Reinsurance - Medicare Advantage (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Premiums Earned, Net [Abstract]
Premiums earned, ceded	$ (444)	$ (470)	$ (489)
Net premiums earned	1,235,769	1,084,869	799,414
Policyholder Benefits and Claims Incurred, Net [Abstract]
Net claims incurred	1,776,388	3,453,952	1,551,178
Reinsurance Recoverables, Including Reinsurance Premium Paid [Abstract]
Reinsurance recoverable on unpaid claims	0	0
Reinsurance premium payable	0	0
Reinsurance recoverable, net	46	500
Insurance Operations
Premiums Earned, Net [Abstract]
Premiums earned, gross	1,236,213	1,085,339	799,903
Premiums earned, ceded	(444)	(470)	(489)
Net premiums earned	1,235,769	1,084,869	799,414
Policyholder Benefits and Claims Incurred, Net [Abstract]
Claims incurred, gross	987,654	985,197	839,136
Claims incurred, ceded	(496)	(1,166)	(1,002)
Net claims incurred	987,158	984,031	$ 838,134
Reinsurance Recoverables, Including Reinsurance Premium Paid [Abstract]
Reinsurance recoverable on paid claims, gross	46	500
Reinsurance recoverable, net	$ 46	$ 500