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Medical Expenses Payable
6 Months Ended
Jun. 30, 2022
Insurance [Abstract]  
Medical Expenses Payable

7. Medical Expenses Payable

The following table is a detail of medical expenses payable as of June 30, 2022 and December 31, 2021:

 

 

 

June 30,
2022

 

 

December 31,
2021

 

Claims incurred but not paid

 

$

84,667

 

 

$

77,073

 

Capitation payable, risk-sharing payable, and other

 

 

89,204

 

 

 

48,813

 

 

 

$

173,871

 

 

$

125,886

 

Each period, we re-examine previously established outstanding claims reserve estimates based on actual claims submissions and other changes in facts and circumstances. As more complete claim information becomes available, we adjust the amount of the estimates and include the changes in estimates in claim costs in the period in which the change is identified. Substantially, all of the total claims paid by us are known and settled within the first year from the date of service, and substantially, all remaining claim amounts are paid within a three-year period.

The following table presents components of the change in medical expenses payable as of June 30, 2022 and 2021:

 

 

 

June 30,
2022

 

 

June 30,
2021

 

Claims incurred but not paid - beginning balance

 

$

77,073

 

 

$

82,391

 

Incurred related to:

 

 

 

 

 

 

Current year

 

 

189,468

 

 

 

164,620

 

Prior years

 

 

(14,657

)

 

 

(3,016

)

Total incurred, net of reinsurance

 

 

174,811

 

 

 

161,604

 

Payments related to:

 

 

 

 

 

 

Current year

 

 

112,674

 

 

 

100,606

 

Prior years

 

 

54,543

 

 

 

66,015

 

Total payments, net of reinsurance

 

 

167,217

 

 

 

166,621

 

Claims incurred but not paid - ending balance

 

 

84,667

 

 

 

77,374

 

Capitation payable, risk-sharing payable, and other

 

 

89,204

 

 

 

59,104

 

Total medical expenses payable

 

$

173,871

 

 

$

136,478

 

In March 2020, the COVID-19 outbreak was declared a pandemic. The COVID-19 virus disproportionately impacts older adults, especially those with chronic illnesses, which describes many of the seniors we serve. For the six months ended June 30, 2021, we experienced higher claims costs due to COVID-19 related inpatient admissions. However, for the remainder of 2021 we saw a decline in COVID-related utilization (compared to the first half of the year) as vaccination rates improved across our senior population. The Delta and Omicron variants caused a rebound in COVID-related inpatient utilization during the second half of 2021 and first quarter of 2022, however, the increase in utilization did not reach first quarter of 2021 levels. While COVID had a less significant impact on the second quarter of 2022 medical expense relative to our first quarter of 2021 medical expense, we remain cautious of the potential impact of the COVID-19 in the future. The ultimate impact of COVID-19 to us and our financial condition is presently unknown, and we continue to monitor the impact of COVID-19 on our claims reserve estimate.

We re-examine previously established outstanding claims reserve estimates based on actual claims submissions and other changes in facts and circumstances. We recognized a favorable prior year development, excluding provision for adverse deviation, of $4,905 and $10,780 for the three and six months ended June 30, 2022, respectively. The favorable prior year development was primarily due to better than expected claims recoveries and actual claims expense being less than expected.