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Income Taxes - Reconciliation to Nominal Tax Rate (Details) - USD ($)
$ in Millions
12 Months Ended
Dec. 31, 2018
Dec. 31, 2017
Dec. 31, 2016
Income Taxes [Abstract]      
Nominal federal income tax rate 21.00% 35.00% 35.00%
Reconciliation of total taxes to nominal federal rate, amount [Abstract]      
Tax expense at nominal rate $ 752 $ 1,262 $ 1,043
Effect of U.S. tax reform legislation (4) 232 0
Effect of undistributed foreign earnings 74 (70) (57)
Health insurance industry tax 78 0 108
State income taxes (net of federal income tax benefit) 10 23 18
Other 25 (73) 24
Total income taxes $ 935 $ 1,374 $ 1,136
Reconciliation of total taxes to nominal federal rate, percent [Abstract]      
Tax expense at nominal rate 21.00% 35.00% 35.00%
Effect of U.S. tax reform legislation (0.10%) 6.40% 0.00%
Effect of undistributed foreign earnings 2.10% (1.90%) (1.90%)
Health insurance industry tax 2.20% 0.00% 3.60%
State income taxes (net of federal income tax benefit) 0.30% 0.60% 0.60%
Other 0.60% (2.00%) 0.80%
Total income taxes 26.10% 38.10% 38.10%