Details) - Magellan Health $ in Millions	Jan. 04, 2022 USD ($)
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value	$ 889
Weighted Average Useful Life in Years	12 years
Purchased contract rights
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value	$ 581
Weighted Average Useful Life in Years	13 years
Provider contracts
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value	$ 120
Weighted Average Useful Life in Years	15 years
Developed technologies
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value	$ 101
Weighted Average Useful Life in Years	5 years
Trade names
Acquired Finite-Lived Intangible Assets [Line Items]
Fair Value	$ 87
Weighted Average Useful Life in Years	17 years

Acquisitions and Divestitures_4

Acquisitions and Divestitures - Divestitures (Details) £ in Millions, $ in Millions

1 Months Ended

12 Months Ended

Jan. 12, 2024 USD ($)

Jun. 13, 2023 USD ($)

Jan. 20, 2023 USD ($)

Dec. 02, 2022 USD ($)

Jul. 14, 2022 USD ($)

Apr. 30, 2023 USD ($)

Dec. 31, 2024 USD ($)

Dec. 31, 2023 USD ($)

Dec. 31, 2022 USD ($)

Dec. 31, 2021 USD ($)

Aug. 31, 2023 USD ($)

Aug. 31, 2023 GBP (£)

Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]

Gain (loss) on divestiture

$ 152

$ 772

$ 88

Impairment charge

529

2,318

229

Goodwill impairment

392

370

Expected tax benefit on loss on divestiture

(899)

(760)

$ (477)

Currency Swap

Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]

Derivative notional amount

$ 931

£ 740

Fair value of swap agreement

(13)

PANTHERx Rare | Disposal Group, Disposed of by Sale, Not Discontinued Operations

Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]

Proceeds from divestitures

$ 1,373

Gain (loss) on divestiture

490

Gain (loss) on divestitures, net of tax

$ 382

Spanish and Central European Businesses | Disposal Group, Held-for-sale or Disposed of by Sale, Not Discontinued Operations

Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]

Gain (loss) on divestiture

(13)

Gain (loss) on divestitures, net of tax

10

Impairment charge

163

Impairment charge, net of tax

140

Magellan Rx | Disposal Group, Disposed of by Sale, Not Discontinued Operations

Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]

Proceeds from divestitures

$ 1,337

Gain (loss) on divestiture

269

22

Gain (loss) on divestitures, net of tax

$ 99

10

Magellan Specialty Health | Disposal Group, Disposed of by Sale, Not Discontinued Operations

Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]

Proceeds from divestitures

$ 245

Gain (loss) on divestiture

$ 79

Consideration on divestiture

646

Contingent consideration, could receive (up to)

$ 150

Magellan Specialty Health | Disposal Group, Held-for-sale or Disposed of by Sale, Not Discontinued Operations

Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]

Assets held for sale

645

Liabilities held for sale

87

Centurion | Disposal Group, Disposed of by Sale, Not Discontinued Operations

Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]

Gain (loss) on divestiture

15

Gain (loss) on divestitures, net of tax

(10)

Centurion | Disposal Group, Held-for-sale or Disposed of by Sale, Not Discontinued Operations

Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]

Impairment charge

259

Impairment charge, net of tax

181

Assets held for sale

236

Liabilities held for sale

198

HealthSmart | Disposal Group, Held-for-sale or Disposed of by Sale, Not Discontinued Operations

Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]

Impairment charge

36

Impairment charge, net of tax

27

Assets held for sale

66

Liabilities held for sale

$ 34

Apixio | Disposal Group, Disposed of by Sale, Not Discontinued Operations

Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]

Gain (loss) on divestiture

$ 93

Gain (loss) on divestitures, net of tax

$ 67

Circle Health | Disposal Group, Held-for-Sale, Not Discontinued Operations

Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]

Assets held for sale

3,897

Liabilities held for sale

3,094

Goodwill impairment

292

Goodwill impairment, net of tax

258

Circle Health | Disposal Group, Held-for-Sale, Not Discontinued Operations | Subsequent Event

Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]

Proceeds from divestitures

$ 931

Circle Health | Disposal Group, Held-for-Sale, Not Discontinued Operations | Subsequent Event | Forecast

Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]

Expected tax benefit on loss on divestiture

$ 50

Operose Health | Disposal Group, Disposed of by Sale, Not Discontinued Operations

Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]

Impairment charge

140

Impairment charge, net of tax

$ 128

Short-term and Long-term Inve_3

Short-term and Long-term Investments, Restricted Deposits - By Investment Type (Details) - USD ($) $ in Millions	Dec. 31, 2023	Dec. 31, 2022
Debt Securities
Gross Unrealized Gains	$ 119	$ 20
Gross Unrealized Losses	(860)	(1,364)
Equity securities	17	17
Private equity investments	833	529
Life insurance contracts	174	157
Total, Amortized Cost	20,872	19,566
Total, Fair Value	20,131	18,222
U.S. Treasury securities and obligations of U.S. government corporations and agencies
Debt Securities
Amortized Cost	403	695
Gross Unrealized Gains	0	0
Gross Unrealized Losses	(8)	(16)
Fair Value	395	679
Corporate securities
Debt Securities
Amortized Cost	9,984	10,127
Gross Unrealized Gains	78	12
Gross Unrealized Losses	(461)	(778)
Fair Value	9,601	9,361
Restricted certificates of deposit
Debt Securities
Amortized Cost	4	4
Gross Unrealized Gains	0	0
Gross Unrealized Losses	0	0
Fair Value	4	4
Restricted cash equivalents
Debt Securities
Amortized Cost	259	256
Gross Unrealized Gains	0	0
Gross Unrealized Losses	0	0
Fair Value	259	256
Short-term time deposits
Debt Securities
Amortized Cost	746	204
Gross Unrealized Gains	0	0
Gross Unrealized Losses	0	0
Fair Value	746	204
Municipal securities
Debt Securities
Amortized Cost	4,135	4,055
Gross Unrealized Gains	21	6
Gross Unrealized Losses	(171)	(280)
Fair Value	3,985	3,781
Asset-backed securities
Debt Securities
Amortized Cost	1,665	1,396
Gross Unrealized Gains	8	0
Gross Unrealized Losses	(35)	(70)
Fair Value	1,638	1,326
Residential mortgage-backed securities
Debt Securities
Amortized Cost	1,503	1,165
Gross Unrealized Gains	7	2
Gross Unrealized Losses	(103)	(121)
Fair Value	1,407	1,046
Commercial mortgage-backed securities
Debt Securities
Amortized Cost	1,149	961
Gross Unrealized Gains	5	0
Gross Unrealized Losses	(82)	(99)
Fair Value	$ 1,072	$ 862

Short-term and Long-term Inve_4

Short-term and Long-term Investments, Restricted Deposits - Narrative (Details) $ in Millions	12 Months Ended
	Dec. 31, 2023 USD ($) position	Dec. 31, 2022 USD ($)
Debt Securities, Available-for-sale [Line Items]
Accrued interest income | $	$ 153	$ 132
Debt Securities, Available-for-Sale, Accrued Interest, after Allowance for Credit Loss, Statement of Financial Position [Extensible Enumeration]	Other Assets, Current	Other Assets, Current
Positions from which gross unrealized losses were generated	5,247
Total investment positions	6,661
Commercial mortgage-backed securities
Debt Securities, Available-for-sale [Line Items]
Investments recorded at fair value that carry weighted average rating of AA plus, period	4 years
Rated Securities | External Credit Rating, Investment Grade | Investment Securities
Debt Securities, Available-for-sale [Line Items]
Percentage of investments in rated securities carry an investment grade rating by nationally recognized statistical rating organizations	99%

Short-term and Long-term Inve_5

Short-term and Long-term Investments, Restricted Deposits - Fair Value of Available-for-Sale Investments in a Continuous Unrealized Loss Position (Details) - USD ($) $ in Millions	Dec. 31, 2023	Dec. 31, 2022
Unrealized Losses
Less Than 12 Months	$ (16)	$ (620)
12 Months or More	(844)	(744)
Fair Value
Less Than 12 Months	1,785	10,075
12 Months or More	11,152	5,747
U.S. Treasury securities and obligations of U.S. government corporations and agencies
Unrealized Losses
Less Than 12 Months	0	(5)
12 Months or More	(8)	(11)
Fair Value
Less Than 12 Months	79	342
12 Months or More	232	184
Corporate securities
Unrealized Losses
Less Than 12 Months	(6)	(340)
12 Months or More	(455)	(438)
Fair Value
Less Than 12 Months	658	5,368
12 Months or More	6,260	3,400
Municipal securities
Unrealized Losses
Less Than 12 Months	(4)	(142)
12 Months or More	(167)	(138)
Fair Value
Less Than 12 Months	553	2,437
12 Months or More	2,237	995
Asset-backed securities
Unrealized Losses
Less Than 12 Months	(2)	(29)
12 Months or More	(33)	(41)
Fair Value
Less Than 12 Months	197	786
12 Months or More	855	486
Residential mortgage-backed securities
Unrealized Losses
Less Than 12 Months	(2)	(55)
12 Months or More	(101)	(66)
Fair Value
Less Than 12 Months	153	629
12 Months or More	814	352
Commercial mortgage-backed securities
Unrealized Losses
Less Than 12 Months	(2)	(49)
12 Months or More	(80)	(50)
Fair Value
Less Than 12 Months	114	513
12 Months or More	754	330
Short-term time deposits
Unrealized Losses
Less Than 12 Months	0	0
12 Months or More	0	0
Fair Value
Less Than 12 Months	31	0
12 Months or More	$ 0	$ 0

Short-term and Long-term Inve_6

Short-term and Long-term Investments, Restricted Deposits - Contractual Maturities of Short-term and Long-term Investments and Restricted Deposits (Details) - USD ($) $ in Millions	Dec. 31, 2023	Dec. 31, 2022
Investments
Amortized Cost
One year or less	$ 2,308	$ 2,207
One year through five years	7,738	7,651
Five years through ten years	3,905	4,066
Greater than ten years	155	135
Asset-backed securities	4,317	3,522
Amortized Cost	18,423	17,581
Fair Value
One year or less	2,284	2,179
One year through five years	7,431	7,147
Five years through ten years	3,735	3,613
Greater than ten years	154	129
Asset-backed securities	4,117	3,234
Fair Value	17,721	16,302
Restricted Deposits
Amortized Cost
One year or less	566	534
One year through five years	527	524
Five years through ten years	298	224
Greater than ten years	34	0
Asset-backed securities	0	0
Amortized Cost	1,425	1,282
Fair Value
One year or less	564	532
One year through five years	504	490
Five years through ten years	283	195
Greater than ten years	35	0
Asset-backed securities	0	0
Fair Value	$ 1,386	$ 1,217

Fair Value Measurements - Fair

Fair Value Measurements - Fair Value Measurements by Level for Assets and Liabilities Measured at Fair Value on a Recurring Basis (Details) - USD ($) $ in Millions	Dec. 31, 2023	Dec. 31, 2022
Assets
Cash and cash equivalents	$ 17,193	$ 12,074
Investments:
Equity securities	17	17
Total assets at fair value	36,317	29,610
Total liabilities at fair value	13
Accounts payable and accrued expenses: | Currency Swap
Investments:
Derivative liability	13
U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Fair value	395	679
Corporate securities
Investments:
Fair value	9,601	9,361
Municipal securities
Investments:
Fair value	3,985	3,781
Short-term time deposits
Investments:
Fair value	746	204
Asset-backed securities
Investments:
Fair value	1,638	1,326
Residential mortgage-backed securities
Investments:
Fair value	1,407	1,046
Commercial mortgage-backed securities
Investments:
Fair value	1,072	862
Level I
Assets
Cash and cash equivalents	17,193	12,074
Investments:
Total assets at fair value	17,862	13,019
Total liabilities at fair value	0
Level I | Accounts payable and accrued expenses: | Currency Swap
Investments:
Derivative liability	0
Level II
Assets
Cash and cash equivalents	0	0
Investments:
Total assets at fair value	18,455	16,591
Total liabilities at fair value	13
Level II | Accounts payable and accrued expenses: | Currency Swap
Investments:
Derivative liability	13
Level III
Assets
Cash and cash equivalents	0	0
Investments:
Total assets at fair value	0	0
Total liabilities at fair value	0
Level III | Accounts payable and accrued expenses: | Currency Swap
Investments:
Derivative liability	0
Investments
Investments:
Fair value	17,721	16,302
Total investments	17,738	16,319
Investments | U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Fair value	62	371
Investments | Corporate securities
Investments:
Fair value	9,564	9,328
Investments | Municipal securities
Investments:
Fair value	3,232	3,165
Investments | Short-term time deposits
Investments:
Fair value	746	204
Investments | Asset-backed securities
Investments:
Fair value	1,638	1,326
Investments | Residential mortgage-backed securities
Investments:
Fair value	1,407	1,046
Investments | Commercial mortgage-backed securities
Investments:
Fair value	1,072	862
Investments | Equity Securities
Investments:
Equity securities	17	17
Investments | Level I
Investments:
Total investments	77	381
Investments | Level I | U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Fair value	62	366
Investments | Level I | Corporate securities
Investments:
Fair value	0	0
Investments | Level I | Municipal securities
Investments:
Fair value	0	0
Investments | Level I | Short-term time deposits
Investments:
Fair value	0	0
Investments | Level I | Asset-backed securities
Investments:
Fair value	0	0
Investments | Level I | Residential mortgage-backed securities
Investments:
Fair value	0	0
Investments | Level I | Commercial mortgage-backed securities
Investments:
Fair value	0	0
Investments | Level I | Equity Securities
Investments:
Equity securities	15	15
Investments | Level II
Investments:
Total investments	17,661	15,938
Investments | Level II | U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Fair value	0	5
Investments | Level II | Corporate securities
Investments:
Fair value	9,564	9,328
Investments | Level II | Municipal securities
Investments:
Fair value	3,232	3,165
Investments | Level II | Short-term time deposits
Investments:
Fair value	746	204
Investments | Level II | Asset-backed securities
Investments:
Fair value	1,638	1,326
Investments | Level II | Residential mortgage-backed securities
Investments:
Fair value	1,407	1,046
Investments | Level II | Commercial mortgage-backed securities
Investments:
Fair value	1,072	862
Investments | Level II | Equity Securities
Investments:
Equity securities	2	2
Investments | Level III
Investments:
Total investments	0	0
Investments | Level III | U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Fair value	0	0
Investments | Level III | Corporate securities
Investments:
Fair value	0	0
Investments | Level III | Municipal securities
Investments:
Fair value	0	0
Investments | Level III | Short-term time deposits
Investments:
Fair value	0	0
Investments | Level III | Asset-backed securities
Investments:
Fair value	0	0
Investments | Level III | Residential mortgage-backed securities
Investments:
Fair value	0	0
Investments | Level III | Commercial mortgage-backed securities
Investments:
Fair value	0	0
Investments | Level III | Equity Securities
Investments:
Equity securities	0	0
Restricted Deposits
Investments:
Fair value	1,386	1,217
Restricted Deposits | U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Fair value	333	308
Restricted Deposits | Corporate securities
Investments:
Fair value	37	33
Restricted Deposits | Municipal securities
Investments:
Fair value	753	616
Restricted Deposits | Cash and cash equivalents
Investments:
Fair value	259	256
Restricted Deposits | Certificates of deposit
Investments:
Fair value	4	4
Restricted Deposits | Level I
Investments:
Fair value	592	564
Restricted Deposits | Level I | U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Fair value	333	308
Restricted Deposits | Level I | Corporate securities
Investments:
Fair value	0	0
Restricted Deposits | Level I | Municipal securities
Investments:
Fair value	0	0
Restricted Deposits | Level I | Cash and cash equivalents
Investments:
Fair value	259	256
Restricted Deposits | Level I | Certificates of deposit
Investments:
Fair value	0	0
Restricted Deposits | Level II
Investments:
Fair value	794	653
Restricted Deposits | Level II | U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Fair value	0	0
Restricted Deposits | Level II | Corporate securities
Investments:
Fair value	37	33
Restricted Deposits | Level II | Municipal securities
Investments:
Fair value	753	616
Restricted Deposits | Level II | Cash and cash equivalents
Investments:
Fair value	0	0
Restricted Deposits | Level II | Certificates of deposit
Investments:
Fair value	4	4
Restricted Deposits | Level III
Investments:
Fair value	0	0
Restricted Deposits | Level III | U.S. Treasury securities and obligations of U.S. government corporations and agencies
Investments:
Fair value	0	0
Restricted Deposits | Level III | Corporate securities
Investments:
Fair value	0	0
Restricted Deposits | Level III | Municipal securities
Investments:
Fair value	0	0
Restricted Deposits | Level III | Cash and cash equivalents
Investments:
Fair value	0	0
Restricted Deposits | Level III | Certificates of deposit
Investments:
Fair value	$ 0	$ 0

Fair Value Measurements - Narra

Fair Value Measurements - Narrative (Details) - USD ($) $ in Millions	Dec. 31, 2023	Dec. 31, 2022
Fair Value Disclosures [Abstract]
Aggregate carrying value which approximates fair value	$ 1,007	$ 686

Property, Software and Equipm_3

Property, Software and Equipment - Components (Details) - USD ($) $ in Millions	Dec. 31, 2023	Dec. 31, 2022
Property, Plant and Equipment [Line Items]
Property, software and equipment, gross	$ 4,419	$ 4,498
Less: accumulated depreciation	(2,400)	(2,066)
Property, software and equipment, net	2,019	2,432
Computer software
Property, Plant and Equipment [Line Items]
Property, software and equipment, gross	2,631	2,224
Computer hardware
Property, Plant and Equipment [Line Items]
Property, software and equipment, gross	542	604
Buildings
Property, Plant and Equipment [Line Items]
Property, software and equipment, gross	534	659
Furniture and office equipment
Property, Plant and Equipment [Line Items]
Property, software and equipment, gross	304	366
Leasehold improvements
Property, Plant and Equipment [Line Items]
Property, software and equipment, gross	252	467
Land
Property, Plant and Equipment [Line Items]
Property, software and equipment, gross	$ 156	$ 178

Property, Software and Equipm_4

Property, Software and Equipment - Narrative (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Property, Plant and Equipment [Abstract]
Depreciation expense	$ 575	$ 614	$ 565
Property, Plant and Equipment [Line Items]
Property, software and equipment, net	2,019	2,432
Remaining asset impairment charges	97	1,627
Real estate owned and related fixed assets
Property, Plant and Equipment [Line Items]
Impairment charges	57	$ 1,050
Circle Health | Disposal Group, Held-for-Sale, Not Discontinued Operations
Property, Plant and Equipment [Line Items]
Property, software and equipment, net	$ 447

Goodwill and Intangible Asset_2

Goodwill and Intangible Assets - Schedule of Changes in Goodwill by Operating Segment (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Goodwill [Roll Forward]
Balance beginning of period	$ 18,812	$ 19,771
Acquisition and purchase accounting adjustments		1,077
Divestitures	(912)	(1,533)
Reallocation		0
Impairments	(392)	(370)
Translation impact	50	(133)
Balance end of period	17,558	18,812
Medicaid
Goodwill [Roll Forward]
Balance beginning of period	10,198	10,194
Acquisition and purchase accounting adjustments		0
Divestitures	0	0
Reallocation		4
Impairments	0	0
Translation impact	0	0
Balance end of period	10,198	10,198
Medicare
Goodwill [Roll Forward]
Balance beginning of period	1,592	1,592
Acquisition and purchase accounting adjustments		0
Divestitures	0	0
Reallocation		0
Impairments	0	0
Translation impact	0	0
Balance end of period	1,592	1,592
Commercial
Goodwill [Roll Forward]
Balance beginning of period	5,424	5,424
Acquisition and purchase accounting adjustments		0
Divestitures	0	0
Reallocation		0
Impairments	0	0
Translation impact	0	0
Balance end of period	5,424	5,424
Other
Goodwill [Roll Forward]
Balance beginning of period	1,598	2,561
Acquisition and purchase accounting adjustments		1,077
Divestitures	(912)	(1,533)
Reallocation		(4)
Impairments	(392)	(370)
Translation impact	50	(133)
Balance end of period	$ 344	$ 1,598

Goodwill and Intangible Asset_3

Goodwill and Intangible Assets - Narrative (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Goodwill [Line Items]
Goodwill impairment	$ 392	$ 370
Amortization expense	718	817	$ 770
Goodwill, divestiture reclass	912	1,533
Goodwill	17,558	18,812	$ 19,771
Specialty Services | Federal Services
Goodwill [Line Items]
Goodwill impairment		$ 216
Disposal Group, Held-for-Sale, Not Discontinued Operations | Circle Health
Goodwill [Line Items]
Goodwill impairment	292
Goodwill	$ 760

Goodwill and Intangible Asset_4

Goodwill and Intangible Assets - Schedule of Intangible Assets (Details) - USD ($) $ in Millions	Dec. 31, 2023	Dec. 31, 2022
Finite-Lived Intangible Assets [Line Items]
Intangible assets	$ 9,698	$ 9,835
Total accumulated amortization	(3,597)	(2,924)
Intangible assets, net	$ 6,101	$ 6,911
Weighted average life in years	13 years 4 months 24 days	13 years 4 months 24 days
Purchased contract rights and customer relationships
Finite-Lived Intangible Assets [Line Items]
Intangible assets	$ 7,845	$ 7,850
Total accumulated amortization	$ (2,768)	$ (2,193)
Weighted average life in years	13 years 6 months	13 years 4 months 24 days
Trade names
Finite-Lived Intangible Assets [Line Items]
Intangible assets	$ 943	$ 983
Total accumulated amortization	$ (320)	$ (263)
Weighted average life in years	15 years 7 months 6 days	15 years 4 months 24 days
Provider contracts
Finite-Lived Intangible Assets [Line Items]
Intangible assets	$ 612	$ 612
Total accumulated amortization	$ (227)	$ (183)
Weighted average life in years	14 years	14 years
Developed technologies
Finite-Lived Intangible Assets [Line Items]
Intangible assets	$ 298	$ 390
Total accumulated amortization	$ (282)	$ (285)
Weighted average life in years	4 years 4 months 24 days	5 years 3 months 18 days

Goodwill and Intangible Asset_5

Goodwill and Intangible Assets - Schedule of Future Amortization Expenses (Details) $ in Millions	Dec. 31, 2023 USD ($)
Finite-Lived Intangible Assets, Net, Amortization Expense, Fiscal Year Maturity [Abstract]
2024	$ 692
2025	690
2026	673
2027	663
2028	$ 662

Medical Claims Liability - Sche

Medical Claims Liability - Schedule of Change in Medical Claims Liability (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Liability for Unpaid Claims and Claims Adjustment Expense [Roll Forward]
Balance, January 1	$ 16,745	$ 14,243	$ 12,438
Less: Reinsurance recoverables	26	23	23
Balance, January 1, net	16,719	14,220	12,415
Acquisitions and divestitures		105
Incurred related to:
Current year	120,680	112,896	100,385
Prior years	(2,036)	(1,367)	(1,783)
Total incurred	118,644	111,529	98,602
Paid related to:
Current year	104,725	97,799	87,427
Prior years	12,937	11,336	9,370
Total paid	117,662	109,135	96,797
Plus: Premium deficiency reserve	250
Balance December 31, net	17,951	16,719	14,220
Plus: Reinsurance recoverables	49	26	23
Balance, December 31	18,000	16,745	14,243
Medicaid
Liability for Unpaid Claims and Claims Adjustment Expense [Roll Forward]
Balance, January 1	11,253	9,845	8,567
Less: Reinsurance recoverables	7	23	23
Balance, January 1, net	11,246	9,822	8,544
Acquisitions and divestitures		0
Incurred related to:
Current year	79,747	76,344	68,720
Prior years	(1,537)	(1,046)	(1,616)
Total incurred	78,210	75,298	67,104
Paid related to:
Current year	69,904	66,221	59,839
Prior years	8,743	7,653	5,987
Total paid	78,647	73,874	65,826
Balance December 31, net	10,809	11,246	9,822
Plus: Reinsurance recoverables	5	7	23
Balance, December 31	10,814	11,253	9,845
Medicare
Liability for Unpaid Claims and Claims Adjustment Expense [Roll Forward]
Balance, January 1	3,431	2,286	2,012
Less: Reinsurance recoverables	0	0	0
Balance, January 1, net	3,431	2,286	2,012
Acquisitions and divestitures		0
Incurred related to:
Current year	19,487	19,474	15,388
Prior years	(343)	(102)	(142)
Total incurred	19,144	19,372	15,246
Paid related to:
Current year	16,631	16,275	13,275
Prior years	2,582	1,952	1,697
Total paid	19,213	18,227	14,972
Plus: Premium deficiency reserve	250
Balance December 31, net	3,612	3,431	2,286
Plus: Reinsurance recoverables	0	0	0
Balance, December 31	3,612	3,431	2,286
Commercial
Liability for Unpaid Claims and Claims Adjustment Expense [Roll Forward]
Balance, January 1	1,921	2,014	1,801
Less: Reinsurance recoverables	19	0	0
Balance, January 1, net	1,902	2,014	1,801
Acquisitions and divestitures		0
Incurred related to:
Current year	19,966	14,296	14,706
Prior years	(150)	(204)	(17)
Total incurred	19,816	14,092	14,689
Paid related to:
Current year	16,823	12,556	12,839
Prior years	1,479	1,648	1,637
Total paid	18,302	14,204	14,476
Balance December 31, net	3,416	1,902	2,014
Plus: Reinsurance recoverables	44	19	0
Balance, December 31	3,460	1,921	2,014
Other
Liability for Unpaid Claims and Claims Adjustment Expense [Roll Forward]
Balance, January 1	140	98	58
Less: Reinsurance recoverables	0	0	0
Balance, January 1, net	140	98	58
Acquisitions and divestitures		105
Incurred related to:
Current year	1,480	2,782	1,571
Prior years	(6)	(15)	(8)
Total incurred	1,474	2,767	1,563
Paid related to:
Current year	1,367	2,747	1,474
Prior years	133	83	49
Total paid	1,500	2,830	1,523
Balance December 31, net	114	140	98
Plus: Reinsurance recoverables	0	0	0
Balance, December 31	$ 114	$ 140	$ 98

Medical Claims Liability - Narr

Medical Claims Liability - Narrative (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Insurance [Abstract]
Amounts recorded as an adjustment to premium revenues related to minimum HBR and return of premium programs	$ 382	$ 198	$ 492

Medical Claims Liability - Cumu

Medical Claims Liability - Cumulative Incurred and Paid Claims (Details) - Health insurance product line - USD ($) $ in Millions	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Claims Development [Line Items]
Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance	$ 330,627
Short-duration insurance contracts, cumulative paid claims and allocated claim adjustment expense, net	313,050
All outstanding liabilities prior to 2021, net of reinsurance	124
Medical claims liability, net of reinsurance	17,701
2021
Claims Development [Line Items]
Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance	99,077	$ 99,087	$ 100,385
Short-duration insurance contracts, cumulative paid claims and allocated claim adjustment expense, net	98,645	98,024	87,427
2022
Claims Development [Line Items]
Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance	110,870	112,896
Short-duration insurance contracts, cumulative paid claims and allocated claim adjustment expense, net	109,680	97,799
2023
Claims Development [Line Items]
Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance	120,680
Short-duration insurance contracts, cumulative paid claims and allocated claim adjustment expense, net	104,725
Medicaid | Operating Segments
Claims Development [Line Items]
Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance	222,236
Short-duration insurance contracts, cumulative paid claims and allocated claim adjustment expense, net	211,465
All outstanding liabilities prior to 2021, net of reinsurance	38
Medical claims liability, net of reinsurance	10,809
Medicaid | Operating Segments | 2021
Claims Development [Line Items]
Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance	67,628	67,682	68,720
Short-duration insurance contracts, cumulative paid claims and allocated claim adjustment expense, net	67,436	66,903	59,838
Medicaid | Operating Segments | 2022
Claims Development [Line Items]
Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance	74,861	76,344
Short-duration insurance contracts, cumulative paid claims and allocated claim adjustment expense, net	74,125	66,220
Medicaid | Operating Segments | 2023
Claims Development [Line Items]
Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance	79,747
Short-duration insurance contracts, cumulative paid claims and allocated claim adjustment expense, net	69,904
Medicare | Operating Segments
Claims Development [Line Items]
Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance	53,948
Short-duration insurance contracts, cumulative paid claims and allocated claim adjustment expense, net	50,636
All outstanding liabilities prior to 2021, net of reinsurance	50
Medical claims liability, net of reinsurance	3,362
Medicare | Operating Segments | 2021
Claims Development [Line Items]
Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance	15,337	15,330	15,388
Short-duration insurance contracts, cumulative paid claims and allocated claim adjustment expense, net	15,187	15,178	13,275
Medicare | Operating Segments | 2022
Claims Development [Line Items]
Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance	19,124	19,475
Short-duration insurance contracts, cumulative paid claims and allocated claim adjustment expense, net	18,818	16,276
Medicare | Operating Segments | 2023
Claims Development [Line Items]
Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance	19,487
Short-duration insurance contracts, cumulative paid claims and allocated claim adjustment expense, net	16,631
Commercial | Operating Segments
Claims Development [Line Items]
Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance	48,632
Short-duration insurance contracts, cumulative paid claims and allocated claim adjustment expense, net	45,252
All outstanding liabilities prior to 2021, net of reinsurance	36
Medical claims liability, net of reinsurance	3,416
Commercial | Operating Segments | 2021
Claims Development [Line Items]
Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance	14,556	14,519	14,706
Short-duration insurance contracts, cumulative paid claims and allocated claim adjustment expense, net	14,466	14,387	12,840
Commercial | Operating Segments | 2022
Claims Development [Line Items]
Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance	14,110	14,296
Short-duration insurance contracts, cumulative paid claims and allocated claim adjustment expense, net	13,963	12,556
Commercial | Operating Segments | 2023
Claims Development [Line Items]
Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance	19,966
Short-duration insurance contracts, cumulative paid claims and allocated claim adjustment expense, net	16,823
Other | Operating Segments
Claims Development [Line Items]
Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance	5,811
Short-duration insurance contracts, cumulative paid claims and allocated claim adjustment expense, net	5,697
All outstanding liabilities prior to 2021, net of reinsurance	0
Medical claims liability, net of reinsurance	114
Other | Operating Segments | 2021
Claims Development [Line Items]
Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance	1,556	1,556	1,571
Short-duration insurance contracts, cumulative paid claims and allocated claim adjustment expense, net	1,556	1,556	$ 1,474
Other | Operating Segments | 2022
Claims Development [Line Items]
Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance	2,775	2,781
Short-duration insurance contracts, cumulative paid claims and allocated claim adjustment expense, net	2,774	$ 2,747
Other | Operating Segments | 2023
Claims Development [Line Items]
Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance	1,480
Short-duration insurance contracts, cumulative paid claims and allocated claim adjustment expense, net	$ 1,367

Medical Claims Liability - Incu

Medical Claims Liability - Incurred Claims and Allocated Claims Adjustment Expenses (Details) - Health insurance product line claim in Millions, $ in Millions	Dec. 31, 2023 USD ($) claim	Dec. 31, 2022 USD ($)	Dec. 31, 2021 USD ($)
Claims Development [Line Items]
Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance	$ 330,627
Medicaid | Operating Segments
Claims Development [Line Items]
Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance	222,236
Medicare | Operating Segments
Claims Development [Line Items]
Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance	53,948
Commercial | Operating Segments
Claims Development [Line Items]
Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance	48,632
Other | Operating Segments
Claims Development [Line Items]
Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance	5,811
2021
Claims Development [Line Items]
Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance	99,077	$ 99,087	$ 100,385
Total IBNR Plus Expected Development on Reported Claims	$ 3
Cumulative Paid Claims | claim	624
2021 | Medicaid | Operating Segments
Claims Development [Line Items]
Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance	$ 67,628	67,682	68,720
Total IBNR Plus Expected Development on Reported Claims	$ 3
Cumulative Paid Claims | claim	376.6
2021 | Medicare | Operating Segments
Claims Development [Line Items]
Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance	$ 15,337	15,330	15,388
Total IBNR Plus Expected Development on Reported Claims	$ 0
Cumulative Paid Claims | claim	185.9
2021 | Commercial | Operating Segments
Claims Development [Line Items]
Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance	$ 14,556	14,519	14,706
Total IBNR Plus Expected Development on Reported Claims	$ 0
Cumulative Paid Claims | claim	60.9
2021 | Other | Operating Segments
Claims Development [Line Items]
Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance	$ 1,556	1,556	$ 1,571
Total IBNR Plus Expected Development on Reported Claims	$ 0
Cumulative Paid Claims | claim	0.6
2022
Claims Development [Line Items]
Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance	$ 110,870	112,896
Total IBNR Plus Expected Development on Reported Claims	$ 429
Cumulative Paid Claims | claim	637.5
2022 | Medicaid | Operating Segments
Claims Development [Line Items]
Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance	$ 74,861	76,344
Total IBNR Plus Expected Development on Reported Claims	$ 306
Cumulative Paid Claims | claim	370.6
2022 | Medicare | Operating Segments
Claims Development [Line Items]
Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance	$ 19,124	19,475
Total IBNR Plus Expected Development on Reported Claims	$ 86
Cumulative Paid Claims | claim	204.7
2022 | Commercial | Operating Segments
Claims Development [Line Items]
Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance	$ 14,110	14,296
Total IBNR Plus Expected Development on Reported Claims	$ 37
Cumulative Paid Claims | claim	57.4
2022 | Other | Operating Segments
Claims Development [Line Items]
Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance	$ 2,775	$ 2,781
Total IBNR Plus Expected Development on Reported Claims	$ 0
Cumulative Paid Claims | claim	4.8
2023
Claims Development [Line Items]
Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance	$ 120,680
Total IBNR Plus Expected Development on Reported Claims	$ 11,135
Cumulative Paid Claims | claim	599.3
2023 | Medicaid | Operating Segments
Claims Development [Line Items]
Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance	$ 79,747
Total IBNR Plus Expected Development on Reported Claims	$ 6,859
Cumulative Paid Claims | claim	327.3
2023 | Medicare | Operating Segments
Claims Development [Line Items]
Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance	$ 19,487
Total IBNR Plus Expected Development on Reported Claims	$ 1,783
Cumulative Paid Claims | claim	198.4
2023 | Commercial | Operating Segments
Claims Development [Line Items]
Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance	$ 19,966
Total IBNR Plus Expected Development on Reported Claims	$ 2,393
Cumulative Paid Claims | claim	69.8
2023 | Other | Operating Segments
Claims Development [Line Items]
Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance	$ 1,480
Total IBNR Plus Expected Development on Reported Claims	$ 100
Cumulative Paid Claims | claim	3.8

Affordable Care Act (Details)

Affordable Care Act (Details) - USD ($) $ in Millions	6 Months Ended	12 Months Ended
	Jun. 30, 2023	Dec. 31, 2023	Dec. 31, 2022
Affordable Care Act [Abstract]
Risk adjustment receivable		$ 893	$ 838
Risk adjustment payable		(2,553)	(780)
Minimum medical loss ratio		(164)	(103)
Cost sharing reduction payable		(114)	$ (99)
Risk adjustment, net receivable increase	$ 306
Risk adjustment pre-tax benefit		$ 260

Debt - Schedule of Debt (Detail

Debt - Schedule of Debt (Details) - USD ($) $ in Millions	Dec. 31, 2023	Dec. 31, 2022
Debt Instrument [Line Items]
Total senior notes	$ 15,675	$ 15,673
Finance leases and other	11	253
Debt issuance costs	(122)	(147)
Total debt	17,829	18,020
Less: current portion	(119)	(82)
Long-term debt	17,710	17,938
Revolving Credit Agreement
Debt Instrument [Line Items]
Credit facility	150	58
Term Loan Facility
Debt Instrument [Line Items]
Credit facility	2,115	2,183
$2,500 million 4.25% Senior Notes, due December 15, 2027 | Senior Notes
Debt Instrument [Line Items]
Face amount	$ 2,500
Interest rate stated, percentage	4.25%
Senior notes	$ 2,395	2,393
$2,300 million 2.45% Senior Notes, due July 15, 2028 | Senior Notes
Debt Instrument [Line Items]
Face amount	$ 2,300
Interest rate stated, percentage	2.45%
Senior notes	$ 2,303	2,303
$3,500 million 4.625% Senior Notes, due December 15, 2029 | Senior Notes
Debt Instrument [Line Items]
Face amount	$ 3,500
Interest rate stated, percentage	4.625%
Senior notes	$ 3,277	3,277
$2,000 million 3.375% Senior Notes, due February 15, 2030 | Senior Notes
Debt Instrument [Line Items]
Face amount	$ 2,000
Interest rate stated, percentage	3.375%
Senior notes	$ 2,000	2,000
$2,200 million 3.00% Senior Notes, due October 15, 2030 | Senior Notes
Debt Instrument [Line Items]
Face amount	$ 2,200
Interest rate stated, percentage	3%
Senior notes	$ 2,200	2,200
$2,200 Million 2.50% Senior Notes due March 1, 2031 | Senior Notes
Debt Instrument [Line Items]
Face amount	$ 2,200
Interest rate stated, percentage	2.50%
Senior notes	$ 2,200	2,200
$1,300 million 2.625% Senior Notes, due August 1, 2031 | Senior Notes
Debt Instrument [Line Items]
Face amount	$ 1,300
Interest rate stated, percentage	2.625%
Senior notes	$ 1,300	$ 1,300

Debt - Senior Notes (Details)

Debt - Senior Notes (Details) - USD ($)	1 Months Ended	12 Months Ended
	Jan. 31, 2022	Dec. 31, 2023	Dec. 31, 2022
Debt Instrument [Line Items]
Debt redemption amount		$ 0
Senior Notes
Debt Instrument [Line Items]
Debt redemption amount			$ 318,000,000
Gain on redemption of notes		$ 14,000,000
Senior Notes | $3,500 million 4.625% Senior Notes, due December 15, 2029
Debt Instrument [Line Items]
Interest rate stated, percentage		4.625%
Debt redemption amount			223,000,000
Face amount		$ 3,500,000,000
Senior Notes | $2,500 million 4.25% Senior Notes, due December 15, 2027
Debt Instrument [Line Items]
Interest rate stated, percentage		4.25%
Debt redemption amount			$ 95,000,000
Face amount		$ 2,500,000,000
Magellan Health
Debt Instrument [Line Items]
Payoff of assumed debt	$ 535,000,000
Interest rate stated, percentage	4.40%

Debt - Circle Health Debt Refin

Debt - Circle Health Debt Refinancing (Details) £ in Millions, $ in Millions	1 Months Ended	12 Months Ended
	May 31, 2022 USD ($)	Dec. 31, 2023 USD ($)	Dec. 31, 2022 USD ($)	Dec. 31, 2021 USD ($)	Dec. 31, 2023 GBP (£)	May 31, 2022 GBP (£)
Debt Instrument [Line Items]
Debt extinguishment | $		$ 0	$ 30	$ (125)
Foreign Line of Credit
Debt Instrument [Line Items]
Revolving credit facility | £					£ 250	£ 250
Debt extinguishment | $	$ 13
Amount drawn on the facility | £					£ 150

Debt - Revolving Credit Facilit

Debt - Revolving Credit Facility and Term Loan Credit Facility (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Aug. 31, 2021
First year
Line of Credit Facility [Line Items]
Amortization payment percentage			0%
Second year following closing
Line of Credit Facility [Line Items]
Amortization payment percentage			2.50%
Thereafter until maturity
Line of Credit Facility [Line Items]
Amortization payment percentage			5%
Revolving credit facility
Line of Credit Facility [Line Items]
Revolving credit facility	$ 2,000
Interest rate	0.25%
Uncommitted option, to increase Credit Facility	$ 500
Ratio of debt to EBITDA, may increase	4
Revolving credit agreement	$ 150	$ 58
Revolving credit facility | Maximum
Line of Credit Facility [Line Items]
Interest rate	1.50%
Revolving credit facility | Minimum
Line of Credit Facility [Line Items]
Interest rate	1.125%
Letter of Credit | Line of Credit
Line of Credit Facility [Line Items]
Revolving credit facility	$ 300
Swing Loan | Line of Credit
Line of Credit Facility [Line Items]
Revolving credit facility	200
Term Loan Facility | Unsecured Debt
Line of Credit Facility [Line Items]
Revolving credit facility	$ 2,200

Debt - Debt Repurchase Program

Debt - Debt Repurchase Program (Details) - USD ($)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2023	Jun. 30, 2022
Debt Instrument [Line Items]
Debt repurchase program, authorized amount			$ 1,000,000,000
Debt redemption amount		$ 0
Remaining amount available under the program		$ 700,000,000
Senior Notes
Debt Instrument [Line Items]
Debt redemption amount	$ 318,000,000
Repurchase of senior notes	$ 300,000,000

Debt - Letters of Credit & Sure

Debt - Letters of Credit & Surety Bonds (Details) $ in Millions	Dec. 31, 2023 USD ($)
Surety Bond
Debt Instrument [Line Items]
Surety bonds outstanding	$ 856
Letter of Credit
Debt Instrument [Line Items]
Letters of credit outstanding	$ 152
Weighted average interest rate of outstanding borrowings	0.70%

Debt - Schedule of Aggregate Ma

Debt - Schedule of Aggregate Maturities of Debt (Details) - USD ($) $ in Millions	Dec. 31, 2023	Dec. 31, 2022
Debt Disclosure [Abstract]
2024	$ 119
2025	113
2026	2,048
2027	2,405
2028	2,300
Thereafter	10,977
Long-Term Debt, Total	17,962
Fair value of outstanding debt	$ 16,322	$ 15,791

Leases - Narrative (Details)

Leases - Narrative (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Jan. 31, 2022
Lessee, Lease, Description [Line Items]
Operating lease expense	$ 349	$ 429
ROU assets	396	2,554
Operating lease liability	1,048	3,313
Cash paid for amounts included in the measurement of lease liabilities recorded as operating cash flows	378	440
Right-of-use assets obtained in exchange for operating lease liability	40	60
Lease liability for leases commenced	40	60
Operating lease not yet commenced, liability	1
ROU asset impairments	40	577
Remaining asset impairment charges	$ 97	$ 1,627
Weighted average remaining lease term	20 years 6 months
Weighted average discount rate for operating leases	5.80%
Circle Health
Lessee, Lease, Description [Line Items]
Weighted average remaining lease term	26 years 3 months 18 days
Excluding Circle Health
Lessee, Lease, Description [Line Items]
Weighted average remaining lease term	8 years 1 month 6 days
Weighted average discount rate for operating leases	3.30%
Maximum
Lessee, Lease, Description [Line Items]
Operating lease not yet commenced, term	5 years
Magellan Health
Lessee, Lease, Description [Line Items]
ROU assets			$ 30
Operating lease liability			$ 30
Circle Health | Disposal Group, Held-for-sale or Disposed of by Sale, Not Discontinued Operations
Lessee, Lease, Description [Line Items]
ROU assets	$ 2,113
Operating lease liability	$ 2,197

Leases - ROU Assets and Liabili

Leases - ROU Assets and Liabilities (Details) - USD ($) $ in Millions	Dec. 31, 2023	Dec. 31, 2022
Assets [Abstract]
ROU assets (recorded within other long-term assets)	$ 396	$ 2,554
Operating Lease, Right-of-Use Asset, Statement of Financial Position [Extensible List]	Other long-term assets	Other long-term assets
Liabilities [Abstract]
Short-term (recorded within accounts payable and accrued expenses)	$ 168	$ 180
Long-term (recorded within other long-term liabilities)	880	3,133
Total lease liabilities	$ 1,048	$ 3,313
Operating Lease, Liability, Current, Statement of Financial Position [Extensible List]	Accounts Payable and Accrued Liabilities, Current	Accounts Payable and Accrued Liabilities, Current
Operating Lease, Liability, Noncurrent, Statement of Financial Position [Extensible List]	Other long-term liabilities	Other long-term liabilities

Leases - Operating Lease Maturi

Leases - Operating Lease Maturity (Details) - USD ($) $ in Millions	Dec. 31, 2023	Dec. 31, 2022
Leases [Abstract]
2024	$ 198
2025	174
2026	148
2027	132
2028	112
Thereafter	434
Total lease payments	1,198
Less: imputed interest	(150)
Total lease liabilities	$ 1,048	$ 3,313

Stockholders' Equity - Narrativ

Stockholders' Equity - Narrative (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Subsidiary, Sale of Stock [Line Items]
Stock repurchase program, increase to authorized amount	$ 4,000
Stock repurchase program authorized amount	10,000
Remaining authorized repurchase amount	5,229
Common stock repurchases	$ 1,643	$ 3,096	$ 297
Employee Stock Compensation Plan
Subsidiary, Sale of Stock [Line Items]
Income tax withholding (in shares)	828,000	1,213,000	1,379,000
Employee Stock Compensation Plan | WellCare
Subsidiary, Sale of Stock [Line Items]
Income tax withholding (in shares)	0	0	326,000
Common stock repurchases			$ 19
Common Stock
Subsidiary, Sale of Stock [Line Items]
Common stock repurchases	$ 1,633	$ 3,096	$ 297

Stockholders' Equity - Share Re

Stockholders' Equity - Share Repurchase Activity (Details) - USD ($) shares in Thousands, $ in Millions	3 Months Ended	12 Months Ended
	Sep. 30, 2022	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Equity, Class of Treasury Stock [Line Items]
Total share repurchases (1)		$ 1,643	$ 3,096	$ 297
Accrual for shares repurchase, excise tax		$ 10
Employee Stock Compensation Plan
Equity, Class of Treasury Stock [Line Items]
Income tax withholding (in shares)		828	1,213	1,379
Income tax withholding		$ 56	$ 102	$ 97
Common Stock
Equity, Class of Treasury Stock [Line Items]
Share buybacks (in shares)		22,886	35,655	2,402
Common stock repurchases (in shares)		23,714	36,868	3,781
Share buybacks		$ 1,577	$ 2,994	$ 200
Total share repurchases (1)		$ 1,633	$ 3,096	$ 297
Common Stock | Accelerated Share Repurchase Agreement
Equity, Class of Treasury Stock [Line Items]
Common stock repurchases (in shares)			11,600
Accelerated share repurchases agreement, amount	$ 1,000

Statutory Capital Requirement_2

Statutory Capital Requirements and Dividend Restrictions (Details) - USD ($) $ in Millions	Dec. 31, 2023	Dec. 31, 2022
Statutory Capital Requirements And Dividend Restrictions [Abstract]
Statutory capital and surplus	$ 18,117	$ 16,436
Required minimum aggregate statutory capital and surplus	8,267	$ 7,979
Capital and surplus or net worth not available for dividends	$ 8,267

Income Taxes - Consolidated Inc

Income Taxes - Consolidated Income Tax Expense (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Income Tax Disclosure [Abstract]
Federal	$ 833	$ 1,144	$ 507
State and local	132	261	114
International	1	4	7
Total current provision	966	1,409	628
Deferred provision	(67)	(649)	(151)
Income tax expense	$ 899	$ 760	$ 477

Income Taxes - Reconciliation o

Income Taxes - Reconciliation of the Tax Provision at the U.S. Federal Statutory Rate to the Provision for Income Taxes (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Income Tax Disclosure [Abstract]
Earnings before income tax	$ 3,598	$ 1,962	$ 1,813
Loss (earnings) attributable to flow through noncontrolling interest	3	(6)	2
Earnings less noncontrolling interest before income tax expense	3,601	1,956	1,815
Tax provision at the U.S. federal statutory rate	756	411	381
State income taxes, net of federal income tax benefit	75	50	63
Nondeductible compensation	38	49	40
Nondeductible PBM legal settlement	0	(5)	78
Nontaxable divestiture (gains) losses	(4)	111	(95)
Deferred taxes for investments in subsidiaries	3	84	0
Excess tax benefit on stock awards	(59)	(13)	(3)
Valuation allowance	26	(17)	29
Nondeductible goodwill	77	69	0
Other, net	(13)	21	(16)
Income tax expense	$ 899	$ 760	$ 477

Income Taxes - Tax Effects of T

Income Taxes - Tax Effects of Temporary Differences Which Give Rise to Deferred Tax Assets and Liabilities (Details) - USD ($) $ in Millions	Dec. 31, 2023	Dec. 31, 2022
Deferred tax assets:
Medical claims liability	$ 217	$ 132
Nondeductible liabilities	111	202
Net operating loss and tax credit carryforwards	71	341
Compensation accruals	113	96
Premium and trade receivables	94	91
Operating lease liability	269	397
Unrealized loss	179	320
Software development costs	193	209
Other	92	85
Deferred tax assets	1,339	1,873
Valuation allowance	(82)	(205)
Net deferred tax assets	1,257	1,668
Deferred tax liabilities:
Goodwill and intangible assets	1,603	1,724
Fixed assets	127	111
Right-of-use asset	98	285
Other	70	163
Deferred tax liabilities	1,898	2,283
Deferred tax liabilities, net	$ (641)	$ (615)

Income Taxes - Narrative (Detai

Income Taxes - Narrative (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Components of Income Tax Expense (Benefit), Continuing Operations [Abstract]
Deferred taxes for investments in subsidiaries	$ 3	$ 84	$ 0
Operating Loss Carryforwards [Line Items]
Operating loss carryforwards and tax credit carryforwards, not subject to expiration	15
Unrecognized tax benefits that would impact effective tax rate	314
Net interest expense related to uncertain tax positions	18	23
Accrued interest and penalties for uncertain tax position	84	$ 66
Decrease in unrecognized tax benefits is reasonably possible	124
Expiration of Statues of Limitations and Projected Settlements
Operating Loss Carryforwards [Line Items]
Decrease in unrecognized tax benefits is reasonably possible	2
Domestic Tax Authority
Operating Loss Carryforwards [Line Items]
Operating loss and tax credit carryforwards	13
State and Local Jurisdiction
Operating Loss Carryforwards [Line Items]
Operating loss carryforwards and tax credit carryforwards, subject to expiration	$ 41

Income Taxes - Schedule of Rese

Income Taxes - Schedule of Reserve for Uncertain Tax Positions That May be Challenged (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022
Reconciliation of Unrecognized Tax Benefits, Excluding Amounts Pertaining to Examined Tax Returns [Roll Forward]
Gross unrecognized tax benefits, January 1	$ 410	$ 355
Gross increases:
Current year tax positions	19	52
Acquired reserves	0	7
Prior year tax positions	29	20
Gross decreases:
Settlements	(2)	(17)
Prior year tax positions	(10)	(3)
Statute of limitation lapses	(7)	(4)
Gross unrecognized tax benefits, December 31	$ 439	$ 410

Stock Incentive Plans - Narrati

Stock Incentive Plans - Narrative (Details) - USD ($) shares in Thousands, $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Available for future awards (in shares)	13,000
Accelerated vesting period	1 year
Allocated share-based compensation expense	$ 216	$ 234	$ 203
Income tax benefit recognized	101	48	35
Fair value of restricted stock and restricted stock units	185	$ 298	$ 264
Unrecognized compensation cost related to non-vested share-based compensation arrangements granted under the plans	$ 243
Weighted-average period	1 year 9 months 18 days
Employee stock purchase plan issued (in shares)	607	449	516
Stock Options | Minimum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock options, restricted stock and restricted stock unit awards vesting period, years	3 years
Stock Options | Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock options, restricted stock and restricted stock unit awards vesting period, years	5 years
Restricted Stock | Minimum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock options, restricted stock and restricted stock unit awards vesting period, years	1 year
Restricted Stock | Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock options, restricted stock and restricted stock unit awards vesting period, years	3 years
Restricted Stock Units Awards | Minimum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock options, restricted stock and restricted stock unit awards vesting period, years	1 year
Restricted Stock Units Awards | Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock options, restricted stock and restricted stock unit awards vesting period, years	3 years

Stock Incentive Plans - Non-Ves

Stock Incentive Plans - Non-Vested Restricted Stock and Restricted Stock (Details) shares in Thousands	12 Months Ended
	Dec. 31, 2023 $ / shares shares
Shares
Balance, beginning of period (in shares) | shares	6,573
Granted (in shares) | shares	4,252
Vested (in shares) | shares	(2,741)
Forfeited (in shares) | shares	(622)
Balance, end of period (in shares) | shares	7,462
Weighted Average Grant Date Fair Value
Balance, beginning of period (usd per share) | $ / shares	$ 74.20
Granted (usd per share) | $ / shares	63.40
Vested (usd per share) | $ / shares	72.37
Forfeited (usd per share) | $ / shares	71.24
Balance, end of period (usd per share) | $ / shares	$ 68.96

Retirement Plan (Details)

Retirement Plan (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Retirement Benefits [Abstract]
Defined contribution plan covered employee, age (at least)	21 years
Defined contribution plan matching contribution expense	$ 131	$ 133	$ 105

Earnings Per Share (Details)

Earnings Per Share (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Net Income (Loss) Attributable to Parent [Abstract]
Earnings attributable to Centene Corporation	$ 2,702	$ 1,202	$ 1,347
Shares used in computing per share amounts:
Weighted average number of common shares outstanding (in shares)	543,319	575,191	582,832
Common stock equivalents (as determined by applying the treasury stock method) (in shares)	2,385	6,849	7,684
Weighted average number of common shares and potential dilutive common shares outstanding (in shares)	545,704	582,040	590,516
Net earnings per common share attributable to Centene Corporation:
Basic earnings per common share (in usd per share)	$ 4.97	$ 2.09	$ 2.31
Diluted earnings per common share (in usd per share)	$ 4.95	$ 2.07	$ 2.28
Anti-dilutive stock options and restricted stock units excluded from the calculation of diluted earnings per common share (in shares)	376	187	44

Segment Information (Details)

Segment Information (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Segment Reporting Information [Line Items]
Premium and service revenues	$ 140,095	$ 135,479	$ 117,983
Premium tax	13,904	9,068	7,999
Total external revenues	153,999	144,547	125,982
Revenues	153,999	144,547	125,982
Medical costs	118,894	111,529	98,602
Cost of services	3,564	7,032	4,894
Gross margin	17,637	16,918	14,487
Operating Segments
Segment Reporting Information [Line Items]
Revenues	16,735	25,191	23,654
Eliminations
Segment Reporting Information [Line Items]
Revenues	(16,735)	(25,191)	(23,654)
Premium
Segment Reporting Information [Line Items]
Premium and service revenues	135,636	127,131	112,319
Service
Segment Reporting Information [Line Items]
Premium and service revenues	4,459	8,348	5,664
Premium and service revenues
Segment Reporting Information [Line Items]
Premium and service revenues	140,095	135,479	117,983
Medicaid
Segment Reporting Information [Line Items]
Revenues	100,759	93,151	84,139
Medical costs	78,210	75,298	67,104
Cost of services	4	0	0
Gross margin	8,641	8,785	9,036
Medicaid | Operating Segments
Segment Reporting Information [Line Items]
Premium tax	13,904	9,068	7,999
Total external revenues	100,759	93,151	84,139
Revenues	0	0	0
Medicaid | Eliminations
Segment Reporting Information [Line Items]
Revenues	0	0	0
Medicaid | Premium | Operating Segments
Segment Reporting Information [Line Items]
Premium and service revenues	86,853	84,084	76,127
Medicaid | Service | Operating Segments
Segment Reporting Information [Line Items]
Premium and service revenues	2	(1)	13
Medicaid | Premium and service revenues | Operating Segments
Segment Reporting Information [Line Items]
Premium and service revenues	86,855	84,083	76,140
Medicare
Segment Reporting Information [Line Items]
Revenues	22,261	22,484	17,512
Medical costs	19,394	19,372	15,246
Cost of services	0	0	0
Gross margin	2,867	3,112	2,266
Medicare | Operating Segments
Segment Reporting Information [Line Items]
Premium tax	0	0	0
Total external revenues	22,261	22,484	17,512
Revenues	0	0	0
Medicare | Eliminations
Segment Reporting Information [Line Items]
Revenues	0	0	0
Medicare | Premium | Operating Segments
Segment Reporting Information [Line Items]
Premium and service revenues	22,261	22,484	17,512
Medicare | Service | Operating Segments
Segment Reporting Information [Line Items]
Premium and service revenues	0	0	0
Medicare | Premium and service revenues | Operating Segments
Segment Reporting Information [Line Items]
Premium and service revenues	22,261	22,484	17,512
Commercial
Segment Reporting Information [Line Items]
Revenues	24,845	17,380	16,956
Medical costs	19,816	14,092	14,689
Cost of services	0	0	0
Gross margin	5,029	3,288	2,267
Commercial | Operating Segments
Segment Reporting Information [Line Items]
Premium tax	0	0	0
Total external revenues	24,845	17,380	16,956
Revenues	0	0	0
Commercial | Eliminations
Segment Reporting Information [Line Items]
Revenues	0	0	0
Commercial | Premium
Segment Reporting Information [Line Items]
Premium and service revenues	24,843	17,377	16,953
Commercial | Service | Operating Segments
Segment Reporting Information [Line Items]
Premium and service revenues	2	3	3
Commercial | Premium and service revenues | Operating Segments
Segment Reporting Information [Line Items]
Premium and service revenues	24,845	17,380	16,956
Other/Eliminations
Segment Reporting Information [Line Items]
Revenues	6,134	11,532	7,375
Medical costs	1,474	2,767	1,563
Cost of services	3,560	7,032	4,894
Gross margin	1,100	1,733	918
Other/Eliminations | Operating Segments
Segment Reporting Information [Line Items]
Premium tax	0	0	0
Total external revenues	6,134	11,532	7,375
Revenues	16,735	25,191	23,654
Other/Eliminations | Eliminations
Segment Reporting Information [Line Items]
Revenues	(16,735)	(25,191)	(23,654)
Other/Eliminations | Premium | Operating Segments
Segment Reporting Information [Line Items]
Premium and service revenues	1,679	3,186	1,727
Other/Eliminations | Service | Operating Segments
Segment Reporting Information [Line Items]
Premium and service revenues	4,455	8,346	5,648
Other/Eliminations | Premium and service revenues | Operating Segments
Segment Reporting Information [Line Items]
Premium and service revenues	$ 6,134	$ 11,532	$ 7,375

Condensed Financial Informati_3

Condensed Financial Information of Registrant - Condensed Balance Sheets (Details) - USD ($) $ in Millions	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Current assets:
Cash and cash equivalents	$ 17,193	$ 12,074	$ 13,118
Other current assets	5,572	2,461
Total current assets	40,756	30,128
Long-term investments	16,286	14,684
Other long-term assets	535	2,686
Total assets	84,641	76,870
Current liabilities:
Current portion of long-term debt	119	82
Total current liabilities	36,716	28,464
Long-term debt	17,710	17,938
Other long-term liabilities	3,618	5,616
Total liabilities	58,685	52,633
Commitments and contingencies
Redeemable noncontrolling interests	19	56
Stockholders' equity:
Preferred stock, $0.001 par value; authorized 10,000 shares; no shares issued or outstanding at December 31, 2023 and December 31, 2022	0	0
Common stock, $0.001 par value; authorized 800,000 shares; 615,291 issued and 534,484 outstanding at December 31, 2023, and 607,847 issued and 550,754 outstanding at December 31, 2022	1	1
Additional paid-in capital	20,304	20,060
Accumulated other comprehensive (loss)	(652)	(1,132)
Retained earnings	12,043	9,341
Treasury stock, at cost (80,807 and 57,093 shares, respectively)	(5,856)	(4,213)
Total Centene stockholders' equity	25,840	24,057
Nonredeemable noncontrolling interest	97	124
Total stockholders' equity	25,937	24,181	$ 26,940	$ 25,885
Total liabilities, redeemable noncontrolling interests and stockholders' equity	84,641	76,870
Parent Company
Current assets:
Cash and cash equivalents	7	12
Other current assets	7	6
Total current assets	14	18
Long-term investments	264	66
Investment in subsidiaries	43,853	42,306
Other long-term assets	186	422
Total assets	44,317	42,812
Current liabilities:
Current liabilities	417	534
Current portion of long-term debt	110	69
Total current liabilities	527	603
Long-term debt	17,708	17,699
Other long-term liabilities	126	273
Total liabilities	18,361	18,575
Commitments and contingencies
Redeemable noncontrolling interests	19	56
Stockholders' equity:
Preferred stock, $0.001 par value; authorized 10,000 shares; no shares issued or outstanding at December 31, 2023 and December 31, 2022	0	0
Common stock, $0.001 par value; authorized 800,000 shares; 615,291 issued and 534,484 outstanding at December 31, 2023, and 607,847 issued and 550,754 outstanding at December 31, 2022	1	1
Additional paid-in capital	20,304	20,060
Accumulated other comprehensive (loss)	(652)	(1,132)
Retained earnings	12,043	9,341
Treasury stock, at cost (80,807 and 57,093 shares, respectively)	(5,856)	(4,213)
Total Centene stockholders' equity	25,840	24,057
Nonredeemable noncontrolling interest	97	124
Total stockholders' equity	25,937	24,181
Total liabilities, redeemable noncontrolling interests and stockholders' equity	$ 44,317	$ 42,812

Condensed Financial Informati_4

Condensed Financial Information of Registrant - Condensed Balance Sheets Additional (Details) - $ / shares	Dec. 31, 2023	Dec. 31, 2022
Preferred stock, par value (in usd per share)	$ 0.001	$ 0.001
Preferred stock, shares authorized (in shares)	10,000,000	10,000,000
Preferred stock, shares issued (in shares)	0	0
Preferred stock, shares outstanding (in shares)	0	0
Common stock, par value (in usd per share)	$ 0.001	$ 0.001
Common stock, shares authorized (in shares)	800,000,000	800,000,000
Common stock, shares issued (in shares)	615,291,000	607,847,000
Common stock, shares outstanding (in shares)	534,484,000	550,754,000
Treasury stock, at cost (in shares)	80,807,000	57,093,000
Parent Company
Preferred stock, par value (in usd per share)	$ 0.001	$ 0.001
Preferred stock, shares authorized (in shares)	10,000,000	10,000,000
Preferred stock, shares issued (in shares)	0	0
Preferred stock, shares outstanding (in shares)	0	0
Common stock, par value (in usd per share)	$ 0.001	$ 0.001
Common stock, shares authorized (in shares)	800,000,000	800,000,000
Common stock, shares issued (in shares)	615,291,000	607,847,000
Common stock, shares outstanding (in shares)	534,484,000	550,754,000
Treasury stock, at cost (in shares)	80,807,000	57,093,000

Condensed Financial Informati_5

Condensed Financial Information of Registrant - Condensed Statements of Operations (Details) - USD ($) $ / shares in Units, $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Expenses:
Selling, general and administrative expenses	$ 12,563	$ 11,589	$ 9,601
Legal settlement	0	0	1,250
Other income (expense):
Investment and other income	1,393	1,279	819
Gain on divestiture	152	772	88
Debt extinguishment	0	30	(125)
Interest expense	(725)	(665)	(665)
Income tax (benefit)	899	760	477
Net earnings	2,699	1,202	1,336
Loss attributable to noncontrolling interests	3	0	11
Net earnings attributable to Centene Corporation	$ 2,702	$ 1,202	$ 1,347
Net earnings per common share attributable to Centene Corporation:
Basic earnings per common share (in usd per share)	$ 4.97	$ 2.09	$ 2.31
Diluted earnings per common share (in usd per share)	$ 4.95	$ 2.07	$ 2.28
Parent Company
Expenses:
Selling, general and administrative expenses	$ 14	$ 21	$ 9
Legal settlement	0	33	1,116
Other income (expense):
Investment and other income	(47)	55	38
Gain on divestiture	108	13	118
Debt extinguishment	0	14	(125)
Interest expense	(710)	(643)	(641)
(Loss) before income taxes	(663)	(615)	(1,735)
Income tax (benefit)	(118)	(208)	(308)
Net (loss) before equity in subsidiaries	(545)	(407)	(1,427)
Equity in earnings from subsidiaries	3,244	1,609	2,763
Net earnings	2,699	1,202	1,336
Loss attributable to noncontrolling interests	3	0	11
Net earnings attributable to Centene Corporation	$ 2,702	$ 1,202	$ 1,347
Net earnings per common share attributable to Centene Corporation:
Basic earnings per common share (in usd per share)	$ 4.97	$ 2.09	$ 2.31
Diluted earnings per common share (in usd per share)	$ 4.95	$ 2.07	$ 2.28

Condensed Financial Informati_6

Condensed Financial Information of Registrant - Condensed Statements of Cash Flows (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Cash flows from operating activities:
Other operating activities, net	$ (4)	$ 125	$ 142
Net cash provided by operating activities	8,053	6,261	4,205
Cash flows from investing activities:
Purchases of investments	(6,622)	(6,736)	(7,400)
Sales and maturities of investments	5,523	3,802	5,458
Other investing activities, net	0	0	19
Net cash (used in) provided by investing activities	(1,191)	(2,921)	(3,299)
Cash flows from financing activities:
Proceeds from common stock issuances	44	70	35
Proceeds from long-term debt	2,335	360	9,267
Payments and repurchases of long-term debt	(2,316)	(1,490)	(7,434)
Common stock repurchases	(1,633)	(3,096)	(297)
Payments for debt extinguishment	0	(14)	(157)
Debt issuance costs	0	0	(72)
Other financing activities, net	0	(27)	20
Net cash (used in) provided by financing activities	(1,658)	(4,197)	1,362
Cash, cash equivalents and restricted cash and cash equivalents, beginning of period	12,330	13,214	10,957
Cash, cash equivalents and restricted cash and cash equivalents, end of period	17,452	12,330	13,214
Parent Company
Cash flows from operating activities:
Dividends from subsidiaries, return on investment	2,823	1,706	2,194
Payments for legal settlement	(326)	(282)	(298)
Other operating activities, net	(334)	(450)	(582)
Net cash provided by operating activities	2,163	974	1,314
Cash flows from investing activities:
Capital contributions to subsidiaries	(443)	(880)	(1,217)
Purchases of investments	(202)	(2)	(723)
Sales and maturities of investments	0	0	66
Dividends from subsidiaries, return of investment	85	10	241
Investments in acquisitions	0	(2,431)	(151)
Proceeds from divestitures	325	0	130
Intercompany activities	(357)	5,785	(1,709)
Other investing activities, net	0	3	0
Net cash (used in) provided by investing activities	(592)	2,485	(3,363)
Cash flows from financing activities:
Proceeds from common stock issuances	44	70	35
Proceeds from long-term debt	2,305	75	9,066
Payments and repurchases of long-term debt	(2,290)	(491)	(7,207)
Common stock repurchases	(1,633)	(3,096)	(297)
Payments for debt extinguishment	0	(14)	(157)
Debt issuance costs	0	0	(72)
Other financing activities, net	(2)	0	22
Net cash (used in) provided by financing activities	(1,576)	(3,456)	1,390
Net increase (decrease) in cash and cash equivalents	(5)	3	(659)
Cash, cash equivalents and restricted cash and cash equivalents, beginning of period	12	9	668
Cash, cash equivalents and restricted cash and cash equivalents, end of period	$ 7	$ 12	$ 9