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SEGMENT INFORMATION
3 Months Ended
Mar. 31, 2020
Segment Reporting [Abstract]  
SEGMENT INFORMATION SEGMENT INFORMATION
We manage our business with three reportable segments: Retail, Group and Specialty, and Healthcare Services. 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 and the strategic partnership with WCAS to develop and operate senior-focused, payor-agnostic, primary care centers.
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 $3.5 billion and $3.1 billion for the three months ended March 31, 2020 and 2019, 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 $30 million and $29 million for the three months ended March 31, 2020 and 2019, 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 2019 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 months ended March 31, 2020 and 2019:
 
Retail
 
Group and Specialty
 
Healthcare
Services
 
Eliminations/
Corporate
 
Consolidated
Three months ended March 31, 2020
(in millions)
External revenues
 
 
 
 
 
 
 
 
Premiums:
 
 
 
 
 
 
 
 
 
Individual Medicare Advantage
$
12,794

 
$

 
$

 
$

 
$
12,794

Group Medicare Advantage
2,011

 

 

 

 
2,011

Medicare stand-alone PDP
755

 

 

 

 
755

Total Medicare
15,560

 

 

 

 
15,560

Fully-insured
163

 
1,229

 

 

 
1,392

Specialty

 
429

 

 

 
429

Medicaid and other
981

 

 

 

 
981

Total premiums
16,704

 
1,658

 

 

 
18,362

Services revenue:
 
 
 
 
 
 
 
 
 
Provider

 

 
104

 

 
104

ASO and other
4

 
195

 

 

 
199

Pharmacy

 

 
121

 

 
121

Total services revenue
4

 
195

 
225

 

 
424

Total external revenues
16,708

 
1,853

 
225

 

 
18,786

Intersegment revenues
 
 
 
 
 
 
 
 
 
Services

 
7

 
4,950

 
(4,957
)
 

Products

 

 
1,910

 
(1,910
)
 

Total intersegment revenues

 
7

 
6,860

 
(6,867
)
 

Investment income
54

 
5

 

 
90

 
149

Total revenues
16,762

 
1,865

 
7,085

 
(6,777
)
 
18,935

Operating expenses:
 
 
 
 
 
 
 
 
 
Benefits
14,464

 
1,311

 

 
(146
)
 
15,629

Operating costs
1,532

 
429

 
6,800

 
(6,644
)
 
2,117

Depreciation and amortization
81

 
20

 
43

 
(29
)
 
115

Total operating expenses
16,077

 
1,760

 
6,843

 
(6,819
)
 
17,861

Income from operations
685

 
105

 
242

 
42

 
1,074

Interest expense

 

 

 
60

 
60

Other expense, net

 

 

 
297

 
297

Income (loss) before income taxes and equity in net earnings
685

 
105

 
242

 
(315
)
 
717

Equity in net earnings

 

 
8

 

 
8

Segment earnings (loss)
$
685

 
$
105

 
$
250

 
$
(315
)
 
$
725

 
 
 
 
 
 
 
 
 
 
 
Retail
 
Group and Specialty
 
Healthcare
Services
 
Eliminations/
Corporate
 
Consolidated
 
(in millions)
Three months ended March 31, 2019
 
 
 
 
 
 
External revenues
 
 
 
 
 
 
 
 
Premiums:
 
 
 
 
 
 
 
 
 
Individual Medicare Advantage
$
10,709

 
$

 
$

 
$

 
$
10,709

Group Medicare Advantage
1,632

 

 

 

 
1,632

Medicare stand-alone PDP
809

 

 

 

 
809

Total Medicare
13,150

 

 

 

 
13,150

Fully-insured
140

 
1,311

 

 

 
1,451

Specialty

 
373

 

 

 
373

Medicaid and other
677

 

 

 

 
677

Total premiums
13,967

 
1,684

 

 

 
15,651

Services revenue:
 
 
 
 
 
 
 
 
 
Provider

 

 
120

 

 
120

ASO and other
5

 
194

 

 

 
199

Pharmacy

 

 
36

 

 
36

Total services revenue
5

 
194

 
156

 

 
355

Total external revenues
13,972

 
1,878

 
156

 

 
16,006

Intersegment revenues
 
 
 
 
 
 
 
 
 
Services

 
4

 
4,306

 
(4,310
)
 

Products

 

 
1,636

 
(1,636
)
 

Total intersegment revenues

 
4

 
5,942

 
(5,946
)
 

Investment income
41

 
5

 

 
55

 
101

Total revenues
14,013

 
1,887

 
6,098

 
(5,891
)
 
16,107

Operating expenses:
 
 
 
 
 
 
 
 
 
Benefits
12,327

 
1,287

 

 
(121
)
 
13,493

Operating costs
1,148

 
413

 
5,888

 
(5,789
)
 
1,660

Depreciation and amortization
73

 
22

 
38

 
(26
)
 
107

Total operating expenses
13,548

 
1,722

 
5,926

 
(5,936
)
 
15,260

Income from operations
465

 
165

 
172

 
45

 
847

Interest expense

 

 

 
62

 
62

Other expense, net

 

 

 
39

 
39

Income (loss) before income taxes and equity in net earnings
465

 
165

 
172

 
(56
)
 
746

Equity in net earnings

 

 
3

 

 
3

Segment earnings (loss)
$
465

 
$
165

 
$
175

 
$
(56
)
 
$
749