ELEVANCE HEALTH, INC. (In Millions, Except Per Share Data or as Otherwise Stated Herein) This Management's Discussion and Analysis of Financial Condition and Results of Operations, or MD&A, should be read in conjunction with the accompanying consolidated financial statements and notes, our consolidated financial statements and notes as of and for the year endedDecember 31, 2019 and the MD&A included in our 2019 Annual Report on Form 10-K. References to the terms "we," "our," "us," or "Anthem" used throughout this MD&A refer toAnthem, Inc. , anIndiana corporation, and unless the context otherwise requires, its direct and indirect subsidiaries. References to the "states" include theDistrict of Columbia , unless the context otherwise requires. Results of operations, cost of care trends, investment yields and other measures for the three and nine months endedSeptember 30, 2020 are not necessarily indicative of the results and trends that may be expected for the full year endingDecember 31, 2020 , or any other period. Overview We are one of the largest health benefits companies inthe United States in terms of medical membership, serving approximately 43 million medical members through our affiliated health plans as ofSeptember 30, 2020 . We serve our members as theBlue Cross licensee forCalifornia and as theBlue Cross and Blue Shield , or BCBS, licensee forColorado ,Connecticut ,Georgia ,Indiana ,Kentucky ,Maine ,Missouri (excluding 30 counties in theKansas City area),Nevada ,New Hampshire ,New York (in theNew York City metropolitan area and upstateNew York ),Ohio ,Virginia (excluding theNorthern Virginia suburbs ofWashington, D.C. ) andWisconsin . In a majority of these service areas, we do business asAnthem Blue Cross ,Anthem Blue Cross and Blue Shield , andEmpire Blue Cross Blue Shield orEmpire Blue Cross . We also conduct business through arrangements with other BCBS licensees as well as other strategic partners. Through our subsidiaries, we also serve customers in numerous states across the country asAIM Specialty Health , Amerigroup,Aspire Health , Beacon,CareMore ,Freedom Health , HealthLink, HealthSun,Optimum HealthCare ,Simply Healthcare , and/or Unicare. Also, in the second quarter of 2019, we began providing pharmacy benefits management, or PBM, services through our IngenioRx subsidiary. We are licensed to conduct insurance operations in all 50 states and theDistrict of Columbia through our subsidiaries. For additional information about our organization, see Part I, Item 1, "Business" and Part II, Item 7, "Management's Discussion and Analysis of Financial Condition and Results of Operations," included in our 2019 Annual Report on Form 10-K. Additional information on our segments can be found in this MD&A and in Note 16, "Segment Information" of the Notes to Consolidated Financial Statements included in Part I, Item 1 of this Form 10-Q. COVID-19 InMarch 2020 , theWorld Health Organization declared the outbreak of a novel strain of coronavirus, or COVID-19, a global health pandemic. The COVID-19 pandemic continues to evolve, and the virus and efforts to prevent its spread have continued to impact the global economy, cause market instability and increased unemployment inthe United States , and it has impacted and will continue to impact our membership and benefit expense. Although increased unemployment caused by the COVID-19 pandemic resulted in a decline in our Local Group membership, our Medicaid membership grew as a result of the temporary suspension of eligibility recertification efforts in response to the COVID-19 pandemic. While the deferral of non-emergent or elective health services by our members decreased our claim costs in the second quarter of 2020, utilization of such services began to rebound and claim costs began to normalize in the third quarter of 2020 as the shelter-in-place, stay-at-home orders and other restrictions on the conduct of businesses were lifted. Furthermore, our expenses increased in the third quarter of 2020 to cover COVID-19 related costs such as testing, treatment of the disease, expanded coverage in benefits and waivers for cost-sharing. As COVID-19 continues to spread, we remain focused on increasing access and coverage for our members, making changes to our membership benefits and business operations and adapting tools and policies to assist consumers and care providers. We are providing expanded telehealth coverage for our Medicare and Medicaid plans, where permissible, throughDecember 31, 2020 and waiving cost shares for in-network telehealth visits, including telephonic visits and those for mental health. We provided expanded telehealth coverage for our members in fully-insured employer plans and Individual plans -44- -------------------------------------------------------------------------------- throughSeptember 30, 2020 . We relaxed early prescription refill policies for maintenance and specialty medications for our members in fully-insured employer plans and Individual plans throughSeptember 30, 2020 and for our Medicare and Medicaid plans, where permissible, throughJanuary 31, 2021 and are encouraging the use of home delivery services to enable access to necessary medications. We are waiving cost sharing for in-network COVID-19 diagnostic tests and treatment and provided various premium credits to members. Future regulatory action could require us to provide additional coverage or credits related to COVID-19 treatments. We are also leveraging data and advanced analytics to provide innovative solutions in response to the COVID-19 pandemic, and introduced a suite of digital tools that serve various functions, including providing member data and updates related to COVID-19, aggregating real-time COVID-19 data to present trends and predictions for our communities, and helping individuals with mental health support or emergency services. We are also providing support to care provider partners of our affiliated health plans to help them continue to focus on caring for patients, including funding and financial assistance, working with care providers to accelerate claims processing for outstanding accounts receivables, resolving claims where possible and appropriate, as well as accelerating payments to support state-specific Medicaid programs. We are simplifying access to care by temporarily suspending select prior authorization requirements for certain services and equipment critical to COVID-19 treatment. To protect our employees and mitigate the spread of COVID-19, we have continued travel limitations and workplace modifications consistent with theCenters for Disease Control and Prevention guidelines and social distancing protocols. We are gradually reopening our offices in accordance with local guidelines; however, the majority of our workforce continues to work remotely. In addition to transitioning to a remote work environment, we expanded our employee benefits to provide additional support. With many individuals and families impacted by the COVID-19 pandemic in a variety of ways, we remain committed to lifting up our local communities through a variety of partnership and relief efforts. During the second quarter of 2020, we contributed$50 million to theAnthem Foundation to support its COVID-19 response and recovery efforts, such as emergency response, food insecurity, mental health and care provider safety resources. The COVID-19 pandemic has created unique and unprecedented challenges, and although it has impacted and will likely continue to impact our membership and benefit expense, we have proactively taken actions to minimize these effects, as discussed above, and it has not had a material adverse effect on our reported results throughSeptember 30, 2020 . However, this may change in the future as the COVID-19 pandemic is evolving and the extent of its impact will depend on future developments, which are highly uncertain and cannot be predicted at this time. We will continue to monitor the COVID-19 pandemic as well as resulting legislative and regulatory changes that may impact our business. For additional discussion regarding our risks related to the COVID-19 pandemic and our other risk factors, see Part I, Item 1A, "Risk Factors" included in our 2019 Annual Report on Form 10-K and Part II, Item 1A, "Risk Factors" included in this Form 10-Q. Business Trends The Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010, as amended, or collectively, the ACA, has changed and may continue to make broad-based changes to theU.S. healthcare system. We expect the ACA will continue to impact our business model and strategy. Also, the legal challenges regarding the ACA, including a federal district court decision invalidating the ACA, or the 2018 ACA Decision, which judgment has been stayed pending appeal, could significantly disrupt our business. During 2019, we modestly expanded our participation in the Individual ACA-compliant market. Our strategy has been, and will continue to be, to only participate in rating regions where we have an appropriate level of confidence that these markets are on a path toward sustainability, including, but not limited to, factors such as expected financial performance, regulatory environment, and underlying market characteristics. We currently offer Individual ACA-compliant products in 91 of the 143 rating regions in which we operate. In addition, the continuing growth in our government-sponsored business exposes us to increased regulatory oversight. In the second quarter of 2019, we began using IngenioRx to market and offer PBM services toAnthem health plan customers throughout the country, as well as to external customers outside of the health plans we own. Our comprehensive PBM services portfolio includes services such as formulary management, pharmacy networks, a prescription drug database, member services and mail order capabilities. IngenioRx delegates certain PBM administrative functions, such as claims processing and prescription fulfillment, toCaremarkPCS Health, L.L.C. , which is a subsidiary of CVS Health Corporation, -45- -------------------------------------------------------------------------------- pursuant to a five-year agreement. With IngenioRx, we retain the responsibilities for clinical and formulary strategy and development, member and employer experiences, operations, sales, marketing, account management and retail network strategy. FromDecember 2009 throughDecember 2019 , we delegated certain PBM functions and administrative services toExpress Scripts Inc. , or Express Scripts, pursuant to our PBM agreement with Express Scripts, or the ESI PBM Agreement. We began transitioning existing members from Express Scripts to IngenioRx in the second quarter of 2019, and completed the transition of all of our members byJanuary 1, 2020 . We expect IngenioRx to provide our members with more cost-effective solutions and improve our ability to integrate pharmacy benefits within our medical and specialty platform. Pricing Trends: We strive to price our healthcare benefit products consistent with anticipated underlying medical cost trends. We continue to closely monitor the COVID-19 pandemic and the impacts it may have on our pricing, such as surges in COVID-19 related hospitalizations, infection rates, and the cost of a potential COVID-19 vaccine. We frequently make adjustments to respond to legislative and regulatory changes as well as pricing and other actions taken by existing competitors and new market entrants. Product pricing in our Commercial & Specialty Business segment, including ourIndividual and Small Group lines of business, remains competitive. Revenues from the Medicare and Medicaid programs are dependent, in whole or in part, upon annual funding from the federal government and/or applicable state governments. The ACA imposed an annual Health Insurance Provider Fee, or HIP Fee, on health insurers that write certain types of health insurance onU.S. risks. We price our affected products to cover the impact of the HIP Fee, when applicable. The HIP Fee was suspended for 2019, has resumed for 2020 and has been permanently eliminated effective in 2021. Medical Cost Trends: Our medical cost trends are primarily driven by increases in the utilization of services across all provider types and the unit cost increases of these services. We work to mitigate these trends through various medical management programs such as utilization management, condition management, program integrity and specialty pharmacy management, as well as benefit design changes. There are many drivers of medical cost trends that can cause variance from our estimates, such as changes in the level and mix of services utilized, regulatory changes, aging of the population, health status and other demographic characteristics of our members, epidemics, pandemics, advances in medical technology, new high cost prescription drugs, and healthcare provider or member fraud. Our underlying Local Group medical cost trends reflect the "allowed amount," or contractual rate, paid to providers. The COVID-19 pandemic has caused our members to defer non-emergent or elective health services, which decreased our claim costs in the second quarter of 2020. The utilization of such services began to rebound and claim costs began to normalize in the third quarter of 2020 and further increases in the utilization of such services may increase our claim costs in the future and affect our medical cost trends. Further, our expenses increased in the third quarter of 2020 to cover COVID-19 related costs such as testing, treatment, expanded coverage in benefits and waivers for cost-sharing. In response to the current crisis, we expanded coverage for certain members in our affiliated health plans for testing and treatment related to a COVID-19 diagnosis throughDecember 31, 2020 . Governmental action has required us to provide full coverage for COVID-19 testing to our members, and future governmental action could require us to provide additional coverage, including, for example, for potential future vaccines. The continued cost and volume of covered services related to the COVID-19 pandemic may have a material adverse effect on our future claim costs. We continue to closely monitor the COVID-19 pandemic and its impacts on our business, financial condition, results of operations and medical cost trend. For additional discussion regarding business trends, see Part I, Item 1, "Business" included in our 2019 Annual Report on Form 10-K. Regulatory Trends and Uncertainties Federal and state legislation has been enacted, and is likely to continue to be enacted, in response to the COVID-19 pandemic that has had, and we expect will continue to have, a significant impact on all of our lines of business, including mandates to waive cost-sharing on COVID-19 testing and related services. The federal government enacted the Coronavirus Preparedness and Response Supplemental Appropriations Act, the Families First Coronavirus Response Act and the CARES Act inMarch 2020 and the Paycheck Protection Program and Health Care Enhancement Act inApril 2020 . These acts provide, among other things, prohibitions on prior authorization and cost-sharing for certain items and services related to COVID-19 tests, reforms including waiving Medicare originating site restrictions for qualified providers providing telehealth services, financial support to health care providers, including expansion of the Medicare accelerated payment program to all providers receiving Medicare payments, and funding to replenish and administer small business loan programs to help small businesses keep their workers employed and healthcare benefits covered in the group market. -46- -------------------------------------------------------------------------------- Regulatory changes have also been enacted, and are likely to continue to be enacted, at the state and federal level in response to the COVID-19 pandemic. Those changes, which could have a significant impact on health benefits, consumer eligibility for public programs, and our cash flows, include mandated expansion of premium payment terms including the time period for which claims can be denied for lack of payment, mandates related to prior authorizations and payment levels to providers, additional consumer enrollment windows, and an increased ability to provide services through telehealth. We are providing extensions to premium payment terms in certain situations and continue to work closely with state regulators that are mandating or requesting such relief. The ACA presented us with new growth opportunities, but also introduced new risks, regulatory challenges and uncertainties, and required changes in the way products are designed, underwritten, priced, distributed and administered. Changes to our business environment are likely to continue as elected officials at the national and state levels continue to enact, and both elected officials and candidates for election continue to propose, significant modifications to existing laws and regulations, including changes to taxes and fees. In addition, the legal challenges regarding the ACA, including the 2018 ACA Decision, which judgment has been stayed pending appeal, continue to contribute to this uncertainty. In a separate development, inApril 2020 , theU.S. Supreme Court ruled that the federal government is required to pay health insurance companies for amounts owed, as calculated under the risk corridor program of the ACA. InJune 2020 , theU.S. Court of Federal Claims entered a final judgment stipulating that we are entitled to reimbursement for risk corridor amounts from 2014, 2015 and 2016. At the end ofSeptember 2020 , theU.S. Department of Health and Human Services , or HHS, issued draft guidance on how to treat the risk corridor recoveries that we expect to receive. Under the proposed guidance from HHS, we will be required to revise previously filed minimum medical loss ratio reports byDecember 31, 2020 , or within 60 days of receiving payment, whichever is later. We will recognize the net premium impact of the risk corridor recoveries in the fourth quarter of 2020. We will continue to review developments and evaluate the impact of the ACA as any further developments or judicial rulings occur. The annual HIP Fee is allocated to health insurers based on the ratio of the amount of an insurer's net premium revenues written during the preceding calendar year to the amount of health insurance premium for allU.S. health risk for those certain lines of business written during the preceding calendar year. We record our estimated liability for the HIP Fee in full at the beginning of the year with a corresponding deferred asset that is amortized on a straight-line basis to selling, general and administrative expense. The final calculation and payment of the annual HIP Fee is due bySeptember 30th of each fee year. The HIP Fee is non-deductible for federal income tax purposes. Our affected products are priced to cover the increased selling, general and administrative and income tax expenses associated with the HIP Fee. The total amount due from allocations to all health insurers is$15,523 for 2020. For the three and nine months endedSeptember 30, 2020 , we recognized$346 and$1,181 , respectively as selling, general and administrative expense for our portion of the HIP Fee. There was no corresponding expense for 2019 due to the suspension of the HIP Fee for 2019. The HIP Fee has been permanently eliminated effective in 2021. For additional discussion regarding regulatory trends and uncertainties and risk factors, see Part I, Item 1, "Business - Regulation", Part I, Item 1A, "Risk Factors", and the "Regulatory Trends and Uncertainties" section of Part II, Item 7, "Management's Discussion and Analysis of Financial Condition and Results of Operations" included in our 2019 Annual Report on Form 10-K and Part II, Item 1A, "Risk Factors" included in this Form 10-Q. Other Significant Items Business and Operational Matters During the third quarter of 2020, we introduced enterprise-wide initiatives to optimize our business and as a result, recorded a charge of$607 in selling, general and administrative expenses. We believe these initiatives largely represent the next step forward in our progression towards becoming a more agile organization, including process automation and a reduction in our office space footprint. For additional information, see Note 4, "Business Optimization Initiatives" and Note 17 "Leases," of the Notes to Consolidated Financial Statements included in Part 1, Item 1 of this Form 10-Q. -47- -------------------------------------------------------------------------------- OnFebruary 28, 2020 , we completed our acquisition ofBeacon Health Options, Inc. , or Beacon, the largest independently held behavioral health organization in the country. At the time of acquisition, Beacon served more than thirty-four million individuals across all fifty states. This acquisition aligns with our strategy to diversify into health services and deliver both integrated solutions and care delivery models that personalize care for people with complex and chronic conditions. For additional information, see Note 3, "Business Acquisitions," of the Notes to Consolidated Financial Statements included in Part 1, Item 1 of this Form 10-Q. Litigation Matters In the consolidated multi-district proceeding in theUnited States District Court for the Northern District of Alabama , or the Court, captioned In re Blue Cross Blue Shield Antitrust Litigation, or the BCBSA Litigation, theBlue Cross Blue Shield Association , or BCBSA, andBlue Cross and/orBlue Shield licensees, including us, or the Blue plans, have approved a settlement agreement and release, or the Subscriber Settlement Agreement, with the plaintiffs representing a putative nationwide class of health plan subscribers. Generally, the lawsuits in the BCBSA Litigation challenge elements of the licensing agreements between the BCBSA and the independently owned and operated Blue plans. The cases were brought by two putative nationwide classes of plaintiffs, health plan subscribers and providers, and the Subscriber Settlement Agreement applies only to the putative subscriber class. No settlement agreement has been reached with the provider plaintiffs at this time, and the defendants continue to contest the consolidated cases brought by the provider plaintiffs. If approved by the Court, the Subscriber Settlement Agreement will require the defendants to make a monetary settlement payment, our portion of which is estimated to be$594 , and will contain certain non-monetary terms including (i) eliminating the "national best efforts" rule in the BCBSA license agreements (which rule limits the percentage of non-Blue revenue permitted for each Blue plan) and (ii) allowing for some large national employers with self-funded benefit plans to be able to request a bid for insurance coverage from a second Blue plan in addition to the local Blue plan. We accrued our estimated payment obligation in the third quarter of 2020. OnOctober 30, 2020 , subscriber plaintiffs are expected to file a motion for certification of a settlement class and for preliminary approval of the Subscriber Settlement Agreement with the Court. Members of the class will be provided notice of the Subscriber Settlement Agreement and an opportunity to opt out of the class. Following the opt out deadline, if the Court grants approval of the Subscriber Settlement Agreement, and after all appellate rights have expired or have been exhausted in a manner that affirms the Court's final order and judgment, the defendants' payment and non-monetary obligations under the Subscriber Settlement Agreement will become effective. For additional information regarding this lawsuit, see Note 12, "Commitments and Contingencies - Litigation and Regulatory Proceedings - Blue Cross Blue Shield Antitrust Litigation," of the Notes to Consolidated Financial Statements included in Part I, Item 1 of this Form 10-Q. InAugust 2020 , theDelaware Court of Chancery ruled that neither we nor Cigna Corporation could collect damages in connection with the now terminated Agreement and Plan of Merger, between us and Cigna Corporation. For additional information, see Note 12, "Commitments and Contingencies - Litigation and Regulatory Proceedings - Cigna Corporation Merger Litigation," of the Notes to Consolidated Financial Statements included in Part I, Item 1 of this Form 10-Q. InJanuary 2019 , we exercised our contractual right to terminate the ESI PBM Agreement, and we completed the transition of our members from Express Scripts to IngenioRx onJanuary 1, 2020 . Notwithstanding our termination of the ESI PBM Agreement, the litigation between us and Express Scripts regarding the ESI PBM Agreement continues. For additional information regarding this lawsuit, see Note 12, "Commitments and Contingencies - Litigation and Regulatory Proceedings -Express Scripts, Inc. Pharmacy Benefit Management Litigation," of the Notes to Consolidated Financial Statements included in Part I, Item 1 of this Form 10-Q. Selected Operating Performance For the twelve months endedSeptember 30, 2020 , total medical membership increased 1.6 million, or 4.0%. Our medical membership grew in both our Government Business and Commercial & Specialty Business segments. The increase in medical membership in our Government Business segment was driven by organic growth in our Medicaid business due to the temporary suspension of eligibility recertification efforts in our markets in response to the COVID-19 pandemic, and growth in our Medicare business. The increase in medical membership in our Commercial & Specialty Business segment was -48- -------------------------------------------------------------------------------- primarily driven by growth in our self-funded business, partially offset by declines in our fully-insured membership due to negative in-group changes as a result of increased unemployment caused by the COVID-19 pandemic. Operating revenue for the three months endedSeptember 30, 2020 was$30,649 , an increase of$4,205 , or 15.9%, from the three months endedSeptember 30, 2019 . Operating revenue for the nine months endedSeptember 30, 2020 was$89,275 , an increase of$13,266 , or 17.5%, from the nine months endedSeptember 30, 2019 . The increase in operating revenue for the three and nine months endedSeptember 30, 2020 compared to 2019 was primarily driven by higher premium revenue in our Government Business segment, as well as pharmacy product revenue related to the launch of IngenioRx. Net income for the three months endedSeptember 30, 2020 was$222 , a decrease of$961 , or 81.2%, from the three months endedSeptember 30, 2019 . The decrease in net income for the three months endedSeptember 30, 2020 was primarily due to lower operating results in our Commercial & Specialty Business and Government Business segments primarily attributable to expenses for the BCBSA litigation accrual and business optimization initiatives recognized during the three months endedSeptember 30, 2020 . These decreases were partially offset by higher operating results in our IngenioRx segment, higher net realized gains on financial instruments and lower income tax expense. Net income for the nine months endedSeptember 30, 2020 was$4,021 , an increase of$148 , or 3.8%, from the nine months endedSeptember 30, 2019 . The increase in net income for the nine months endedSeptember 30, 2020 compared to 2019 was primarily a result of higher operating results in our IngenioRx and Government Business segments. These increases were partially offset by lower operating results in our Commercial & Specialty Business segment, higher income tax expense and a decrease in net earnings from investment activities. Our fully-diluted earnings per share, or EPS, was$0.87 for the three months endedSeptember 30, 2020 , which represented an 80.9% decrease from EPS of$4.55 for the three months endedSeptember 30, 2019 . The decrease in EPS for the three months endedSeptember 30, 2020 compared to 2019 resulted from the decrease in net income. Our fully-diluted EPS was$15.75 for the nine months endedSeptember 30, 2020 , which represented a 6.2% increase from fully-diluted EPS of$14.83 for the nine months endedSeptember 30, 2019 . The increase in EPS for the nine months endedSeptember 30, 2020 compared to 2019 resulted from the increase in net income and the impact of a lower weighted average number of shares outstanding during the nine months endedSeptember 30, 2020 . Operating cash flow for the nine months endedSeptember 30, 2020 and 2019 was$6,875 and$4,734 , respectively. This increase was primarily attributable to higher net income in 2020, when excluding the non-cash impact of accrued expenses related to our business optimization initiatives and the BCBSA litigation accrual recognized in the third quarter of 2020. The increase was further due to a delay of certain payroll tax payments in 2020 as permitted by the CARES Act. -49- --------------------------------------------------------------------------------
Membership
The following table presents our medical membership by customer type, funding arrangement and reportable segment as ofSeptember 30, 2020 and 2019. Also included below is other membership by product. At this time, the following table does not include membership resulting from our acquisition of Beacon. The medical membership and other membership data presented are unaudited and in certain instances include estimates of the number of members represented by each contract at the end of the period. For a more detailed description of our medical membership, see the "Membership" section of Part II, Item 7, "Management's Discussion and Analysis of Financial Condition and Results of Operations" included in our 2019 Annual Report on Form 10-K. September 30 (In thousands) 2020 2019 Change % Change Medical Membership Customer Type Local Group 15,509 15,659 (150) (1.0) % Individual 701 711 (10) (1.4) % National: National Accounts 7,773 7,666 107 1.4 % BlueCard® 6,106 5,967 139 2.3 % Total National 13,879 13,633 246 1.8 % Medicare: Medicare Advantage 1,416 1,203 213 17.7 % Medicare Supplement 933 893 40 4.5 % Total Medicare 2,349 2,096 253 12.1 % Medicaid 8,569 7,293 1,276 17.5 % Federal Employees Health Benefits 1,618 1,592 26 1.6 % Total Medical Membership by Customer Type 42,625 40,984 1,641 4.0 % Funding Arrangement Self-Funded 25,633 25,368 265 1.0 % Fully-Insured 16,992 15,616 1,376 8.8 % Total Medical Membership by Funding Arrangement 42,625 40,984 1,641 4.0 % Reportable Segment Commercial & Specialty Business 30,089 30,003 86 0.3 % Government Business 12,536 10,981 1,555 14.2 % Total Medical Membership by Reportable Segment 42,625 40,984 1,641 4.0 % Other Membership Life and Disability Members 5,029 4,970 59 1.2 % Dental Members 6,051 5,942 109 1.8 % Dental Administration Members 1,315 5,526 (4,211) (76.2) % Vision Members 7,487 7,232 255 3.5 % Medicare Part D Standalone Members 405 285 120 42.1 % -50-
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Medical Membership Total medical membership grew in both our Government Business and Commercial & Specialty Business segments as well as by funding arrangement. Fully-insured membership increased primarily due to growth in our Medicaid and Medicare businesses, partially offset by membership decreases in our fully-insured Local Group business. Local Group membership decreased due to negative in-group changes as a result of increased unemployment caused by the COVID-19 pandemic, which was partially offset by sales exceeding lapses. Self-funded medical membership increased primarily as a result of membership increases in our National business driven by higher BlueCard® activity at other BCBSA plans whose members reside in or travel to our licensed areas and our acquisition of a third-party administrator. Medicaid membership increased primarily due to organic growth in existing markets due to the temporary suspension of eligibility recertification during the COVID-19 pandemic as well as our acquisition of Medicaid plans inMissouri andNebraska . Medicare membership increased primarily due to higher sales. Other Membership Our other membership can be impacted by changes in our medical membership, as our medical members often purchase our other products that are ancillary to our health business. We have experienced growth in our life and disability membership primarily due to higher sales in our Local Group business. Dental membership increased due to higher sales in our National Accounts and growth in membership in our Federal Employees Health Benefits program. Dental administration membership decreased due to the lapse of a large dental administration services contract. Vision membership increased due to higher sales in ourMedicare and Local Group businesses. Consolidated Results of Operations Our consolidated summarized results of operations and other financial information for the three and nine months endedSeptember 30, 2020 and 2019 are as follows:
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