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SEGMENT INFORMATION
6 Months Ended
Jun. 30, 2019
Segment Reporting [Abstract]  
SEGMENT INFORMATION SEGMENT INFORMATION
We manage our business with three reportable segments: Retail, Group and Specialty, and Healthcare Services. Beginning January 1, 2018, we exited the individual commercial fully-insured medical health insurance business, as well as certain other business, and therefore no longer report separately the Individual Commercial segment and the Other Business category in the current year. Previously, the Other Business category included businesses that were not individually reportable because they did not meet the quantitative thresholds required by generally accepted accounting principles, primarily our closed-block of commercial long-term care insurance policies which were sold in 2018. These segments are based on a combination of the type of health plan customer and adjacent businesses centered on well-being solutions for our health plans and other customers, as described below. These segment groupings are consistent with information used by our Chief Executive Officer, the Chief Operating Decision Maker, to assess performance and allocate resources.
The Retail segment consists of Medicare benefits, marketed to individuals or directly via group Medicare accounts. In addition, the Retail segment also includes our contract with CMS to administer the Limited Income Newly Eligible Transition, or LI-NET, prescription drug plan program and contracts with various states to provide Medicaid, dual eligible, and Long-Term Support Services benefits, which we refer to collectively as our state-based contracts. The Group and Specialty segment consists of employer group commercial fully-insured medical and specialty health insurance benefits marketed to individuals and employer groups, including dental, vision, and other supplemental health benefits, as well as administrative services only, or ASO products. In addition, our Group and Specialty segment includes military services business, primarily our TRICARE T2017 East Region contract. The Healthcare Services segment includes our services
offered to our health plan members as well as to third parties, including pharmacy solutions, provider services, and clinical care service, such as home health and other services and capabilities to promote wellness and advance population health, including our minority investment in Kindred at Home. We reported under the category of Other Businesses those businesses that did not align with the reportable segments described above, primarily our closed-block long-term care insurance policies, which were sold in 2018.
Our Healthcare Services intersegment revenues primarily relate to managing prescription drug coverage for members of our other segments through Humana Pharmacy Solutions®, or HPS, and includes the operations of Humana Pharmacy, Inc., our mail order pharmacy business. These revenues consist of the prescription price (ingredient cost plus dispensing fee), including the portion to be settled with the member (co-share) or with the government (subsidies), plus any associated administrative fees. Services revenues related to the distribution of prescriptions by third party retail pharmacies in our networks are recognized when the claim is processed and product revenues from dispensing prescriptions from our mail order pharmacies are recorded when the prescription or product is shipped. Our pharmacy operations, which are responsible for designing pharmacy benefits, including defining member co-share responsibilities, determining formulary listings, contracting with retail pharmacies, confirming member eligibility, reviewing drug utilization, and processing claims, act as a principal in the arrangement on behalf of members in our other segments. As principal, our Healthcare Services segment reports revenues on a gross basis, including co-share amounts from members collected by third party retail pharmacies at the point of service.
In addition, our Healthcare Services intersegment revenues include revenues earned by certain owned providers derived from risk-based and non-risk-based managed care agreements with our health plans. Under risk-based agreements, the provider receives a monthly capitated fee that varies depending on the demographics and health status of the member, for each member assigned to these owned providers by our health plans. The owned provider assumes the economic risk of funding the assigned members’ healthcare services. Under non risk-based agreements, our health plans retain the economic risk of funding the assigned members' healthcare services. Our Healthcare Services segment reports provider services revenues associated with risk-based agreements on a gross basis, whereby capitation fee revenue is recognized in the period in which the assigned members are entitled to receive healthcare services. Provider services revenues associated with non-risk-based agreements are presented net of associated healthcare costs.
We present our condensed consolidated results of operations from the perspective of the health plans. As a result, the cost of providing benefits to our members, whether provided via a third party provider or internally through a stand-alone subsidiary, is classified as benefits expense and excludes the portion of the cost for which the health plans do not bear responsibility, including member co-share amounts and government subsidies of $3.6 billion and $3.3 billion for the three months ended June 30, 2019 and 2018, respectively. For the six months ended June 30, 2019 and 2018 these amounts were $6.7 billion and $6.2 billion, respectively. In addition, depreciation and amortization expense associated with certain businesses in our Healthcare Services segment delivering benefits to our members, primarily associated with our provider services and pharmacy operations, are included with benefits expense. The amount of this expense was $31 million and $30 million for the three months ended June 30, 2019 and 2018, respectively. For the six months ended June 30, 2019 and 2018, the amount of this expense was $60 million and $69 million, respectively.
Other than those described previously, the accounting policies of each segment are the same and are described in Note 2 to the consolidated financial statements included in our 2018 Form 10-K. Transactions between reportable segments primarily consist of sales of services rendered by our Healthcare Services segment, primarily pharmacy, provider, and clinical care services, to our Retail and Group and Specialty segment customers. Intersegment sales and expenses are recorded at fair value and eliminated in consolidation. Members served by our segments often use the same provider networks, enabling us in some instances to obtain more favorable contract terms with providers. Our segments also share indirect costs and assets. As a result, the profitability of each segment is interdependent. We allocate most operating expenses to our segments. Assets and certain corporate income and expenses are not allocated to the segments, including the portion of investment income not supporting segment operations, interest expense on corporate debt, and certain other corporate expenses. These items are managed at a corporate level. These corporate amounts are reported separately from our reportable segments and are included with intersegment eliminations in the tables presenting segment results below.




Our segment results were as follows for the three and six months ended June 30, 2019 and 2018:
 
Retail
 
Group and Specialty
 
Healthcare
Services
 
Eliminations/
Corporate
 
Consolidated
 
(in millions)
Three months ended June 30, 2019
 
 
 
 
 
 
External revenues
 
 
 
 
 
 
 
 
Premiums:
 
 
 
 
 
 
 
 
 
Individual Medicare Advantage
$
10,793

 
$

 
$

 
$

 
$
10,793

Group Medicare Advantage
1,626

 

 

 

 
1,626

Medicare stand-alone PDP
818

 

 

 

 
818

Total Medicare
13,237

 

 

 

 
13,237

Fully-insured
144

 
1,284

 

 

 
1,428

Specialty

 
387

 

 

 
387

Medicaid and other
724

 

 

 

 
724

Total premiums
14,105

 
1,671

 

 

 
15,776

Services revenue:
 
 
 
 
 
 
 
 
 
Provider

 

 
111

 

 
111

ASO and other
5

 
193

 

 

 
198

Pharmacy

 

 
46

 

 
46

Total services revenue
5

 
193

 
157

 

 
355

Total external revenues
14,110

 
1,864

 
157

 

 
16,131

Intersegment revenues
 
 
 
 
 
 
 
 
 
Services

 
5

 
4,496

 
(4,501
)
 

Products

 

 
1,733

 
(1,733
)
 

Total intersegment revenues

 
5

 
6,229

 
(6,234
)
 

Investment income
48

 
5

 
1

 
60

 
114

Total revenues
14,158

 
1,874

 
6,387

 
(6,174
)
 
16,245

Operating expenses:
 
 
 
 
 
 
 
 
 
Benefits
12,019

 
1,442

 

 
(143
)
 
13,318

Operating costs
1,206

 
406

 
6,135

 
(6,044
)
 
1,703

Depreciation and amortization
77

 
21

 
40

 
(29
)
 
109

Total operating expenses
13,302

 
1,869

 
6,175

 
(6,216
)
 
15,130

Income from operations
856

 
5

 
212

 
42

 
1,115

Interest expense

 

 

 
60

 
60

Other income, net

 

 

 
(174
)
 
(174
)
Income before income taxes and equity in net earnings
856

 
5

 
212

 
156

 
1,229

Equity in net earnings of Kindred at Home

 

 
12

 

 
12

Segment earnings
$
856

 
$
5

 
$
224

 
$
156

 
$
1,241

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Retail
 
Group and Specialty
 
Healthcare
Services
 
Individual Commercial
 
Other
Businesses
 
Eliminations/
Corporate
 
Consolidated
 
(in millions)
Three months ended June 30, 2018
 
 
 
 
 
 
 
 
 
 
External revenues
 
 
 
 
 
 
 
 
 
 
 
 
Premiums:
 
 
 
 
 
 
 
 
 
 
 
 
 
Individual Medicare Advantage
$
8,908

 
$

 
$

 
$

 
$

 
$

 
$
8,908

Group Medicare Advantage
1,509

 

 

 

 

 

 
1,509

Medicare stand-alone PDP
914

 

 

 

 

 

 
914

Total Medicare
11,331

 

 

 

 

 

 
11,331

Fully-insured
125

 
1,346

 

 
10

 

 

 
1,481

Specialty

 
342

 

 

 

 

 
342

Medicaid and other
550

 

 

 

 
9

 

 
559

Total premiums
12,006

 
1,688

 

 
10

 
9

 

 
13,713

Services revenue:
 
 
 
 
 
 
 
 
 
 
 
 
 
Provider

 

 
112

 

 

 

 
112

ASO and other
3

 
208

 

 

 
2

 

 
213

Pharmacy

 

 
57

 

 

 

 
57

Total services revenue
3

 
208

 
169

 

 
2

 

 
382

Total external revenues
12,009

 
1,896

 
169

 
10

 
11

 

 
14,095

Intersegment revenues
 
 
 
 
 
 
 
 
 
 
 
 
 
Services

 
4

 
4,194

 

 

 
(4,198
)
 

Products

 

 
1,611

 

 

 
(1,611
)
 

Total intersegment revenues

 
4

 
5,805

 

 

 
(5,809
)
 

Investment income
30

 
6

 
17

 

 
65

 
46

 
164

Total revenues
12,039

 
1,906

 
5,991

 
10

 
76

 
(5,763
)
 
14,259

Operating expenses:
 
 
 
 
 
 
 
 
 
 
 
 
 
Benefits
10,270

 
1,357

 

 
(9
)
 
39

 
(121
)
 
11,536

Operating costs
1,210

 
447

 
5,749

 
1

 
2

 
(5,648
)
 
1,761

Depreciation and amortization
66

 
22

 
36

 

 

 
(24
)
 
100

Total operating expenses
11,546

 
1,826

 
5,785

 
(8
)
 
41

 
(5,793
)
 
13,397

Income from operations
493

 
80

 
206

 
18

 
35

 
30

 
862

Loss on sale of business

 

 

 

 

 
790

 
790

Interest expense

 

 

 

 

 
53

 
53

Income (loss) before income taxes and equity in net earnings
493

 
80

 
206

 
18

 
35

 
(813
)
 
19

Equity in net earnings of Kindred at Home

 

 

 

 

 

 

Segment earnings (loss)
$
493

 
$
80

 
$
206

 
$
18

 
$
35

 
$
(813
)
 
$
19

 
 
 
 
 
 
 
 
 
 
 
Retail
 
Group and Specialty
 
Healthcare
Services
 
Eliminations/
Corporate
 
Consolidated
 
(in millions)
Six months ended June 30, 2019
 
 
 
 
 
 
 
 
External revenues
 
 
 
 
 
 
 
 
Premiums:
 
 
 
 
 
 
 
 
 
Individual Medicare Advantage
$
21,502

 
$

 
$

 
$

 
$
21,502

Group Medicare Advantage
3,258

 

 

 

 
3,258

Medicare stand-alone PDP
1,627

 

 

 

 
1,627

Total Medicare
26,387

 

 

 

 
26,387

Fully-insured
284

 
2,595

 

 

 
2,879

Specialty

 
760

 

 

 
760

Medicaid and other
1,401

 

 

 

 
1,401

Total premiums
28,072

 
3,355

 

 

 
31,427

Services revenue:
 
 
 
 
 
 
 
 
 
Provider

 

 
231

 

 
231

ASO and other
10

 
387

 

 

 
397

Pharmacy

 

 
82

 

 
82

Total services revenue
10

 
387

 
313

 

 
710

Total external revenues
28,082

 
3,742

 
313

 

 
32,137

Intersegment revenues
 
 
 
 
 
 
 
 
 
Services

 
9

 
8,802

 
(8,811
)
 

Products

 

 
3,369

 
(3,369
)
 

Total intersegment revenues

 
9

 
12,171

 
(12,180
)
 

Investment income
89

 
10

 
1

 
115

 
215

Total revenues
28,171

 
3,761

 
12,485

 
(12,065
)
 
32,352

Operating expenses:
 
 
 
 
 
 
 
 
 
Benefits
24,346

 
2,729

 

 
(264
)
 
26,811

Operating costs
2,354

 
819

 
12,023

 
(11,833
)
 
3,363

Depreciation and amortization
150

 
43

 
78

 
(55
)
 
216

Total operating expenses
26,850

 
3,591

 
12,101

 
(12,152
)
 
30,390

Income from operations
1,321

 
170

 
384

 
87

 
1,962

Interest expense

 

 

 
122

 
122

Other income, net

 

 

 
(135
)
 
(135
)
Income before income taxes and equity in net earnings
1,321

 
170

 
384

 
100

 
1,975

Equity in net earnings of Kindred at Home

 

 
15

 

 
15

Segment earnings
$
1,321

 
$
170

 
$
399

 
$
100

 
$
1,990





 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Retail
 
Group and Specialty
 
Healthcare
Services
 
Individual Commercial
 
Other
Businesses
 
Eliminations/
Corporate
 
Consolidated
 
(in millions)
Six months ended June 30, 2018
 
 
 
 
 
 
 
 
 
 
External Revenues
 
 
 
 
 
 
 
 
 
 
 
 
Premiums:
 
 
 
 
 
 
 
 
 
 
 
 
 
Individual Medicare Advantage
$
17,878

 
$

 
$

 
$

 
$

 
$

 
$
17,878

Group Medicare Advantage
3,033

 

 

 

 

 

 
3,033

Medicare stand-alone PDP
1,810

 

 

 

 

 

 
1,810

Total Medicare
22,721

 

 

 

 

 

 
22,721

Fully-insured
250

 
2,738

 

 
5

 

 

 
2,993

Specialty

 
689

 

 

 

 

 
689

Medicaid and other
1,103

 

 

 

 
18

 

 
1,121

Total premiums
24,074

 
3,427

 

 
5

 
18

 

 
27,524

Services revenue:
 
 
 
 
 
 
 
 
 
 
 
 
 
Provider

 

 
177

 

 

 

 
177

ASO and other
5

 
427

 

 

 
4

 

 
436

Pharmacy

 

 
96

 

 

 

 
96

Total services revenue
5

 
427

 
273

 

 
4

 

 
709

Total external revenues
24,079

 
3,854

 
273

 
5

 
22

 

 
28,233

Intersegment revenues
 
 
 
 
 
 
 
 
 
 
 
 
 
Services

 
9

 
8,212

 

 

 
(8,221
)
 

Products

 

 
3,146

 

 

 
(3,146
)
 

Total intersegment revenues

 
9

 
11,358

 

 

 
(11,367
)
 

Investment income
67

 
13

 
23

 

 
100

 
102

 
305

Total revenues
24,146

 
3,876

 
11,654

 
5

 
122

 
(11,265
)
 
28,538

Operating expenses:
 
 
 
 
 
 
 
 
 
 
 
 
 
Benefits
20,822

 
2,630

 

 
(69
)
 
65

 
(242
)
 
23,206

Operating costs
2,432

 
910

 
11,190

 
3

 
4

 
(11,029
)
 
3,510

Depreciation and amortization
132

 
45

 
85

 

 

 
(62
)
 
200

Total operating expenses
23,386

 
3,585

 
11,275

 
(66
)
 
69

 
(11,333
)
 
26,916

Income from operations
760

 
291

 
379

 
71

 
53

 
68

 
1,622

Loss on sale of business

 

 

 

 

 
790

 
790

Interest expense

 

 

 

 

 
106

 
106

Income (loss) before income taxes and equity in net earnings
760

 
291

 
379

 
71

 
53

 
(828
)
 
726

Equity in net earnings of Kindred at Home

 

 

 

 

 

 

Segment earnings (loss)
$
760

 
$
291

 
$
379

 
$
71

 
$
53

 
$
(828
)
 
$
726