Cover Page
Cover Page - USD ($) shares in Millions, $ in Billions | 12 Months Ended | ||
Dec. 31, 2023 | Feb. 09, 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 | 1-31719 | ||
Entity Registrant Name | MOLINA HEALTHCARE, INC. | ||
Entity Incorporation, State or Country Code | DE | ||
Entity Tax Identification Number | 13-4204626 | ||
Entity Address, Address Line One | 200 Oceangate | ||
Entity Address, Address Line Two | Suite 100 | ||
Entity Address, City or Town | Long Beach | ||
Entity Address, State or Province | CA | ||
Entity Address, Postal Zip Code | 90802 | ||
City Area Code | 562 | ||
Local Phone Number | 435-3666 | ||
Title of 12(b) Security | Common Stock, $0.001 Par Value | ||
Trading Symbol | MOH | ||
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 | ||
ICFR Auditor Attestation Flag | true | ||
Document Financial Statement Error Correction [Flag] | false | ||
Entity Shell Company | false | ||
Entity Public Float | $ 17.4 | ||
Entity Common Stock, Shares Outstanding | 58.4 | ||
Documents Incorporated by Reference | Portions of the registrant’s Proxy Statement for the 2024 Annual Meeting of Stockholders are incorporated by reference into Part III of this Annual Report on Form 10-K, to the extent described therein. | ||
Entity Central Index Key | 0001179929 | ||
Amendment Flag | false | ||
Document Fiscal Year Focus | 2023 | ||
Document Fiscal Period Focus | FY |
Audit Information
Audit Information | 12 Months Ended |
Dec. 31, 2023 | |
Audit Information [Abstract] | |
Auditor Name | Ernst & Young LLP |
Auditor Location | Los Angeles, California |
Auditor Firm ID | 42 |
CONSOLIDATED STATEMENTS OF INCO
CONSOLIDATED STATEMENTS OF INCOME - USD ($) shares in Millions, $ in Millions | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Revenue: | |||
Premium revenue | $ 32,529 | $ 30,883 | $ 26,855 |
Premium tax revenue | 1,069 | 873 | 787 |
Investment income | 394 | 143 | 52 |
Other revenue | 80 | 75 | 77 |
Total revenue | 34,072 | 31,974 | 27,771 |
Operating expenses: | |||
Medical care costs | 28,669 | 27,175 | 23,704 |
General and administrative expenses | 2,462 | 2,311 | 2,068 |
Premium tax expenses | 1,069 | 873 | 787 |
Depreciation and amortization | 171 | 176 | 131 |
Impairment | 0 | 208 | 0 |
Other | 128 | 58 | 61 |
Total operating expenses | 32,499 | 30,801 | 26,751 |
Operating income | 1,573 | 1,173 | 1,020 |
Other expenses, net: | |||
Interest expense | 109 | 110 | 120 |
Other expenses, net | 0 | 0 | 25 |
Total other expenses, net | 109 | 110 | 145 |
Income before income tax expense | 1,464 | 1,063 | 875 |
Income tax expense | 373 | 271 | 216 |
Net income | $ 1,091 | $ 792 | $ 659 |
Net income per share: | |||
Basic (in dollars per share) | $ 18.91 | $ 13.72 | $ 11.40 |
Diluted (in dollars per share) | $ 18.77 | $ 13.55 | $ 11.25 |
Weighted average shares outstanding: | |||
Basic (in shares) | 57.7 | 57.8 | 57.8 |
Diluted (in shares) | 58.1 | 58.5 | 58.6 |
CONSOLIDATED STATEMENTS OF COMP
CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Statement of Comprehensive Income [Abstract] | |||
Net income | $ 1,091 | $ 792 | $ 659 |
Other comprehensive income (loss): | |||
Unrealized investment income (loss) | 102 | (204) | (55) |
Less: effect of income taxes | 24 | (49) | (13) |
Other comprehensive income (loss), net of tax | 78 | (155) | (42) |
Comprehensive income | $ 1,169 | $ 637 | $ 617 |
CONSOLIDATED BALANCE SHEETS
CONSOLIDATED BALANCE SHEETS - USD ($) $ in Millions | Dec. 31, 2023 | Dec. 31, 2022 |
Current assets: | ||
Cash and cash equivalents | $ 4,848 | $ 4,006 |
Investments | 4,259 | 3,499 |
Receivables | 3,104 | 2,302 |
Prepaid expenses and other current assets | 331 | 277 |
Total current assets | 12,542 | 10,084 |
Property, equipment, and capitalized software, net | 270 | 259 |
Goodwill and intangible assets, net | 1,449 | 1,390 |
Restricted investments | 261 | 238 |
Deferred income taxes, net | 227 | 220 |
Other assets | 143 | 123 |
Total assets | 14,892 | 12,314 |
Current liabilities: | ||
Medical claims and benefits payable | 4,204 | 3,528 |
Amounts due government agencies | 2,294 | 2,079 |
Accounts payable, accrued liabilities and other | 1,252 | 889 |
Deferred revenue | 418 | 359 |
Total current liabilities | 8,168 | 6,855 |
Long-term debt | 2,180 | 2,176 |
Finance lease liabilities | 205 | 215 |
Other long-term liabilities | 124 | 104 |
Total liabilities | 10,677 | 9,350 |
Stockholders’ equity: | ||
Common stock, $0.001 par value per share; 150 million shares authorized; outstanding: 58 million shares at each of December 31, 2023, and December 31, 2022 | 0 | 0 |
Preferred stock, $0.001 par value per share; 20 million shares authorized, no shares issued and outstanding | 0 | 0 |
Additional paid-in capital | 410 | 328 |
Accumulated other comprehensive loss | (82) | (160) |
Retained earnings | 3,887 | 2,796 |
Total stockholders’ equity | 4,215 | 2,964 |
Total liabilities and stockholders’ equity | $ 14,892 | $ 12,314 |
CONSOLIDATED BALANCE SHEETS (Pa
CONSOLIDATED BALANCE SHEETS (Parenthetical) - $ / shares | Dec. 31, 2023 | Dec. 31, 2022 |
Statement of Financial Position [Abstract] | ||
Common stock, par value (in dollars per share) | $ 0.001 | $ 0.001 |
Common stock, shares authorized (in shares) | 150,000,000 | 150,000,000 |
Common stock, shares, outstanding (in shares) | 58,000,000 | 58,000,000 |
Preferred stock, par value (in dollars per share) | $ 0.001 | $ 0.001 |
Preferred stock, shares authorized (in shares) | 20,000,000 | 20,000,000 |
Preferred stock, shares issued (in shares) | 0 | 0 |
Preferred stock, shares outstanding (in shares) | 0 | 0 |
CONSOLIDATED STATEMENTS OF STOC
CONSOLIDATED STATEMENTS OF STOCKHOLDERS’ EQUITY - USD ($) shares in Millions, $ in Millions | Total | Common Stock | Additional Paid-in Capital | Accumulated Other Comprehensive (Loss) Income | Retained Earnings |
Beginning Balance (in shares) at Dec. 31, 2020 | 59 | ||||
Beginning Balance at Dec. 31, 2020 | $ 2,096 | $ 0 | $ 199 | $ 37 | $ 1,860 |
Increase (Decrease) in Stockholders' Equity [Roll Forward] | |||||
Net income | 659 | 659 | |||
Common stock purchases (in shares) | (1) | ||||
Common stock purchases | (122) | (2) | (120) | ||
Other comprehensive income (loss), net | (42) | (42) | |||
Share-based compensation | 39 | 39 | |||
Ending Balance (in shares) at Dec. 31, 2021 | 58 | ||||
Ending Balance at Dec. 31, 2021 | 2,630 | $ 0 | 236 | (5) | 2,399 |
Increase (Decrease) in Stockholders' Equity [Roll Forward] | |||||
Net income | 792 | 792 | |||
Common stock purchases (in shares) | (1) | ||||
Common stock purchases | (400) | (5) | (395) | ||
Other comprehensive income (loss), net | (155) | (155) | |||
Share-based compensation (in shares) | 1 | ||||
Share-based compensation | $ 97 | 97 | |||
Ending Balance (in shares) at Dec. 31, 2022 | 58 | 58 | |||
Ending Balance at Dec. 31, 2022 | $ 2,964 | $ 0 | 328 | (160) | 2,796 |
Increase (Decrease) in Stockholders' Equity [Roll Forward] | |||||
Net income | 1,091 | 1,091 | |||
Other comprehensive income (loss), net | 78 | 78 | |||
Share-based compensation | $ 82 | 82 | |||
Ending Balance (in shares) at Dec. 31, 2023 | 58 | 58 | |||
Ending Balance at Dec. 31, 2023 | $ 4,215 | $ 0 | $ 410 | $ (82) | $ 3,887 |
CONSOLIDATED STATEMENTS OF CASH
CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Operating activities: | |||
Net income | $ 1,091 | $ 792 | $ 659 |
Adjustments to reconcile net income to net cash provided by operating activities: | |||
Depreciation and amortization | 171 | 176 | 131 |
Deferred income taxes | (31) | (66) | (24) |
Share-based compensation | 115 | 103 | 72 |
Loss on debt repayment | 0 | 0 | 25 |
Impairment | 0 | 208 | 0 |
Other, net | 2 | 8 | 33 |
Changes in operating assets and liabilities, net of the effect of acquisitions: | |||
Receivables | (778) | (95) | (415) |
Prepaid expenses and other current assets | (69) | (124) | (19) |
Medical claims and benefits payable | 580 | 153 | 471 |
Amounts due government agencies | 196 | (428) | 1,046 |
Accounts payable, accrued liabilities and other | 328 | 55 | 138 |
Deferred revenue | 59 | (11) | (5) |
Income taxes | (2) | 2 | 7 |
Net cash provided by operating activities | 1,662 | 773 | 2,119 |
Investing activities: | |||
Purchases of investments | (1,433) | (1,913) | (2,713) |
Proceeds from sales and maturities of investments | 772 | 1,398 | 1,329 |
Net cash paid in business combinations | (3) | (134) | (129) |
Purchases of property, equipment and capitalized software | (84) | (91) | (77) |
Other, net | 4 | (50) | (63) |
Net cash used in investing activities | (744) | (790) | (1,653) |
Financing activities: | |||
Common stock purchases | 0 | (400) | (128) |
Common stock withheld to settle employee tax obligations | (60) | (54) | (53) |
Contingent consideration liabilities settled | 0 | (20) | (20) |
Proceeds from senior notes offerings, net of issuance costs | 0 | 0 | 740 |
Repayment of senior notes | 0 | 0 | (723) |
Other, net | 2 | 33 | 1 |
Net cash used in financing activities | (58) | (441) | (183) |
Net increase (decrease) in cash and cash equivalents, and restricted cash and cash equivalents | 860 | (458) | 283 |
Cash and cash equivalents, and restricted cash and cash equivalents at beginning of period | 4,048 | 4,506 | 4,223 |
Cash and cash equivalents, and restricted cash and cash equivalents at end of period | 4,908 | 4,048 | 4,506 |
Cash paid during the period for: | |||
Income taxes, net | 405 | 340 | 235 |
Interest | $ 108 | $ 108 | $ 127 |
Organization and Basis of Prese
Organization and Basis of Presentation | 12 Months Ended |
Dec. 31, 2023 | |
Organization, Consolidation and Presentation of Financial Statements [Abstract] | |
Organization and Basis of Presentation | Organization and Basis of Presentation Organization and Operations Molina Healthcare, Inc. provides managed healthcare services under the Medicaid and Medicare programs, and through the state insurance marketplaces (the “Marketplace”). Molina was founded in 1980 as a provider organization serving low-income families in Southern California and reincorporated in Delaware in 2002. We currently have four reportable segments consisting of: 1) Medicaid; 2) Medicare; 3) Marketplace; and 4) Other. Our reportable segments are consistent with how we currently manage the business and view the markets we serve. As of December 31, 2023, we served approximately 5.0 million members eligible for government-sponsored healthcare programs, located across 20 states. Our state Medicaid contracts typically have terms of three In addition to contract renewal, our state Medicaid contracts may be periodically amended to include or exclude certain health benefits (such as pharmacy services, behavioral health services, or long-term care services); populations such as the aged, blind or disabled (“ABD”); and regions or service areas. In Medicare, we enter into Medicare Advantage-Part D contracts with the Centers for Medicare and Medicaid Services (“CMS”) annually, and for dual-eligible programs, we enter into contracts with CMS, in partnership with each state’s department of health and human services. Such contracts typically have terms of one In Marketplace, we enter into contracts with CMS, which end on December 31 of each year, and must be renewed annually. Consolidation and Presentation The consolidated financial statements include the accounts of Molina Healthcare, Inc., and its subsidiaries. All significant inter-company balances and transactions have been eliminated in consolidation. Financial information related to subsidiaries acquired during any year is included only for periods subsequent to their acquisition. We have reclassified certain 2022 amounts in the deferred tax asset and liabilities table in Note 12, “Income Taxes,” to conform to the 2023 presentation. In the opinion of management, all adjustments considered necessary for a fair presentation of the results as of the date and for the periods presented have been included; such adjustments consist of normal recurring adjustments. Use of Estimates |
Significant Accounting Policies
Significant Accounting Policies | 12 Months Ended |
Dec. 31, 2023 | |
Accounting Policies [Abstract] | |
Significant Accounting Policies | Significant Accounting Policies Cash and Cash Equivalents Cash and cash equivalents consist of cash and short-term, highly liquid investments that are both readily convertible into known amounts of cash and have a maturity of three months or less on the date of purchase. The following table provides a reconciliation of cash, cash equivalents, and restricted cash and cash equivalents reported within the accompanying consolidated balance sheets that sum to the total of the same such amounts presented in the accompanying consolidated statements of cash flows. The restricted cash and cash equivalents presented below are included in “Restricted investments” in the accompanying consolidated balance sheets. December 31, 2023 2022 2021 (In millions) Cash and cash equivalents $ 4,848 $ 4,006 $ 4,438 Restricted cash and cash equivalents 60 42 68 Total cash and cash equivalents, and restricted cash and cash equivalents presented in the consolidated statements of cash flows $ 4,908 $ 4,048 $ 4,506 Investments Our investments are principally held in debt securities, which are grouped into two separate categories for accounting and reporting purposes: available-for-sale securities and held-to-maturity securities. Available-for-sale (“AFS”) securities are recorded at fair value and unrealized gains and losses, if any, are recorded in stockholders’ equity as other comprehensive income, net of applicable income taxes. Held-to-maturity (“HTM”) securities are recorded at amortized cost, which approximates fair value, and unrealized holding gains or losses are not generally recognized. Realized gains and losses and unrealized losses arising from credit-related factors with respect to AFS and HTM securities are included in the determination of net income. The cost of securities sold is determined using the specific-identification method. Our investment policy requires that all of our investments have final maturities of less than 15 years, or less than 15 years average life for structured securities. Investments and restricted investments are subject to interest rate risk and will decrease in value if market rates increase. Declines in interest rates over time will reduce our investment income. In general, our AFS securities are classified as current assets without regard to the securities’ contractual maturity dates because they may be readily liquidated. We monitor our investments for credit-related impairment. For comprehensive discussions of the fair value and classification of our investments, see Note 5, “Fair Value Measurements,” and Note 6, “Investments.” Accrued interest receivable relating to our AFS and HTM securities is presented within “Prepaid expenses and other current assets” in the accompanying consolidated balance sheets, and amounted to $53 million and $35 million at December 31, 2023, and 2022, respectively. We do not measure an allowance for credit losses on accrued interest receivable. Instead, we write off accrued interest receivable that has not been collected within 90 days of the interest payment due date. We recognize such write-offs as a reversal of investment income. No accrued interest was written off during the year ended December 31, 2023 and 2022. Receivables Receivables consist primarily of premium amounts due from government agencies, which are subject to potential retroactive adjustments. We apply the current expected credit loss model to measure expected credits losses on our receivables based on available information about past events and reasonable and supportable forecasts. Because substantially all of our receivable amounts are readily determinable and substantially all of our creditors are governmental authorities, our allowance for credit losses is insignificant. Any amounts determined to be uncollectible are charged to expense when such determination is made. December 31, 2023 2022 (In millions) Government receivables $ 2,354 $ 1,702 Pharmacy rebate receivables 330 291 Other 420 309 Total receivables $ 3,104 $ 2,302 Business Combinations We account for business combinations using the acquisition method of accounting, which requires us to recognize the assets acquired and the liabilities assumed at their acquisition date fair values. As discussed below, the excess of the purchase consideration transferred over the fair value of the net tangible and intangible assets acquired is recorded as goodwill. While we use our best estimates and assumptions to accurately value assets acquired and liabilities assumed at the acquisition date, our estimates are inherently uncertain and subject to refinement. As a result, during the measurement period, which may be up to one year from the acquisition date, we may record adjustments to the assets acquired and liabilities assumed with the corresponding offset to goodwill. Measurement period adjustments are recorded in the period in which they are determined, as if they had been completed at the acquisition date. Upon the conclusion of the final determination of the values of assets acquired or liabilities assumed, or one year after the date of acquisition, whichever comes first, any subsequent adjustments are recorded within our consolidated results of operations. Refer to Note 4, “Business Combinations,” and Note 9, “Goodwill and Intangible Assets, Net,” for further details. Long-Lived Assets, including Intangible Assets Long-lived assets consist primarily of property, equipment, capitalized software (see Note 7, “Property, Equipment, and Capitalized Software, Net”), and intangible assets resulting from acquisitions. Long-lived assets are subject to impairment tests when events or circumstances indicate that the asset’s (or asset group’s) carrying value may not be recoverable. Finite-lived, separately-identified intangible assets acquired in business combinations are assets that represent future expected benefits but lack physical substance (such as purchased contract rights and provider contracts). Intangible assets are initially recorded at fair value and are then amortized on a straight-line basis over their expected useful lives, generally between five Determining the fair value of separately identifiable intangible assets requires management to make estimates, which are based on all available information and in some cases assumptions with respect to the timing and amount of future revenues and expenses associated with an asset. Determining the useful life of an intangible asset also requires judgment, as different types of intangible assets will have different useful lives. The most significant intangible asset we typically record in a business combination is contract rights associated with membership acquired. In determining the estimated fair value of the intangible assets, we typically apply the income approach, which discounts the projected future net cash flows using an appropriate discount rate that reflects the risk associated with such projected future cash flows. The most critical assumptions used in determining the fair value of contract rights include forecasted operating margins and the weighted average cost of capital. Our intangible assets are subject to impairment tests when events or circumstances indicate that a finite-lived intangible asset’s (or asset group’s) carrying value may not be recoverable. Consideration is given to a number of potential impairment indicators, including the ability of our health plan subsidiaries to obtain the renewal by amendment of their contracts in each state prior to the actual expiration of their contracts. However, there can be no assurance that these contracts will continue to be renewed. Following the identification of any potential impairment indicators, to determine whether an impairment exists, we would compare the carrying amount of a finite-lived intangible asset with the greater of the undiscounted cash flows that are expected to result from the use of the asset or related group of assets, or its value under the asset liquidation method. If it is determined that the carrying amount of the asset is not recoverable, the amount by which the carrying value exceeds the estimated fair value is recorded as an impairment. Refer to Note 9, “Goodwill and Intangible Assets, Net,” for further details. Goodwill Goodwill represents the excess of the purchase consideration over the fair value of net assets acquired in business combinations. Goodwill is not amortized but is tested for impairment on an annual basis and more frequently if impairment indicators are present. Impairment indicators may include experienced or expected operating cash-flow deterioration or losses, significant losses of membership, loss of state funding, loss of state contracts, and other factors. Goodwill is impaired if the carrying amount of a reporting unit exceeds its estimated fair value. This excess is recorded as an impairment loss and adjusted if necessary for the impact of tax-deductible goodwill. The loss recognized may not exceed the total goodwill allocated to the reporting unit. When testing goodwill for impairment, we may first assess qualitative factors, such as industry and market factors, the dynamic economic and political environments in which we operate, cost factors, and changes in overall performance, to determine if it is more likely than not that the carrying value of our reporting units exceed their estimated fair values. If our qualitative assessment indicates that it is more likely than not that the carrying value of a reporting unit exceeds its estimated fair value, we perform the quantitative assessment. We may also elect to bypass the qualitative assessment and proceed directly to the quantitative assessment. We performed a qualitative goodwill assessment of our reporting units in the fourth quarter of 2023, and did not identify any factors indicating that the carrying value of our reporting units exceeded their estimated fair values. If performing a quantitative assessment, we generally estimate the fair values of our reporting units by applying the income approach, using discounted cash flows. The base year in the reporting units’ discounted cash flows is derived from the annual financial planning cycle, which commences in the fourth quarter of the year. As part of a quantitative assessment, we may also apply the asset liquidation method to estimate the fair value of individual reporting units, which is computed as total assets minus total liabilities, excluding intangible assets and deferred taxes. Finally, we apply a market approach to reconcile the value of our reporting units to our consolidated market value. Under the market approach, we consider publicly-traded comparable company information to determine revenue and earnings multiples which are used to estimate our reporting units’ fair values. The assumptions used are consistent with those used in our long-range business plan and annual planning process. However, if these assumptions differ from actual results, the outcome of our goodwill impairment tests could be adversely affected. Leases Right-of-use (“ROU”) assets represent our right to use the underlying assets over the lease term, and lease liabilities represent our obligation for lease payments arising from the related leases. ROU assets and lease liabilities are recognized at the lease commencement date based on the present value of lease payments over the lease term. Lease terms may include options to extend or terminate the lease when we believe it is reasonably certain that we will exercise such options. If applicable, we account for lease and non-lease components within a lease as a single lease component. Because most of our leases do not provide an implicit interest rate, we generally use our incremental borrowing rate to determine the present value of lease payments. Lease expenses for operating lease payments are recognized on a straight-line basis over the lease term, and the related ROU assets and liabilities are reduced to the present value of the remaining lease payments at the end of each period. Finance lease payments reduce finance lease liabilities, the related ROU assets are amortized on a straight-line basis over the lease term, and interest expense is recognized using the effective interest method. The significant majority of our operating leases consist of long-term operating leases for office space. Short-term leases (those with terms of 12 months or less) are not recorded as ROU assets or liabilities in the consolidated balance sheets. For certain leases that represent a portfolio of similar assets, such as a fleet of vehicles, we apply a portfolio approach to account for the related ROU assets and liabilities, rather than account for such assets and the related liabilities individually. A nominal number of our lease agreements include rental payments that adjust periodically for inflation. Our lease agreements do not contain any material residual value guarantees or material restrictive covenants. Refer to Note 8, “Leases,” for further details. Medical Claims and Benefits Payable Medical care costs are recognized in the period in which services are provided and include fee-for-service claims, pharmacy benefits, capitation payments to providers, and various other medically-related costs. Under fee-for-service claims arrangements with providers, we retain the financial responsibility for medical care provided and incur costs based on actual utilization of hospital and physician services. Such medical care costs include amounts paid by us as well as estimated medical claims and benefits payable for costs that were incurred but not paid as of the reporting date (“IBNP”). Pharmacy benefits represent payments for members' prescription drug costs, net of rebates from drug manufacturers. We estimate pharmacy rebates based on historical and current utilization of prescription drugs and contractual provisions. Capitation payments represent monthly contractual fees paid to providers, who are responsible for providing medical care to members, which could include medical or ancillary costs like dental, vision and other supplemental health benefits. Such capitation costs are fixed in advance of the periods covered and are not subject to significant accounting estimates. Other medical care costs include all medically-related administrative costs, amounts due to providers pursuant to risk-sharing or other incentive arrangements, provider claims, and other healthcare expenses. Examples of medically-related administrative costs include expenses relating to health education, quality assurance, case management, care coordination, disease management, and 24-hour on-call nurses. Additionally, we include an estimate for the cost of settling claims incurred through the reporting date in our medical claims and benefits payable liability . Medical claims and benefits payable consist mainly of fee-for-service IBNP, unpaid pharmacy claims, capitation costs, other medical costs, including amounts payable to providers pursuant to risk-sharing or other incentive arrangements and amounts payable to providers on behalf of certain state agencies for certain state assessments in which we assume no financial risk . IBNP includes the costs of claims incurred as of the balance sheet date which have been reported to us, and our best estimate of the cost of claims incurred but not yet reported to us. When more complete claims payment information and healthcare cost trend data becomes available, we reflect changes in these estimates as an increase or decrease to medical care costs in the consolidated results of operations in the period in which they are determined. The estimation of the IBNP liability requires a significant degree of judgment in applying actuarial methods, determining the appropriate assumptions and considering numerous factors. Of those factors, we consider estimated completion factors and the assumed healthcare cost trend to be the most critical assumptions. Other relevant factors also include, but are not limited to, healthcare service utilization trends, claim inventory levels, changes in membership, product mix, seasonality, benefit changes or changes in Medicaid fee schedules, provider contract changes, prior authorizations and the incidence of catastrophic or pandemic cases. Because of the significant degree of judgment involved in estimation of our IBNP liability, there is considerable variability and uncertainty inherent in such estimates. Each reporting period, the recognized IBNP liability represents our best estimate of the total amount of unpaid claims incurred as of the balance sheet date using a consistent methodology in estimating our IBNP liability, including a provision for moderately adverse conditions for each current period. We believe our current estimates are reasonable and adequate; however, the development of our estimate is a continuous process that we monitor and update as more complete claims payment information and healthcare cost trend data becomes available. Actual medical care costs may be less than we previously estimated (favorable development) or more than we previously estimated (unfavorable development), and any differences could be material. Any adjustments to reflect favorable development would be recognized as a decrease to medical care costs, and any adjustments to reflect unfavorable development would be recognized as an increase to medical care costs , in the period in which the adjustments are determined. Refer to Note 10, “Medical Claims and Benefits Payable,” for a table presenting the components of the change in our medical claims and benefits payable, for all periods presented in the accompanying consolidated financial statements. Premium Revenue Recognition and Amounts Due Government Agencies Premium revenue is generated from our contracts with state and federal agencies, in connection with our participation in the Medicaid, Medicare, and Marketplace programs. Premium revenue is generally received based on per member per month (“PMPM”) rates established in advance of the periods covered. These premium revenues are recognized in the month that members are entitled to receive healthcare services, and premiums collected in advance are deferred. Many of our contracts contain provisions that may adjust or limit revenue or profit. Consequently, we recognize premium revenue as it is earned under such provisions. Liabilities accrued for premiums to be returned under such provisions are reported in the aggregate as “Amounts due government agencies” in the accompanying consolidated balance sheets. State Medicaid programs and the federal Medicare program periodically adjust premium rates, including certain components of premium revenue that are subject to accounting estimates further discussed below. Minimum MLR, Medical Cost Corridors and Profit Sharing. A portion of our Medicaid premium revenue may be returned if certain minimum amounts are not spent on defined medical care costs as a percentage of premium revenue, or minimum medical loss ratio (“Minimum MLR”). Under certain medical cost corridor provisions, the health plans may receive additional premiums if amounts spent on medical care costs exceed a defined maximum threshold. This includes remaining risk corridors that were enacted by various states in 2020 in response to the reduced demand for medical services stemming from COVID-19. Our contracts with certain states contain profit sharing provisions under which we refund amounts to the states if our health plans generate profit above a certain specified percentage. In some cases, we are limited in the amount of administrative costs that we may deduct in calculating the refund, if any. We recorded aggregate liabilities under the terms of such contract provisions of $1,344 million and $1,145 million at December 31, 2023 and 2022, respectively, to amounts due government agencies. The Affordable Care Act (“ACA”) established a Minimum MLR of 85% for Medicare. Federal regulations define what constitutes medical costs and premium revenue. If the Minimum MLR is not met, we may be required to pay rebates to the federal government. Our dual-eligible plans may also be subject to state-specific Minimum MLRs, medical cost corridors, and profit-sharing provisions. We recognize estimated rebates as an adjustment to premium revenue in our consolidated statements of income. We recorded a liability under the terms of such contract provisions of $64 million and $84 million at December 31, 2023 and 2022, respectively, to amounts due government agencies. The ACA established a Minimum MLR of 80% for the Marketplace. If the Minimum MLR is not met, we may be required to pay rebates to our Marketplace policyholders. The Marketplace risk adjustment program discussed below is taken into consideration when computing the Minimum MLR. We recognize estimated rebates under the Minimum MLR as an adjustment to premium revenue in our consolidated statements of income. The amounts were insignificant at December 31, 2023 and 2022. Risk Adjustment. Our Medicare premiums are subject to retroactive increase or decrease based on the health status of our Medicare members (as measured by member risk score). We estimate our members’ risk scores and the related amount of Medicare revenue that will ultimately be realized for the periods presented based on our knowledge of our members’ health status, risk scores and CMS practices. We also estimate amounts owed to CMS for Part D settlements. We recorded a liability under the terms of such contract provisions of $66 million and $76 million at December 31, 2023 and 2022, respectively, to amounts due government agencies. Under this program for our Marketplace business, our health plans’ composite risk scores are compared with the overall average risk score for the relevant state and market pool. Generally, our health plans will make a risk adjustment payment into the pool if their composite risk scores are below the average risk score (risk adjustment payable), and will receive a risk adjustment payment from the pool if their composite risk scores are above the average risk score (risk adjustment receivable). We estimate our ultimate premium based on insurance policy year-to-date experience, and recognize estimated premiums relating to the risk adjustment program as an adjustment to premium revenue in our consolidated statements of income. As of December 31, 2023, Marketplace risk adjustment payables amounted to $201 million and related receivables amounted to $241 million, for a net receivable of $40 million. Marketplace risk adjustment receivables at December 31, 2023 are net of a $41 million credit loss allowance resulting from a credit loss recognized in the third quarter of 2023 on 2022 Marketplace risk adjustment receivables due to the insolvency of an issuer in the Texas risk pool. This charge is included in other operating expenses in the accompanying consolidated statements of income. As of December 31, 2022, Marketplace risk adjustment payables amounted to $230 million and related receivables amounted to $135 million, for a net payable of $95 million. Other Premium Adjustments. State Medicaid programs periodically adjust premium revenues on a retroactive basis for rate changes and changes in membership and eligibility data. In certain states, adjustments are made based on the health status of our members (as measured through a risk score). In these cases, we adjust our premium revenue in the period in which we determine that the adjustment is probable and reasonably estimable, based on our best estimate of the ultimate premium we expect to realize for the period being adjusted. Quality Incentives At many of our health plans, revenue ranging from approximately 1% to 4% of certain health plan premiums is earned only if certain performance measures are met. Such performance measures are generally found in our Medicaid and MMP contracts. Quality incentive premium revenue is recognized when it is earned under such provisions. Reinsurance We bear underwriting and reserving risks associated with our health plan subsidiaries. In certain cases, we limit our risk of significant catastrophic losses by maintaining high deductible reinsurance coverage with a highly-rated, unaffiliated insurance company (the “third-party reinsurer”). Because we remain liable for losses in the event the third-party reinsurer is unable to pay its portion of the losses, we continually monitor the third-party reinsurer’s financial condition, including its ability to maintain high credit ratings. Intercompany transactions with our captive are eliminated in consolidation. We report reinsurance premiums as a reduction to premium revenue, while related reinsurance recoveries are reported as a reduction to medical care costs. In certain cases, we participate in state-run reinsurance programs for which no reinsurance premium is paid. Reinsurance premiums amounted to $11 million, $2 million, and $2 million for the years ended December 31, 2023, 2022, and 2021, respectively. Reinsurance recoveries amounted to $21 million, $35 million, and $33 million for the years ended December 31, 2023, 2022, and 2021, respectively. Reinsurance recoverable of $28 million, and $27 million, as of December 31, 2023, and 2022, respectively, is included in “Receivables” in the accompanying consolidated balance sheets. Premium Deficiency Reserves on Loss Contracts We assess the profitability of our contracts to determine if it is probable that a loss will be incurred in the future by reviewing current results and forecasts. For purposes of this assessment, contracts are grouped in a manner consistent with our method of acquiring, servicing and measuring the profitability of such contracts. A premium deficiency reserve (“PDR”) is recognized if anticipated future medical care and administrative costs exceed anticipated future premium revenue, investment income and reinsurance recoveries. Income Taxes We account for income taxes under the asset and liability method. Deferred tax assets and liabilities are determined based on the difference between the financial statement and tax bases of assets and liabilities using enacted tax rates expected to be in effect during the year in which the basis differences reverse. Valuation allowances are established when management determines it is more likely than not that some portion, or all, of the deferred tax assets will not be realized. For further discussion and disclosure, see Note 12, “Income Taxes.” Taxes Based on Premiums Premium and Use Tax. Certain of our health plans are assessed a tax based on premium revenue collected. The premium revenues we receive from these states include reimbursement for the premium tax assessment. We have reported these taxes on a gross basis, as premium tax revenue and as premium tax expenses in the consolidated statements of income. Concentrations of Credit Risk Financial instruments that potentially subject us to concentrations of credit risk consist primarily of cash and cash equivalents, investments, receivables, and restricted investments. Our investments and a portion of our cash equivalents are managed by professional portfolio managers operating under documented investment guidelines. Our portfolio managers must obtain our prior approval before selling investments where the loss position of those investments exceeds certain levels. Our investments consist primarily of investment-grade debt securities with final maturities of less than 15 years, or less than 15 years average life for structured securities. Restricted investments are invested principally in cash, cash equivalents, U.S. Treasury securities, and corporate debt securities. Concentration of credit risk with respect to accounts receivable is limited because our payors consist principally of the federal government, and governments of each state in which our health plan subsidiaries operate. Risks and Uncertainties Our profitability depends in large part on our ability to accurately predict and effectively manage medical care costs. We continually review our medical costs in light of our underlying claims experience and revised actuarial data. However, several factors could adversely affect medical care costs. These factors, which include changes in healthcare practices, inflation, new technologies, major epidemics, natural disasters, and malpractice litigation, are beyond our control and may have an adverse effect on our ability to accurately predict and effectively control medical care costs. Costs in excess of those anticipated could have a material adverse effect on our financial condition, results of operations, or cash flows. We operate health plans primarily as a direct contractor with the states, and in Los Angeles County, California, as a subcontractor to another health plan holding a direct contract with the state. We are therefore dependent upon a relatively small number of contracts to support our revenue. The loss of any one of those contracts could have a material adverse effect on our financial position, results of operations, or cash flows. In addition, our ability to arrange for the provision of medical services to our members is dependent upon our ability to develop and maintain adequate provider networks. Our inability to develop or maintain such networks might, in certain circumstances, have a material adverse effect on our financial position, results of operations, or cash flows. Significant Customers We receive the majority of our revenues under contracts or subcontracts with state Medicaid managed care programs, which are considered individual external customers. Instances where these contracts were at least 10% of our total premium revenue for the year ended December 31, 2023 were Washington with 14.0%, Texas with 13.9%, and New York with 11.4%. Recent Accounting Pronouncements In November 2023, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) 2023-07, Improvements to Reportable Segment Disclosures , which will require disclosure of incremental segment information on an annual and interim basis for all public entities. The amendments do not change how a public entity identifies its operating segments, aggregates those operating segments, or applies the quantitative thresholds to determine its reportable segments. ASU 2023-07 is effective for annual reporting beginning with the fiscal year ending December 31, 2024, and for interim periods thereafter. We are currently evaluating the incremental disclosures that will be required in the footnotes to our consolidated financial statements. In December 2023, the FASB issued ASU 2023-09, Improvements to Income Tax Disclosures , which will require incremental income tax disclosures on an annual basis for all public entities. The amendments require that public business entities disclose specific categories in the rate reconciliation and provide additional information for reconciling items meeting a quantitative threshold. The amendments also require disclosure of income taxes paid to be disaggregated by jurisdiction, and disclosure of income tax expense disaggregated by federal, state, and foreign. ASU 2023-09 is effective for annual reporting beginning with the fiscal year ending December 31, 2025. We are currently evaluating the incremental disclosures that will be required in our consolidated financial statements. Other recent accounting pronouncements issued by the FASB (including its Emerging Issues Task Force), the American Institute of Certified Public Accountants, and the Securities and Exchange Commission (“SEC”) did not have, nor does management expect such pronouncements to have, a significant impact on our present or future consolidated financial statements. |
Net Income Per Share
Net Income Per Share | 12 Months Ended |
Dec. 31, 2023 | |
Earnings Per Share [Abstract] | |
Net Income Per Share | Net Income Per Share The following table sets forth the calculation of basic and diluted net income per share: Year Ended December 31, 2023 2022 2021 (In millions, except net income per share) Numerator: Net income $ 1,091 $ 792 $ 659 Denominator: Shares outstanding at the beginning of the period 57.4 57.9 58.0 Weighted-average number of shares issued: Stock purchases — (0.5) (0.5) Stock-based compensation 0.3 0.4 0.3 Denominator for basic net income per share 57.7 57.8 57.8 Effect of dilutive securities: (1) Stock-based compensation 0.4 0.7 0.8 Denominator for diluted net income per share 58.1 58.5 58.6 Net income per share - Basic (2) $ 18.91 $ 13.72 $ 11.40 Net income per share - Diluted (2) $ 18.77 $ 13.55 $ 11.25 _______________________________ (1) The dilutive effect of all potentially dilutive common shares is calculated using the treasury stock method. Certain potentially dilutive common shares issuable are not included in the computation of diluted net income per share because to do so would have been anti-dilutive. |
Business Combinations
Business Combinations | 12 Months Ended |
Dec. 31, 2023 | |
Business Combination and Asset Acquisition [Abstract] | |
Business Combinations | Business Combinations In 2023, we closed on one business combination in the Medicaid and Medicare segments, consistent with our growth strategy. For this transaction, we applied the acquisition method of accounting, where the total purchase price was allocated to the tangible and intangible assets acquired and liabilities assumed, based on their fair values as of the acquisition date. The pro forma effects of this acquisition for prior periods were not material to our consolidated results of operations. Costs to complete acquisitions amounted to $4 million in the aggregate for the year ended December 31, 2023, and were recorded as “General and administrative expenses” in the accompanying consolidated statements of income. My Choice. On September 1, 2023, we closed on our acquisition of My Choice Wisconsin for preliminary purchase consideration of approximately $74 million. Finalization of purchase price adjustments, as provided in the definitive asset purchase agreement governing the transaction, is expected to occur in the first half of 2024. Goodwill is calculated as the excess of the consideration transferred over the net assets recognized and represents the estimated future economic benefits arising from other assets acquired that could not be individually identified and separately recognized. Such assets include synergies we expect to achieve as a result of the transaction, such as the use of our existing infrastructure to support the added membership, and future economic benefits arising from the assembled workforce. We allocated goodwill in the amounts of $95 million to the Medicaid segment and $31 million to the Medicare segment. The goodwill is entirely deductible for income tax purposes. The following table summarizes the provisional fair values assigned to assets acquired and liabilities assumed, in millions. Assets acquired: Current assets $ 96 Goodwill 126 Intangible assets 18 Other long-term assets 7 Liabilities assumed: Medical claims and benefits payable (96) Amounts due government agencies (19) Accounts payable, accrued and other long-term liabilities (58) Net consideration transferred $ 74 The table below presents intangible assets acquired, by major class, for the My Choice acquisition. The weighted-average amortization period, in the aggregate, is 6.5 years. Fair Value Life (In millions) (Years) Contract rights - member list $ 13 7 Trade Name 3 2 Provider network 2 10 $ 18 Bright Health Medicare. |
Fair Value Measurements
Fair Value Measurements | 12 Months Ended |
Dec. 31, 2023 | |
Fair Value Disclosures [Abstract] | |
Fair Value Measurements | Fair Value Measurements We consider the carrying amounts of current assets and current liabilities to approximate their fair values because of the relatively short period of time between the origination of these instruments and their expected realization or payment. For our financial instruments measured at fair value on a recurring basis, we prioritize the inputs used in measuring fair value according to a three-tier fair value hierarchy as follows: Level 1 — Observable Inputs. Level 1 financial instruments are actively traded and therefore the fair value for these securities is based on quoted market prices for identical securities in active markets. Level 2 — Directly or Indirectly Observable Inputs. Fair value for these investments is determined using a market approach based on quoted prices for similar securities in active markets or quoted prices for identical securities in inactive markets. Level 3 — Unobservable Inputs. Level 3 financial instruments are valued using unobservable inputs that represent management’s best estimate of what market participants would use in pricing the financial instrument at the measurement date. As of December 31, 2022, our Level 3 financial instruments consisted of contingent consideration liabilities. Our financial instruments measured at fair value on a recurring basis at December 31, 2023, were as follows: Total Level 1 Level 2 Level 3 (In millions) Corporate debt securities $ 2,732 $ — $ 2,732 $ — Mortgage-backed securities 911 — 911 — Asset-backed securities 365 — 365 — Municipal securities 166 — 166 — U.S. Treasury notes 40 — 40 — Other 45 — 45 — Total assets $ 4,259 $ — $ 4,259 $ — Our financial instruments measured at fair value on a recurring basis at December 31, 2022, were as follows: Total Level 1 Level 2 Level 3 (In millions) Corporate debt securities $ 2,184 $ — $ 2,184 $ — Mortgage-backed securities 731 — 731 — Asset-backed securities 288 — 288 — Municipal securities 149 — 149 — U.S. Treasury notes 105 — 105 — Other 42 — 42 — Total assets $ 3,499 $ — $ 3,499 $ — Contingent consideration liabilities $ 8 $ — $ — $ 8 Total liabilities $ 8 $ — $ — $ 8 Level 3 Contingent Consideration Liabilities The net changes in fair value of Level 3 financial instruments are reported in “Other” operating expenses in our consolidated statements of income. In the year ended December 31, 2022, we recognized a loss of $4 million, primarily for the increase in the fair value of the contingent consideration liability described below. In the year ended December 31, 2023, we paid the seller $8 million in connection with our 2020 acquisition of certain assets of Passport Health Plan, Inc., which represented the final payment of the consideration due relating to an operating income guarantee. The amount paid in the year ended December 31, 2023, has been presented in “Operating activities” in the accompanying consolidated statements of cash flows. Fair Value Measurements – Disclosure Only The carrying amounts and estimated fair values of our notes payable are classified as Level 2 financial instruments. Fair value for these securities is determined using a market approach based on quoted market prices for similar securities in active markets or quoted prices for identical securities in inactive markets. December 31, 2023 December 31, 2022 Carrying Fair Value Carrying Fair Value (In millions) 4.375% Notes due 2028 $ 794 $ 757 $ 792 $ 729 3.875% Notes due 2030 644 583 643 554 3.875% Notes due 2032 742 654 741 629 Total $ 2,180 $ 1,994 $ 2,176 $ 1,912 |
Investments
Investments | 12 Months Ended |
Dec. 31, 2023 | |
Investments, Debt and Equity Securities [Abstract] | |
Investments | Investments Available-for-Sale We consider all of our investments classified as current assets to be available-for-sale. The following tables summarize our current investments as of the dates indicated: December 31, 2023 Amortized Gross Estimated Gains Losses (In millions) Corporate debt securities $ 2,781 $ 16 $ 65 $ 2,732 Mortgage-backed securities 951 4 44 911 Asset-backed securities 376 1 12 365 Municipal securities 172 — 6 166 U.S. Treasury notes 40 — — 40 Other 47 — 2 45 Total $ 4,367 $ 21 $ 129 $ 4,259 December 31, 2022 Amortized Gross Estimated Gains Losses (In millions) Corporate debt securities $ 2,303 $ 2 $ 121 $ 2,184 Mortgage-backed securities 787 — 56 731 Asset-backed securities 308 — 20 288 Municipal securities 160 — 11 149 U.S. Treasury notes 106 — 1 105 Other 45 — 3 42 Total $ 3,709 $ 2 $ 212 $ 3,499 Expected maturities may differ from contractual maturities because borrowers may have the right to call or prepay obligations with or without call or prepayment penalties. The contractual maturities of our current investments as of December 31, 2023 are summarized below: Amortized Estimated (In millions) Due in one year or less $ 538 $ 530 Due after one year through five years 2,437 2,384 Due after five years through ten years 406 405 Due after ten years 986 940 Total $ 4,367 $ 4,259 In the years ended December 31, 2023, 2022, and 2021, maturities and redemptions of available-for-sale securities amounted to $513 million, $1,069 million, and $948 million, respectively, and sales amounted to $259 million, $329 million, and $381 million, respectively. Gross realized gains and losses from sales of available-for-sale securities are calculated under the specific identification method and are included in investment income. Gross realized investment gains amounted to $1 million, $1 million and $10 million in the years ended December 31, 2023, 2022 and 2021, respectively, and were reclassified into earnings from other comprehensive income on a net-of-tax basis. Gross realized investment losses amounted to $11 million and $7 million in the years ended December 31, 2023 and 2022, respectively, and were reclassified into earnings from other comprehensive income on a net-of-tax basis. Gross realized investment losses were insignificant in the year ended December 31, 2021. We have determined that unrealized losses at December 31, 2023 and 2022 primarily resulted from fluctuating interest rates, rather than a deterioration of the creditworthiness of the issuers. Therefore, we determined that an allowance for credit losses was not necessary. So long as we maintain the intent and ability to hold these securities to maturity, we are unlikely to experience realized losses. In the event that we dispose of these securities before maturity, we expect that realized losses, if any, will be insignificant. The following table segregates those available-for-sale investments that have been in a continuous loss position for less than 12 months, and those that have been in a continuous loss position for 12 months or more as of December 31, 2023: In a Continuous Loss Position In a Continuous Loss Position Estimated Unrealized Total Number of Positions Estimated Unrealized Total Number of Positions (Dollars in millions) Corporate debt securities $ 263 $ 1 160 $ 1,553 $ 64 754 Mortgage-backed securities 123 2 98 549 42 283 Asset-backed securities — — — 195 12 91 Municipal securities — — — 117 6 116 Other — — — 17 2 17 Total $ 386 $ 3 258 $ 2,431 $ 126 1,261 The following table segregates those available-for-sale investments that have been in a continuous loss position for less than 12 months, and those that have been in a continuous loss position for 12 months or more as of December 31, 2022: In a Continuous Loss Position In a Continuous Loss Position Estimated Unrealized Total Number of Positions Estimated Unrealized Total Number of Positions (Dollars in millions) Corporate debt securities $ 1,124 $ 45 683 $ 887 $ 76 371 Mortgage-backed securities 395 20 220 319 36 131 Asset-backed securities 161 6 108 118 14 59 Municipal securities 75 4 83 57 7 57 U.S. Treasury notes 88 1 6 — — — Other 15 1 16 17 2 6 Total $ 1,858 $ 77 1,116 $ 1,398 $ 135 624 Restricted Investments Held-to-Maturity Pursuant to the regulations governing our state health plan subsidiaries, we maintain statutory deposits and deposits required by government authorities primarily in cash, cash equivalents, U.S. Treasury securities, and corporate debt securities. We also maintain restricted investments as protection against the insolvency of certain capitated providers. The use of these funds is limited as required by regulations in the various states in which we operate, or as needed in the event of insolvency of capitated providers. Therefore, such investments are reported as “Restricted investments” in the accompanying consolidated balance sheets. We have the ability to hold these restricted investments until maturity, and as a result, we would not expect the value of these investments to decline significantly due to a sudden change in market interest rates. Our held-to-maturity restricted investments are carried at amortized cost, which approximates fair value, of which $190 million will mature in one year or less, $65 million will mature in one through five years, and $6 million will mature after five years. The following table presents the balances of restricted investments: December 31, 2023 2022 (In millions) Cash and cash equivalents $ 60 $ 42 U.S. Treasury notes 167 159 Corporate debt securities 34 37 Total restricted investments $ 261 $ 238 |
Property, Equipment, and Capita
Property, Equipment, and Capitalized Software, Net | 12 Months Ended |
Dec. 31, 2023 | |
Property, Plant and Equipment [Abstract] | |
Property, Equipment, and Capitalized Software, Net | Property, Equipment, and Capitalized Software, Net Property and equipment are stated at historical cost. Replacements and major improvements are capitalized, and repairs and maintenance are charged to expense as incurred. Software developed for internal use is capitalized. Property and equipment are generally depreciated using the straight-line method over estimated useful lives ranging from three five The Company recognized an impairment on property and equipment of $16 million associated with our reduction in leased space used in our business operations in the year ended December 31, 2022. A summary of property, equipment, and capitalized software is as follows: December 31, 2023 2022 (In millions) Capitalized software $ 687 $ 615 Property and equipment 199 221 Building and improvements 41 41 Land 5 5 Total cost 932 882 Less: accumulated amortization - capitalized software (537) (482) Less: accumulated depreciation and amortization - property, equipment, building, and improvements (192) (213) Total accumulated depreciation and amortization (729) (695) ROU assets - finance leases 67 72 Property, equipment, and capitalized software, net $ 270 $ 259 The following table presents all depreciation and amortization recognized in our consolidated statements of income: Year Ended December 31, 2023 2022 2021 (In millions) Recorded in depreciation and amortization: Amortization of intangible assets $ 85 $ 77 $ 49 Amortization of capitalized software 58 54 41 Amortization of finance leases 18 28 25 Depreciation and amortization of property, equipment, building, and improvements 10 17 16 Total depreciation and amortization recognized $ 171 $ 176 $ 131 |
Leases
Leases | 12 Months Ended |
Dec. 31, 2023 | |
Leases [Abstract] | |
Leases | Leases We are a party to operating and finance leases primarily for our corporate and health plan offices. Our operating leases have remaining lease terms up to 12 years, some of which include options to extend the leases for up to 10 years. As of December 31, 2023, the weighted average remaining operating lease term is 8 years. Our finance leases have remaining lease terms up to 15 years, some of which include options to extend the leases for up to 25 years. As of December 31, 2023, the weighted average remaining finance lease term is 12 years. In the year ended December 31, 2022, the Company recognized $192 million of ROU asset impairments associated with our reduction in leased space used in our business operations to accommodate our move to a remote work environment. As of December 31, 2023, the weighted-average discount rate used to compute the present value of lease payments was 4.8% for operating lease liabilities, and 6.4% for finance lease liabilities. The components of lease expense for the years ended December 31, 2023, 2022, and 2021 are presented in the following table. Year Ended December 31, 2023 2022 2021 (In millions) Operating lease expense $ 15 $ 31 $ 34 Finance lease expense: Amortization of ROU assets $ 18 $ 28 $ 25 Interest on lease liabilities 15 15 15 Total finance lease expense $ 33 $ 43 $ 40 Supplemental consolidated cash flow information related to leases follows: Year Ended December 31, 2023 2022 2021 (In millions) Cash used in operating activities: Operating leases $ 28 $ 31 $ 33 Finance leases 15 15 15 Cash used in financing activities: Finance leases 24 15 18 ROU assets recognized in exchange for lease obligations: Operating leases 12 10 86 Finance leases 13 18 18 Supplemental information related to leases, including location of amounts reported in the accompanying consolidated balance sheets, follows: December 31, 2023 2022 (In millions) Operating leases: ROU assets Other assets $ 43 $ 43 Lease liabilities Accounts payable and accrued liabilities (current) $ 20 $ 41 Other long-term liabilities (non-current) 85 77 Total operating lease liabilities $ 105 $ 118 Finance leases: ROU assets Property, equipment, and capitalized software, net $ 67 $ 72 Lease liabilities Accounts payable and accrued liabilities (current) $ 21 $ 22 Finance lease liabilities (non-current) 205 215 Total finance lease liabilities $ 226 $ 237 Maturities of lease liabilities as of December 31, 2023, were as follows: Operating Finance Leases Leases (In millions) 2024 $ 24 $ 34 2025 20 30 2026 14 26 2027 11 24 2028 9 25 Thereafter 50 194 Subtotal - undiscounted lease payments 128 333 Less imputed interest (23) (107) Total $ 105 $ 226 |
Leases | Leases We are a party to operating and finance leases primarily for our corporate and health plan offices. Our operating leases have remaining lease terms up to 12 years, some of which include options to extend the leases for up to 10 years. As of December 31, 2023, the weighted average remaining operating lease term is 8 years. Our finance leases have remaining lease terms up to 15 years, some of which include options to extend the leases for up to 25 years. As of December 31, 2023, the weighted average remaining finance lease term is 12 years. In the year ended December 31, 2022, the Company recognized $192 million of ROU asset impairments associated with our reduction in leased space used in our business operations to accommodate our move to a remote work environment. As of December 31, 2023, the weighted-average discount rate used to compute the present value of lease payments was 4.8% for operating lease liabilities, and 6.4% for finance lease liabilities. The components of lease expense for the years ended December 31, 2023, 2022, and 2021 are presented in the following table. Year Ended December 31, 2023 2022 2021 (In millions) Operating lease expense $ 15 $ 31 $ 34 Finance lease expense: Amortization of ROU assets $ 18 $ 28 $ 25 Interest on lease liabilities 15 15 15 Total finance lease expense $ 33 $ 43 $ 40 Supplemental consolidated cash flow information related to leases follows: Year Ended December 31, 2023 2022 2021 (In millions) Cash used in operating activities: Operating leases $ 28 $ 31 $ 33 Finance leases 15 15 15 Cash used in financing activities: Finance leases 24 15 18 ROU assets recognized in exchange for lease obligations: Operating leases 12 10 86 Finance leases 13 18 18 Supplemental information related to leases, including location of amounts reported in the accompanying consolidated balance sheets, follows: December 31, 2023 2022 (In millions) Operating leases: ROU assets Other assets $ 43 $ 43 Lease liabilities Accounts payable and accrued liabilities (current) $ 20 $ 41 Other long-term liabilities (non-current) 85 77 Total operating lease liabilities $ 105 $ 118 Finance leases: ROU assets Property, equipment, and capitalized software, net $ 67 $ 72 Lease liabilities Accounts payable and accrued liabilities (current) $ 21 $ 22 Finance lease liabilities (non-current) 205 215 Total finance lease liabilities $ 226 $ 237 Maturities of lease liabilities as of December 31, 2023, were as follows: Operating Finance Leases Leases (In millions) 2024 $ 24 $ 34 2025 20 30 2026 14 26 2027 11 24 2028 9 25 Thereafter 50 194 Subtotal - undiscounted lease payments 128 333 Less imputed interest (23) (107) Total $ 105 $ 226 |
Goodwill and Intangible Assets,
Goodwill and Intangible Assets, Net | 12 Months Ended |
Dec. 31, 2023 | |
Goodwill and Intangible Assets Disclosure [Abstract] | |
Goodwill and Intangible Assets, Net | Goodwill and Intangible Assets, Net Goodwill The following table presents the changes in the carrying amounts of goodwill by segment, for the periods presented. Medicaid Medicare Other Consolidated (In millions) Balance, December 31, 2021 $ 769 $ 169 $ 44 $ 982 Acquisitions and measurement period adjustments 130 3 — 133 Balance, December 31, 2022 899 172 44 1,115 Acquisitions and measurement period adjustments 95 31 — 126 Balance, December 31, 2023 $ 994 $ 203 $ 44 $ 1,241 The changes in the carrying amounts of both goodwill and intangible assets, net, in 2023, were due to the acquisition described in Note 4, “Business Combinations.” Intangible Assets, Net The following table provides the details of identified intangible assets, by major class, for the periods presented. December 31, 2023 December 31, 2022 Cost Accumulated Carrying Amount Cost Accumulated Carrying Amount (In millions) Contract rights and licenses $ 520 $ 357 $ 163 $ 507 $ 279 $ 228 Provider networks 59 29 30 57 24 33 Trade names 22 7 15 19 5 14 Total $ 601 $ 393 $ 208 $ 583 $ 308 $ 275 |
Medical Claims and Benefits Pay
Medical Claims and Benefits Payable | 12 Months Ended |
Dec. 31, 2023 | |
Insurance [Abstract] | |
Medical Claims and Benefits Payable | Medical Claims and Benefits Payable The following table provides the details of our medical claims and benefits payable as of the dates indicated. December 31, 2023 2022 2021 (In millions) Fee-for-service claims incurred but not paid (“IBNP”) $ 2,901 $ 2,597 $ 2,486 Pharmacy payable 202 206 219 Capitation payable 100 94 82 Other 1,001 631 576 Total $ 4,204 $ 3,528 $ 3,363 “Other” medical claims and benefits payable includes amounts payable to certain providers for which we act as an intermediary on behalf of various government agencies without assuming financial risk. Such receipts and payments do not impact our consolidated statements of income. Non-risk provider payables amounted to $481 million, $228 million and $226 million, as of December 31, 2023, 2022, and 2021, respectively. The following tables present the components of the change in our medical claims and benefits payable for the periods indicated. Year Ended December 31, 2023 Medicaid Medicare Marketplace Consolidated (In millions) Medical claims and benefits payable, beginning balance $ 2,815 $ 452 $ 261 $ 3,528 Components of medical care costs related to: Current year 23,749 3,802 1,545 29,096 Prior years (395) (11) (21) (427) Total medical care costs 23,354 3,791 1,524 28,669 Payments for medical care costs related to: Current year 20,999 3,293 1,323 25,615 Prior years 2,069 431 234 2,734 Total paid 23,068 3,724 1,557 28,349 Acquired balances, net of post-acquisition adjustments 82 14 — 96 Change in non-risk and other provider payables 261 (1) — 260 Medical claims and benefits payable, ending balance $ 3,444 $ 532 $ 228 $ 4,204 Year Ended December 31, 2022 Medicaid Medicare Marketplace Consolidated (In millions) Medical claims and benefits payable, beginning balance $ 2,580 $ 404 $ 379 $ 3,363 Components of medical care costs related to: Current year 22,097 3,390 1,972 27,459 Prior years (251) (32) (1) (284) Total medical care costs 21,846 3,358 1,971 27,175 Payments for medical care costs related to: Current year 19,655 2,944 1,746 24,345 Prior years 1,966 361 343 2,670 Total paid 21,621 3,305 2,089 27,015 Acquired balances, net of post-acquisition adjustments 12 — — 12 Change in non-risk and other provider payables (2) (5) — (7) Medical claims and benefits payable, ending balance $ 2,815 $ 452 $ 261 $ 3,528 Year Ended December 31, 2021 Medicaid Medicare Marketplace Consolidated (In millions) Medical claims and benefits payable, beginning balance $ 2,129 $ 392 $ 175 $ 2,696 Components of medical care costs related to: Current year 18,321 2,970 2,652 23,943 Prior years (182) (39) (18) (239) Total medical care costs 18,139 2,931 2,634 23,704 Payments for medical care costs related to: Current year 16,284 2,573 2,291 21,148 Prior years 1,601 340 139 2,080 Total paid 17,885 2,913 2,430 23,228 Acquired balances, net of post-acquisition adjustments 205 (8) — 197 Change in non-risk and other provider payables (8) 2 — (6) Medical claims and benefits payable, ending balance $ 2,580 $ 404 $ 379 $ 3,363 The amounts presented for “Components of medical care costs related to: Prior years” represent the amount by which our original estimate of medical claims and benefits payable at the beginning of the year varied from the actual liabilities, based on information (principally the payment of claims) developed since those liabilities were first reported. Our estimates of medical claims and benefits payable recorded at December 31, 2023, 2022 and 2021 developed favorably by approximately $427 million, $284 million and $239 million in 2023, 2022 and 2021, respectively. The favorable prior year development recognized in 2023 was primarily due to lower than expected utilization of medical services by our members and improved operating performance, mainly in the Medicaid segment. Consequently, the ultimate costs recognized in 2023, as claims payments were processed, were lower than our estimates in 2022. The favorable prior year development recognized in 2022 was primarily due to lower than expected utilization of medical services by our members and improved operating performance, mainly in the Medicaid segment. Consequently, the ultimate costs recognized in 2022, as claims payments were processed, were lower than our estimates in 2021, which was not discernible until additional information was provided, and as claims payments were processed. The favorable prior year development recognized in 2021 was primarily due to lower than expected utilization of medical services by our Medicaid members, and to a lesser extent our Medicare and Marketplace members, and improved operating performance. Consequently, the ultimate costs recognized in 2021 were lower than our original estimates in 2020, which was not discernible until additional information was provided, and as claims payments were processed. The following tables provide information about our consolidated incurred and paid claims development as of December 31, 2023, as well as cumulative claims frequency and the total of incurred but not paid claims liabilities. The pattern of incurred and paid claims development is consistent across each of our segments. The cumulative claim frequency is measured by claim event, and includes claims covered under capitated arrangements. Incurred Claims and Allocated Claims Adjustment Expenses Total IBNP Cumulative number of reported claims Benefit Year 2021 2022 2023 (Unaudited) (Unaudited) (In millions) 2021 $ 24,167 $ 23,979 $ 23,912 $ 18 133 2022 27,459 27,128 77 163 2023 29,096 2,803 153 $ 80,136 $ 2,898 Cumulative Paid Claims and Allocated Claims Adjustment Expenses Benefit Year 2021 2022 2023 (Unaudited) (Unaudited) (In millions) 2021 $ 21,148 $ 23,871 $ 23,894 2022 24,345 27,051 2023 25,615 $ 76,560 The following table represents a reconciliation of claims development to the aggregate carrying amount of the liability for medical claims and benefits payable. 2023 (In millions) Incurred claims and allocated claims adjustment expenses $ 80,136 Less: cumulative paid claims and allocated claims adjustment expenses (76,560) All outstanding liabilities before 2021 3 Acquired balances 96 Non-risk and other provider payables 529 Medical claims and benefits payable $ 4,204 |
Debt
Debt | 12 Months Ended |
Dec. 31, 2023 | |
Debt Disclosure [Abstract] | |
Debt | Debt Contractual maturities of debt, as of December 31, 2023, are illustrated in the following table. All amounts represent the principal amounts of the debt instruments outstanding. Total 2024 2025 2026 2027 2028 Thereafter (In millions) 4.375% Notes due 2028 $ 800 $ — $ — $ — $ — $ 800 $ — 3.875% Notes due 2030 650 — — — — — 650 3.875% Notes due 2032 750 — — — — — 750 Total $ 2,200 $ — $ — $ — $ — $ 800 $ 1,400 The following table summarizes our outstanding debt obligations, all of which are non-current as of the dates reported below: December 31, 2023 2022 (In millions) Non-current long-term debt: 4.375% Notes due 2028 $ 800 $ 800 3.875% Notes due 2030 650 650 3.875% Notes due 2032 750 750 Less: unamortized debt issuance costs (20) (24) Total $ 2,180 $ 2,176 Credit Agreement We are party to a credit agreement (the “Credit Agreement”) which includes a revolving credit facility (“Credit Facility”) of $1.0 billion, among other provisions. The Credit Agreement has a term of five years, and all amounts outstanding will be due and payable on June 8, 2025. Borrowings under the Credit Agreement bear interest based, at our election, on a base rate or other defined rate, plus in each case, the applicable margin. In addition to interest payable on the principal amount of indebtedness outstanding from time to time under the Credit Agreement, we are required to pay a quarterly commitment fee. Effective April 26, 2023, we amended the Credit Agreement to transition from the use of the London Interbank Offered Rate, or LIBOR, to the Secured Overnight Financing Rate, or SOFR, as a benchmark interest rate used in the Credit Agreement. We have other relationships, including financial advisory and banking, with some parties to the Credit Agreement. The Credit Agreement contains customary non-financial and financial covenants. As of December 31, 2023, we were in compliance with all financial and non-financial covenants under the Credit Agreement. As of December 31, 2023, no amounts were outstanding under the Credit Facility. Senior Notes Our senior notes are described below. Each of these notes are senior unsecured obligations of the Parent corporation, Molina Healthcare, Inc., and rank equally in right of payment with all existing and future senior debt, and senior to all existing and future subordinated debt of Molina Healthcare, Inc. In addition, each of the indentures governing the senior notes contain customary non-financial covenants and change of control provisions. As of December 31, 2023, we were in compliance with all non-financial covenants in the indentures governing the senior notes. The indentures governing the senior notes contain cross-default provisions that are triggered upon default by us or any of our subsidiaries on any indebtedness in excess of the amount specified in the applicable indenture. 4.375% Notes due 2028. We have $800 million aggregate principal amount of senior notes (the “4.375% Notes”) outstanding as of December 31, 2023, which are due June 15, 2028, unless earlier redeemed. Interest, at a rate of 4.375% per annum, is payable semiannually in arrears on June 15 and December 15. 3.875% Notes due 2030. We have $650 million aggregate principal amount of senior notes (the “3.875% Notes due 2030”) outstanding as of December 31, 2023, which are due November 15, 2030, unless earlier redeemed. Interest, at a rate of 3.875% per annum, is payable semiannually in arrears on May 15 and November 15. 3.875% Notes due 2032. |
Income Taxes
Income Taxes | 12 Months Ended |
Dec. 31, 2023 | |
Income Tax Disclosure [Abstract] | |
Income Taxes | Income Taxes Income tax expense for continuing operations consisted of the following: Year Ended December 31, 2023 2022 2021 (In millions) Current: Federal $ 349 $ 297 $ 209 State 55 40 31 Total current 404 337 240 Deferred: Federal (28) (66) (17) State (3) — (7) Total deferred (31) (66) (24) Income tax expense $ 373 $ 271 $ 216 A reconciliation of the U.S. federal statutory income tax rate to the combined effective income tax rate for continuing operations is as follows: Year Ended December 31, 2023 2022 2021 Statutory federal tax (benefit) rate 21.0 % 21.0 % 21.0 % State income provision (benefit), net of federal benefit 2.8 3.0 2.2 Nondeductible compensation 1.4 1.8 1.5 Other 0.3 (0.3) — Effective tax expense rate 25.5 % 25.5 % 24.7 % Our effective tax rate is based on expected income, statutory tax rates, and tax planning opportunities available to us in the various jurisdictions in which we operate. Management estimates and judgments are required in determining our effective tax rate. We are routinely under audit by federal, state, or local authorities regarding the timing and amount of deductions, nexus of income among various tax jurisdictions, and compliance with federal, state, foreign, and local tax laws. Deferred tax assets and liabilities are classified as non-current. Significant components of our deferred tax assets and liabilities as of December 31, 2023 and 2022 were as follows: December 31, 2023 2022 (In millions) Accrued expenses and reserve liabilities $ 94 $ 77 Other accrued medical costs 26 24 Net operating losses 7 9 Unearned premiums 19 16 Lease liabilities 87 88 Unrealized losses 26 49 Fixed assets and intangibles 24 9 Tax credit carryover 5 5 Other 6 5 Valuation allowance (24) (18) Total deferred income tax assets, net of valuation allowance 270 264 Right-of-use assets (29) (29) Prepaid expenses (14) (15) Total deferred income tax liabilities (43) (44) Net deferred income tax asset $ 227 $ 220 At December 31, 2023, we had state net operating loss carryforwards of $53 million, which begin expiring in 2036. At December 31, 2023, we had foreign net operating loss carryforwards of $11 million, which begin expiring in 2031. At December 31, 2023, we had foreign tax credit carryovers of $5 million, which expire in 2030. We evaluate the need for a valuation allowance taking into consideration the ability to carry back and carry forward tax credits and losses, available tax planning strategies and future income, including reversal of temporary differences. We have determined that as of December 31, 2023, $24 million of deferred tax assets did not satisfy the recognition criteria. Therefore, we increased our valuation allowance by $6 million, from $18 million at December 31, 2022, to $24 million as of December 31, 2023. We recognize tax benefits only if the tax position is more likely than not to be sustained. We are subject to income taxes in the United States, Puerto Rico, and numerous state jurisdictions. Significant judgment is required in evaluating our tax positions and determining our provision for income taxes. During the ordinary course of business, there are many transactions and calculations for which the ultimate tax determination is uncertain. We establish reserves for tax-related uncertainties based on estimates of whether, and the extent to which, additional taxes will be due. These reserves are established when we believe that certain positions might be challenged despite our belief that our tax return positions are fully supportable. We adjust these reserves in light of changing facts and circumstances, such as the outcome of tax audits. The provision for income taxes includes the impact of reserve provisions and changes to reserves that are considered appropriate. The roll forward of our unrecognized tax benefits is as follows: Year Ended December 31, 2023 2022 2021 (In millions) Gross unrecognized tax benefits at beginning of period $ (5) $ (15) $ (20) Settlements — — 5 Lapse in statute of limitations — 10 — Gross unrecognized tax benefits at end of period $ (5) $ (5) $ (15) The total amount of unrecognized tax benefits at December 31, 2023, 2022 and 2021 that, if recognized, would affect the effective tax rates is $5 million, $5 million, and $15 million, respectively. We expect that during the next 12 months it is reasonably possible that unrecognized tax benefit liabilities may decrease by $5 million due to resolution of a state refund claim. The state refund claim will not result in a cash payment for income taxes if our claim is denied. Our continuing practice is to recognize interest and/or penalties related to unrecognized tax benefits in income tax expense. Amounts accrued for the payment of interest and penalties as of December 31, 2023, 2022 and 2021 were insignificant. |
Stockholders' Equity
Stockholders' Equity | 12 Months Ended |
Dec. 31, 2023 | |
Equity [Abstract] | |
Stockholders' Equity | Stockholders' Equity Stock Purchase Programs In September 2023, our board of directors authorized the purchase of up to $750 million of our common stock. This new program supersedes the stock purchase program previously approved by our board of directors in November 2022 and extends through December 31, 2024. The exact timing and amount of any repurchase is determined by management based on market conditions and share price, in addition to other factors, and subject to the restrictions relating to volume, price, and timing under applicable law. No shares were purchased in 2023 and through February 9, 2024. Share-Based Compensation In connection with our employee stock plans, approximately 442,000 shares and 755,000 shares of common stock were issued, net of shares used to settle employees’ income tax obligations, during the years ended December 31, 2023, and 2022, respectively. Total share-based compensation expense is reported in “General and administrative expenses” in the accompanying consolidated statements of income, and summarized below. Year Ended December 31, 2023 2022 2021 (In millions) Pretax Net-of-Tax Pretax Net-of-Tax Pretax Net-of-Tax RSAs and PSUs (defined below) $ 108 $ 102 $ 97 $ 90 $ 66 $ 62 Employee stock purchase plan and stock options 7 7 6 6 6 6 Total $ 115 $ 109 $ 103 $ 96 $ 72 $ 68 Equity Incentive Plan At December 31, 2023, we had employee equity incentives outstanding under our 2019 Equity Incentive Plan (the “2019 EIP”). The 2019 EIP provides for awards, in the form of restricted stock awards (“RSAs”), performance units (“PSUs”), stock options, and other stock– or cash–based awards, to eligible persons who perform services for us. The 2019 EIP provides for the issuance of up to 2.9 million shares of our common stock. Stock-based awards . RSAs and PSUs are granted with a fair value equal to the market price of our common stock on the date of grant, and generally vest in equal annual installments over periods up to four years from the date of grant. PSUs vest in their entirety at the end of three-year performance periods, if their performance conditions are met. We generally recognize expense for RSAs and PSUs on a straight-line basis. The weighted-average grant date fair value of our RSAs was $277.37 in 2023, $312.27 in 2022, and $224.63 in 2021. The weighted-average grant date fair value of our PSUs was $233.50 in 2023, $214.94 in 2022, and $74.52 in 2021. Activity for stock-based awards in the year ended December 31, 2023, is summarized below. RSAs Weighted PSUs Weighted Unvested balance, December 31, 2022 511,105 $ 237.10 312,830 $ 193.09 Granted 294,604 277.37 470,284 233.50 Vested (224,269) 210.22 (328,998) 124.98 Forfeited (45,993) 261.71 (43,742) 261.01 Unvested balance, December 31, 2023 535,447 $ 268.41 410,374 $ 286.77 As of December 31, 2023, total unrecognized compensation expense related to unvested RSAs and PSUs was $88 million, and $52 million, respectively, which we expect to recognize over a remaining weighted-average period of 2.1 years, and 1.1 years, respectively. This unrecognized compensation cost assumes an estimated forfeiture rate of 8% for non-executive employees as of December 31, 2023, based on actual forfeitures over the last 4 years. The total fair value of awards vested is presented in the following table. Year Ended December 31, 2023 2022 2021 (In millions) RSAs $ 62 $ 70 $ 53 PSUs 90 69 71 Total vested $ 152 $ 139 $ 124 Stock Options. Stock option awards generally have an exercise price equal to the fair market value of our common stock on the date of grant, vest in equal annual installments over periods up to four years from the date of grant, and have a maximum term of ten years from the date of grant. Stock option activity for the year ended December 31, 2023, is summarized below. Number of Shares Weighted Average Exercise Price Aggregate Intrinsic Value Weighted Average Remaining Contractual term (Per share) (In millions) (Years) Stock options outstanding as of December 31, 2022 5,000 $ 33.02 Exercised (5,000) 33.02 Stock options outstanding, vested, and exercisable as of December 31, 2023 — — $ — 0.0 No stock options were granted in 2023, 2022, or 2021. As of December 31, 2023, there was no unrecognized compensation expense related to unvested stock options. Employee Stock Purchase Plans (“ESPP”) Under our ESPP, eligible employees may purchase common shares at 85% of the lower of the fair market value of our common stock on either the first or last trading day of each six-month offering period. Each participant is limited to a maximum purchase of $25,000 (as measured by the fair value of the stock acquired) per year through payroll deductions. We estimate the fair value of the stock issued using a standard option pricing model. For the years ended December 31, 2023, 2022, and 2021, the inputs to this model were as follows: risk-free interest rates of approximately 0.1% to 5.4%; expected volatility of approximately 28% to 54%, dividend yields of 0%, and an average expected life of 0.5 years. |
Employee Benefit Plans
Employee Benefit Plans | 12 Months Ended |
Dec. 31, 2023 | |
Postemployment Benefits [Abstract] | |
Employee Benefit Plans | Employee Benefit Plans We sponsor defined contribution 401(k) plans that cover substantially all employees of our company and its subsidiaries. Eligible employees are permitted to contribute up to the maximum amount allowed by law. We match up to the first 4% of compensation contributed by employees. Expense recognized in connection with our contributions to the 401(k) plans amounted to $54 million, $45 million, and $41 million in the years ended December 31, 2023, 2022, and 2021, respectively. We also have a non-qualified deferred compensation plan for certain key employees. Under this plan, eligible participants may defer portions of their base salary and bonus to provide tax-deferred growth. The deferrals are distributable based upon termination of employment or other periods, as elected under the plan and were $39 million and $26 million as of December 31, 2023 and 2022, respectively. |
Commitments and Contingencies
Commitments and Contingencies | 12 Months Ended |
Dec. 31, 2023 | |
Commitments and Contingencies Disclosure [Abstract] | |
Commitments and Contingencies | Commitments and Contingencies Regulatory Capital Requirements and Dividend Restrictions Our health plans, which are generally operated by our respective wholly owned subsidiaries in those states in which our health plans operate, are subject to state laws and regulations that, among other things, require the maintenance of minimum levels of statutory capital, as defined by each state. The National Association of Insurance Commissioners (“NAIC”), has adopted model rules which, if implemented by the states, set minimum capitalization requirements for insurance companies, HMOs, and other entities bearing risk for healthcare coverage. The requirements take the form of risk-based capital (“RBC”) rules which may vary from state to state. Regulators in some states may also enforce capital requirements that require the retention of net worth in excess of amounts formally required by statute or regulation. All of our health plans except California, Florida, Massachusetts and New York, are subject to the RBC rules. The minimum statutory capital requirements in these states are based on a percentage of annualized premium revenue, a percentage of annualized health care costs, a percentage of certain liabilities, or other financial ratios. If our California, Florida, Massachusetts or New York health plans became subject to RBC rules, minimum capital required for those states could increase. Our Massachusetts health plan maintains a $35 million performance bond, effective through December 31, 2024, to partially satisfy minimum net worth requirements in that state. Statutes, regulations and informal capital requirements also restrict the timing, payment, and amount of dividends and other distributions that may be paid to us as the sole stockholder. To the extent our subsidiaries must comply with these regulations, they may not have the financial flexibility to transfer funds to us. Based on current statutes and regulations, the net assets in these subsidiaries, which may not be transferable to us in the form of loans, advances, or cash dividends was approximately $3.7 billion at December 31, 2023. Because of the statutory restrictions that inhibit the ability of our health plans to transfer net assets to us, the amount of retained earnings readily available to pay dividends to our stockholders is generally limited to cash, cash equivalents and investments held by the parent company—Molina Healthcare, Inc. Such cash, cash equivalents and investments amounted to $742 million and $375 million as of December 31, 2023 and 2022, respectively. As of December 31, 2023, our health plans had aggregate statutory capital and surplus of approximately $4.1 billion, which was in excess of the required minimum aggregate statutory capital and surplus of approximately $2.3 billion. We have the ability and commitment to provide additional capital to each of our health plans when necessary to ensure that statutory capital and surplus continues to meet regulatory requirements. Legal Proceedings The healthcare industry is subject to numerous laws and regulations of federal, state, and local governments, as well as various contractual provisions, governing our operations. Compliance with these laws, regulations, and contractual provisions can be subject to government audit, review, and interpretation, as well as regulatory actions. Penalties associated with violations of these laws, regulations, and contractual provisions can include significant fines and penalties, temporary or permanent exclusion from participating in publicly funded programs, a limitation on our ability to market or sell products, the repayment of previously billed and collected revenues, and reputational damage. We are involved in legal actions in the ordinary course of business including, but not limited to, various employment claims, vendor disputes and provider claims. Some of these legal actions seek monetary damages, including claims for punitive damages, which may not be covered by insurance. We review legal matters and update our estimates, or range of estimates, of reasonably possible losses and related disclosures, as necessary. We have accrued liabilities for legal matters for which we deem the loss to be both probable and reasonably estimable. These liability estimates could change as a result of further developments. The outcome of these legal actions are inherently uncertain. An adverse determination in one or more of these pending matters could have a material adverse effect on our consolidated financial position, results of operations, or cash flows. Kentucky RFP. On September 4, 2020, Anthem Kentucky Managed Care Plan, Inc. (“Anthem”) brought an action in Franklin County Circuit Court against the Kentucky Finance and Administration Cabinet, the Kentucky Cabinet for Health and Family Services, and all of the five winning bidder health plans, including our Kentucky health plan. On September 9, 2022, the Kentucky Court of Appeals ruled that, with regard to the earlier Circuit Court ruling granting Anthem relief, the Circuit Court should not have invalidated the 2020 procurement and thus should not have awarded a contract to Anthem. Anthem sought discretionary review by the Kentucky Supreme Court (“KSC”) of the ruling by the Court of Appeals. On April 19, 2023, KSC granted Anthem’s request for discretionary review and ordered legal briefing, which the parties completed in September 2023. KSC has scheduled oral arguments on March 7, 2024. Pending further KSC order, our Kentucky health plan will continue to operate for the foreseeable future under its current Medicaid contract. At this time, the Company cannot predict the outcome, or provide a reasonable estimate or range of estimates of the possible outcome or loss, if any, in this matter. Puerto Rico. On August 13, 2021, Molina Healthcare of Puerto Rico, Inc. (“MHPR”) filed a complaint with the Commonwealth of Puerto Rico, Court of First Instance, San Juan (State Court) asserting, among other claims, breach of contract against Puerto Rico Health Insurance Administration (“ASES”). On September 13, 2021, ASES filed a counterclaim and a third-party complaint against MHPR and the Company. The parties are engaged in settlement conversations. A status hearing was held on September 28, 2023, in which ASES and Molina informed the Court of the ongoing settlement conversations. On January 15, 2024, ASES and Molina informed the court that they had reached an agreement in principle, and the Court has scheduled a status conference on March 5, 2024 . T he Company cannot predict the outcome, or provide a reasonable estimate or range of estimates of the possible outcome or loss, if any, in this matter. Texas Qui Tam Litigation. On May 7, 2013, a relator filed under seal a qui tam action in Texas state court against Molina Healthcare, Inc. and Molina Healthcare of Texas, Inc., asserting claims under the Texas Medicaid Fraud Prevention Act (“TMFPA”) on behalf of the State of Texas. The original petition alleged that Molina Healthcare of Texas knowingly failed to assess its STAR+PLUS members in accordance with the terms of its Medicaid contract with the State and made false statements to the State concerning those assessments that permitted Molina Healthcare of Texas to receive from the State unnecessary payments. As required by the TMFPA, the original petition was filed in camera and under seal, and without Molina’s awareness, to permit the State to decide whether to intervene and assume responsibility for prosecuting the lawsuit. In 2019, the State declined to intervene. In June 2019, as a result of the State’s election to decline intervention, the trial court unsealed the original petition, at which time Molina became aware of the lawsuit. The relator amended her original petition and served Molina in July 2019. In September 2019, Molina filed a motion to dismiss the relator’s claims under the Texas Citizens Participation Act. After the trial court denied the motion, and following extended appellate proceedings which automatically stayed all trial court proceedings, discovery in the lawsuit commenced in late 2021. The relator’s third amended petition was filed on January 19, 2024. The petition alleges that, during the periods in question some ten years ago, Molina failed to assess STAR+PLUS members for personal attendant services, failed to provide those members with contractually required health care benefits, and misrepresented to the State Molina’s capacity to perform the assessments and the status of the assessments. Based on these allegations, the relator contends that Molina is liable to the State under the TMFPA for statutorily defined civil remedies, disgorgement of previous capitation payments, and interest. Molina denies the relator’s allegations as well as any liability in the lawsuit, and intends to defend against the relator’s allegations vigorously. The lawsuit is currently in the discovery phase, with trial set before the Texas District Court, Travis County in late September 2024. The case remains subject to significant additional proceedings, and due to numerous factors of uncertainty presented in the case, we are currently unable to make a reasonable estimate, or range of estimates, with regard to the ultimate outcome of this matter. Professional Liability Insurance We carry medical professional liability insurance for healthcare services rendered in our primary care locations and throughout the communities we serve. In addition, we carry managed care errors and omissions insurance for all managed care services that we provide. |
Segments
Segments | 12 Months Ended |
Dec. 31, 2023 | |
Segment Reporting [Abstract] | |
Segments | Segments We currently have four reportable segments consisting of: 1) Medicaid; 2) Medicare; 3) Marketplace; and 4) Other. Our reportable segments are consistent with how we currently manage the business and view the markets we serve. The Medicaid, Medicare, and Marketplace segments represent the government-funded or sponsored programs under which we offer managed healthcare services. The Other segment, which is insignificant to our consolidated results of operations, includes long-term services and supports consultative services in Wisconsin. The key metrics used to assess the performance of our Medicaid, Medicare, and Marketplace segments are premium revenue, medical margin and medical care ratio (“MCR”). MCR represents the amount of medical care costs as a percentage of premium revenue. Therefore, the underlying medical margin, or the amount earned by the Medicaid, Medicare, and Marketplace segments after medical costs are deducted from premium revenue, represents the most important measure of earnings reviewed by management, and is used by our chief executive officer to review results, assess performance, and allocate resources. The key metric used to assess the performance of our Other segment is service margin. The service margin is equal to service revenue minus cost of service revenue. We do not report total assets by segment since this is not a metric used to assess segment performance or allocate resources. The following table presents total revenue by segment. Inter-segment revenue was insignificant for all periods presented. Year Ended December 31, 2023 2022 2021 (In millions) Total revenue: Medicaid $ 27,707 $ 25,783 $ 21,231 Medicare 4,227 3,824 3,379 Marketplace 2,062 2,296 3,091 Other 76 71 70 Consolidated $ 34,072 $ 31,974 $ 27,771 The following table reconciles margin by segment to consolidated income before income tax expense: Year Ended December 31, 2023 2022 2021 (In millions) Margin: Medicaid $ 2,973 $ 2,981 $ 2,322 Medicare 388 437 430 Marketplace 499 290 399 Other 9 11 14 Total margin 3,869 3,719 3,165 Add: other operating revenues (1) 1,467 1,020 846 Less: other operating expenses (2) (3,763) (3,566) (2,991) Operating income 1,573 1,173 1,020 Less: other expenses, net (3) 109 110 145 Income before income tax expense $ 1,464 $ 1,063 $ 875 ______________________ (1) Other operating revenues include premium tax revenue, investment income and certain other revenue. (2) Other operating expenses include general and administrative expenses, premium tax expenses, depreciation and amortization, impairment, and certain other operating expenses. (3) |
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 The condensed balance sheets as of December 31, 2023 and 2022, and the related condensed statements of income, comprehensive income and cash flows for each of the three years in the period ended December 31, 2023 for our parent company Molina Healthcare, Inc. (the “Registrant”), are presented below. Condensed Balance Sheets December 31, 2023 2022 (In millions, except per-share data) ASSETS Current assets: Cash and cash equivalents $ 694 $ 329 Investments 48 46 Due from affiliates 174 143 Prepaid expenses and other current assets 133 106 Total current assets 1,049 624 Property, equipment, and capitalized software, net 234 224 Goodwill and intangible assets, net 825 731 Investments in subsidiaries 4,911 4,142 Deferred income taxes, net 57 37 Advances to related parties and other assets 94 78 Total assets $ 7,170 $ 5,836 LIABILITIES AND STOCKHOLDERS’ EQUITY Current liabilities: Accounts payable, accrued liabilities and other $ 527 $ 448 Total current liabilities 527 448 Long-term debt 2,180 2,176 Finance lease liabilities 205 215 Other long-term liabilities 43 33 Total liabilities 2,955 2,872 Stockholders’ equity: Common stock, $0.001 par value; 150 million shares authorized; outstanding: 58 million shares at each of December 31, 2023 and December 31, 2022 — — Preferred stock, $0.001 par value; 20 million shares authorized, no shares issued and outstanding — — Additional paid-in capital 410 328 Accumulated other comprehensive loss (82) (160) Retained earnings 3,887 2,796 Total stockholders’ equity 4,215 2,964 Total liabilities and stockholders’ equity $ 7,170 $ 5,836 See accompanying notes. Condensed Statements of Income Year Ended December 31, 2023 2022 2021 (In millions) Revenue: Administrative services fees $ 2,038 $ 1,826 $ 1,496 Investment income and other revenue 27 8 11 Total revenue 2,065 1,834 1,507 Expenses: General and administrative expenses 1,952 1,721 1,424 Depreciation and amortization 131 141 98 Impairment — 138 — Other 20 — 5 Total operating expenses 2,103 2,000 1,527 Operating loss (38) (166) (20) Interest expense 109 110 120 Other expenses, net — — 25 Total other expenses, net 109 110 145 Loss before income tax benefit and equity in net earnings of subsidiaries (147) (276) (165) Income tax benefit (7) (42) (21) Net loss before equity in net earnings of subsidiaries (140) (234) (144) Equity in net earnings of subsidiaries 1,231 1,026 803 Net income $ 1,091 $ 792 $ 659 Condensed Statements of Comprehensive Income Year Ended December 31, 2023 2022 2021 (In millions) Net income $ 1,091 $ 792 $ 659 Other comprehensive income (loss): Unrealized investment income (loss) 102 (204) (55) Less: effect of income taxes 24 (49) (13) Other comprehensive income (loss), net of tax 78 (155) (42) Comprehensive income $ 1,169 $ 637 $ 617 See accompanying notes. Condensed Statements of Cash Flows Year Ended December 31, 2023 2022 2021 (In millions) Operating activities: Net cash provided by operating activities $ 81 $ 119 $ 60 Investing activities: Capital contributions to subsidiaries (221) (159) (440) Dividends received from subsidiaries 705 668 564 Purchases of investments (2) (29) (27) Proceeds from sales and maturities of investments 1 49 21 Purchases of property, equipment and capitalized software (79) (86) (70) Net cash paid in business combinations (74) — (263) Change in amounts due to/from affiliates 5 (69) 40 Other, net 7 3 (3) Net cash provided by (used in) investing activities 342 377 (178) Financing activities: Common stock purchases — (400) (128) Common stock withheld to settle employee tax obligations (60) (54) (53) Contingent consideration liabilities settled — (20) (20) Proceeds from senior notes offering, net of issuance costs — — 740 Repayment of senior notes — — (723) Other, net 2 33 1 Net cash used in financing activities (58) (441) (183) Net increase (decrease) in cash and cash equivalents 365 55 (301) Cash and cash equivalents at beginning of period 329 274 575 Cash and cash equivalents at end of period $ 694 $ 329 $ 274 Notes to Condensed Financial Information of Registrant Note A - Basis of Presentation The Registrant was incorporated in 2002. Prior to that date, Molina Healthcare of California (formerly known as Molina Medical Centers) operated as a California health plan and as the parent company for three other state health plans. In June 2003, the employees and operations of the corporate entity were transferred from Molina Healthcare of California to the Registrant. The Registrant’s investment in subsidiaries is stated at cost plus equity in undistributed earnings of subsidiaries since the date of acquisition. The accompanying condensed financial information of the Registrant should be read in conjunction with the consolidated financial statements and accompanying notes. Note B - Transactions with Subsidiaries The Registrant provides certain centralized medical and administrative services to our subsidiaries pursuant to administrative services agreements that include, but are not limited to, information technology, product development and administration, underwriting, claims processing, customer service, certain care management services, human resources, marketing, purchasing, risk management, actuarial, finance, accounting, compliance, legal and public relations. Fees are based on the fair market value of services rendered and are recorded as operating revenue. Payment is subordinated to the subsidiaries’ ability to comply with minimum capital and other restrictive financial requirements of the states in which they operate. Charges in 2023, 2022, and 2021 for these services amounted to $2,038 million, $1,826 million, and $1,496 million, respectively, and are included in operating revenue. The Registrant and its subsidiaries are included in the consolidated federal and state income tax returns filed by the Registrant. Income taxes are allocated to each subsidiary in accordance with an intercompany tax allocation agreement. The agreement allocates income taxes in an amount generally equivalent to the amount which would be expensed by the subsidiary if it filed a separate tax return. Net operating loss benefits are paid to the subsidiary by the Registrant to the extent such losses are utilized in the consolidated tax returns. Note C - Dividends and Capital Contributions When the Registrant receives dividends from its subsidiaries, such amounts are recorded as a reduction to the investments in the respective subsidiaries. |
Pay vs Performance Disclosure
Pay vs Performance Disclosure - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Pay vs Performance Disclosure | |||
Net income | $ 1,091 | $ 792 | $ 659 |
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 |
Significant Accounting Polici_2
Significant Accounting Policies (Policies) | 12 Months Ended |
Dec. 31, 2023 | |
Accounting Policies [Abstract] | |
Consolidation and Presentation | Consolidation and Presentation The consolidated financial statements include the accounts of Molina Healthcare, Inc., and its subsidiaries. All significant inter-company balances and transactions have been eliminated in consolidation. Financial information related to subsidiaries acquired during any year is included only for periods subsequent to their acquisition. We have reclassified certain 2022 amounts in the deferred tax asset and liabilities table in Note 12, “Income Taxes,” to conform to the 2023 presentation. In the opinion of management, all adjustments considered necessary for a fair presentation of the results as of the date and for the periods presented have been included; such adjustments consist of normal recurring adjustments. |
Use of Estimates | Use of Estimates |
Cash and Cash Equivalents | Cash and Cash Equivalents |
Investments | Investments Our investments are principally held in debt securities, which are grouped into two separate categories for accounting and reporting purposes: available-for-sale securities and held-to-maturity securities. Available-for-sale (“AFS”) securities are recorded at fair value and unrealized gains and losses, if any, are recorded in stockholders’ equity as other comprehensive income, net of applicable income taxes. Held-to-maturity (“HTM”) securities are recorded at amortized cost, which approximates fair value, and unrealized holding gains or losses are not generally recognized. Realized gains and losses and unrealized losses arising from credit-related factors with respect to AFS and HTM securities are included in the determination of net income. The cost of securities sold is determined using the specific-identification method. Our investment policy requires that all of our investments have final maturities of less than 15 years, or less than 15 years average life for structured securities. Investments and restricted investments are subject to interest rate risk and will decrease in value if market rates increase. Declines in interest rates over time will reduce our investment income. |
Receivables | Receivables Receivables consist primarily of premium amounts due from government agencies, which are subject to potential retroactive adjustments. We apply the current expected credit loss model to measure expected credits losses on our receivables based on available information about past events and reasonable and supportable forecasts. Because substantially all of our receivable amounts are readily determinable and substantially all of our creditors are governmental authorities, our allowance for credit losses is insignificant. Any amounts determined to be uncollectible are charged to expense when such determination is made. |
Business Combinations | Business Combinations |
Long-Lived Assets, including Intangible Assets | Long-Lived Assets, including Intangible Assets Long-lived assets consist primarily of property, equipment, capitalized software (see Note 7, “Property, Equipment, and Capitalized Software, Net”), and intangible assets resulting from acquisitions. Long-lived assets are subject to impairment tests when events or circumstances indicate that the asset’s (or asset group’s) carrying value may not be recoverable. Finite-lived, separately-identified intangible assets acquired in business combinations are assets that represent future expected benefits but lack physical substance (such as purchased contract rights and provider contracts). Intangible assets are initially recorded at fair value and are then amortized on a straight-line basis over their expected useful lives, generally between five Determining the fair value of separately identifiable intangible assets requires management to make estimates, which are based on all available information and in some cases assumptions with respect to the timing and amount of future revenues and expenses associated with an asset. Determining the useful life of an intangible asset also requires judgment, as different types of intangible assets will have different useful lives. The most significant intangible asset we typically record in a business combination is contract rights associated with membership acquired. In determining the estimated fair value of the intangible assets, we typically apply the income approach, which discounts the projected future net cash flows using an appropriate discount rate that reflects the risk associated with such projected future cash flows. The most critical assumptions used in determining the fair value of contract rights include forecasted operating margins and the weighted average cost of capital. Property and equipment are stated at historical cost. Replacements and major improvements are capitalized, and repairs and maintenance are charged to expense as incurred. Software developed for internal use is capitalized. Property and equipment are generally depreciated using the straight-line method over estimated useful lives ranging from three five |
Intangible Assets | Our intangible assets are subject to impairment tests when events or circumstances indicate that a finite-lived intangible asset’s (or asset group’s) carrying value may not be recoverable. Consideration is given to a number of potential impairment indicators, including the ability of our health plan subsidiaries to obtain the renewal by amendment of their contracts in each state prior to the actual expiration of their contracts. However, there can be no assurance that these contracts will continue to be renewed. Following the identification of any potential impairment indicators, to determine whether an impairment exists, we would compare the carrying amount of a finite-lived intangible asset with the greater of the undiscounted cash flows that are expected to result from the use of the asset or related group of assets, or its value under the asset liquidation method. If it is determined that the carrying amount of the asset is not recoverable, the amount by which the carrying value exceeds the estimated fair value is recorded as an impairment. |
Goodwill | Goodwill Goodwill represents the excess of the purchase consideration over the fair value of net assets acquired in business combinations. Goodwill is not amortized but is tested for impairment on an annual basis and more frequently if impairment indicators are present. Impairment indicators may include experienced or expected operating cash-flow deterioration or losses, significant losses of membership, loss of state funding, loss of state contracts, and other factors. Goodwill is impaired if the carrying amount of a reporting unit exceeds its estimated fair value. This excess is recorded as an impairment loss and adjusted if necessary for the impact of tax-deductible goodwill. The loss recognized may not exceed the total goodwill allocated to the reporting unit. When testing goodwill for impairment, we may first assess qualitative factors, such as industry and market factors, the dynamic economic and political environments in which we operate, cost factors, and changes in overall performance, to determine if it is more likely than not that the carrying value of our reporting units exceed their estimated fair values. If our qualitative assessment indicates that it is more likely than not that the carrying value of a reporting unit exceeds its estimated fair value, we perform the quantitative assessment. We may also elect to bypass the qualitative assessment and proceed directly to the quantitative assessment. We performed a qualitative goodwill assessment of our reporting units in the fourth quarter of 2023, and did not identify any factors indicating that the carrying value of our reporting units exceeded their estimated fair values. If performing a quantitative assessment, we generally estimate the fair values of our reporting units by applying the income approach, using discounted cash flows. The base year in the reporting units’ discounted cash flows is derived from the annual financial planning cycle, which commences in the fourth quarter of the year. As part of a quantitative assessment, we may also apply the asset liquidation method to estimate the fair value of individual reporting units, which is computed as total assets minus total liabilities, excluding intangible assets and deferred taxes. Finally, we apply a market approach to reconcile the value of our reporting units to our consolidated market value. Under the market approach, we consider publicly-traded comparable company information to determine revenue and earnings multiples which are used to estimate our reporting units’ fair values. The assumptions used are consistent with those used in our long-range business plan and annual planning process. However, if these assumptions differ from actual results, the outcome of our goodwill impairment tests could be adversely affected. |
Leases | Leases Right-of-use (“ROU”) assets represent our right to use the underlying assets over the lease term, and lease liabilities represent our obligation for lease payments arising from the related leases. ROU assets and lease liabilities are recognized at the lease commencement date based on the present value of lease payments over the lease term. Lease terms may include options to extend or terminate the lease when we believe it is reasonably certain that we will exercise such options. If applicable, we account for lease and non-lease components within a lease as a single lease component. Because most of our leases do not provide an implicit interest rate, we generally use our incremental borrowing rate to determine the present value of lease payments. Lease expenses for operating lease payments are recognized on a straight-line basis over the lease term, and the related ROU assets and liabilities are reduced to the present value of the remaining lease payments at the end of each period. Finance lease payments reduce finance lease liabilities, the related ROU assets are amortized on a straight-line basis over the lease term, and interest expense is recognized using the effective interest method. |
Medical Claims and Benefits Payable | Medical Claims and Benefits Payable Medical care costs are recognized in the period in which services are provided and include fee-for-service claims, pharmacy benefits, capitation payments to providers, and various other medically-related costs. Under fee-for-service claims arrangements with providers, we retain the financial responsibility for medical care provided and incur costs based on actual utilization of hospital and physician services. Such medical care costs include amounts paid by us as well as estimated medical claims and benefits payable for costs that were incurred but not paid as of the reporting date (“IBNP”). Pharmacy benefits represent payments for members' prescription drug costs, net of rebates from drug manufacturers. We estimate pharmacy rebates based on historical and current utilization of prescription drugs and contractual provisions. Capitation payments represent monthly contractual fees paid to providers, who are responsible for providing medical care to members, which could include medical or ancillary costs like dental, vision and other supplemental health benefits. Such capitation costs are fixed in advance of the periods covered and are not subject to significant accounting estimates. Other medical care costs include all medically-related administrative costs, amounts due to providers pursuant to risk-sharing or other incentive arrangements, provider claims, and other healthcare expenses. Examples of medically-related administrative costs include expenses relating to health education, quality assurance, case management, care coordination, disease management, and 24-hour on-call nurses. Additionally, we include an estimate for the cost of settling claims incurred through the reporting date in our medical claims and benefits payable liability . Medical claims and benefits payable consist mainly of fee-for-service IBNP, unpaid pharmacy claims, capitation costs, other medical costs, including amounts payable to providers pursuant to risk-sharing or other incentive arrangements and amounts payable to providers on behalf of certain state agencies for certain state assessments in which we assume no financial risk . IBNP includes the costs of claims incurred as of the balance sheet date which have been reported to us, and our best estimate of the cost of claims incurred but not yet reported to us. When more complete claims payment information and healthcare cost trend data becomes available, we reflect changes in these estimates as an increase or decrease to medical care costs in the consolidated results of operations in the period in which they are determined. The estimation of the IBNP liability requires a significant degree of judgment in applying actuarial methods, determining the appropriate assumptions and considering numerous factors. Of those factors, we consider estimated completion factors and the assumed healthcare cost trend to be the most critical assumptions. Other relevant factors also include, but are not limited to, healthcare service utilization trends, claim inventory levels, changes in membership, product mix, seasonality, benefit changes or changes in Medicaid fee schedules, provider contract changes, prior authorizations and the incidence of catastrophic or pandemic cases. Because of the significant degree of judgment involved in estimation of our IBNP liability, there is considerable variability and uncertainty inherent in such estimates. Each reporting period, the recognized IBNP liability represents our best estimate of the total amount of unpaid claims incurred as of the balance sheet date using a consistent methodology in estimating our IBNP liability, including a provision for moderately adverse conditions for each current period. We believe our current estimates are reasonable and adequate; however, the development of our estimate is a continuous process that we monitor and update as more complete claims payment information and healthcare cost trend data becomes available. Actual medical care costs may be less than we previously estimated (favorable development) or more than we previously estimated (unfavorable development), and any differences could be material. Any adjustments to reflect favorable development would be recognized as a decrease to medical care costs, and any adjustments to reflect unfavorable development would be recognized as an increase to medical care costs , in the period in which the adjustments are determined. Refer to Note 10, “Medical Claims and Benefits Payable,” for a table presenting the components of the change in our medical claims and benefits payable, for all periods presented in the accompanying consolidated financial statements. Premium Revenue Recognition and Amounts Due Government Agencies Premium revenue is generated from our contracts with state and federal agencies, in connection with our participation in the Medicaid, Medicare, and Marketplace programs. Premium revenue is generally received based on per member per month (“PMPM”) rates established in advance of the periods covered. These premium revenues are recognized in the month that members are entitled to receive healthcare services, and premiums collected in advance are deferred. Many of our contracts contain provisions that may adjust or limit revenue or profit. Consequently, we recognize premium revenue as it is earned under such provisions. Liabilities accrued for premiums to be returned under such provisions are reported in the aggregate as “Amounts due government agencies” in the accompanying consolidated balance sheets. State Medicaid programs and the federal Medicare program periodically adjust premium rates, including certain components of premium revenue that are subject to accounting estimates further discussed below. Minimum MLR, Medical Cost Corridors and Profit Sharing. The Affordable Care Act (“ACA”) established a Minimum MLR of 85% for Medicare. Federal regulations define what constitutes medical costs and premium revenue. If the Minimum MLR is not met, we may be required to pay rebates to the federal government. Our dual-eligible plans may also be subject to state-specific Minimum MLRs, medical cost corridors, and profit-sharing provisions. We recognize estimated rebates as an adjustment to premium revenue in our consolidated statements of income. We recorded a liability under the terms of such contract provisions of $64 million and $84 million at December 31, 2023 and 2022, respectively, to amounts due government agencies. The ACA established a Minimum MLR of 80% for the Marketplace. If the Minimum MLR is not met, we may be required to pay rebates to our Marketplace policyholders. The Marketplace risk adjustment program discussed below is taken into consideration when computing the Minimum MLR. We recognize estimated rebates under the Minimum MLR as an adjustment to premium revenue in our consolidated statements of income. The amounts were insignificant at December 31, 2023 and 2022. Risk Adjustment. Our Medicare premiums are subject to retroactive increase or decrease based on the health status of our Medicare members (as measured by member risk score). We estimate our members’ risk scores and the related amount of Medicare revenue that will ultimately be realized for the periods presented based on our knowledge of our members’ health status, risk scores and CMS practices. We also estimate amounts owed to CMS for Part D settlements. We recorded a liability under the terms of such contract provisions of $66 million and $76 million at December 31, 2023 and 2022, respectively, to amounts due government agencies. Other Premium Adjustments. State Medicaid programs periodically adjust premium revenues on a retroactive basis for rate changes and changes in membership and eligibility data. In certain states, adjustments are made based on the health status of our members (as measured through a risk score). In these cases, we adjust our premium revenue in the period in which we determine that the adjustment is probable and reasonably estimable, based on our best estimate of the ultimate premium we expect to realize for the period being adjusted. Quality Incentives |
Reinsurance | Reinsurance We bear underwriting and reserving risks associated with our health plan subsidiaries. In certain cases, we limit our risk of significant catastrophic losses by maintaining high deductible reinsurance coverage with a highly-rated, unaffiliated insurance company (the “third-party reinsurer”). Because we remain liable for losses in the event the third-party reinsurer is unable to pay its portion of the losses, we continually monitor the third-party reinsurer’s financial condition, including its ability to maintain high credit ratings. Intercompany transactions with our captive are eliminated in consolidation. |
Income Taxes | Income Taxes We account for income taxes under the asset and liability method. Deferred tax assets and liabilities are determined based on the difference between the financial statement and tax bases of assets and liabilities using enacted tax rates expected to be in effect during the year in which the basis differences reverse. Valuation allowances are |
Taxes Based on Premiums | Taxes Based on Premiums Premium and Use Tax. |
Concentrations of Credit Risk | Concentrations of Credit Risk |
Risks and Uncertainties | Risks and Uncertainties Our profitability depends in large part on our ability to accurately predict and effectively manage medical care costs. We continually review our medical costs in light of our underlying claims experience and revised actuarial data. However, several factors could adversely affect medical care costs. These factors, which include changes in healthcare practices, inflation, new technologies, major epidemics, natural disasters, and malpractice litigation, are beyond our control and may have an adverse effect on our ability to accurately predict and effectively control medical care costs. Costs in excess of those anticipated could have a material adverse effect on our financial condition, results of operations, or cash flows. We operate health plans primarily as a direct contractor with the states, and in Los Angeles County, California, as a subcontractor to another health plan holding a direct contract with the state. We are therefore dependent upon a relatively small number of contracts to support our revenue. The loss of any one of those contracts could have a material adverse effect on our financial position, results of operations, or cash flows. In addition, our ability to arrange for the provision of medical services to our members is dependent upon our ability to develop and maintain adequate provider networks. Our inability to develop or maintain such networks might, in certain circumstances, have a material adverse effect on our financial position, results of operations, or cash flows. |
Recent Accounting Pronouncements | Recent Accounting Pronouncements In November 2023, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) 2023-07, Improvements to Reportable Segment Disclosures , which will require disclosure of incremental segment information on an annual and interim basis for all public entities. The amendments do not change how a public entity identifies its operating segments, aggregates those operating segments, or applies the quantitative thresholds to determine its reportable segments. ASU 2023-07 is effective for annual reporting beginning with the fiscal year ending December 31, 2024, and for interim periods thereafter. We are currently evaluating the incremental disclosures that will be required in the footnotes to our consolidated financial statements. In December 2023, the FASB issued ASU 2023-09, Improvements to Income Tax Disclosures , which will require incremental income tax disclosures on an annual basis for all public entities. The amendments require that public business entities disclose specific categories in the rate reconciliation and provide additional information for reconciling items meeting a quantitative threshold. The amendments also require disclosure of income taxes paid to be disaggregated by jurisdiction, and disclosure of income tax expense disaggregated by federal, state, and foreign. ASU 2023-09 is effective for annual reporting beginning with the fiscal year ending December 31, 2025. We are currently evaluating the incremental disclosures that will be required in our consolidated financial statements. Other recent accounting pronouncements issued by the FASB (including its Emerging Issues Task Force), the American Institute of Certified Public Accountants, and the Securities and Exchange Commission (“SEC”) did not have, nor does management expect such pronouncements to have, a significant impact on our present or future consolidated financial statements. |
Fair Value Measurements | Fair Value Measurements We consider the carrying amounts of current assets and current liabilities to approximate their fair values because of the relatively short period of time between the origination of these instruments and their expected realization or payment. For our financial instruments measured at fair value on a recurring basis, we prioritize the inputs used in measuring fair value according to a three-tier fair value hierarchy as follows: Level 1 — Observable Inputs. Level 1 financial instruments are actively traded and therefore the fair value for these securities is based on quoted market prices for identical securities in active markets. Level 2 — Directly or Indirectly Observable Inputs. Fair value for these investments is determined using a market approach based on quoted prices for similar securities in active markets or quoted prices for identical securities in inactive markets. Level 3 — Unobservable Inputs. |
Significant Accounting Polici_3
Significant Accounting Policies (Tables) | 12 Months Ended |
Dec. 31, 2023 | |
Accounting Policies [Abstract] | |
Schedule of Cash and Cash Equivalents | The restricted cash and cash equivalents presented below are included in “Restricted investments” in the accompanying consolidated balance sheets. December 31, 2023 2022 2021 (In millions) Cash and cash equivalents $ 4,848 $ 4,006 $ 4,438 Restricted cash and cash equivalents 60 42 68 Total cash and cash equivalents, and restricted cash and cash equivalents presented in the consolidated statements of cash flows $ 4,908 $ 4,048 $ 4,506 |
Schedule of Restricted Cash and Cash Equivalents | The restricted cash and cash equivalents presented below are included in “Restricted investments” in the accompanying consolidated balance sheets. December 31, 2023 2022 2021 (In millions) Cash and cash equivalents $ 4,848 $ 4,006 $ 4,438 Restricted cash and cash equivalents 60 42 68 Total cash and cash equivalents, and restricted cash and cash equivalents presented in the consolidated statements of cash flows $ 4,908 $ 4,048 $ 4,506 |
Schedule of Receivables | December 31, 2023 2022 (In millions) Government receivables $ 2,354 $ 1,702 Pharmacy rebate receivables 330 291 Other 420 309 Total receivables $ 3,104 $ 2,302 |
Net Income Per Share (Tables)
Net Income Per Share (Tables) | 12 Months Ended |
Dec. 31, 2023 | |
Earnings Per Share [Abstract] | |
Schedule of Denominators for The Computation of Basic and Diluted Earnings Per Share | The following table sets forth the calculation of basic and diluted net income per share: Year Ended December 31, 2023 2022 2021 (In millions, except net income per share) Numerator: Net income $ 1,091 $ 792 $ 659 Denominator: Shares outstanding at the beginning of the period 57.4 57.9 58.0 Weighted-average number of shares issued: Stock purchases — (0.5) (0.5) Stock-based compensation 0.3 0.4 0.3 Denominator for basic net income per share 57.7 57.8 57.8 Effect of dilutive securities: (1) Stock-based compensation 0.4 0.7 0.8 Denominator for diluted net income per share 58.1 58.5 58.6 Net income per share - Basic (2) $ 18.91 $ 13.72 $ 11.40 Net income per share - Diluted (2) $ 18.77 $ 13.55 $ 11.25 _______________________________ (1) The dilutive effect of all potentially dilutive common shares is calculated using the treasury stock method. Certain potentially dilutive common shares issuable are not included in the computation of diluted net income per share because to do so would have been anti-dilutive. |
Business Combinations (Tables)
Business Combinations (Tables) | 12 Months Ended |
Dec. 31, 2023 | |
Business Combination and Asset Acquisition [Abstract] | |
Schedule of Recognized Identified Assets Acquired and Liabilities Assumed | The following table summarizes the provisional fair values assigned to assets acquired and liabilities assumed, in millions. Assets acquired: Current assets $ 96 Goodwill 126 Intangible assets 18 Other long-term assets 7 Liabilities assumed: Medical claims and benefits payable (96) Amounts due government agencies (19) Accounts payable, accrued and other long-term liabilities (58) Net consideration transferred $ 74 |
Schedule of Intangible Assets | Fair Value Life (In millions) (Years) Contract rights - member list $ 13 7 Trade Name 3 2 Provider network 2 10 $ 18 |
Fair Value Measurements (Tables
Fair Value Measurements (Tables) | 12 Months Ended |
Dec. 31, 2023 | |
Fair Value Disclosures [Abstract] | |
Schedule of Fair Value of Assets Measured on Recurring Basis | Our financial instruments measured at fair value on a recurring basis at December 31, 2023, were as follows: Total Level 1 Level 2 Level 3 (In millions) Corporate debt securities $ 2,732 $ — $ 2,732 $ — Mortgage-backed securities 911 — 911 — Asset-backed securities 365 — 365 — Municipal securities 166 — 166 — U.S. Treasury notes 40 — 40 — Other 45 — 45 — Total assets $ 4,259 $ — $ 4,259 $ — Our financial instruments measured at fair value on a recurring basis at December 31, 2022, were as follows: Total Level 1 Level 2 Level 3 (In millions) Corporate debt securities $ 2,184 $ — $ 2,184 $ — Mortgage-backed securities 731 — 731 — Asset-backed securities 288 — 288 — Municipal securities 149 — 149 — U.S. Treasury notes 105 — 105 — Other 42 — 42 — Total assets $ 3,499 $ — $ 3,499 $ — Contingent consideration liabilities $ 8 $ — $ — $ 8 Total liabilities $ 8 $ — $ — $ 8 |
Schedule of Fair Value Measurements of Senior Notes | December 31, 2023 December 31, 2022 Carrying Fair Value Carrying Fair Value (In millions) 4.375% Notes due 2028 $ 794 $ 757 $ 792 $ 729 3.875% Notes due 2030 644 583 643 554 3.875% Notes due 2032 742 654 741 629 Total $ 2,180 $ 1,994 $ 2,176 $ 1,912 |
Investments (Tables)
Investments (Tables) | 12 Months Ended |
Dec. 31, 2023 | |
Investments, Debt and Equity Securities [Abstract] | |
Schedule of Investments | The following tables summarize our current investments as of the dates indicated: December 31, 2023 Amortized Gross Estimated Gains Losses (In millions) Corporate debt securities $ 2,781 $ 16 $ 65 $ 2,732 Mortgage-backed securities 951 4 44 911 Asset-backed securities 376 1 12 365 Municipal securities 172 — 6 166 U.S. Treasury notes 40 — — 40 Other 47 — 2 45 Total $ 4,367 $ 21 $ 129 $ 4,259 December 31, 2022 Amortized Gross Estimated Gains Losses (In millions) Corporate debt securities $ 2,303 $ 2 $ 121 $ 2,184 Mortgage-backed securities 787 — 56 731 Asset-backed securities 308 — 20 288 Municipal securities 160 — 11 149 U.S. Treasury notes 106 — 1 105 Other 45 — 3 42 Total $ 3,709 $ 2 $ 212 $ 3,499 |
Schedule of Contractual Maturities of Investments | The contractual maturities of our current investments as of December 31, 2023 are summarized below: Amortized Estimated (In millions) Due in one year or less $ 538 $ 530 Due after one year through five years 2,437 2,384 Due after five years through ten years 406 405 Due after ten years 986 940 Total $ 4,367 $ 4,259 |
Schedule of Available-for-Sale Investments | The following table segregates those available-for-sale investments that have been in a continuous loss position for less than 12 months, and those that have been in a continuous loss position for 12 months or more as of December 31, 2023: In a Continuous Loss Position In a Continuous Loss Position Estimated Unrealized Total Number of Positions Estimated Unrealized Total Number of Positions (Dollars in millions) Corporate debt securities $ 263 $ 1 160 $ 1,553 $ 64 754 Mortgage-backed securities 123 2 98 549 42 283 Asset-backed securities — — — 195 12 91 Municipal securities — — — 117 6 116 Other — — — 17 2 17 Total $ 386 $ 3 258 $ 2,431 $ 126 1,261 The following table segregates those available-for-sale investments that have been in a continuous loss position for less than 12 months, and those that have been in a continuous loss position for 12 months or more as of December 31, 2022: In a Continuous Loss Position In a Continuous Loss Position Estimated Unrealized Total Number of Positions Estimated Unrealized Total Number of Positions (Dollars in millions) Corporate debt securities $ 1,124 $ 45 683 $ 887 $ 76 371 Mortgage-backed securities 395 20 220 319 36 131 Asset-backed securities 161 6 108 118 14 59 Municipal securities 75 4 83 57 7 57 U.S. Treasury notes 88 1 6 — — — Other 15 1 16 17 2 6 Total $ 1,858 $ 77 1,116 $ 1,398 $ 135 624 |
Schedule of Balances of Restricted Investments | The following table presents the balances of restricted investments: December 31, 2023 2022 (In millions) Cash and cash equivalents $ 60 $ 42 U.S. Treasury notes 167 159 Corporate debt securities 34 37 Total restricted investments $ 261 $ 238 |
Property, Equipment, and Capi_2
Property, Equipment, and Capitalized Software, Net (Tables) | 12 Months Ended |
Dec. 31, 2023 | |
Property, Plant and Equipment [Abstract] | |
Schedule of Property and Equipment and Depreciation and Amortization Recognized | A summary of property, equipment, and capitalized software is as follows: December 31, 2023 2022 (In millions) Capitalized software $ 687 $ 615 Property and equipment 199 221 Building and improvements 41 41 Land 5 5 Total cost 932 882 Less: accumulated amortization - capitalized software (537) (482) Less: accumulated depreciation and amortization - property, equipment, building, and improvements (192) (213) Total accumulated depreciation and amortization (729) (695) ROU assets - finance leases 67 72 Property, equipment, and capitalized software, net $ 270 $ 259 The following table presents all depreciation and amortization recognized in our consolidated statements of income: Year Ended December 31, 2023 2022 2021 (In millions) Recorded in depreciation and amortization: Amortization of intangible assets $ 85 $ 77 $ 49 Amortization of capitalized software 58 54 41 Amortization of finance leases 18 28 25 Depreciation and amortization of property, equipment, building, and improvements 10 17 16 Total depreciation and amortization recognized $ 171 $ 176 $ 131 |
Leases (Tables)
Leases (Tables) | 12 Months Ended |
Dec. 31, 2023 | |
Leases [Abstract] | |
Schedule of Components of Lease Expense and Supplemental Consolidated Cash flow Information | The components of lease expense for the years ended December 31, 2023, 2022, and 2021 are presented in the following table. Year Ended December 31, 2023 2022 2021 (In millions) Operating lease expense $ 15 $ 31 $ 34 Finance lease expense: Amortization of ROU assets $ 18 $ 28 $ 25 Interest on lease liabilities 15 15 15 Total finance lease expense $ 33 $ 43 $ 40 Supplemental consolidated cash flow information related to leases follows: Year Ended December 31, 2023 2022 2021 (In millions) Cash used in operating activities: Operating leases $ 28 $ 31 $ 33 Finance leases 15 15 15 Cash used in financing activities: Finance leases 24 15 18 ROU assets recognized in exchange for lease obligations: Operating leases 12 10 86 Finance leases 13 18 18 |
Schedule of Supplemental Lease Information | Supplemental information related to leases, including location of amounts reported in the accompanying consolidated balance sheets, follows: December 31, 2023 2022 (In millions) Operating leases: ROU assets Other assets $ 43 $ 43 Lease liabilities Accounts payable and accrued liabilities (current) $ 20 $ 41 Other long-term liabilities (non-current) 85 77 Total operating lease liabilities $ 105 $ 118 Finance leases: ROU assets Property, equipment, and capitalized software, net $ 67 $ 72 Lease liabilities Accounts payable and accrued liabilities (current) $ 21 $ 22 Finance lease liabilities (non-current) 205 215 Total finance lease liabilities $ 226 $ 237 |
Schedule of Operating Lease Maturities | Maturities of lease liabilities as of December 31, 2023, were as follows: Operating Finance Leases Leases (In millions) 2024 $ 24 $ 34 2025 20 30 2026 14 26 2027 11 24 2028 9 25 Thereafter 50 194 Subtotal - undiscounted lease payments 128 333 Less imputed interest (23) (107) Total $ 105 $ 226 |
Schedule of Finance Lease Maturities | Maturities of lease liabilities as of December 31, 2023, were as follows: Operating Finance Leases Leases (In millions) 2024 $ 24 $ 34 2025 20 30 2026 14 26 2027 11 24 2028 9 25 Thereafter 50 194 Subtotal - undiscounted lease payments 128 333 Less imputed interest (23) (107) Total $ 105 $ 226 |
Goodwill and Intangible Asset_2
Goodwill and Intangible Assets, Net (Tables) | 12 Months Ended |
Dec. 31, 2023 | |
Goodwill and Intangible Assets Disclosure [Abstract] | |
Schedule of Goodwill | The following table presents the changes in the carrying amounts of goodwill by segment, for the periods presented. Medicaid Medicare Other Consolidated (In millions) Balance, December 31, 2021 $ 769 $ 169 $ 44 $ 982 Acquisitions and measurement period adjustments 130 3 — 133 Balance, December 31, 2022 899 172 44 1,115 Acquisitions and measurement period adjustments 95 31 — 126 Balance, December 31, 2023 $ 994 $ 203 $ 44 $ 1,241 |
Schedule of Identified Intangible Assets, by Major Class | The following table provides the details of identified intangible assets, by major class, for the periods presented. December 31, 2023 December 31, 2022 Cost Accumulated Carrying Amount Cost Accumulated Carrying Amount (In millions) Contract rights and licenses $ 520 $ 357 $ 163 $ 507 $ 279 $ 228 Provider networks 59 29 30 57 24 33 Trade names 22 7 15 19 5 14 Total $ 601 $ 393 $ 208 $ 583 $ 308 $ 275 |
Medical Claims and Benefits P_2
Medical Claims and Benefits Payable (Tables) | 12 Months Ended |
Dec. 31, 2023 | |
Insurance [Abstract] | |
Schedule of Liability for Unpaid Claims and Claims Adjustment Expense | The following table provides the details of our medical claims and benefits payable as of the dates indicated. December 31, 2023 2022 2021 (In millions) Fee-for-service claims incurred but not paid (“IBNP”) $ 2,901 $ 2,597 $ 2,486 Pharmacy payable 202 206 219 Capitation payable 100 94 82 Other 1,001 631 576 Total $ 4,204 $ 3,528 $ 3,363 |
Schedule of Components of The Change in Medical Claims and Benefits Payable | The following tables present the components of the change in our medical claims and benefits payable for the periods indicated. Year Ended December 31, 2023 Medicaid Medicare Marketplace Consolidated (In millions) Medical claims and benefits payable, beginning balance $ 2,815 $ 452 $ 261 $ 3,528 Components of medical care costs related to: Current year 23,749 3,802 1,545 29,096 Prior years (395) (11) (21) (427) Total medical care costs 23,354 3,791 1,524 28,669 Payments for medical care costs related to: Current year 20,999 3,293 1,323 25,615 Prior years 2,069 431 234 2,734 Total paid 23,068 3,724 1,557 28,349 Acquired balances, net of post-acquisition adjustments 82 14 — 96 Change in non-risk and other provider payables 261 (1) — 260 Medical claims and benefits payable, ending balance $ 3,444 $ 532 $ 228 $ 4,204 Year Ended December 31, 2022 Medicaid Medicare Marketplace Consolidated (In millions) Medical claims and benefits payable, beginning balance $ 2,580 $ 404 $ 379 $ 3,363 Components of medical care costs related to: Current year 22,097 3,390 1,972 27,459 Prior years (251) (32) (1) (284) Total medical care costs 21,846 3,358 1,971 27,175 Payments for medical care costs related to: Current year 19,655 2,944 1,746 24,345 Prior years 1,966 361 343 2,670 Total paid 21,621 3,305 2,089 27,015 Acquired balances, net of post-acquisition adjustments 12 — — 12 Change in non-risk and other provider payables (2) (5) — (7) Medical claims and benefits payable, ending balance $ 2,815 $ 452 $ 261 $ 3,528 Year Ended December 31, 2021 Medicaid Medicare Marketplace Consolidated (In millions) Medical claims and benefits payable, beginning balance $ 2,129 $ 392 $ 175 $ 2,696 Components of medical care costs related to: Current year 18,321 2,970 2,652 23,943 Prior years (182) (39) (18) (239) Total medical care costs 18,139 2,931 2,634 23,704 Payments for medical care costs related to: Current year 16,284 2,573 2,291 21,148 Prior years 1,601 340 139 2,080 Total paid 17,885 2,913 2,430 23,228 Acquired balances, net of post-acquisition adjustments 205 (8) — 197 Change in non-risk and other provider payables (8) 2 — (6) Medical claims and benefits payable, ending balance $ 2,580 $ 404 $ 379 $ 3,363 |
Schedule of Incurred and Paid Claims Development | The following tables provide information about our consolidated incurred and paid claims development as of December 31, 2023, as well as cumulative claims frequency and the total of incurred but not paid claims liabilities. The pattern of incurred and paid claims development is consistent across each of our segments. The cumulative claim frequency is measured by claim event, and includes claims covered under capitated arrangements. Incurred Claims and Allocated Claims Adjustment Expenses Total IBNP Cumulative number of reported claims Benefit Year 2021 2022 2023 (Unaudited) (Unaudited) (In millions) 2021 $ 24,167 $ 23,979 $ 23,912 $ 18 133 2022 27,459 27,128 77 163 2023 29,096 2,803 153 $ 80,136 $ 2,898 Cumulative Paid Claims and Allocated Claims Adjustment Expenses Benefit Year 2021 2022 2023 (Unaudited) (Unaudited) (In millions) 2021 $ 21,148 $ 23,871 $ 23,894 2022 24,345 27,051 2023 25,615 $ 76,560 |
Schedule of Reconciliation of Claims Development to Liability | The following table represents a reconciliation of claims development to the aggregate carrying amount of the liability for medical claims and benefits payable. 2023 (In millions) Incurred claims and allocated claims adjustment expenses $ 80,136 Less: cumulative paid claims and allocated claims adjustment expenses (76,560) All outstanding liabilities before 2021 3 Acquired balances 96 Non-risk and other provider payables 529 Medical claims and benefits payable $ 4,204 |
Debt (Tables)
Debt (Tables) | 12 Months Ended |
Dec. 31, 2023 | |
Debt Disclosure [Abstract] | |
Schedule of Maturities of Long-Term Debt | Contractual maturities of debt, as of December 31, 2023, are illustrated in the following table. All amounts represent the principal amounts of the debt instruments outstanding. Total 2024 2025 2026 2027 2028 Thereafter (In millions) 4.375% Notes due 2028 $ 800 $ — $ — $ — $ — $ 800 $ — 3.875% Notes due 2030 650 — — — — — 650 3.875% Notes due 2032 750 — — — — — 750 Total $ 2,200 $ — $ — $ — $ — $ 800 $ 1,400 |
Schedule of Long Term Debt | The following table summarizes our outstanding debt obligations, all of which are non-current as of the dates reported below: December 31, 2023 2022 (In millions) Non-current long-term debt: 4.375% Notes due 2028 $ 800 $ 800 3.875% Notes due 2030 650 650 3.875% Notes due 2032 750 750 Less: unamortized debt issuance costs (20) (24) Total $ 2,180 $ 2,176 |
Income Taxes (Tables)
Income Taxes (Tables) | 12 Months Ended |
Dec. 31, 2023 | |
Income Tax Disclosure [Abstract] | |
Schedule of Provision for Income Taxes | Income tax expense for continuing operations consisted of the following: Year Ended December 31, 2023 2022 2021 (In millions) Current: Federal $ 349 $ 297 $ 209 State 55 40 31 Total current 404 337 240 Deferred: Federal (28) (66) (17) State (3) — (7) Total deferred (31) (66) (24) Income tax expense $ 373 $ 271 $ 216 |
Schedule of Effective Income Tax Rate Reconciliation to The Statutory Federal Income Tax Rate | A reconciliation of the U.S. federal statutory income tax rate to the combined effective income tax rate for continuing operations is as follows: Year Ended December 31, 2023 2022 2021 Statutory federal tax (benefit) rate 21.0 % 21.0 % 21.0 % State income provision (benefit), net of federal benefit 2.8 3.0 2.2 Nondeductible compensation 1.4 1.8 1.5 Other 0.3 (0.3) — Effective tax expense rate 25.5 % 25.5 % 24.7 % |
Schedule of Significant Components of Deferred Tax Assets and Liabilities | Significant components of our deferred tax assets and liabilities as of December 31, 2023 and 2022 were as follows: December 31, 2023 2022 (In millions) Accrued expenses and reserve liabilities $ 94 $ 77 Other accrued medical costs 26 24 Net operating losses 7 9 Unearned premiums 19 16 Lease liabilities 87 88 Unrealized losses 26 49 Fixed assets and intangibles 24 9 Tax credit carryover 5 5 Other 6 5 Valuation allowance (24) (18) Total deferred income tax assets, net of valuation allowance 270 264 Right-of-use assets (29) (29) Prepaid expenses (14) (15) Total deferred income tax liabilities (43) (44) Net deferred income tax asset $ 227 $ 220 |
Schedule of Unrecognized Tax Benefits Roll Forward | The roll forward of our unrecognized tax benefits is as follows: Year Ended December 31, 2023 2022 2021 (In millions) Gross unrecognized tax benefits at beginning of period $ (5) $ (15) $ (20) Settlements — — 5 Lapse in statute of limitations — 10 — Gross unrecognized tax benefits at end of period $ (5) $ (5) $ (15) |
Stockholders' Equity (Tables)
Stockholders' Equity (Tables) | 12 Months Ended |
Dec. 31, 2023 | |
Equity [Abstract] | |
Schedule of Stock Based Compensation Expense | Total share-based compensation expense is reported in “General and administrative expenses” in the accompanying consolidated statements of income, and summarized below. Year Ended December 31, 2023 2022 2021 (In millions) Pretax Net-of-Tax Pretax Net-of-Tax Pretax Net-of-Tax RSAs and PSUs (defined below) $ 108 $ 102 $ 97 $ 90 $ 66 $ 62 Employee stock purchase plan and stock options 7 7 6 6 6 6 Total $ 115 $ 109 $ 103 $ 96 $ 72 $ 68 |
Schedule of Restricted and Performance Stock Activity | Activity for stock-based awards in the year ended December 31, 2023, is summarized below. RSAs Weighted PSUs Weighted Unvested balance, December 31, 2022 511,105 $ 237.10 312,830 $ 193.09 Granted 294,604 277.37 470,284 233.50 Vested (224,269) 210.22 (328,998) 124.98 Forfeited (45,993) 261.71 (43,742) 261.01 Unvested balance, December 31, 2023 535,447 $ 268.41 410,374 $ 286.77 |
Schedule of Stock Options, Activity | The total fair value of awards vested is presented in the following table. Year Ended December 31, 2023 2022 2021 (In millions) RSAs $ 62 $ 70 $ 53 PSUs 90 69 71 Total vested $ 152 $ 139 $ 124 Number of Shares Weighted Average Exercise Price Aggregate Intrinsic Value Weighted Average Remaining Contractual term (Per share) (In millions) (Years) Stock options outstanding as of December 31, 2022 5,000 $ 33.02 Exercised (5,000) 33.02 Stock options outstanding, vested, and exercisable as of December 31, 2023 — — $ — 0.0 |
Segments (Tables)
Segments (Tables) | 12 Months Ended |
Dec. 31, 2023 | |
Segment Reporting [Abstract] | |
Schedule of Operating Segment Information | The following table presents total revenue by segment. Inter-segment revenue was insignificant for all periods presented. Year Ended December 31, 2023 2022 2021 (In millions) Total revenue: Medicaid $ 27,707 $ 25,783 $ 21,231 Medicare 4,227 3,824 3,379 Marketplace 2,062 2,296 3,091 Other 76 71 70 Consolidated $ 34,072 $ 31,974 $ 27,771 The following table reconciles margin by segment to consolidated income before income tax expense: Year Ended December 31, 2023 2022 2021 (In millions) Margin: Medicaid $ 2,973 $ 2,981 $ 2,322 Medicare 388 437 430 Marketplace 499 290 399 Other 9 11 14 Total margin 3,869 3,719 3,165 Add: other operating revenues (1) 1,467 1,020 846 Less: other operating expenses (2) (3,763) (3,566) (2,991) Operating income 1,573 1,173 1,020 Less: other expenses, net (3) 109 110 145 Income before income tax expense $ 1,464 $ 1,063 $ 875 ______________________ (1) Other operating revenues include premium tax revenue, investment income and certain other revenue. (2) Other operating expenses include general and administrative expenses, premium tax expenses, depreciation and amortization, impairment, and certain other operating expenses. (3) |
Condensed Financial Informati_2
Condensed Financial Information of Registrant (Tables) | 12 Months Ended |
Dec. 31, 2023 | |
Condensed Financial Information Disclosure [Abstract] | |
Schedule of Condensed Balance Sheets | Condensed Balance Sheets December 31, 2023 2022 (In millions, except per-share data) ASSETS Current assets: Cash and cash equivalents $ 694 $ 329 Investments 48 46 Due from affiliates 174 143 Prepaid expenses and other current assets 133 106 Total current assets 1,049 624 Property, equipment, and capitalized software, net 234 224 Goodwill and intangible assets, net 825 731 Investments in subsidiaries 4,911 4,142 Deferred income taxes, net 57 37 Advances to related parties and other assets 94 78 Total assets $ 7,170 $ 5,836 LIABILITIES AND STOCKHOLDERS’ EQUITY Current liabilities: Accounts payable, accrued liabilities and other $ 527 $ 448 Total current liabilities 527 448 Long-term debt 2,180 2,176 Finance lease liabilities 205 215 Other long-term liabilities 43 33 Total liabilities 2,955 2,872 Stockholders’ equity: Common stock, $0.001 par value; 150 million shares authorized; outstanding: 58 million shares at each of December 31, 2023 and December 31, 2022 — — Preferred stock, $0.001 par value; 20 million shares authorized, no shares issued and outstanding — — Additional paid-in capital 410 328 Accumulated other comprehensive loss (82) (160) Retained earnings 3,887 2,796 Total stockholders’ equity 4,215 2,964 Total liabilities and stockholders’ equity $ 7,170 $ 5,836 |
Schedule of Condensed Statements of Income | Condensed Statements of Income Year Ended December 31, 2023 2022 2021 (In millions) Revenue: Administrative services fees $ 2,038 $ 1,826 $ 1,496 Investment income and other revenue 27 8 11 Total revenue 2,065 1,834 1,507 Expenses: General and administrative expenses 1,952 1,721 1,424 Depreciation and amortization 131 141 98 Impairment — 138 — Other 20 — 5 Total operating expenses 2,103 2,000 1,527 Operating loss (38) (166) (20) Interest expense 109 110 120 Other expenses, net — — 25 Total other expenses, net 109 110 145 Loss before income tax benefit and equity in net earnings of subsidiaries (147) (276) (165) Income tax benefit (7) (42) (21) Net loss before equity in net earnings of subsidiaries (140) (234) (144) Equity in net earnings of subsidiaries 1,231 1,026 803 Net income $ 1,091 $ 792 $ 659 |
Schedule of Condensed Statements of Comprehensive Income | Condensed Statements of Comprehensive Income Year Ended December 31, 2023 2022 2021 (In millions) Net income $ 1,091 $ 792 $ 659 Other comprehensive income (loss): Unrealized investment income (loss) 102 (204) (55) Less: effect of income taxes 24 (49) (13) Other comprehensive income (loss), net of tax 78 (155) (42) Comprehensive income $ 1,169 $ 637 $ 617 |
Schedule of Condensed Statements of Cash Flows | Condensed Statements of Cash Flows Year Ended December 31, 2023 2022 2021 (In millions) Operating activities: Net cash provided by operating activities $ 81 $ 119 $ 60 Investing activities: Capital contributions to subsidiaries (221) (159) (440) Dividends received from subsidiaries 705 668 564 Purchases of investments (2) (29) (27) Proceeds from sales and maturities of investments 1 49 21 Purchases of property, equipment and capitalized software (79) (86) (70) Net cash paid in business combinations (74) — (263) Change in amounts due to/from affiliates 5 (69) 40 Other, net 7 3 (3) Net cash provided by (used in) investing activities 342 377 (178) Financing activities: Common stock purchases — (400) (128) Common stock withheld to settle employee tax obligations (60) (54) (53) Contingent consideration liabilities settled — (20) (20) Proceeds from senior notes offering, net of issuance costs — — 740 Repayment of senior notes — — (723) Other, net 2 33 1 Net cash used in financing activities (58) (441) (183) Net increase (decrease) in cash and cash equivalents 365 55 (301) Cash and cash equivalents at beginning of period 329 274 575 Cash and cash equivalents at end of period $ 694 $ 329 $ 274 |
Organization and Basis of Pre_2
Organization and Basis of Presentation (Details) member in Millions | 12 Months Ended |
Dec. 31, 2023 segment member state | |
Basis Of Presentation [Line Items] | |
Number of reportable segments | segment | 4 |
Health Plans | |
Basis Of Presentation [Line Items] | |
Number of members eligible for the health care programs | member | 5 |
Number of states with programs | state | 20 |
Medicaid | Minimum | |
Basis Of Presentation [Line Items] | |
Contract term | 3 years |
Medicaid | Maximum | |
Basis Of Presentation [Line Items] | |
Contract term | 5 years |
Medicare | Minimum | |
Basis Of Presentation [Line Items] | |
Contract term | 1 year |
Medicare | Maximum | |
Basis Of Presentation [Line Items] | |
Contract term | 3 years |
Significant Accounting Polici_4
Significant Accounting Policies - Cash, Cash Equivalents, and Restricted Cash (Details) - USD ($) $ in Millions | Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | Dec. 31, 2020 |
Accounting Policies [Abstract] | ||||
Cash and cash equivalents | $ 4,848 | $ 4,006 | $ 4,438 | |
Restricted cash and cash equivalents | 60 | 42 | 68 | |
Total cash and cash equivalents, and restricted cash and cash equivalents presented in the consolidated statements of cash flows | $ 4,908 | $ 4,048 | $ 4,506 | $ 4,223 |
Significant Accounting Polici_5
Significant Accounting Policies - Additional Information (Details) - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Property, Plant and Equipment [Line Items] | |||
Maturity period (less than) | 15 years | ||
Interest receivable | $ 53 | $ 35 | |
Minimum MLR, medical cost corridors and profit sharing liability | 1,344 | 1,145 | |
Government agencies liability | 64 | 84 | |
Risk adjustments liability | 66 | 76 | |
Risk adjustment payable | 201 | 230 | |
Risk adjustment receivable | 241 | 135 | |
Risk adjustment, net receivable | 40 | ||
Risk adjustment, credit loss allowances | 41 | ||
Risk adjustment, net payable | 95 | ||
Prepaid reinsurance premiums | 11 | 2 | $ 2 |
Reinsurance recoveries | 21 | 35 | $ 33 |
Reinsurance recoverable | $ 28 | $ 27 | |
NEW YORK | |||
Property, Plant and Equipment [Line Items] | |||
Premium revenue percentage | 11.40% | ||
TEXAS | |||
Property, Plant and Equipment [Line Items] | |||
Premium revenue percentage | 13.90% | ||
WASHINGTON | |||
Property, Plant and Equipment [Line Items] | |||
Premium revenue percentage | 14% | ||
Minimum | |||
Property, Plant and Equipment [Line Items] | |||
Useful life | 5 years | ||
Minimum | Premium revenue | |||
Property, Plant and Equipment [Line Items] | |||
Revenue ranging | 1% | ||
Maximum | |||
Property, Plant and Equipment [Line Items] | |||
Useful life | 16 years | ||
Maximum | Premium revenue | |||
Property, Plant and Equipment [Line Items] | |||
Revenue ranging | 4% | ||
Structured Securities | |||
Property, Plant and Equipment [Line Items] | |||
Average maturity period (less than) | 15 years |
Significant Accounting Polici_6
Significant Accounting Policies - Receivables (Details) - USD ($) $ in Millions | Dec. 31, 2023 | Dec. 31, 2022 |
Statutory Accounting Practices [Line Items] | ||
Total receivables | $ 3,104 | $ 2,302 |
Government receivables | ||
Statutory Accounting Practices [Line Items] | ||
Total receivables | 2,354 | 1,702 |
Pharmacy rebate receivables | ||
Statutory Accounting Practices [Line Items] | ||
Total receivables | 330 | 291 |
Other | ||
Statutory Accounting Practices [Line Items] | ||
Total receivables | $ 420 | $ 309 |
Net Income Per Share (Details)
Net Income Per Share (Details) - USD ($) $ / shares in Units, shares in Millions, $ in Millions | 12 Months Ended | |||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | Dec. 31, 2020 | |
Numerator: | ||||
Net income | $ 1,091 | $ 792 | $ 659 | |
Denominator: | ||||
Shares outstanding at the beginning of the period (in shares) | 57.4 | 57.9 | 58 | |
Weighted-average number of shares issued: | ||||
Stock purchases (in shares) | 0 | (0.5) | (0.5) | |
Stock-based compensation (in shares) | 0.3 | 0.4 | 0.3 | |
Denominator for basic net income per share (in shares) | 57.7 | 57.8 | 57.8 | |
Effect of dilutive securities: | ||||
Stock-based compensation (in shares) | 0.4 | 0.7 | 0.8 | |
Denominator for diluted net income per share (in shares) | 58.1 | 58.5 | 58.6 | |
Net income per share: | ||||
Net income per share - Basic (in dollars per share) | $ 18.91 | $ 13.72 | $ 11.40 | |
Net income per share - Diluted (in dollars per share) | $ 18.77 | $ 13.55 | $ 11.25 |
Business Combinations - Narrati
Business Combinations - Narrative (Details) $ in Millions | 12 Months Ended | ||||
Jan. 01, 2024 USD ($) | Sep. 01, 2023 USD ($) | Dec. 31, 2023 USD ($) combination | Dec. 31, 2022 USD ($) | Dec. 31, 2021 USD ($) | |
Business Acquisition [Line Items] | |||||
Number of business combinations | combination | 1 | ||||
Acquisition costs | $ 4 | ||||
Goodwill | $ 1,241 | $ 1,115 | $ 982 | ||
My Choice Wisconsin | |||||
Business Acquisition [Line Items] | |||||
Purchase price | $ 74 | ||||
Goodwill | $ 126 | ||||
Weighted-average life | 6 years 6 months | ||||
My Choice Wisconsin | Medicaid Segment | |||||
Business Acquisition [Line Items] | |||||
Goodwill | $ 95 | ||||
My Choice Wisconsin | Medicare Segment | |||||
Business Acquisition [Line Items] | |||||
Goodwill | $ 31 | ||||
Bright | Medicare Segment | Subsequent Event | |||||
Business Acquisition [Line Items] | |||||
Purchase price | $ 441 |
Business Combinations - Schedul
Business Combinations - Schedule of The Provisional Fair Values Assigned To Assets Acquired and Liabilities Assumed (Details) - USD ($) $ in Millions | Dec. 31, 2023 | Sep. 01, 2023 | Dec. 31, 2022 | Dec. 31, 2021 |
Assets acquired: | ||||
Goodwill | $ 1,241 | $ 1,115 | $ 982 | |
My Choice Wisconsin | ||||
Assets acquired: | ||||
Current assets | $ 96 | |||
Goodwill | 126 | |||
Intangible assets | 18 | |||
Other long-term assets | 7 | |||
Liabilities assumed: | ||||
Medical claims and benefits payable | (96) | |||
Amounts due government agencies | (19) | |||
Accounts payable, accrued and other long-term liabilities | (58) | |||
Net consideration transferred | $ 74 |
Business Combinations - Intangi
Business Combinations - Intangible Assets (Details) - My Choice Wisconsin $ in Millions | Sep. 01, 2023 USD ($) |
Acquired Finite-Lived Intangible Assets [Line Items] | |
Intangible assets | $ 18 |
Contract rights - member list | |
Acquired Finite-Lived Intangible Assets [Line Items] | |
Intangible assets | $ 13 |
Useful life | 7 years |
Trade names | |
Acquired Finite-Lived Intangible Assets [Line Items] | |
Intangible assets | $ 3 |
Useful life | 2 years |
Provider network | |
Acquired Finite-Lived Intangible Assets [Line Items] | |
Intangible assets | $ 2 |
Useful life | 10 years |
Fair Value Measurements - Finan
Fair Value Measurements - Financial Instruments on a Recurring Basis (Details) - USD ($) $ in Millions | Dec. 31, 2023 | Dec. 31, 2022 |
Fair value of assets measured on recurring basis | ||
Debt securities, available-for-sale | $ 4,259 | $ 3,499 |
Total assets | 4,259 | 3,499 |
Contingent consideration liabilities | 8 | |
Total liabilities | 8 | |
Corporate debt securities | ||
Fair value of assets measured on recurring basis | ||
Debt securities, available-for-sale | 2,732 | 2,184 |
Mortgage-backed securities | ||
Fair value of assets measured on recurring basis | ||
Debt securities, available-for-sale | 911 | 731 |
Asset-backed securities | ||
Fair value of assets measured on recurring basis | ||
Debt securities, available-for-sale | 365 | 288 |
Municipal securities | ||
Fair value of assets measured on recurring basis | ||
Debt securities, available-for-sale | 166 | 149 |
U.S. Treasury notes | ||
Fair value of assets measured on recurring basis | ||
Debt securities, available-for-sale | 40 | 105 |
Other | ||
Fair value of assets measured on recurring basis | ||
Debt securities, available-for-sale | 45 | 42 |
Level 1 | ||
Fair value of assets measured on recurring basis | ||
Total assets | 0 | 0 |
Contingent consideration liabilities | 0 | |
Total liabilities | 0 | |
Level 1 | Corporate debt securities | ||
Fair value of assets measured on recurring basis | ||
Debt securities, available-for-sale | 0 | 0 |
Level 1 | Mortgage-backed securities | ||
Fair value of assets measured on recurring basis | ||
Debt securities, available-for-sale | 0 | 0 |
Level 1 | Asset-backed securities | ||
Fair value of assets measured on recurring basis | ||
Debt securities, available-for-sale | 0 | 0 |
Level 1 | Municipal securities | ||
Fair value of assets measured on recurring basis | ||
Debt securities, available-for-sale | 0 | 0 |
Level 1 | U.S. Treasury notes | ||
Fair value of assets measured on recurring basis | ||
Debt securities, available-for-sale | 0 | 0 |
Level 1 | Other | ||
Fair value of assets measured on recurring basis | ||
Debt securities, available-for-sale | 0 | 0 |
Level 2 | ||
Fair value of assets measured on recurring basis | ||
Total assets | 4,259 | 3,499 |
Contingent consideration liabilities | 0 | |
Total liabilities | 0 | |
Level 2 | Corporate debt securities | ||
Fair value of assets measured on recurring basis | ||
Debt securities, available-for-sale | 2,732 | 2,184 |
Level 2 | Mortgage-backed securities | ||
Fair value of assets measured on recurring basis | ||
Debt securities, available-for-sale | 911 | 731 |
Level 2 | Asset-backed securities | ||
Fair value of assets measured on recurring basis | ||
Debt securities, available-for-sale | 365 | 288 |
Level 2 | Municipal securities | ||
Fair value of assets measured on recurring basis | ||
Debt securities, available-for-sale | 166 | 149 |
Level 2 | U.S. Treasury notes | ||
Fair value of assets measured on recurring basis | ||
Debt securities, available-for-sale | 40 | 105 |
Level 2 | Other | ||
Fair value of assets measured on recurring basis | ||
Debt securities, available-for-sale | 45 | 42 |
Level 3 | ||
Fair value of assets measured on recurring basis | ||
Total assets | 0 | 0 |
Contingent consideration liabilities | 8 | |
Total liabilities | 8 | |
Level 3 | Corporate debt securities | ||
Fair value of assets measured on recurring basis | ||
Debt securities, available-for-sale | 0 | 0 |
Level 3 | Mortgage-backed securities | ||
Fair value of assets measured on recurring basis | ||
Debt securities, available-for-sale | 0 | 0 |
Level 3 | Asset-backed securities | ||
Fair value of assets measured on recurring basis | ||
Debt securities, available-for-sale | 0 | 0 |
Level 3 | Municipal securities | ||
Fair value of assets measured on recurring basis | ||
Debt securities, available-for-sale | 0 | 0 |
Level 3 | U.S. Treasury notes | ||
Fair value of assets measured on recurring basis | ||
Debt securities, available-for-sale | 0 | 0 |
Level 3 | Other | ||
Fair value of assets measured on recurring basis | ||
Debt securities, available-for-sale | $ 0 | $ 0 |
Fair Value Measurements - Addit
Fair Value Measurements - Additional Information (Details) - USD ($) $ in Millions | 12 Months Ended | |
Dec. 31, 2023 | Dec. 31, 2022 | |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Fair value recognized loss | $ 4 | |
Passport Health Plan Inc | ||
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Contingent consideration paid to seller included in financing and operating activities | $ 8 |
Fair Value Measurements - Long-
Fair Value Measurements - Long-Term Debt (Details) - USD ($) $ in Millions | Dec. 31, 2023 | Dec. 31, 2022 |
Carrying Amount | ||
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items] | ||
Fair value of debt | $ 2,180 | $ 2,176 |
Fair Value | ||
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items] | ||
Fair value of debt | $ 1,994 | 1,912 |
Senior Notes | 4.375% Notes due 2028 | ||
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items] | ||
Debt instrument, interest rate, stated percentage | 4.375% | |
Senior Notes | 4.375% Notes due 2028 | Carrying Amount | ||
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items] | ||
Fair value of debt | $ 794 | 792 |
Senior Notes | 4.375% Notes due 2028 | Fair Value | ||
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items] | ||
Fair value of debt | $ 757 | 729 |
Senior Notes | 3.875% Notes due 2030 | ||
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items] | ||
Debt instrument, interest rate, stated percentage | 3.875% | |
Senior Notes | 3.875% Notes due 2030 | Carrying Amount | ||
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items] | ||
Fair value of debt | $ 644 | 643 |
Senior Notes | 3.875% Notes due 2030 | Fair Value | ||
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items] | ||
Fair value of debt | $ 583 | 554 |
Senior Notes | 3.875% Notes due 2032 | ||
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items] | ||
Debt instrument, interest rate, stated percentage | 3.875% | |
Senior Notes | 3.875% Notes due 2032 | Carrying Amount | ||
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items] | ||
Fair value of debt | $ 742 | 741 |
Senior Notes | 3.875% Notes due 2032 | Fair Value | ||
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items] | ||
Fair value of debt | $ 654 | $ 629 |
Investments - Schedule of Inves
Investments - Schedule of Investments (Details) - USD ($) $ in Millions | Dec. 31, 2023 | Dec. 31, 2022 |
Debt Securities, Available-for-sale [Line Items] | ||
Amortized Cost | $ 4,367 | $ 3,709 |
Gross Unrealized Gains | 21 | 2 |
Gross Unrealized Losses | 129 | 212 |
Estimated Fair Value | 4,259 | 3,499 |
Corporate debt securities | ||
Debt Securities, Available-for-sale [Line Items] | ||
Amortized Cost | 2,781 | 2,303 |
Gross Unrealized Gains | 16 | 2 |
Gross Unrealized Losses | 65 | 121 |
Estimated Fair Value | 2,732 | 2,184 |
Mortgage-backed securities | ||
Debt Securities, Available-for-sale [Line Items] | ||
Amortized Cost | 951 | 787 |
Gross Unrealized Gains | 4 | 0 |
Gross Unrealized Losses | 44 | 56 |
Estimated Fair Value | 911 | 731 |
Asset-backed securities | ||
Debt Securities, Available-for-sale [Line Items] | ||
Amortized Cost | 376 | 308 |
Gross Unrealized Gains | 1 | 0 |
Gross Unrealized Losses | 12 | 20 |
Estimated Fair Value | 365 | 288 |
Municipal securities | ||
Debt Securities, Available-for-sale [Line Items] | ||
Amortized Cost | 172 | 160 |
Gross Unrealized Gains | 0 | 0 |
Gross Unrealized Losses | 6 | 11 |
Estimated Fair Value | 166 | 149 |
U.S. Treasury notes | ||
Debt Securities, Available-for-sale [Line Items] | ||
Amortized Cost | 40 | 106 |
Gross Unrealized Gains | 0 | 0 |
Gross Unrealized Losses | 0 | 1 |
Estimated Fair Value | 40 | 105 |
Other | ||
Debt Securities, Available-for-sale [Line Items] | ||
Amortized Cost | 47 | 45 |
Gross Unrealized Gains | 0 | 0 |
Gross Unrealized Losses | 2 | 3 |
Estimated Fair Value | $ 45 | $ 42 |
Investments - Contractual Matur
Investments - Contractual Maturities (Details) - USD ($) $ in Millions | Dec. 31, 2023 | Dec. 31, 2022 |
Amortized Cost | ||
Due in one year or less | $ 538 | |
Due after one year through five years | 2,437 | |
Due after five years through ten years | 406 | |
Due after ten years | 986 | |
Amortized Cost | 4,367 | $ 3,709 |
Estimated Fair Value | ||
Due in one year or less | 530 | |
Due after one year through five years | 2,384 | |
Due after five years through ten years | 405 | |
Due after ten years | 940 | |
Amortized Cost | $ 4,259 | $ 3,499 |
Investments - Narrative (Detail
Investments - Narrative (Details) - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Investments, Debt and Equity Securities [Abstract] | |||
Available-for-sale, securities maturities and redemptions | $ 513 | $ 1,069 | $ 948 |
Debt securities, sale | 259 | 329 | 381 |
Gross realized investment gains | 1 | 1 | 10 |
Gross realized investment loss | 11 | $ 7 | $ 0 |
Amortized Cost, Due in one year or less | 190 | ||
Amortized Cost, Due one year through five years | 65 | ||
Amortized cost, due after five years | $ 6 |
Investments - Available-for-Sal
Investments - Available-for-Sale (Details) $ in Millions | Dec. 31, 2023 USD ($) position | Dec. 31, 2022 USD ($) position |
Debt Securities, Available-for-sale [Line Items] | ||
In a Continuous Loss Position for Less than 12 Months, Estimated Fair Value | $ 386 | $ 1,858 |
In a Continuous Loss Position for Less than 12 Months, Gross Unrealized Losses | $ 3 | $ 77 |
In a Continuous Loss Position for Less than 12 Months, Total Number of Positions | position | 258 | 1,116 |
In a Continuous Loss Position for 12 Months or More, Estimated Fair Value | $ 2,431 | $ 1,398 |
In a Continuous Loss Position for 12 Months or More, Gross Unrealized Losses | $ 126 | $ 135 |
In a Continuous Loss Position for 12 Months or More, Total Number of Positions | position | 1,261 | 624 |
Corporate debt securities | ||
Debt Securities, Available-for-sale [Line Items] | ||
In a Continuous Loss Position for Less than 12 Months, Estimated Fair Value | $ 263 | $ 1,124 |
In a Continuous Loss Position for Less than 12 Months, Gross Unrealized Losses | $ 1 | $ 45 |
In a Continuous Loss Position for Less than 12 Months, Total Number of Positions | position | 160 | 683 |
In a Continuous Loss Position for 12 Months or More, Estimated Fair Value | $ 1,553 | $ 887 |
In a Continuous Loss Position for 12 Months or More, Gross Unrealized Losses | $ 64 | $ 76 |
In a Continuous Loss Position for 12 Months or More, Total Number of Positions | position | 754 | 371 |
Mortgage-backed securities | ||
Debt Securities, Available-for-sale [Line Items] | ||
In a Continuous Loss Position for Less than 12 Months, Estimated Fair Value | $ 123 | $ 395 |
In a Continuous Loss Position for Less than 12 Months, Gross Unrealized Losses | $ 2 | $ 20 |
In a Continuous Loss Position for Less than 12 Months, Total Number of Positions | position | 98 | 220 |
In a Continuous Loss Position for 12 Months or More, Estimated Fair Value | $ 549 | $ 319 |
In a Continuous Loss Position for 12 Months or More, Gross Unrealized Losses | $ 42 | $ 36 |
In a Continuous Loss Position for 12 Months or More, Total Number of Positions | position | 283 | 131 |
Asset-backed securities | ||
Debt Securities, Available-for-sale [Line Items] | ||
In a Continuous Loss Position for Less than 12 Months, Estimated Fair Value | $ 0 | $ 161 |
In a Continuous Loss Position for Less than 12 Months, Gross Unrealized Losses | $ 0 | $ 6 |
In a Continuous Loss Position for Less than 12 Months, Total Number of Positions | position | 0 | 108 |
In a Continuous Loss Position for 12 Months or More, Estimated Fair Value | $ 195 | $ 118 |
In a Continuous Loss Position for 12 Months or More, Gross Unrealized Losses | $ 12 | $ 14 |
In a Continuous Loss Position for 12 Months or More, Total Number of Positions | position | 91 | 59 |
Municipal securities | ||
Debt Securities, Available-for-sale [Line Items] | ||
In a Continuous Loss Position for Less than 12 Months, Estimated Fair Value | $ 0 | $ 75 |
In a Continuous Loss Position for Less than 12 Months, Gross Unrealized Losses | $ 0 | $ 4 |
In a Continuous Loss Position for Less than 12 Months, Total Number of Positions | position | 0 | 83 |
In a Continuous Loss Position for 12 Months or More, Estimated Fair Value | $ 117 | $ 57 |
In a Continuous Loss Position for 12 Months or More, Gross Unrealized Losses | $ 6 | $ 7 |
In a Continuous Loss Position for 12 Months or More, Total Number of Positions | position | 116 | 57 |
U.S. Treasury notes | ||
Debt Securities, Available-for-sale [Line Items] | ||
In a Continuous Loss Position for Less than 12 Months, Estimated Fair Value | $ 88 | |
In a Continuous Loss Position for Less than 12 Months, Gross Unrealized Losses | $ 1 | |
In a Continuous Loss Position for Less than 12 Months, Total Number of Positions | position | 6 | |
In a Continuous Loss Position for 12 Months or More, Estimated Fair Value | $ 0 | |
In a Continuous Loss Position for 12 Months or More, Gross Unrealized Losses | $ 0 | |
In a Continuous Loss Position for 12 Months or More, Total Number of Positions | position | 0 | |
Other | ||
Debt Securities, Available-for-sale [Line Items] | ||
In a Continuous Loss Position for Less than 12 Months, Estimated Fair Value | $ 0 | $ 15 |
In a Continuous Loss Position for Less than 12 Months, Gross Unrealized Losses | $ 0 | $ 1 |
In a Continuous Loss Position for Less than 12 Months, Total Number of Positions | position | 0 | 16 |
In a Continuous Loss Position for 12 Months or More, Estimated Fair Value | $ 17 | $ 17 |
In a Continuous Loss Position for 12 Months or More, Gross Unrealized Losses | $ 2 | $ 2 |
In a Continuous Loss Position for 12 Months or More, Total Number of Positions | position | 17 | 6 |
Investments - Balances of Restr
Investments - Balances of Restricted Investments (Details) - USD ($) $ in Millions | Dec. 31, 2023 | Dec. 31, 2022 |
Schedule of Held-to-maturity Securities [Line Items] | ||
Restricted investments | $ 261 | $ 238 |
Cash and cash equivalents | ||
Schedule of Held-to-maturity Securities [Line Items] | ||
Restricted investments | 60 | 42 |
U.S. Treasury notes | ||
Schedule of Held-to-maturity Securities [Line Items] | ||
Restricted investments | 167 | 159 |
Corporate debt securities | ||
Schedule of Held-to-maturity Securities [Line Items] | ||
Restricted investments | $ 34 | $ 37 |
Property, Equipment, and Capi_3
Property, Equipment, and Capitalized Software, Net - Additional Information (Details) - USD ($) $ in Millions | 12 Months Ended | |
Dec. 31, 2022 | Dec. 31, 2023 | |
Property and equipment | ||
Property, Plant and Equipment [Line Items] | ||
Impairment on property and equipment | $ 16 | |
Property and equipment | Minimum | ||
Property, Plant and Equipment [Line Items] | ||
Useful life of property plant and equipment | 3 years | |
Property and equipment | Maximum | ||
Property, Plant and Equipment [Line Items] | ||
Useful life of property plant and equipment | 7 years | |
Software | ||
Property, Plant and Equipment [Line Items] | ||
Useful life of property plant and equipment | 3 years | |
Leasehold improvements | Minimum | ||
Property, Plant and Equipment [Line Items] | ||
Useful life of property plant and equipment | 5 years | |
Leasehold improvements | Maximum | ||
Property, Plant and Equipment [Line Items] | ||
Useful life of property plant and equipment | 10 years | |
Building and improvements | Minimum | ||
Property, Plant and Equipment [Line Items] | ||
Useful life of property plant and equipment | 31 years 6 months | |
Building and improvements | Maximum | ||
Property, Plant and Equipment [Line Items] | ||
Useful life of property plant and equipment | 40 years |
Property, Equipment, and Capi_4
Property, Equipment, and Capitalized Software, Net - Summary of Property, Equipment, and Capitalized Software (Details) - USD ($) $ in Millions | Dec. 31, 2023 | Dec. 31, 2022 |
Property, Plant and Equipment [Line Items] | ||
Total cost | $ 932 | $ 882 |
Less: accumulated amortization - capitalized software | (537) | (482) |
Less: accumulated depreciation and amortization - property, equipment, building, and improvements | (192) | (213) |
Total accumulated depreciation and amortization | (729) | (695) |
ROU assets - finance leases | 67 | 72 |
Property, equipment, and capitalized software, net | 270 | 259 |
Capitalized software | ||
Property, Plant and Equipment [Line Items] | ||
Total cost | 687 | 615 |
Property and equipment | ||
Property, Plant and Equipment [Line Items] | ||
Total cost | 199 | 221 |
Building and improvements | ||
Property, Plant and Equipment [Line Items] | ||
Total cost | 41 | 41 |
Land | ||
Property, Plant and Equipment [Line Items] | ||
Total cost | $ 5 | $ 5 |
Property, Equipment, and Capi_5
Property, Equipment, and Capitalized Software, Net - Depreciation and Amortization (Details) - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Recorded in depreciation and amortization: | |||
Amortization of intangible assets | $ 85 | $ 77 | $ 49 |
Amortization of capitalized software | 58 | 54 | 41 |
Amortization of finance leases | 18 | 28 | 25 |
Depreciation and amortization of property, equipment, building, and improvements | 10 | 17 | 16 |
Total depreciation and amortization recognized | $ 171 | $ 176 | $ 131 |
Leases - Narrative (Details)
Leases - Narrative (Details) - USD ($) $ in Millions | 12 Months Ended | |
Dec. 31, 2022 | Dec. 31, 2023 | |
Leases [Abstract] | ||
Operating lease, remaining lease term | 12 years | |
Operating lease renewal term | 10 years | |
Operating leases, weighted average remaining lease term | 8 years | |
Finance lease, remaining lease term | 15 years | |
Finance lease renewal term | 25 years | |
Finance leases, weighted average remaining lease term | 12 years | |
ROU assets impairments | $ 192 | |
Operating leases, weighted average discount rate | 4.80% | |
Finance leases, weighted average discount rate | 6.40% |
Leases - Components of Lease Ex
Leases - Components of Lease Expense (Details) - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Leases [Abstract] | |||
Operating lease expense | $ 15 | $ 31 | $ 34 |
Finance lease expense: | |||
Amortization of ROU assets | 18 | 28 | 25 |
Interest on lease liabilities | 15 | 15 | 15 |
Total finance lease expense | $ 33 | $ 43 | $ 40 |
Leases - Supplemental Cash Flow
Leases - Supplemental Cash Flow (Details) - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Cash used in operating activities: | |||
Operating leases | $ 28 | $ 31 | $ 33 |
Finance leases | 15 | 15 | 15 |
Cash used in financing activities: | |||
Finance leases | 24 | 15 | 18 |
ROU assets recognized in exchange for lease obligations: | |||
Operating leases | 12 | 10 | 86 |
Finance leases | $ 13 | $ 18 | $ 18 |
Leases - Supplemental Balance S
Leases - Supplemental Balance Sheet Information (Details) - USD ($) $ in Millions | Dec. 31, 2023 | Dec. 31, 2022 |
ROU assets | ||
Other assets | $ 43 | $ 43 |
Lease liabilities | ||
Accounts payable and accrued liabilities (current) | 20 | 41 |
Other long-term liabilities (non-current) | 85 | 77 |
Total operating lease liabilities | 105 | 118 |
ROU assets | ||
Property, equipment, and capitalized software, net | 67 | 72 |
Lease liabilities | ||
Accounts payable and accrued liabilities (current) | 21 | 22 |
Finance lease liabilities (non-current) | 205 | 215 |
Total finance lease liabilities | $ 226 | $ 237 |
Operating Lease, Right-of-Use Asset, Statement of Financial Position [Extensible List] | Other assets | Other assets |
Finance Lease, Liability, Current, Statement of Financial Position [Extensible List] | Accounts Payable and Accrued Liabilities, Current | Accounts Payable and Accrued Liabilities, Current |
Finance 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 - Lease Maturities (Deta
Leases - Lease Maturities (Details) - USD ($) $ in Millions | Dec. 31, 2023 | Dec. 31, 2022 |
Operating | ||
2024 | $ 24 | |
2025 | 20 | |
2026 | 14 | |
2027 | 11 | |
2028 | 9 | |
Thereafter | 50 | |
Subtotal - undiscounted lease payments | 128 | |
Less imputed interest | (23) | |
Total operating lease liabilities | 105 | $ 118 |
Finance | ||
2024 | 34 | |
2025 | 30 | |
2026 | 26 | |
2027 | 24 | |
2028 | 25 | |
Thereafter | 194 | |
Subtotal - undiscounted lease payments | 333 | |
Less imputed interest | (107) | |
Total finance lease liabilities | $ 226 | $ 237 |
Goodwill and Intangible Asset_3
Goodwill and Intangible Assets, Net - Balances of Goodwill (Details) - USD ($) $ in Millions | 12 Months Ended | |
Dec. 31, 2023 | Dec. 31, 2022 | |
Goodwill [Roll Forward] | ||
Beginning balance | $ 1,115 | $ 982 |
Acquisitions and measurement period adjustments | 126 | 133 |
Ending balance | 1,241 | 1,115 |
Medicaid | ||
Goodwill [Roll Forward] | ||
Beginning balance | 899 | 769 |
Acquisitions and measurement period adjustments | 95 | 130 |
Ending balance | 994 | 899 |
Medicare | ||
Goodwill [Roll Forward] | ||
Beginning balance | 172 | 169 |
Acquisitions and measurement period adjustments | 31 | 3 |
Ending balance | 203 | 172 |
Other | ||
Goodwill [Roll Forward] | ||
Beginning balance | 44 | 44 |
Acquisitions and measurement period adjustments | 0 | 0 |
Ending balance | $ 44 | $ 44 |
Goodwill and Intangible Asset_4
Goodwill and Intangible Assets, Net - Intangible Assets Balances (Details) - USD ($) $ in Millions | Dec. 31, 2023 | Dec. 31, 2022 |
Finite-Lived Intangible Assets [Line Items] | ||
Cost | $ 601 | $ 583 |
Accumulated Amortization | 393 | 308 |
Carrying Amount | 208 | 275 |
Contract rights and licenses | ||
Finite-Lived Intangible Assets [Line Items] | ||
Cost | 520 | 507 |
Accumulated Amortization | 357 | 279 |
Carrying Amount | 163 | 228 |
Provider networks | ||
Finite-Lived Intangible Assets [Line Items] | ||
Cost | 59 | 57 |
Accumulated Amortization | 29 | 24 |
Carrying Amount | 30 | 33 |
Trade names | ||
Finite-Lived Intangible Assets [Line Items] | ||
Cost | 22 | 19 |
Accumulated Amortization | 7 | 5 |
Carrying Amount | $ 15 | $ 14 |
Goodwill and Intangible Asset_5
Goodwill and Intangible Assets, Net - Additional Information (Details) $ in Millions | Dec. 31, 2023 USD ($) |
Goodwill and Intangible Assets Disclosure [Abstract] | |
Future amortization expense, 2024 | $ 71 |
Future amortization expense, 2025 | 67 |
Future amortization expense, 2026 | 27 |
Future amortization expense, 2027 | 15 |
Future amortization expense, 2028 | $ 8 |
Medical Claims and Benefits P_3
Medical Claims and Benefits Payable - Medical Claims and Future Benefits (Details) - USD ($) $ in Millions | Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | Dec. 31, 2020 |
Insurance [Abstract] | ||||
Fee-for-service claims incurred but not paid (“IBNP”) | $ 2,901 | $ 2,597 | $ 2,486 | |
Pharmacy payable | 202 | 206 | 219 | |
Capitation payable | 100 | 94 | 82 | |
Other | 1,001 | 631 | 576 | |
Medical claims and benefits payable | $ 4,204 | $ 3,528 | $ 3,363 | $ 2,696 |
Medical Claims and Benefits P_4
Medical Claims and Benefits Payable - Additional Information (Details) - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Insurance [Abstract] | |||
Non-risk provide payables | $ 481 | $ 228 | $ 226 |
Prior period claims, favorable development | $ 427 | $ 284 | $ 239 |
Medical Claims and Benefits P_5
Medical Claims and Benefits Payable - Components of the Change (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] | |||
Medical claims and benefits payable, beginning balance | $ 3,528 | $ 3,363 | $ 2,696 |
Components of medical care costs related to: | |||
Current year | 29,096 | 27,459 | 23,943 |
Prior years | (427) | (284) | (239) |
Incurred Claims and Allocated Claims Adjustment Expenses | 28,669 | 27,175 | 23,704 |
Payments for medical care costs related to: | |||
Current year | 25,615 | 24,345 | 21,148 |
Prior years | 2,734 | 2,670 | 2,080 |
Total paid | 28,349 | 27,015 | 23,228 |
Acquired balances, net of post-acquisition adjustments | 96 | 12 | 197 |
Change in non-risk and other provider payables | 260 | (7) | (6) |
Medical claims and benefits payable, ending balance | 4,204 | 3,528 | 3,363 |
Medicaid | |||
Liability for Unpaid Claims and Claims Adjustment Expense [Roll Forward] | |||
Medical claims and benefits payable, beginning balance | 2,815 | 2,580 | 2,129 |
Components of medical care costs related to: | |||
Current year | 23,749 | 22,097 | 18,321 |
Prior years | (395) | (251) | (182) |
Incurred Claims and Allocated Claims Adjustment Expenses | 23,354 | 21,846 | 18,139 |
Payments for medical care costs related to: | |||
Current year | 20,999 | 19,655 | 16,284 |
Prior years | 2,069 | 1,966 | 1,601 |
Total paid | 23,068 | 21,621 | 17,885 |
Acquired balances, net of post-acquisition adjustments | 82 | 12 | 205 |
Change in non-risk and other provider payables | 261 | (2) | (8) |
Medical claims and benefits payable, ending balance | 3,444 | 2,815 | 2,580 |
Medicare | |||
Liability for Unpaid Claims and Claims Adjustment Expense [Roll Forward] | |||
Medical claims and benefits payable, beginning balance | 452 | 404 | 392 |
Components of medical care costs related to: | |||
Current year | 3,802 | 3,390 | 2,970 |
Prior years | (11) | (32) | (39) |
Incurred Claims and Allocated Claims Adjustment Expenses | 3,791 | 3,358 | 2,931 |
Payments for medical care costs related to: | |||
Current year | 3,293 | 2,944 | 2,573 |
Prior years | 431 | 361 | 340 |
Total paid | 3,724 | 3,305 | 2,913 |
Acquired balances, net of post-acquisition adjustments | 14 | 0 | (8) |
Change in non-risk and other provider payables | (1) | (5) | 2 |
Medical claims and benefits payable, ending balance | 532 | 452 | 404 |
Marketplace | |||
Liability for Unpaid Claims and Claims Adjustment Expense [Roll Forward] | |||
Medical claims and benefits payable, beginning balance | 261 | 379 | 175 |
Components of medical care costs related to: | |||
Current year | 1,545 | 1,972 | 2,652 |
Prior years | (21) | (1) | (18) |
Incurred Claims and Allocated Claims Adjustment Expenses | 1,524 | 1,971 | 2,634 |
Payments for medical care costs related to: | |||
Current year | 1,323 | 1,746 | 2,291 |
Prior years | 234 | 343 | 139 |
Total paid | 1,557 | 2,089 | 2,430 |
Acquired balances, net of post-acquisition adjustments | 0 | 0 | 0 |
Change in non-risk and other provider payables | 0 | 0 | 0 |
Medical claims and benefits payable, ending balance | $ 228 | $ 261 | $ 379 |
Medical Claims and Benefits P_6
Medical Claims and Benefits Payable - Incurred Claims and Allocated Adjustment Expense (Details) claim in Millions, $ in Millions | 12 Months Ended | ||
Dec. 31, 2023 USD ($) claim | Dec. 31, 2022 USD ($) | Dec. 31, 2021 USD ($) | |
Product Information [Line Items] | |||
Incurred Claims and Allocated Claims Adjustment Expenses | $ 28,669 | $ 27,175 | $ 23,704 |
Incurred Claims and Allocated Claims Adjustment Expenses | 80,136 | ||
Total IBNP | 2,898 | ||
Benefit Year 2021 | |||
Product Information [Line Items] | |||
Incurred Claims and Allocated Claims Adjustment Expenses | 23,912 | 23,979 | $ 24,167 |
Total IBNP | $ 18 | ||
Cumulative number of reported claims (in claim) | claim | 133 | ||
Benefit Year 2022 | |||
Product Information [Line Items] | |||
Incurred Claims and Allocated Claims Adjustment Expenses | $ 27,128 | $ 27,459 | |
Total IBNP | $ 77 | ||
Cumulative number of reported claims (in claim) | claim | 163 | ||
Benefit Year 2023 | |||
Product Information [Line Items] | |||
Incurred Claims and Allocated Claims Adjustment Expenses | $ 29,096 | ||
Total IBNP | $ 2,803 | ||
Cumulative number of reported claims (in claim) | claim | 153 |
Medical Claims and Benefits P_7
Medical Claims and Benefits Payable - Cumulative Paid Claims and Allocated Claims Adjustment Expenses (Details) - USD ($) $ in Millions | Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 |
Product Information [Line Items] | |||
Claims paid | $ 76,560 | ||
Benefit Year 2021 | |||
Product Information [Line Items] | |||
Claims paid | 23,894 | $ 23,871 | $ 21,148 |
Benefit Year 2022 | |||
Product Information [Line Items] | |||
Claims paid | 27,051 | $ 24,345 | |
Benefit Year 2023 | |||
Product Information [Line Items] | |||
Claims paid | $ 25,615 |
Medical Claims and Benefits P_8
Medical Claims and Benefits Payable - Reconciliation of Claims Development (Details) - USD ($) $ in Millions | 12 Months Ended | |||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | Dec. 31, 2020 | |
Insurance [Abstract] | ||||
Incurred claims and allocated claims adjustment expenses | $ 80,136 | |||
Less: cumulative paid claims and allocated claims adjustment expenses | (76,560) | |||
All outstanding liabilities before 2021 | 3 | |||
Acquired balances | 96 | |||
Non-risk and other provider payables | 529 | |||
Medical claims and benefits payable | $ 4,204 | $ 3,528 | $ 3,363 | $ 2,696 |
Debt - Maturities (Details)
Debt - Maturities (Details) $ in Millions | Dec. 31, 2023 USD ($) |
Debt Instrument [Line Items] | |
Total | $ 2,200 |
2024 | 0 |
2025 | 0 |
2026 | 0 |
2027 | 0 |
2028 | 800 |
Thereafter | $ 1,400 |
Senior Notes | 4.375% Notes due 2028 | |
Debt Instrument [Line Items] | |
Percentage of contractual interest rate | 4.375% |
Total | $ 800 |
2024 | 0 |
2025 | 0 |
2026 | 0 |
2027 | 0 |
2028 | 800 |
Thereafter | $ 0 |
Senior Notes | 3.875% Notes due 2030 | |
Debt Instrument [Line Items] | |
Percentage of contractual interest rate | 3.875% |
2024 | $ 0 |
2025 | 0 |
2026 | 0 |
2027 | 0 |
2028 | 0 |
Thereafter | $ 650 |
Senior Notes | 3.875% Notes due 2032 | |
Debt Instrument [Line Items] | |
Percentage of contractual interest rate | 3.875% |
Total | $ 750 |
2024 | 0 |
2025 | 0 |
2026 | 0 |
2027 | 0 |
2028 | 0 |
Thereafter | $ 750 |
Debt - Schedule of Long-Term De
Debt - Schedule of Long-Term Debt (Details) - USD ($) $ in Millions | Dec. 31, 2023 | Dec. 31, 2022 |
Debt Instrument [Line Items] | ||
Less: unamortized debt issuance costs | $ (20) | $ (24) |
Total | $ 2,180 | 2,176 |
Senior Notes | 4.375% Notes due 2028 | ||
Debt Instrument [Line Items] | ||
Percentage of contractual interest rate | 4.375% | |
Non-current portion of long-term debt | $ 800 | 800 |
Senior Notes | 3.875% Notes due 2030 | ||
Debt Instrument [Line Items] | ||
Percentage of contractual interest rate | 3.875% | |
Non-current portion of long-term debt | $ 650 | 650 |
Senior Notes | 3.875% Notes due 2032 | ||
Debt Instrument [Line Items] | ||
Percentage of contractual interest rate | 3.875% | |
Non-current portion of long-term debt | $ 750 | $ 750 |
Debt - Credit Agreement (Detail
Debt - Credit Agreement (Details) - Line of Credit | 12 Months Ended |
Dec. 31, 2023 USD ($) | |
Line of Credit Facility [Line Items] | |
Agreement term | 5 years |
Credit Facility | |
Line of Credit Facility [Line Items] | |
Maximum borrowing capacity | $ 1,000,000,000 |
Amount outstanding under letter of credit | $ 0 |
Debt - Senior Notes (Details)
Debt - Senior Notes (Details) - Senior Notes | Dec. 31, 2023 USD ($) |
4.375% Notes due 2028 | |
Debt Instrument [Line Items] | |
Percentage of contractual interest rate on notes | 4.375% |
Aggregate principal amount of notes outstanding | $ 800,000,000 |
3.875% Notes due 2030 | |
Debt Instrument [Line Items] | |
Percentage of contractual interest rate on notes | 3.875% |
Aggregate principal amount of notes outstanding | $ 650,000,000 |
3.875% Notes due 2032 | |
Debt Instrument [Line Items] | |
Percentage of contractual interest rate on notes | 3.875% |
Aggregate principal amount of notes outstanding | $ 750,000,000 |
Income Taxes - Provision for In
Income Taxes - Provision for Income Taxes (Details) - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Current: | |||
Federal | $ 349 | $ 297 | $ 209 |
State | 55 | 40 | 31 |
Total current | 404 | 337 | 240 |
Deferred: | |||
Federal | (28) | (66) | (17) |
State | (3) | 0 | (7) |
Total deferred | (31) | (66) | (24) |
Income tax expense | $ 373 | $ 271 | $ 216 |
Income Taxes - Reconciliation o
Income Taxes - Reconciliation of the U.S. Federal Statutory Income Tax Rate (Details) | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Income Tax Disclosure [Abstract] | |||
Statutory federal tax (benefit) rate | 21% | 21% | 21% |
State income provision (benefit), net of federal benefit | 2.80% | 3% | 2.20% |
Nondeductible compensation | 1.40% | 1.80% | 1.50% |
Other | 0.30% | (0.30%) | 0% |
Effective tax expense rate | 25.50% | 25.50% | 24.70% |
Income Taxes - Deferred Tax Ass
Income Taxes - Deferred Tax Assets and Liabilities (Details) - USD ($) $ in Millions | Dec. 31, 2023 | Dec. 31, 2022 |
Income Tax Disclosure [Abstract] | ||
Accrued expenses and reserve liabilities | $ 94 | $ 77 |
Other accrued medical costs | 26 | 24 |
Net operating losses | 7 | 9 |
Unearned premiums | 19 | 16 |
Lease liabilities | 87 | 88 |
Unrealized losses | 26 | 49 |
Fixed assets and intangibles | 24 | 9 |
Tax credit carryover | 5 | 5 |
Other | 6 | 5 |
Valuation allowance | (24) | (18) |
Total deferred income tax assets, net of valuation allowance | 270 | 264 |
Right-of-use assets | (29) | (29) |
Prepaid expenses | (14) | (15) |
Total deferred income tax liabilities | (43) | (44) |
Net deferred income tax asset | $ 227 | $ 220 |
Income Taxes - Additional Infor
Income Taxes - Additional Information (Details) - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Operating Loss Carryforwards [Line Items] | |||
Deferred tax assets | $ 24 | ||
Increased in deferred tax asset valuation allowance | 6 | ||
Valuation allowance | 24 | $ 18 | |
Impact on effective tax rate if tax benefits are recognized | 5 | $ 5 | $ 15 |
Liability for unrecognized tax benefits, potential decrease | 5 | ||
State | |||
Operating Loss Carryforwards [Line Items] | |||
Operating loss carryforwards | 53 | ||
Foreign | |||
Operating Loss Carryforwards [Line Items] | |||
Operating loss carryforwards | 11 | ||
Tax credit carryovers | $ 5 |
Income Taxes - Unrecognized Tax
Income Taxes - Unrecognized Tax Benefits (Details) - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Unrecognized tax benefits roll forward | |||
Gross unrecognized tax benefits at beginning of period | $ (5) | $ (15) | $ (20) |
Settlements | 0 | 0 | 5 |
Lapse in statute of limitations | 0 | 10 | 0 |
Gross unrecognized tax benefits at end of period | $ (5) | $ (5) | $ (15) |
Stockholders' Equity - Addition
Stockholders' Equity - Additional Information (Details) - USD ($) | 1 Months Ended | 12 Months Ended | |||
Feb. 09, 2024 | Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | Sep. 30, 2023 | |
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||
Forfeiture rate | 8% | ||||
Stock option expiration period | 4 years | ||||
Granted (in shares) | 0 | 0 | 0 | ||
Exercised (in shares) | 5,000 | ||||
Unvested stock options (in shares) | 0 | ||||
Employee Stock Purchase Plan | |||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||
Employee purchase price as a percentage of stock price | 85% | ||||
Offering period | 6 months | ||||
Maximum annual contribution per employee | $ 25,000 | ||||
Risk-free interest rate, minimum | 0.10% | ||||
Risk-free interest rate, maximum | 5.40% | ||||
Minimum expected volatility rate inputs for fair value measurement | 28% | ||||
Maximum expected volatility rate inputs for fair value measurement | 54% | ||||
Dividend yield | 0% | ||||
Expected term of awards | 6 months | ||||
RSUs | |||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||
Maximum award vesting period | 4 years | ||||
Granted (in dollars per share) | $ 277.37 | $ 312.27 | $ 224.63 | ||
Unrecognized compensation expense | $ 88,000,000 | ||||
Weighted average period for recognition | 2 years 1 month 6 days | ||||
PSUs | |||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||
Maximum award vesting period | 3 years | ||||
Granted (in dollars per share) | $ 233.50 | $ 214.94 | $ 74.52 | ||
Unrecognized compensation expense | $ 52,000,000 | ||||
Weighted average period for recognition | 1 year 1 month 6 days | ||||
Stock options | |||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||
Maximum award vesting period | 4 years | ||||
Stock option expiration period | 10 years | ||||
2019 EIP | |||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||
Number of shares issued under ESPP (in shares) | 2,900,000 | ||||
Common Stock | |||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||
Common stock authorized | $ 750,000,000 | ||||
Repurchases of common stock (in shares) | 0 | ||||
Share-based compensation (in shares) | 1,000,000 | ||||
Common Stock | Subsequent Event | |||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||
Repurchases of common stock (in shares) | 0 | ||||
Common Stock | Employee Stock Purchase Plan | |||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||
Share-based compensation (in shares) | 442,000 | 755,000 |
Stockholders' Equity - Componen
Stockholders' Equity - Components of Share-based Compensation (Details) - USD ($) $ 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] | |||
Pretax Charges | $ 115 | $ 103 | $ 72 |
Net-of-Tax Amount | 109 | 96 | 68 |
RSAs and PSUs (defined below) | |||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||
Pretax Charges | 108 | 97 | 66 |
Net-of-Tax Amount | 102 | 90 | 62 |
Employee stock purchase plan and stock options | |||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||
Pretax Charges | 7 | 6 | 6 |
Net-of-Tax Amount | $ 7 | $ 6 | $ 6 |
Stockholders' Equity - Restrict
Stockholders' Equity - Restricted and Performance Stock Activity (Details) - $ / shares | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
RSUs | |||
RSAs and PSUs | |||
Unvested balance, beginning of period (in shares) | 511,105 | ||
Granted (in shares) | 294,604 | ||
Vested (in shares) | (224,269) | ||
Forfeited (in shares) | (45,993) | ||
Unvested balance, shares end of period (in shares) | 535,447 | 511,105 | |
Weighted Average Grant Date Fair Value | |||
Unvested balance, beginning balance (in dollars per share) | $ 237.10 | ||
Granted (in dollars per share) | 277.37 | $ 312.27 | $ 224.63 |
Vested (in dollars per share) | 210.22 | ||
Forfeited (in dollars per share) | 261.71 | ||
Unvested balance, ending balance (in dollars per share) | $ 268.41 | $ 237.10 | |
PSUs | |||
RSAs and PSUs | |||
Unvested balance, beginning of period (in shares) | 312,830 | ||
Granted (in shares) | 470,284 | ||
Vested (in shares) | (328,998) | ||
Forfeited (in shares) | (43,742) | ||
Unvested balance, shares end of period (in shares) | 410,374 | 312,830 | |
Weighted Average Grant Date Fair Value | |||
Unvested balance, beginning balance (in dollars per share) | $ 193.09 | ||
Granted (in dollars per share) | 233.50 | $ 214.94 | $ 74.52 |
Vested (in dollars per share) | 124.98 | ||
Forfeited (in dollars per share) | 261.01 | ||
Unvested balance, ending balance (in dollars per share) | $ 286.77 | $ 193.09 |
Stockholders' Equity - Fair Val
Stockholders' Equity - Fair Value of Awards Granted and Vested (Details) - USD ($) $ 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] | |||
Fair value of restricted shares vested | $ 152 | $ 139 | $ 124 |
RSUs | |||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||
Fair value of restricted shares vested | 62 | 70 | 53 |
PSUs | |||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||
Fair value of restricted shares vested | $ 90 | $ 69 | $ 71 |
Stockholders' Equity - Stock Op
Stockholders' Equity - Stock Option Activity (Details) $ / shares in Units, $ in Millions | 12 Months Ended |
Dec. 31, 2023 USD ($) $ / shares shares | |
Number of Shares | |
Beginning balance, outstanding (in shares) | shares | 5,000 |
Exercised (in shares) | shares | (5,000) |
Ending balance, outstanding (in shares) | shares | 0 |
Weighted Average Exercise Price | |
Beginning balance, outstanding (in dollars per share) | $ / shares | $ 33.02 |
Exercised (in dollars per share) | $ / shares | 33.02 |
Ending balance, outstanding (in dollars per share) | $ / shares | $ 0 |
Outstanding, Aggregate Intrinsic Value | $ | $ 0 |
Outstanding, Weighted Average Remaining Contractual term | 0 years |
Employee Benefit Plans (Details
Employee Benefit Plans (Details) - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Postemployment Benefits [Abstract] | |||
Maximum matching contribution by employer under defined contribution plan | 4% | ||
Expense recognized in connection with contributions | $ 54 | $ 45 | $ 41 |
Deferred compensation plan | $ 39 | $ 26 |
Commitments and Contingencies (
Commitments and Contingencies (Details) - USD ($) $ in Millions | Dec. 31, 2023 | Dec. 31, 2022 |
Statutory Accounting Practices [Line Items] | ||
Performance bond | $ 35 | |
Net assets of subsidiaries subject to restrictions | 3,700 | |
Aggregate statutory capital and surplus | 4,100 | |
Required minimum statutory capital surplus | 2,300 | |
Parent Company | ||
Statutory Accounting Practices [Line Items] | ||
Cash, cash equivalents, and investments | $ 742 | $ 375 |
Segments - Narrative (Details)
Segments - Narrative (Details) | 12 Months Ended |
Dec. 31, 2023 segment | |
Segment Reporting [Abstract] | |
Number of reportable segments | 4 |
Segments - Schedule of Operatin
Segments - Schedule of Operating Segment Information (Details) - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Segment Reporting Information [Line Items] | |||
Revenues | $ 34,072 | $ 31,974 | $ 27,771 |
Medicaid | |||
Segment Reporting Information [Line Items] | |||
Revenues | 27,707 | 25,783 | 21,231 |
Medicare | |||
Segment Reporting Information [Line Items] | |||
Revenues | 4,227 | 3,824 | 3,379 |
Marketplace | |||
Segment Reporting Information [Line Items] | |||
Revenues | 2,062 | 2,296 | 3,091 |
Other | |||
Segment Reporting Information [Line Items] | |||
Revenues | $ 76 | $ 71 | $ 70 |
Segments - Reconciliation of Gr
Segments - Reconciliation of Gross Margin to Consolidated Income (Details) - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Segment Reporting Information [Line Items] | |||
Less: Other operating expenses | $ (32,499) | $ (30,801) | $ (26,751) |
Operating income | 1,573 | 1,173 | 1,020 |
Less: other expenses, net | 109 | 110 | 145 |
Income before income tax expense | 1,464 | 1,063 | 875 |
Medicaid | |||
Segment Reporting Information [Line Items] | |||
Total margin | 2,973 | 2,981 | 2,322 |
Medicare | |||
Segment Reporting Information [Line Items] | |||
Total margin | 388 | 437 | 430 |
Marketplace | |||
Segment Reporting Information [Line Items] | |||
Total margin | 499 | 290 | 399 |
Other | |||
Segment Reporting Information [Line Items] | |||
Total margin | 9 | 11 | 14 |
Operating Segments | |||
Segment Reporting Information [Line Items] | |||
Total margin | 3,869 | 3,719 | 3,165 |
Other Operating | |||
Segment Reporting Information [Line Items] | |||
Add: Other operating revenues | 1,467 | 1,020 | 846 |
Less: Other operating expenses | $ (3,763) | $ (3,566) | $ (2,991) |
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 | $ 4,848 | $ 4,006 | $ 4,438 | |
Investments | 4,259 | 3,499 | ||
Prepaid expenses and other current assets | 331 | 277 | ||
Total current assets | 12,542 | 10,084 | ||
Property, equipment, and capitalized software, net | 270 | 259 | ||
Goodwill and intangible assets, net | 1,449 | 1,390 | ||
Deferred income taxes, net | 227 | 220 | ||
Total assets | 14,892 | 12,314 | ||
Current liabilities: | ||||
Accounts payable, accrued liabilities and other | 1,252 | 889 | ||
Total current liabilities | 8,168 | 6,855 | ||
Long-term debt | 2,180 | 2,176 | ||
Finance lease liabilities | 205 | 215 | ||
Other long-term liabilities | 124 | 104 | ||
Total liabilities | 10,677 | 9,350 | ||
Stockholders’ equity: | ||||
Common stock, $0.001 par value; 150 million shares authorized; outstanding: 58 million shares at each of December 31, 2023 and December 31, 2022 | 0 | 0 | ||
Preferred stock, $0.001 par value; 20 million shares authorized, no shares issued and outstanding | 0 | 0 | ||
Additional paid-in capital | 410 | 328 | ||
Accumulated other comprehensive loss | (82) | (160) | ||
Retained earnings | 3,887 | 2,796 | ||
Total stockholders’ equity | 4,215 | 2,964 | $ 2,630 | $ 2,096 |
Total liabilities and stockholders’ equity | 14,892 | 12,314 | ||
Parent Company | ||||
Current assets: | ||||
Cash and cash equivalents | 694 | 329 | ||
Investments | 48 | 46 | ||
Prepaid expenses and other current assets | 133 | 106 | ||
Total current assets | 1,049 | 624 | ||
Property, equipment, and capitalized software, net | 234 | 224 | ||
Goodwill and intangible assets, net | 825 | 731 | ||
Investments in subsidiaries | 4,911 | 4,142 | ||
Deferred income taxes, net | 57 | 37 | ||
Advances to related parties and other assets | 94 | 78 | ||
Total assets | 7,170 | 5,836 | ||
Current liabilities: | ||||
Accounts payable, accrued liabilities and other | 527 | 448 | ||
Total current liabilities | 527 | 448 | ||
Long-term debt | 2,180 | 2,176 | ||
Finance lease liabilities | 205 | 215 | ||
Other long-term liabilities | 43 | 33 | ||
Total liabilities | 2,955 | 2,872 | ||
Stockholders’ equity: | ||||
Common stock, $0.001 par value; 150 million shares authorized; outstanding: 58 million shares at each of December 31, 2023 and December 31, 2022 | 0 | 0 | ||
Preferred stock, $0.001 par value; 20 million shares authorized, no shares issued and outstanding | 0 | 0 | ||
Additional paid-in capital | 410 | 328 | ||
Accumulated other comprehensive loss | (82) | (160) | ||
Retained earnings | 3,887 | 2,796 | ||
Total stockholders’ equity | 4,215 | 2,964 | ||
Total liabilities and stockholders’ equity | 7,170 | 5,836 | ||
Parent Company | Affiliated Entity | ||||
Current assets: | ||||
Due from affiliates | $ 174 | $ 143 |
Condensed Financial Informati_4
Condensed Financial Information of Registrant - Condensed Balance Sheets - Additional Information (Details) - $ / shares | Dec. 31, 2023 | Dec. 31, 2022 |
Condensed Financial Statements, Captions [Line Items] | ||
Common stock, par value (in dollars per share) | $ 0.001 | $ 0.001 |
Common stock, shares authorized (in shares) | 150,000,000 | 150,000,000 |
Common stock, shares, outstanding (in shares) | 58,000,000 | 58,000,000 |
Preferred stock, par value (in dollars per share) | $ 0.001 | $ 0.001 |
Preferred stock, shares authorized (in shares) | 20,000,000 | 20,000,000 |
Preferred stock, shares issued (in shares) | 0 | 0 |
Preferred stock, shares outstanding (in shares) | 0 | 0 |
Parent Company | ||
Condensed Financial Statements, Captions [Line Items] | ||
Common stock, par value (in dollars per share) | $ 0.001 | $ 0.001 |
Common stock, shares authorized (in shares) | 150,000,000 | 150,000,000 |
Common stock, shares, outstanding (in shares) | 58,000,000 | 58,000,000 |
Preferred stock, par value (in dollars per share) | $ 0.001 | $ 0.001 |
Preferred stock, shares authorized (in shares) | 20,000,000 | 20,000,000 |
Preferred stock, shares issued (in shares) | 0 | 0 |
Preferred stock, shares outstanding (in shares) | 0 | 0 |
Condensed Financial Informati_5
Condensed Financial Information of Registrant - Condensed Statements of Operations (Details) - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Revenue: | |||
Revenues | $ 34,072 | $ 31,974 | $ 27,771 |
Expenses: | |||
General and administrative expenses | 2,462 | 2,311 | 2,068 |
Depreciation and amortization | 171 | 176 | 131 |
Impairment | 0 | 208 | 0 |
Total operating expenses | 32,499 | 30,801 | 26,751 |
Operating income | 1,573 | 1,173 | 1,020 |
Interest expense | 109 | 110 | 120 |
Other expenses, net | 0 | 0 | 25 |
Income tax benefit | 373 | 271 | 216 |
Net income | 1,091 | 792 | 659 |
Parent Company | |||
Revenue: | |||
Administrative services fees | 2,038 | 1,826 | 1,496 |
Investment income and other revenue | 27 | 8 | 11 |
Revenues | 2,065 | 1,834 | 1,507 |
Expenses: | |||
General and administrative expenses | 1,952 | 1,721 | 1,424 |
Depreciation and amortization | 131 | 141 | 98 |
Impairment | 0 | 138 | 0 |
Other | 20 | 0 | 5 |
Total operating expenses | 2,103 | 2,000 | 1,527 |
Operating income | (38) | (166) | (20) |
Interest expense | 109 | 110 | 120 |
Other expenses, net | 0 | 0 | 25 |
Total other expenses, net | 109 | 110 | 145 |
Loss before income tax benefit and equity in net earnings of subsidiaries | (147) | (276) | (165) |
Income tax benefit | (7) | (42) | (21) |
Net loss before equity in net earnings of subsidiaries | (140) | (234) | (144) |
Equity in net earnings of subsidiaries | 1,231 | 1,026 | 803 |
Net income | 1,091 | 792 | 659 |
Parent Company | Affiliated Entity | |||
Revenue: | |||
Revenues | $ 2,038 | $ 1,826 | $ 1,496 |
Condensed Financial Informati_6
Condensed Financial Information of Registrant - Condensed Statements of Comprehensive Income (Details) - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Condensed Financial Statements, Captions [Line Items] | |||
Net income | $ 1,091 | $ 792 | $ 659 |
Other comprehensive income (loss): | |||
Unrealized investment income (loss) | 102 | (204) | (55) |
Less: effect of income taxes | 24 | (49) | (13) |
Other comprehensive income (loss), net of tax | 78 | (155) | (42) |
Comprehensive income | 1,169 | 637 | 617 |
Parent Company | |||
Condensed Financial Statements, Captions [Line Items] | |||
Net income | 1,091 | 792 | 659 |
Other comprehensive income (loss): | |||
Unrealized investment income (loss) | 102 | (204) | (55) |
Less: effect of income taxes | 24 | (49) | (13) |
Other comprehensive income (loss), net of tax | 78 | (155) | (42) |
Comprehensive income | $ 1,169 | $ 637 | $ 617 |
Condensed Financial Informati_7
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 | |
Operating activities: | |||
Net cash provided by operating activities | $ 1,662 | $ 773 | $ 2,119 |
Investing activities: | |||
Purchases of investments | (1,433) | (1,913) | (2,713) |
Proceeds from sales and maturities of investments | 772 | 1,398 | 1,329 |
Purchases of property, equipment and capitalized software | (84) | (91) | (77) |
Other, net | 4 | (50) | (63) |
Net cash used in investing activities | (744) | (790) | (1,653) |
Financing activities: | |||
Common stock purchases | 0 | (400) | (128) |
Common stock withheld to settle employee tax obligations | (60) | (54) | (53) |
Contingent consideration liabilities settled | 0 | (20) | (20) |
Proceeds from senior notes offerings, net of issuance costs | 0 | 0 | 740 |
Repayment of senior notes | 0 | 0 | (723) |
Other, net | 2 | 33 | 1 |
Net cash used in financing activities | (58) | (441) | (183) |
Net increase (decrease) in cash and cash equivalents, and restricted cash and cash equivalents | 860 | (458) | 283 |
Cash and cash equivalents, and restricted cash and cash equivalents at beginning of period | 4,048 | 4,506 | 4,223 |
Cash and cash equivalents, and restricted cash and cash equivalents at end of period | 4,908 | 4,048 | 4,506 |
Parent Company | |||
Operating activities: | |||
Net cash provided by operating activities | 81 | 119 | 60 |
Investing activities: | |||
Capital contributions to subsidiaries | (221) | (159) | (440) |
Dividends received from subsidiaries | 705 | 668 | 564 |
Purchases of investments | (2) | (29) | (27) |
Proceeds from sales and maturities of investments | 1 | 49 | 21 |
Purchases of property, equipment and capitalized software | (79) | (86) | (70) |
Net cash paid in business combinations | (74) | 0 | (263) |
Change in amounts due to/from affiliates | 5 | (69) | 40 |
Other, net | 7 | 3 | (3) |
Net cash used in investing activities | 342 | 377 | (178) |
Financing activities: | |||
Common stock purchases | 0 | (400) | (128) |
Common stock withheld to settle employee tax obligations | (60) | (54) | (53) |
Contingent consideration liabilities settled | 0 | (20) | (20) |
Proceeds from senior notes offerings, net of issuance costs | 0 | 0 | 740 |
Repayment of senior notes | 0 | 0 | (723) |
Other, net | 2 | 33 | 1 |
Net cash used in financing activities | (58) | (441) | (183) |
Net increase (decrease) in cash and cash equivalents, and restricted cash and cash equivalents | 365 | 55 | (301) |
Cash and cash equivalents, and restricted cash and cash equivalents at beginning of period | 329 | 274 | 575 |
Cash and cash equivalents, and restricted cash and cash equivalents at end of period | $ 694 | $ 329 | $ 274 |
Condensed Financial Informati_8
Condensed Financial Information of Registrant - Notes to Condensed Financial Information (Details) - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Related Party Transaction [Line Items] | |||
Medicaid | $ 34,072 | $ 31,974 | $ 27,771 |
Parent Company | |||
Related Party Transaction [Line Items] | |||
Medicaid | 2,065 | 1,834 | 1,507 |
Parent Company | Affiliated Entity | |||
Related Party Transaction [Line Items] | |||
Medicaid | $ 2,038 | $ 1,826 | $ 1,496 |