10-K 0001156039-26-000013 (2026-02-06) vs 10-K 0001156039-25-000010 (2025-02-20)
| Section | Compared text | Words now | Changed |
|---|
| Risk Factors | Item 1A | 13,346 |
15.2% |
| MD&A | Item 7 | 13,810 |
16.2% |
| Legal Proceedings | Item 3, via Note 14 – Commitments and Contingencies | 1,927 |
39.6% |
| Accounting Policies | Item 8, Note 2 – Basis of Presentation and Significant Accounting Policies | 7,723 |
12.5% |
The redline: what was cut and what was added
In each section, the paragraph that changed most, marked against last year's 10-K:
cut words struck through, new words highlighted and underlined.
Risk Factors 252 words changed in this paragraph; it is 32% similar to last year's version.
Revenues from the Medicare and Medicaid programs are determined, in whole or in part, by the federal government and/or applicable state governments, and base premium rates paid by each state or federal agency differ depending upon a combination of factors such as defined upper payment limits, a member’s health status, age, gender, county or region, benefit mix, member eligibility category and risk scores. Rates may be affected by federal and state budgetary constraints. Certain state contracts are subject to cancellation in the event of the unavailability of state funds. Additionally, ongoing CMS changes to the calculation of risk in the Medicare Advantage program may impact our revenue. For example, CMS made significant changes to the structure of the hierarchical condition category model in version 28, which may impact risk adjustment factor (“RAF”) scores for a larger percentage of Medicare Advantage beneficiaries and could result in changes to beneficiary RAF scores with or without a change in the patient’s health status. The federal government or any state in which we operate could decrease rates paid to us, pay us less than the amount necessary to keep pace with our cost trends, cancel our contracts retroactively or seek an adjustment to previously negotiated rates. In addition, various states’ Medicare-Medicaid dual-eligible plans are still subject to uncertainty surrounding payment rates and other requirements, which could affect where we seek to participate in these programs. For example, CMS will require in future years that health plans offering certain dual-eligible products must also align with integrated Medicaid products in the same service area. Some states are also requiring companies to offer Medicaid within a state and are conducting competitive bid processes to qualify to offer dual-eligible products. An unexpected reduction in payments, inadequate government funding or significantly delayed payments for these programs may adversely affect our business, cash flows, financial condition and results of operations.
Source: Item 1A, 10-K 0001156039-26-000013 vs Item 1A, 10-K 0001156039-25-000010
Legal Proceedings 193 words changed in this paragraph; it is 40% similar to last year's version.
Four notices of appeal of The BCBSA and Blue plans approved a settlement agreement and release with the Final Approval Order were heard by a panel of subscriber plaintiffs (the “Subscriber Settlement Agreement”), which received final approval from the United States Court of Appeals for the Eleventh Circuit (the “Eleventh Circuit”) in September 2023, and 2022. The ultimate amount paid by the Eleventh Circuit affirmed the Court’s Final Approval Order approving Company under the Subscriber Settlement Agreement was $604, which was primarily accrued in October 2023. Petitions for rehearing were filed by certain appellants in November 2023 and December 2023 and were denied in January 2024. As a result, the Eleventh Circuit issued a mandate terminating the jurisdiction of the Eleventh Circuit in February 2024. In March 2024, Home Depot, one of the appellants, filed a petition for certiorari to the United States Supreme Court (the “Supreme Court”). On the respondents' request, the Supreme Court granted an extension to respond until May 2024. In April 2024, David Behenna, another appellant, filed a petition for certiorari to the Supreme Court, and the defendants and the subscriber plaintiffs filed briefs in opposition in May 2024. In June 2024, the Supreme Court declined to grant certiorari, exhausting all appellate rights. 2020. The Subscriber Settlement Agreement and the defendants' payment and non-monetary obligations under the Subscriber Settlement Agreement became effective in June 2024, with the request for second Blue plan bid provisions effective in September 2024. The funds held in escrow will be distributed to members of the subscriber class in accordance with the Subscriber Settlement Agreement.
Source: Item 3, via Note 14 – Commitments and Contingencies, 10-K 0001156039-26-000013 vs Item 3, via Note 14 – Commitments and Contingencies, 10-K 0001156039-25-000010
MD&A 167 words changed in this paragraph; it is 55% similar to last year's version.
The Inflation Reduction Act of 2022 contains a variety of (“IRA”) includes several provisions that have impacted, and continue to impact impact, our business including by business. These provisions include extending the American Rescue Plan Act of 2021's enhanced Premium Tax Credits (“PTC”) PTCs through 2025; imposing a new corporate alternative minimum tax; providing establishing a one percent excise tax on repurchases of stock; allowing stock by issuers; authorizing CMS to negotiate prices on a limited set of Medicare prescription drugs in Medicare effective beginning in 2026; instituting caps on insulin cost sharing in Medicare; redesigning the Medicare Part D benefit; requiring drug manufacturers to pay rebates if prices increase beyond inflation; and delaying the implementation of the Trump Administration Medicare drug rebate rule until at least 2032. From 2021 to 2025, Individual market enrollment grew significantly, driven in part by enhanced PTCs, which reduced Public Exchange coverage premiums for individuals who qualified. This, in combination with lower membership effectuation rates, particularly in geographies with high concentrations of highly subsidized members, have driven a market-wide increase in morbidity, resulting in elevated medical cost trends. The extension enhanced PTCs expired on December 31, 2025. As a result, the amount of Public Exchange coverage premiums may increase for those individuals previously receiving the enhanced PTC has allowed for growth in Individual Public Exchange enrollment and has supported continuity of coverage since Medicaid eligibility redeterminations resumed in 2023. If Congress does not act to extend the enhanced PTC, they will expire at the end of 2025, PTCs, which could have a material adverse effect on our business and results of operations. may negatively impact individual market enrollment.
Source: Item 7, 10-K 0001156039-26-000013 vs Item 7, 10-K 0001156039-25-000010
Accounting Policies 115 words changed in this paragraph; it is 61% similar to last year's version.
Liabilities for claims incurred but not reported and reported but not yet processed through our systems are determined in the aggregate, employing actuarial methods that are commonly used by health insurance actuaries and meet Actuarial Standards of Practice. Our reserving practice for claim liabilities is to consistently recognize the appropriate amount of reserve within a level of confidence required by Actuarial Standards of Practice. We determine the amount of the liability for incurred but not yet reported or processed claims by following a detailed actuarial process that uses both historical claim payment patterns as well as emerging medical cost trends to project our best estimate of claim liabilities. Under this process, historical paid claims data is formatted into “claim triangles,” which compare claim incurred dates to the dates of claim payments. This information is analyzed to create “completion factors” that represent the average percentage of total incurred claims that have been paid through a given date after being incurred. Completion factors are applied to claims paid through the period-end date to estimate the ultimate claim expense incurred for the period. Actuarial estimates of incurred but not paid claim liabilities are then determined by subtracting the actual paid claims from the estimate of the ultimate incurred claims.
Source: Item 8, Note 2 – Basis of Presentation and Significant Accounting Policies, 10-K 0001156039-26-000013 vs Item 8, Note 2 – Basis of Presentation and Significant Accounting Policies, 10-K 0001156039-25-000010
Every change, by type
Sentences and paragraphs of ELV's Risk Factors and MD&A, 10-K 2026-02-06 against 10-K 2025-02-20.
Each links to the text at sec.gov.
Quiet changes are sentences kept from last year with one to four words changed, at least one of them a hedge, a modal or a qualifier
(may, could, will, not, significant, material…). A year or date rolling forward is not counted.
The full word list
adverse, adversely, all, although, anticipate, anticipates, any, approximately, believe, believes, can, cannot, certain, could, expect, expects, generally, however, if, intend, intends, largely, likely, many, material, materially, may, might, most, must, never, no, not, possible, primarily, probable, should, significant, significantly, some, substantial, substantially, unlikely, will, would
AddedRisk Factors
Revenues from the Medicare and Medicaid programs are determined, in whole or in part, by the federal government and/or applicable state governments, and base premium rates paid by each state or federal agency differ depending upon a combination of factors such as defined upper payment limits, a member’s health status, age, gender, county or region, benefit mix, member
Read it in 10-K 2026-02-06 at sec.gov ↗
AddedRisk Factors
We are periodically subject to government audits, including CMS RADV audits of our Medicare Advantage Plans to validate diagnostic data, patient claims and financial reporting, and audits of our Medicare Part D plans by the Medicare Part D Recovery Audit Contractor (“RAC”), as well as state Medicaid RAC programs. Certain of our contracts currently have pending RADV audits
Read it in 10-K 2026-02-06 at sec.gov ↗
AddedRisk Factors
Furthermore, legislative or regulatory actions intended to address rising health-care costs or affordability concerns may result in the imposition of additional requirements on health insurers, including mandated benefits, restrictions on premium increases, or other pricing limitations, which could increase costs, constrain pricing flexibility, and adversely affect our financial condition and results of operations.
Read it in 10-K 2026-02-06 at sec.gov ↗
AddedRisk Factors
The direct provision of healthcare services by certain of our subsidiaries involves risks of additional litigation brought against us or our associates for alleged malpractice or professional liability claims arising out of the delivery of healthcare and related
Read it in 10-K 2026-02-06 at sec.gov ↗
AddedRisk Factors
Federal and state legislatures and regulators also regularly consider new laws and regulations as well as changes to existing requirements that could adversely affect current industry practices and our business. These new and changing laws and regulations include or could include changes to compensation, prohibitions or limitations on spread pricing contracting, requirements regarding rebates and/or fees, additional data reporting to plan sponsors and public sources, restrictions on the development and use of formularies and other utilization management tools, the use of average wholesale prices or other pricing benchmarks, pricing for
Read it in 10-K 2026-02-06 at sec.gov ↗
AddedRisk Factors
Recently, California enacted legislation that significantly regulates pharmacy benefit managers and pharmacy pricing practices. The law imposes requirements related to price transparency, restrictions on spread pricing, rebate pass-through obligations, licensing, and fiduciary duties. In addition, Congress recently passed the Consolidated Appropriations Act of 2026, which includes pharmacy benefit manager reforms requiring pharmacy benefit managers to remit all rebates, fees (other than bona fide service fees), and other remuneration received from entities such as manufacturers and group purchasing organizations to commercial plan sponsors, and to provide detailed commercial claims reporting, effective thirty months after enactment. The legislation also imposes extensive reporting requirements and delinks pharmacy benefit manager compensation in Medicare Part D by prohibiting pharmacy benefit managers from receiving remuneration related to Part D drugs in any form other than bona fide service fees that cannot be based on a drug’s price, effective in 2028. There continues to be the potential that similar or additional legislation may be adopted at the state or federal level. These changes in legislation within the prescription drug industry and pharmacy benefit management practices have both short-term and long-term impacts that could have an adverse effect on our business and results of operations.
Read it in 10-K 2026-02-06 at sec.gov ↗
AddedRisk Factors
2021 Appropriations Act, which requires reporting of plan spending, the cost of plan pharmacy benefits, enrollee premiums and any manufacturer rebates received by the plan or issuer, may adversely affect our competitive position, cash flows, financial condition and results of operations.
Read it in 10-K 2026-02-06 at sec.gov ↗
AddedRisk Factors
•a significant failure of our internal control over financial reporting or a failure to remediate identified deficiencies;
Read it in 10-K 2026-02-06 at sec.gov ↗
AddedRisk Factors
•failure of our corporate governance policies or procedures or breakdowns in oversight that could impair risk management, compliance, or strategic execution.
Read it in 10-K 2026-02-06 at sec.gov ↗
RemovedRisk Factors
disasters in connection with climate change, geopolitical instability and other public health crises; and new mandated benefits and treatment guidelines and changes to other regulations impacting our business.
Read it in 10-K 2025-02-20 at sec.gov ↗
RemovedRisk Factors
We are required to obtain and maintain insurance, licenses and other regulatory approvals to market certain of our products and services, to increase prices for certain regulated products and services and to consummate some of our acquisitions and dispositions.
Read it in 10-K 2025-02-20 at sec.gov ↗
RemovedRisk Factors
MLR and rebates related thereto; claims related to privacy, intellectual property and vendor disputes; claims related to our use of personal information and other proprietary data; and, customer audits and contract performance, including government contracts. These actions or proceedings could result in substantial costs to us, require management to spend substantial time focused on litigation, result in negative media attention, and may adversely affect our business, reputation, financial condition, results of operations and cash flows.
Read it in 10-K 2025-02-20 at sec.gov ↗
RewordedRisk Factors
If the information systems we rely upon to run our business were found to be inaccurate or unreliable or if we fail to adequately maintain, upgrade, enhance, expand and protect our information systems, security controls and data integrity effectively, we could experience problems in determining medical cost estimates and establishing appropriate pricing and reserves, have disputes with customers and providers, lengthen the pace of integration activities or otherwise delay the launch of acquired products, face regulatory problems, including sanctions and penalties, incur increases in operating expenses or suffer other adverse consequences, including a decrease in membership.
Read it in 10-K 2026-02-06 at sec.gov ↗
RewordedRisk Factors
These could include claims relating to the denial or limitation of health benefits; federal and state false claims act laws; dispensing of drugs associated with our pharmacy services business; professional liability claims arising out of the delivery of healthcare and related services to the public; development or application of medical policies and coverage and clinical guidelines; medical malpractice actions; allegations of anti-competitive and unfair business activities; provider disputes over reimbursement and contracts; provider tiering programs; narrow networks; termination of provider contracts; the recovery of overpayments from providers; fee-based business; disputes over co-payment calculations; reimbursement of out-of-network claims; the failure to disclose certain business practices; the failure to comply with various state or federal laws, including but not limited to: to ERISA and the Mental Health Parity Act; the calculation of minimum MLR and rebates related thereto; claims related to privacy, intellectual property and vendor disputes; claims related to our use of personal information and other proprietary data; and customer audits and contract performance, including government contracts.
Read it in 10-K 2026-02-06 at sec.gov ↗
RewordedRisk Factors
Factors that have contributed, and may continue to contribute, to a reduction in enrollment include: reductions in workforce by existing customers; a reduction in Medicaid membership due to the end implementation of the temporary suspension of more stringent eligibility redetermination for Medicaid recipients in response to the COVID-19 pandemic; protocols by state agencies; a general economic upturn that results in fewer individuals being eligible for Medicaid programs; a general economic downturn that results in business failures and high unemployment rates; employers no longer offering certain healthcare coverage as an employee benefit or electing to offer coverage on a voluntary, employee-funded basis; participation on Public Exchanges; federal and state regulatory changes; changes, including Medicaid community engagement requirements; changes in procurement practices or funding structures by government agencies; failure to obtain new customers or retain existing customers; premium increases and benefit changes; our exit from a specific market; market or health plan offering; negative publicity and news coverage; and, and failure to attain or maintain nationally recognized accreditations.
Read it in 10-K 2026-02-06 at sec.gov ↗
RewordedRisk Factors
In addition, this could negatively affect our operations, cause system disruptions, damage our reputation, cause membership losses and contract breaches, expose us or our members to the risk of financial or medical identity theft, and result in regulatory enforcement actions, material fines and penalties, litigation or other actions that could have an adverse effect on our business, cash flows, financial condition and results of operations.
Read it in 10-K 2026-02-06 at sec.gov ↗
RewordedRisk Factors
Further, the estimated value of our reporting units may be impacted because of business decisions we make associated with by any future changes to laws and regulations, macroeconomic developments, shifts in competitive dynamics, or other factors that alter the expected cash flows of our reporting units, which could unfavorably affect the carrying value of certain goodwill and other intangible assets and result in impairment charges in future periods.
Read it in 10-K 2026-02-06 at sec.gov ↗
RewordedRisk Factors
These factors include, among others: changes in healthcare practices; healthcare utilization patterns; demographic characteristics including the aging population; previously uninsured members entering the healthcare system; short and long-term risks associated with our members' lifestyle decisions; medical cost inflation; increased labor costs; provider and member fraud; evolution of new technologies, drugs and treatments; increased cost of individual services; increased number and cost of prescription drugs; direct-to-consumer marketing by drug manufacturers; clusters of high cost cases; increased use of services, including resulting from pandemics, large-scale medical emergencies, increasing natural disasters, geopolitical instability and other public health crises; and new mandated benefits and treatment guidelines and changes to other regulations impacting our business.
Read it in 10-K 2026-02-06 at sec.gov ↗
RewordedRisk Factors
In addition, changes in government regulations, policies or funding that apply to government-sponsored programs such as Medicare and Medicaid including, among other things, reimbursement levels, quality-based bonus payment determinations, eligibility and redetermination requirements, taxes or assessments for our programs, such as premium taxes on health insurance, benefit coverage requirements requirements, rate-setting methodologies, audit and oversight practices, and additional governmental participation, have adversely affected, and could in the future adversely affect, our business, cash flows, financial condition, and results of operations.
Read it in 10-K 2026-02-06 at sec.gov ↗
RewordedRisk Factors
Further, if If we do not improve maintain our Star Ratings, Ratings in future years, or if quality-based bonus payments are reduced or eliminated, we will would likely experience further a negative impact on our revenues and the benefits that our plans can offer, which could materially and adversely affect the marketability of our plans, our ability to expand our business, our membership levels, and our results of operations, financial condition and cash flows.
Read it in 10-K 2026-02-06 at sec.gov ↗
RewordedRisk Factors
A pandemic or other large-scale medical emergency or public health crisis, such as the COVID-19 pandemic, referred to collectively as “public health crises,” may cause illness, death, quarantines, business reduced operations or shutdowns of businesses and school shutdowns, reductions in business activity, travel and financial transactions, schools, unemployment, inflation, labor shortages, supply chain interruptions, disruptions in public and private infrastructure and overall economic and financial market instability.
Read it in 10-K 2026-02-06 at sec.gov ↗
RewordedRisk Factors
Negative publicity and sentiment in the healthcare industry is driven by factors that include, but are not limited to, premium rate increases, rates, prior authorization practices, industry consolidation, cost of care initiatives initiatives, level of customer satisfaction with our products and services and debate about current or proposed legislation.
Read it in 10-K 2026-02-06 at sec.gov ↗
RewordedRisk Factors
The rapid advancement of these technologies presents opportunities for us, but there are risks associated with the development and deployment of AI, and there can be no assurance that our usage of AI will enhance our operations. AI.
Read it in 10-K 2026-02-06 at sec.gov ↗
RewordedRisk Factors
Frequent and sometimes unpredictable changes to existing laws, rules and regulations or judicial interpretation, application or enforcement thereof, or development of new laws, rules, regulatory interpretations or judgments could force us to change how we conduct our business, affect the products and services we offer (and where we offer them), restrict revenue and enrollment growth, increase our costs, including operating, healthcare technology and administrative costs, restrict our ability to obtain new product approvals approvals, modify existing products, and implement changes in premium rates, and require enhancements to our compliance infrastructure and internal controls environment, which could adversely impact our business and results of operations. environment.
Read it in 10-K 2026-02-06 at sec.gov ↗
Quiet changesRisk Factors
Additional risks and uncertainties not presently known to us or that we currently believe to be immaterial may also materially and adversely affect us.
Read it in 10-K 2026-02-06 at sec.gov ↗
Quiet changesRisk Factors
If we fail to appropriately predict, price for and manage healthcare costs, the profitability of our products and services could decline, which could materially adversely affect our business, cash flows, financial condition and results of operations.
Read it in 10-K 2026-02-06 at sec.gov ↗
Quiet changesRisk Factors
Numerous factors affecting healthcare costs may adversely affect our ability to predict and manage such costs, and may could adversely impact our business, cash flows, financial condition and results of operations.
Read it in 10-K 2026-02-06 at sec.gov ↗
Quiet changesRisk Factors
In addition, any variation from our cost expectations regarding acuity, enrollment levels, adverse selection, or other assumptions utilized in setting premium rates, could have a material an adverse effect on our results of operations, financial position, and cash flows.
Read it in 10-K 2026-02-06 at sec.gov ↗
Quiet changesRisk Factors
Any such future litigation or governmental investigation could divert the attention of management from the operation of our business, result in reputational damage and have a material an adverse impact on our business, cash flows, financial condition, and results of operations.
Read it in 10-K 2026-02-06 at sec.gov ↗
Quiet changesRisk Factors
Changes in existing laws or regulations applicable to these programs, or their interpretations, are difficult to predict and could have a material an adverse effect on our business, cash flows, financial condition and results of operations.
Read it in 10-K 2026-02-06 at sec.gov ↗
Quiet changesRisk Factors
Further, our state Medicaid contracts have not always been renewed, we have not always been awarded new contracts as a result of the competitive procurement process, and in some cases, we have lost members under existing contracts as a result of a post-award challenge by unsuccessful bidders, each of which could take place in the future and have a material an adverse effect on our business, cash flows, financial condition and results of operations.
Read it in 10-K 2026-02-06 at sec.gov ↗
Quiet changesRisk Factors
If we fail to report and correct errors discovered through our own auditing procedures, during a RADV or RAC audit or during state regulatory audits, or otherwise fail to comply with applicable laws and regulations, we could be subject to fines, civil penalties or other sanctions, which could have a material an adverse effect on our ability to participate in these programs, and on our financial condition, cash flows and results of operations.
Read it in 10-K 2026-02-06 at sec.gov ↗
Quiet changesRisk Factors
A shift of enrollees from more profitable products to less profitable products could have a material an adverse effect on our cash flows, financial condition and results of operations.
Read it in 10-K 2026-02-06 at sec.gov ↗
Quiet changesRisk Factors
If CVS fails to provide pharmacy benefit manager services as contractually required, we may not be able to meet the full demands of our customers, which could have a material an adverse effect on our business, reputation and results of operations.
Read it in 10-K 2026-02-06 at sec.gov ↗
Quiet changesRisk Factors
Failure to adequately implement, consolidate, integrate, streamline, maintain and upgrade effective and efficient information systems, including those powered by or incorporating AI, with sufficiently advanced technological capabilities could result in investigations, audits, fines and penalties, competitive and cost disadvantages to us compared to our competitors, contractual damages, and diversion of management’s time, and could have a material an adverse effect on our business, financial condition and results of operations.
Read it in 10-K 2026-02-06 at sec.gov ↗
Quiet changesRisk Factors
Our failure to implement adequate business continuity and disaster recovery strategies could significantly reduce our ability to provide products and services to our customers and members, which could have a material an adverse effect on our business and results of operations.
Read it in 10-K 2026-02-06 at sec.gov ↗
AddedMD&A
Membership shifts from Medicaid into our Individual ACA (as defined below) business following the redetermination process that began in April 2023, together with lower membership effectuation rates, particularly in geographies with high concentrations of highly subsidized members, have driven a market-wide increase in morbidity, resulting in elevated medical cost trends. Medicaid cost trends remain elevated due to higher population acuity and increased utilization of services. In response, we are working on program improvements in partnership with the states, strengthening care management, and optimizing our clinical strategy to improve effectiveness and lower costs.
Read it in 10-K 2026-02-06 at sec.gov ↗
AddedMD&A
Affordable Care Act: We continue to participate in the Individual state- or federally-facilitated marketplaces (the “Public Exchange”) in nearly all of our Anthem Blue Cross and Anthem Blue Cross and Blue Shield service areas. In 2025, we expanded our operations into select service areas in Florida, Maryland, and Texas through our Simply Healthcare and Wellpoint brands. Going forward, we expect the Public Exchange to be influenced by policy and regulatory changes, particularly around federal subsidies, compliance requirements, and market stability.
Read it in 10-K 2026-02-06 at sec.gov ↗
AddedMD&A
The federal budget reconciliation legislation, known as the One Big Beautiful Bill Act (the “OBBBA”) was signed into law on July 4, 2025. The OBBBA includes provisions that could impact our business and operations including: requiring more frequent Medicaid redeterminations for beneficiaries receiving coverage under a state's Medicaid expansion program implemented pursuant to the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010, as amended, (collectively, the “ACA”); imposing work or community engagement requirements on certain adults in the ACA Medicaid expansion population; and requiring specific cost-sharing for certain services used by adults in the ACA Medicaid expansion population. The OBBBA also makes changes to federal requirements regarding Medicaid state directed payments and provider taxes, including taxes on managed care organizations; delays implementation of Medicaid final regulations on certain eligibility and enrollment provisions; reduces the allowable home equity asset threshold for individuals seeking eligibility for long-term care under Medicaid; establishes a new Rural Health Transformation program; eliminates the repayment limit for excess advanced Premium Tax Credits (“PTCs”) under the ACA; modifies the rules regarding Health Savings Account (“HSA”) eligible plans under the ACA and makes permanent an extension of the safe harbor first established under the Coronavirus Aid, Relief, and Economic Security Act, allowing pre-deductible coverage of telehealth services for HSA eligible high-deductible health plans; among other provisions.
Read it in 10-K 2026-02-06 at sec.gov ↗
AddedMD&A
Additional federal and state guidance is being issued to implement these OBBBA provisions. Implementation dates vary, with many provisions impacting commercial plans effective January 1, 2026, and many Medicaid-related provisions effective in 2027 and 2028. States may choose to implement certain Medicaid provisions as early as 2026.
Read it in 10-K 2026-02-06 at sec.gov ↗
AddedMD&A
In February 2026, Congress passed the Consolidated Appropriations Act, which includes pharmacy benefit manager reforms requiring pharmacy benefit managers to remit all rebates, fees (other than bona fide service fees), and other remuneration received from entities such as manufacturers and group purchasing organizations to commercial plan sponsors, and to provide detailed commercial claims reporting, effective thirty months after enactment. The legislation also imposes extensive reporting requirements and delinks pharmacy benefit manager compensation in Medicare Part D by prohibiting pharmacy benefit managers from receiving remuneration related to Part D drugs in any form other than bona fide service fees that cannot be based on a drug’s price, effective in 2028.
Read it in 10-K 2026-02-06 at sec.gov ↗
AddedMD&A
In addition, in June 2025, CMS finalized the Marketplace Integrity and Affordability Regulation, which modifies the Public exchange open enrollment period beginning in plan year 2027 and eligibility for PTCs, among other requirements. In September 2025, a federal court delayed the effective dates for several provisions of the Marketplace Integrity and Affordability Regulation pending the resolution of ongoing litigation challenging the legality of those provisions. Also, in September 2025, CMS issued guidance modifying eligibility requirements for ACA catastrophic plans.
Read it in 10-K 2026-02-06 at sec.gov ↗
AddedMD&A
In addition, subsequent budget reconciliation legislation enacted during 2023-2025 included provisions affecting Medicaid eligibility enrollment and program financing, which may influence state Medicaid policies and beneficiary coverage dynamics over time.
Read it in 10-K 2026-02-06 at sec.gov ↗
AddedMD&A
Operating expense increased primarily due to increases in premium tax expenses and assessments and increases in targeted investments to support and strengthen our workforce and accelerate technology adoption, partially offset by non-recurrence of the BCBSA provider settlement recorded in 2024.
Read it in 10-K 2026-02-06 at sec.gov ↗
AddedMD&A
Other expense increased primarily due to higher interest expense related to our issuance of senior notes during the fourth quarter of 2024. The increase also related to higher intangible asset amortization expense related to acquisitions in the fourth quarter of 2024.
Read it in 10-K 2026-02-06 at sec.gov ↗
AddedMD&A
Our effective income tax rate decreased from 24.5% to 15.6%, due to a discrete non-operating tax benefit and favorable resolution of uncertain tax positions. The discrete non-operating tax benefit related to an internal restructuring of certain Elevance Health subsidiaries.
Read it in 10-K 2026-02-06 at sec.gov ↗
AddedMD&A
1 Operating revenue within our Commercial line of business related to our Individual business, including ACA products, was $9,295, $8,295 and $6,187 for the year ended December 31, 2025, 2024, and 2023, respectively.
Read it in 10-K 2026-02-06 at sec.gov ↗
RemovedMD&A
We have organized our brand portfolio into the following core go-to-market brands:
Read it in 10-K 2025-02-20 at sec.gov ↗
RemovedMD&A
We continue to participate in the Individual state- or federally-facilitated marketplaces (“the Public Exchange”) in nearly all of our Anthem Blue Cross and Anthem Blue Cross and Blue Shield service areas. We anticipate growth in our Public Exchange memberships as former Medicaid members, no longer eligible for Medicaid coverage, continue to seek alternative coverage options. Additionally, we are entering select service areas in Florida, Maryland, and Texas in 2025, using our Simply Healthcare and Wellpoint brands, and we are actively evaluating expansion opportunities in additional marketplaces beyond 2025. Changes to our business environment are likely to continue as elected officials at the national and state levels continue to enact significant modifications to existing laws and regulations, including changes to available subsidies, taxes and fees.
Read it in 10-K 2025-02-20 at sec.gov ↗
RemovedMD&A
The Consolidated Appropriations Act of 2021 (the “2021 Appropriations Act”) has impacted our business, including by imposing additional disclosure and reporting requirements related to broker compensation, mental health parity, pharmacy benefits and drug costs, as well as procedures and coverage requirements related to surprise medical bills, provider directory maintenance and continuity of care for certain patients. The requirements applicable to us under the 2021 Appropriations Act had varying effective dates, beginning in December 2021.
Read it in 10-K 2025-02-20 at sec.gov ↗
RemovedMD&A
The health plan price transparency regulations issued by the U.S. Departments of Health and Human Services, Labor, and Treasury (“the Tri-Agencies”) pursuant to the 2021 Appropriations Act required us to begin disclosing certain pricing information regarding negotiated rates and historical payment information with providers in 2022. Additionally, as directed by law, we make available to members personalized out-of-pocket cost information and underlying negotiated rates.
Read it in 10-K 2025-02-20 at sec.gov ↗
RemovedMD&A
During the third quarter of 2023, based on a strategic review of our operations, assets and investments, management implemented the “2023-2024 Business Efficiency Program” to refine the focus of our investments, and optimize our physical footprint. The 2023-2024 Business Efficiency Program included the write-off of certain information technology assets and contract exit costs, a reduction in staff including the relocation of certain job functions, and the impairment of assets associated with the closure or partial closure of data centers and offices. The 2023-2024 Business Efficiency Program was finalized as of December 31, 2024. For additional information, see Note 4, “Business Optimization Initiatives,” and Note 18, “Leases,” of the Notes to Consolidated Financial Statements included in Part II, Item 8 of this Annual Report on Form 10-K.
Read it in 10-K 2025-02-20 at sec.gov ↗
RemovedMD&A
On August 6, 2024, as discussed in Note 5 “Investments,” we made an equity investment of $2,580 that resulted in our minority interest ownership of approximately 35% of Augusta Topco Holdings, L.P. (“Mosaic Health”), a joint venture with Clayton, Dubilier & Rice (“CD&R”) that is designed to accelerate innovation in care delivery across multiple regions in the United States by bringing together certain care delivery and enablement assets of Carelon Management Services, LLC (“CMSI Assets”), a Carelon Health business, and two CD&R portfolio businesses, apree health and Millennium Physician Group. Our additional contribution of the CMSI Assets to Mosaic Health was completed on January 1, 2025, for which we received an additional $300 of equity (approximately 5% ownership) in Mosaic Health. The CMSI Assets are included under the captions “Assets held for sale” and “Liabilities held for sale” in our consolidated balance sheets as of December 31, 2024.
Read it in 10-K 2025-02-20 at sec.gov ↗
RemovedMD&A
On February 15, 2023, we completed our acquisition of BioPlus Parent, LLC and its subsidiaries (“BioPlus”) from CarepathRx Aggregator, LLC. Prior to the acquisition, BioPlus was one of the largest independent specialty pharmacy organizations in the United States. BioPlus, which operates as part of CarelonRx, seeks to connect payors and providers of specialty pharmaceuticals to meet the medication therapy needs of patients with complex medical conditions. This acquisition aligns with our vision to be an innovative, valuable and inclusive healthcare partner by providing care management programs that improve the lives of the people we serve.
Read it in 10-K 2025-02-20 at sec.gov ↗
RemovedMD&A
On April 1, 2024, we completed the sale of our life and disability businesses to StanCorp Financial Group, Inc. (“The Standard”), a provider of financial protection products and services for employers and individuals, which resulted in a gain on sale of business of $201 in the year ended December 31, 2024. Upon closing, we and The Standard entered into a product distribution partnership. The related net assets held for sale for the life and disability businesses divested as of December 31, 2023, and the results of operations for such businesses for the year ended December 31, 2024 were not material.
Read it in 10-K 2025-02-20 at sec.gov ↗
RemovedMD&A
various technological enhancements to the BlueCard program. We recognized our estimated payment obligation under the Provider Settlement Agreement of $666 in September 2024.
Read it in 10-K 2025-02-20 at sec.gov ↗
RemovedMD&A
Our benefit expense ratio increased, primarily driven by higher Medicaid membership cost trends due to Medicaid rates being inadequate to cover medical cost trends that were well in excess of historical averages, primarily due to the Medicaid membership redeterminations.
Read it in 10-K 2025-02-20 at sec.gov ↗
RemovedMD&A
Other expense decreased primarily due to decreased amortization of intangible assets during the twelve months ended December 31, 2024. During the twelve months ended December 31, 2023, we had increased amortization of other intangible assets as the amortization period of certain assets was shortened to align with the dates our new branding took place.
Read it in 10-K 2025-02-20 at sec.gov ↗
RemovedMD&A
Our effective income tax rate increased from 22.3% to 24.5%, primarily due to the impact of geographic changes in the mix of our 2024 earnings.
Read it in 10-K 2025-02-20 at sec.gov ↗
RewordedMD&A
Other significant changes in sources and uses of cash year-over-year included (a) additional sources of cash from other sources of cash, net, issuances of short- and long-term debt, net of repayments, issuances of common stock under employee stock plans and proceeds from sales, maturities, calls and redemptions of investments, net of purchases, and issuances of common stock under employee stock plans purchases and (b) increased uses of cash from purchases of subsidiaries, net of cash acquired, the repurchase and retirement of common stock, cash dividends and the purchase of property and equipment, cash dividends, and other uses of cash, net. equipment.
Read it in 10-K 2026-02-06 at sec.gov ↗
RewordedMD&A
If approved by the Court, the The Provider Settlement Agreement will require required the defendants to make a monetary settlement payment, our portion of which is estimated to be $666, payment and will contain also required that certain non-monetary terms including (i) expansion of certain opportunities to contract with providers in contiguous service areas, (ii) certain prompt pay commitments, and (iii) various technological enhancements to the BlueCard program, be implemented on a timeline set forth in the Provider Settlement Agreement.
Read it in 10-K 2026-02-06 at sec.gov ↗
RewordedMD&A
The Inflation Reduction Act of 2022 contains a variety of These provisions that have impacted, and continue to impact our business including by include extending the American Rescue Plan Act of 2021's enhanced Premium Tax Credits (“PTC”) PTCs through 2025; imposing a new corporate alternative minimum tax; providing establishing a one percent excise tax on repurchases of stock; allowing stock by issuers; authorizing CMS to negotiate prices on a limited set of Medicare prescription drugs in Medicare effective beginning in 2026; instituting caps on insulin cost sharing in Medicare; redesigning the Medicare Part D benefit; requiring drug manufacturers to pay rebates if prices increase beyond inflation; and delaying the implementation of the Trump Administration Medicare drug rebate rule until at least 2032.
Read it in 10-K 2026-02-06 at sec.gov ↗
RewordedMD&A
Since December 31, 2023, 2024, total cash, cash equivalents and investments in fixed maturity and equity securities decreased increased by $1,529, $1,520, primarily due to lower amounts for purchases of subsidiaries, net of cash acquired, changes in bank overdrafts, lower cash used for common stock repurchases, purchases of subsidiaries net lower other uses of cash acquired, and decreased purchases of property and equipment and cash dividends paid to shareholders. equipment.
Read it in 10-K 2026-02-06 at sec.gov ↗
RewordedMD&A
This was primarily driven by the fact that the change in prior year redundancy reported for 2024 as compared to 2023 decreased whereas the change in prior year redundancy reported for 2023 as compared to 2022 was less than the change in the prior year redundancy reported for 2022 as compared to 2021. increased.
Read it in 10-K 2026-02-06 at sec.gov ↗
RewordedMD&A
The increase in operating Operating loss was decreased primarily due to the non-recurring accrual recorded during the year ended December 31, 2024 for the Provider Settlement Agreement associated with the BCBSA Litigation, partially offset by disciplined cost management Litigation and lower business optimization charges. charges in the year ended December 31, 2025.
Read it in 10-K 2026-02-06 at sec.gov ↗
RewordedMD&A
Operating revenue increased primarily due to the acquisition of CareBridge in December 2024 and the continued expansion of risk-based capabilities in our medical benefit management, specialty care solutions and behavioral health and post-acute care services, as well as acquisitions completed in 2024. services.
Read it in 10-K 2026-02-06 at sec.gov ↗
RewordedMD&A
The BCBSA and Blue plans approved a settlement agreement and release with the subscriber plaintiffs (the “Subscriber Settlement Agreement”), and which received final approval from the ultimate amount paid by the Company under the Subscriber Settlement Agreement was $604, which was primarily accrued Court in 2020. September 2022.
Read it in 10-K 2026-02-06 at sec.gov ↗
RewordedMD&A
This decrease increase was partially offset by cash generated from operations, lower issuances of short-and-long term debt, net of repayment, repayments, lower cash generated from operations and lower proceeds from sales, maturities, calls, and redemptions, net of purchases and issuances of common stock. stock under the employee stock plans.
Read it in 10-K 2026-02-06 at sec.gov ↗
RewordedMD&A
For the year ended December 31, 2024, 2025, this metric was 12.3%, 9.0%, largely driven by favorable completion factor development from 2023 as well as favorable trend factor development at the end of 2023. 2024 as well as favorable completion factor development from 2024.
Read it in 10-K 2026-02-06 at sec.gov ↗
RewordedMD&A
Our 2024 Star Ratings, which are used for payment year 2025, 2026 Stars Ratings reflect that 53% approximately 59% of our Medicare Advantage members were are enrolled in plans rated at least 4.0 Stars or higher. higher, or the equivalent.
Read it in 10-K 2026-02-06 at sec.gov ↗
RewordedMD&A
Total operating revenue increased primarily as a result of premium rate increases in all of our lines of business Health Benefits segment in recognition of medical cost trends, recently completed acquisitions, and growth in CarelonRx product revenue and recent acquisitions. our Medicare Advantage business.
Read it in 10-K 2026-02-06 at sec.gov ↗
Quiet changesMD&A
While some provisions became effective on January 1, 2025, additional guidance from the Tri-Agencies will be is necessary to assess the full impact of these regulations on our operations and financial results.
Read it in 10-K 2026-02-06 at sec.gov ↗
Quiet changesMD&A
Given the inherent uncertainty of changes in market conditions and the significant judgments involved, there is continuing risk that declines in fair value may occur and additional impairment losses on investments may be recorded in future periods.
Read it in 10-K 2026-02-06 at sec.gov ↗
