Humana(HUM) - 2024 Q4 - Annual Report

Membership and Revenue - As of December 31, 2024, Humana had approximately 16 million members in medical benefit plans and about 5 million members in specialty products[14]. - 85% of total premiums and services revenue in 2024 were derived from federal government contracts, with 14% from individual Medicare Advantage contracts in Florida, covering approximately 924,800 members[14]. - Total premiums and services revenue for the Insurance segment was $113,070 million, with individual Medicare Advantage contributing$ 88,019 million, representing 75.6% of the segment's revenue[21]. - Florida contracts accounted for approximately $16.4 billion in premiums revenue, which is about 19% of individual Medicare Advantage premiums revenue and 14% of consolidated premiums and services revenue[29]. - The total insurance medical membership reached 16,347.1 thousand as of December 31, 2024, with TRICARE services accounting for 6,009.1 thousand members, representing 36.80% of the total[57]. - Approximately 94% of total premiums and services revenue for the year ended December 31, 2024, came from federal and state government health care coverage programs[124]. Medicare Advantage and Related Products - Humana's individual Medicare Advantage products are renewed annually, with all contracts for 2025 approved by CMS[30]. - Humana's Medicare Advantage plans are designed to provide benefits exceeding traditional Medicare, including reduced cost sharing and enhanced prescription drug benefits[24]. - The company offers stand-alone prescription drug plans under Medicare Part D, including a co-branded plan with Walmart[31]. - The company provided health insurance coverage to approximately 924,800 individual Medicare Advantage members in Florida, accounting for about 14% of total premiums and services revenue for the year ended December 31, 2024[124]. - The number of Medicare Advantage plans rated 4-star or higher is expected to significantly decline in 2025, which could negatively impact quality bonus payments from CMS and overall revenues[109]. - Approximately 25% of Medicare Advantage members are enrolled in plans rated 4-star or higher for 2025, down from 94% in 2024, which may negatively impact 2026 quality bonus payments from CMS[110]. Strategic Initiatives and Partnerships - Humana plans to exit the Employer Group Commercial Medical Products business by the first half of 2025, following a strategic review[41]. - The company has a strategic partnership with Welsh, Carson, Anderson & Stowe to develop additional primary care centers, with 133 clinics currently operating and the capacity to open or acquire up to 20 more[52]. - The company is enhancing Medicaid-Medicare integration through Dual-Eligible Special Needs Plans (D-SNP) to improve health outcomes for dual eligible members[39]. - The company frequently engages in discussions for acquisitions and strategic alliances, with successful integration being critical to avoid material adverse effects on operations[152]. Financial Performance and Risks - The company has made substantial investments in the Medicare program, which is a key part of its business strategy, and any failure to achieve growth in this area may materially affect its financial results[108]. - The company estimates that costs associated with health care services delivered to members are sensitive to claim payment patterns and medical cost trends, which may lead to insufficient reserves[96]. - The company faces intense competitive pressure to contain premium prices while managing increasing medical and administrative costs[102]. - The company is exposed to risks from government policies regarding Medicare Advantage and Medicaid programs, which can directly impact profitability and operational costs[103]. - Legislative or regulatory changes, including those affecting the Medicare Advantage program, could restrict revenue growth and increase operating costs, impacting financial performance[138]. Operational and Compliance Issues - The company is involved in various legal actions that could result in substantial monetary damages or changes in business practices[118]. - The company has been a target of cybersecurity attacks, which could lead to significant regulatory fines or reputational damage[115]. - The company conducts medical record reviews to ensure compliance with data and payment accuracy under the risk adjustment model[126]. - Humana Inc. filed a lawsuit against the U.S. Department of Health and Human Services, claiming the Final RADV Rule violates the Administrative Procedure Act (APA) and should be set aside[130]. - The company is subject to various governmental audits and investigations that could result in penalties, loss of licensure, or exclusion from government health care programs, adversely affecting operations and financial position[135]. Human Resources and Workforce - The voluntary turnover rate (VTR) for associates during 2024 was 14.4%, an increase from 13.4% in 2023[85]. - The company employed approximately 1,100 sales representatives and 2,700 telemarketing representatives as of December 31, 2024, to assist in marketing Medicare products[74]. - The company is committed to continuous learning and growth, offering resources for professional development and education assistance to its associates[90]. - The ability to attract and retain qualified medical professionals is essential for the success of healthcare services, with competition in this market expected to remain high[157]. Investment and Market Conditions - The company believes it has adequate resources to fund operations and expansion for at least the next twelve months, but market conditions could affect credit availability[168]. - Downgrades in debt ratings could negatively affect the company's competitive position and increase borrowing costs[164]. - Volatility in securities and credit markets may significantly impact the value of the investment portfolio and related income[167]. Insurance Segment Overview - The Insurance segment includes Medicare benefits, state-based contracts, and employer group commercial health insurance, contributing to diverse revenue streams[208]. - The CenterWell segment encompasses pharmacy, primary care, and home solutions, aimed at enhancing healthcare experiences and potentially lowering drug costs[209]. - Intersegment transactions primarily involve sales from the CenterWell segment to the Insurance segment, indicating interdependence in profitability[210]. Financial Metrics and Performance Indicators - The benefit ratio, a measure of underwriting profitability, and the operating cost ratio, a measure of administrative spending efficiency, are key performance statistics for the company[198]. - The company recorded value creation initiative charges of$ 281 million in 2024 and $436 million in 2023, primarily within operating costs[200]. - The company reported impairment charges of$ 200 million related to indefinite-lived intangible assets in 2024, compared to $91 million in 2023[202].