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SEGMENT INFORMATION
9 Months Ended
Sep. 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. The reportable 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
our 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 $4.0 billion and $3.5 billion for the three months ended September 30, 2019 and 2018, respectively. For the nine months ended September 30, 2019 and 2018 these amounts were $10.7 billion and $9.7 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 $32 million and $29 million for the three months ended September 30, 2019 and 2018, respectively. For the nine months ended September 30, 2019 and 2018, the amount of this expense was $92 million and $98 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 nine months ended September 30, 2019 and 2018:
 
Retail
 
Group and Specialty
 
Healthcare
Services
 
Eliminations/
Corporate
 
Consolidated
Three months ended September 30, 2019
(in millions)
External revenues
 
 
 
 
 
 
 
 
Premiums:
 
 
 
 
 
 
 
 
 
Individual Medicare Advantage
$
10,752

 
$

 
$

 
$

 
$
10,752

Group Medicare Advantage
1,609

 

 

 

 
1,609

Medicare stand-alone PDP
781

 

 

 

 
781

Total Medicare
13,142

 

 

 

 
13,142

Fully-insured
150

 
1,278

 

 

 
1,428

Specialty

 
400

 

 

 
400

Medicaid and other
742

 

 

 

 
742

Total premiums
14,034

 
1,678

 

 

 
15,712

Services revenue:
 
 
 
 
 
 
 
 
 
Provider

 

 
136

 

 
136

ASO and other
4

 
200

 

 

 
204

Pharmacy

 

 
53

 

 
53

Total services revenue
4

 
200

 
189

 

 
393

Total external revenues
14,038

 
1,878

 
189

 

 
16,105

Intersegment revenues
 
 
 
 
 
 
 
 
 
Services

 
4

 
4,654

 
(4,658
)
 

Products

 

 
1,759

 
(1,759
)
 

Total intersegment revenues

 
4

 
6,413

 
(6,417
)
 

Investment income
50

 
7

 

 
79

 
136

Total revenues
14,088

 
1,889

 
6,602

 
(6,338
)
 
16,241

Operating expenses:
 
 
 
 
 
 
 
 
 
Benefits
12,050

 
1,448

 

 
(141
)
 
13,357

Operating costs
1,310

 
413

 
6,348

 
(6,182
)
 
1,889

Depreciation and amortization
89

 
24

 
43

 
(29
)
 
127

Total operating expenses
13,449

 
1,885

 
6,391

 
(6,352
)
 
15,373

Income from operations
639

 
4

 
211

 
14

 
868

Interest expense

 

 

 
62

 
62

Other income, net

 

 

 
(82
)
 
(82
)
Income before income taxes and equity in net earnings
639

 
4

 
211

 
34

 
888

Equity in net earnings of Kindred at Home

 

 
1

 

 
1

Segment earnings
$
639

 
$
4

 
$
212

 
$
34

 
$
889

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Retail
 
Group and Specialty
 
Healthcare
Services
 
Individual Commercial
 
Other
Businesses
 
Eliminations/
Corporate
 
Consolidated
 
(in millions)
Three months ended September 30, 2018
 
 
 
 
 
 
 
 
 
 
External revenues
 
 
 
 
 
 
 
 
 
 
 
 
Premiums:
 
 
 
 
 
 
 
 
 
 
 
 
 
Individual Medicare Advantage
$
8,912

 
$

 
$

 
$

 
$

 
$

 
$
8,912

Group Medicare Advantage
1,542

 

 

 

 

 

 
1,542

Medicare stand-alone PDP
893

 

 

 

 

 

 
893

Total Medicare
11,347

 

 

 

 

 

 
11,347

Fully-insured
129

 
1,345

 

 
1

 

 

 
1,475

Specialty

 
325

 

 

 

 

 
325

Medicaid and other
561

 

 

 

 
4

 

 
565

Total premiums
12,037

 
1,670

 

 
1

 
4

 

 
13,712

Services revenue:
 
 
 
 
 
 
 
 
 
 
 
 
 
Provider

 

 
113

 

 

 

 
113

ASO and other
1

 
215

 

 

 

 

 
216

Pharmacy

 

 
52

 

 

 

 
52

Total services revenue
1

 
215

 
165

 

 

 

 
381

Total external revenues
12,038

 
1,885

 
165

 
1

 
4

 

 
14,093

Intersegment revenues
 
 
 
 
 
 
 
 
 
 
 
 
 
Services

 
4

 
4,214

 

 

 
(4,218
)
 

Products

 

 
1,576

 

 

 
(1,576
)
 

Total intersegment revenues

 
4

 
5,790

 

 

 
(5,794
)
 

Investment income
35

 
5

 
11

 

 
10

 
52

 
113

Total revenues
12,073

 
1,894

 
5,966

 
1

 
14

 
(5,742
)
 
14,206

Operating expenses:
 
 
 
 
 
 
 
 
 
 
 
 
 
Benefits
10,020

 
1,347

 

 
(4
)
 
12

 
(132
)
 
11,243

Operating costs
1,352

 
445

 
5,720

 

 
2

 
(5,619
)
 
1,900

Depreciation and amortization
67

 
21

 
40

 

 

 
(26
)
 
102

Total operating expenses
11,439

 
1,813

 
5,760

 
(4
)
 
14

 
(5,777
)
 
13,245

Income from operations
634

 
81

 
206

 
5

 

 
35

 
961

Gain on sale of business

 

 

 

 

 
(4
)
 
(4
)
Interest expense

 

 

 

 

 
53

 
53

Other expense, net

 

 

 

 

 
11

 
11

Income (loss) before income taxes and equity in net earnings
634

 
81

 
206

 
5

 

 
(25
)
 
901

Equity in net earnings of Kindred at Home

 

 
9

 

 

 

 
9

Segment earnings (loss)
$
634

 
$
81

 
$
215

 
$
5

 
$

 
$
(25
)
 
$
910


 
 
 
 
 
 
 
 
 
 
 
Retail
 
Group and Specialty
 
Healthcare
Services
 
Eliminations/
Corporate
 
Consolidated
 
(in millions)
Nine months ended September 30, 2019
 
 
 
 
 
 
 
 
External revenues
 
 
 
 
 
 
 
 
Premiums:
 
 
 
 
 
 
 
 
 
Individual Medicare Advantage
$
32,254

 
$

 
$

 
$

 
$
32,254

Group Medicare Advantage
4,867

 

 

 

 
4,867

Medicare stand-alone PDP
2,408

 

 

 

 
2,408

Total Medicare
39,529

 

 

 

 
39,529

Fully-insured
434

 
3,873

 

 

 
4,307

Specialty

 
1,160

 

 

 
1,160

Medicaid and other
2,143

 

 

 

 
2,143

Total premiums
42,106

 
5,033

 

 

 
47,139

Services revenue:
 
 
 
 
 
 
 
 
 
Provider

 

 
367

 

 
367

ASO and other
14

 
587

 

 

 
601

Pharmacy

 

 
135

 

 
135

Total services revenue
14

 
587

 
502

 

 
1,103

Total external revenues
42,120

 
5,620

 
502

 

 
48,242

Intersegment revenues
 
 
 
 
 
 
 
 
 
Services

 
13

 
13,456

 
(13,469
)
 

Products

 

 
5,128

 
(5,128
)
 

Total intersegment revenues

 
13

 
18,584

 
(18,597
)
 

Investment income
139

 
17

 
1

 
194

 
351

Total revenues
42,259

 
5,650

 
19,087

 
(18,403
)
 
48,593

Operating expenses:
 
 
 
 
 
 
 
 
 
Benefits
36,396

 
4,177

 

 
(405
)
 
40,168

Operating costs
3,664

 
1,232

 
18,371

 
(18,015
)
 
5,252

Depreciation and amortization
239

 
67

 
121

 
(84
)
 
343

Total operating expenses
40,299

 
5,476

 
18,492

 
(18,504
)
 
45,763

Income from operations
1,960

 
174

 
595

 
101

 
2,830

Interest expense

 

 

 
184

 
184

Other income, net

 

 

 
(217
)
 
(217
)
Income before income taxes and equity in net earnings
1,960

 
174

 
595

 
134

 
2,863

Equity in net earnings of Kindred at Home

 

 
16

 

 
16

Segment earnings
$
1,960

 
$
174

 
$
611

 
$
134

 
$
2,879



 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Retail
 
Group and Specialty
 
Healthcare
Services
 
Individual Commercial
 
Other
Businesses
 
Eliminations/
Corporate
 
Consolidated
 
(in millions)
Nine months ended September 30, 2018
 
 
 
 
 
 
 
 
 
 
External Revenues
 
 
 
 
 
 
 
 
 
 
 
 
Premiums:
 
 
 
 
 
 
 
 
 
 
 
 
 
Individual Medicare Advantage
$
26,790

 
$

 
$

 
$

 
$

 
$

 
$
26,790

Group Medicare Advantage
4,575

 

 

 

 

 

 
4,575

Medicare stand-alone PDP
2,703

 

 

 

 

 

 
2,703

Total Medicare
34,068

 

 

 

 

 

 
34,068

Fully-insured
379

 
4,083

 

 
6

 

 

 
4,468

Specialty

 
1,014

 

 

 

 

 
1,014

Medicaid and other
1,664

 

 

 

 
22

 

 
1,686

Total premiums
36,111

 
5,097

 

 
6

 
22

 

 
41,236

Services revenue:
 
 
 
 
 
 
 
 
 
 
 
 
 
Provider

 

 
290

 

 

 

 
290

ASO and other
6

 
642

 

 

 
4

 

 
652

Pharmacy

 

 
148

 

 

 

 
148

Total services revenue
6

 
642

 
438

 

 
4

 

 
1,090

Total external revenues
36,117

 
5,739

 
438

 
6

 
26

 

 
42,326

Intersegment revenues
 
 
 
 
 
 
 
 
 
 
 
 
 
Services

 
13

 
12,426

 

 

 
(12,439
)
 

Products

 

 
4,722

 

 

 
(4,722
)
 

Total intersegment revenues

 
13

 
17,148

 

 

 
(17,161
)
 

Investment income
102

 
18

 
34

 

 
110

 
154

 
418

Total revenues
36,219

 
5,770

 
17,620

 
6

 
136

 
(17,007
)
 
42,744

Operating expenses:
 
 
 
 
 
 
 
 
 
 
 
 
 
Benefits
30,842

 
3,977

 

 
(73
)
 
77

 
(374
)
 
34,449

Operating costs
3,784

 
1,355

 
16,910

 
3

 
6

 
(16,648
)
 
5,410

Depreciation and amortization
199

 
66

 
125

 

 

 
(88
)
 
302

Total operating expenses
34,825

 
5,398

 
17,035

 
(70
)
 
83

 
(17,110
)
 
40,161

Income from operations
1,394

 
372

 
585

 
76

 
53

 
103

 
2,583

Loss on sale of business

 

 

 

 

 
786

 
786

Interest expense

 

 

 

 

 
159

 
159

Other expense, net

 

 

 

 

 
11

 
11

Income (loss) before income taxes and equity in net earnings
1,394

 
372

 
585

 
76

 
53

 
(853
)
 
1,627

Equity in net earnings of Kindred at Home

 

 
9

 

 

 

 
9

Segment earnings (loss)
$
1,394

 
$
372

 
$
594

 
$
76

 
$
53

 
$
(853
)
 
$
1,636