SEGMENT INFORMATION

3 Months Ended

Mar. 31, 2021

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 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 non-consolidating 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 $3.6 billion and $3.5 billion for the three months ended March 31, 2021 and 2020, 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 $26 million and $30 million for the three months ended March 31, 2021 and 2020, 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 2020 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, 2021 and 2020:

	Retail		Group and Specialty		Healthcare Services		Eliminations/ Corporate		Consolidated
Three months ended March 31, 2021	(in millions)
External revenues
Premiums:
Individual Medicare Advantage	$	14,815	$	—	$	—	$	—	$	14,815
Group Medicare Advantage	1,755		—		—		—		1,755
Medicare stand-alone PDP	664		—		—		—		664
Total Medicare	17,234		—		—		—		17,234
Fully-insured	178		1,099		—		—		1,277
Specialty	—		434		—		—		434
Medicaid and other	1,179		—		—		—		1,179
Total premiums	18,591		1,533		—		—		20,124
Services revenue:
Provider	—		—		115		—		115
ASO and other	5		190		—		—		195
Pharmacy	—		—		156		—		156
Total services revenue	5		190		271		—		466
Total external revenues	18,596		1,723		271		—		20,590
Intersegment revenues
Services	—		10		4,774		(4,784)		—
Products	—		—		2,152		(2,152)		—
Total intersegment revenues	—		10		6,926		(6,936)		—
Investment income	52		4		1		21		78
Total revenues	18,648		1,737		7,198		(6,915)		20,668
Operating expenses:
Benefits	16,299		1,145		—		(148)		17,296
Operating costs	1,451		397		6,910		(6,751)		2,007
Depreciation and amortization	104		21		40		(23)		142
Total operating expenses	17,854		1,563		6,950		(6,922)		19,445
Income from operations	794		174		248		7		1,223
Interest expense	—		—		—		68		68
Other expense, net	—		—		—		115		115
Income (loss) before income taxes and equity in net earnings	794		174		248		(176)		1,040
Equity in net earnings	—		—		21		—		21
Segment earnings (loss)	$	794	$	174	$	269	$	(176)	$	1,061

	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