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Unpaid Claims
 12 Months Ended
Dec. 31, 2023
Liability for Unpaid Claims and Claims Adjustment Expense, Activity in Liability [Abstract]  
Unpaid Claims Unpaid Claims
Activity within the liability for Unpaid claims, including claims adjustment expenses, for the years ended December 31, 2023 and 2022, respectively, is summarized as follows:
Years ended December 31,
20232022
(in thousands)
Gross and net balance, beginning of period (1)
$137,395 $136,317 
Incurred related to:
Current year996,158 1,023,355 
Prior years(9,000)(39,324)
Total incurred987,158 984,031 
Paid related to:
Current year865,930 892,495 
Prior years121,523 90,458 
Total paid987,453 982,953 
Gross and net balance, end of period (1)(2)
$137,100 $137,395 
(1)    Includes amounts due to related parties.
(2)    Differs from the total Unpaid claims amount reported on the Consolidated Balance Sheets due to the fact the figure here excludes unpaid claims for the Company's Non-Insurance operations of $2.9 million and $6.1 million at December 31, 2023 and 2022, respectively.
The Company uses a variety of standard actuarial techniques to establish unpaid claims reserves. Management estimates are supported by the Company's actuarial analysis. The Company utilizes an internal actuarial team to review the adequacy of unpaid claim and unpaid claim adjustment expense. The estimation of claim costs is inherently difficult and requires significant judgment. The estimation has considerable inherent variability and can fluctuate significantly depending upon several factors, including medical cost trends and claim payment patterns, general economic conditions, and regulatory changes. The time value of money is not taken into account for the purposes of calculating the liability for unpaid claims. Management believes that the current reserves are adequate based on currently available information.
Unpaid Claims for Insurance Operations
Unpaid claims for Insurance operations were $137.1 million at December 31, 2023. During the year ended December 31, 2023, $121.5 million was paid for incurred claims attributable to insured events of prior years. A favorable development of $9.0 million was recognized during the year ended December 31, 2023, resulting from the Company's actual experience with claims developing differently as compared to the Company's estimates at December 31, 2022. A favorable development of $39.3 million was recognized during the year ended December 31, 2022, resulting from the Company's actual experience with claims developing differently as compared to the Company's estimates at December 31, 2021. Original estimates are increased or decreased, as additional information becomes known regarding individual claims. The ratio of current year medical claims paid as a percentage of current year Net medical claims incurred was 86.9% for the year ended December 31, 2023, and 87.2% for the year ended December 31, 2022. This ratio serves as an indicator of claims processing speed, indicating that claims were processed at a slower rate during the year ended December 31, 2023, than during the year ended December 31, 2022.
The following tables provide information regarding incurred and paid claims development for medical claims, as well as cumulative claim frequency and the total of incurred but not reported liabilities at December 31, 2023, respectively:

Cumulative incurred claims for the
years ended December 31,
Incurred year
2021*
2022*
2023
Total IBNR(1)
Number of reported claims
(in thousands)(in ones)
2021 and prior
$2,138,604 $2,099,334 $1,938,863 $1,902 7,491,528 
2022— 1,023,355 910,776 4,652 3,358,454 
2023— — 996,158 130,546 3,141,069 
Total$2,138,604 $3,122,689 $3,845,797 $137,100 13,991,051 
(1)    Differs from the total unpaid claims amount reported on the Consolidated Balance Sheets due to the fact the figure here excludes unpaid claims for the Company's ACO of $2.9 million as of December 31, 2023.

Cumulative net paid claims through December 31,
Paid year
2021*
2022*
2023
(in thousands)
Incurred year
2021 and prior
$2,002,287 $2,092,800 $1,936,643 
2022— 892,495 906,124 
2023— — 865,930 
Total$2,002,287 $2,985,295 $3,708,697 
*Unaudited supplemental information
The reconciliation of net incurred and paid claims development tables to unpaid claims and claims adjustment expenses for medical claims on the Consolidated Balance Sheets is as follows:
December 31, 2023
(in thousands)
Cumulative incurred claims, net$3,845,797 
Less: cumulative paid claims, net3,708,697 
Net unpaid claims, including claims adjustment expenses(1)
$137,100 
(1) The following balance reflects the unpaid claims for Medicare Advantage only. The ACO and other medical unpaid claims should be included in order to reconcile to the total unpaid claims on the Consolidated Balance Sheets.