ANTHEM : MANAGEMENT'S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS (form 10-Q)

(In Millions, Except Per Share Data or as Otherwise Stated Herein)
This Management's Discussion and Analysis of Financial Condition and Results of
Operations ("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 ended December 31, 2020 and the MD&A
included in our 2020 Annual Report on Form 10-K. References to the terms "we,"
"our," "us," or "Anthem" used throughout this MD&A refer to Anthem, Inc., an
Indiana corporation, and unless the context otherwise requires, its direct and
indirect subsidiaries. References to the "states" include the District of
Columbia and Puerto Rico, unless the context otherwise requires.
Results of operations, cost of care trends, investment yields and other measures
for the three and six months ended June 30, 2021 are not necessarily indicative
of the results and trends that may be expected for the full year ending
December 31, 2021, or any other period.
Overview
We are one of the largest health benefits companies in the United States in
terms of medical membership, serving greater than 44 medical members through our
affiliated health plans as of June 30, 2021. We are an independent licensee of
the Blue Cross and Blue Shield Association ("BCBSA"), an association of
independent health benefit plans. We serve our members as the Blue Cross
licensee for California and as the Blue Cross and Blue Shield ("BCBS") licensee
for Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri
(excluding 30 counties in the Kansas City area), Nevada, New Hampshire, New York
(in the New York City metropolitan area and upstate New York), Ohio, Virginia
(excluding the Northern Virginia suburbs of Washington, D.C.) and Wisconsin. In
a majority of these service areas, we do business as Anthem Blue Cross, Anthem
Blue Cross and Blue Shield, and Empire Blue Cross Blue Shield or Empire 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 and Puerto Rico as AIM Specialty Health,
Amerigroup, Aspire Health, Beacon, CareMore, Freedom Health, HealthLink,
HealthSun, MMM, Optimum HealthCare, Simply Healthcare, and/or UniCare. Pharmacy
benefits management ("PBM") services are offered through our IngenioRx
subsidiary. We are licensed to conduct insurance operations in all fifty states,
the District of Columbia and Puerto Rico 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 2020 Annual
Report on Form 10-K. Additional information on our segments can be found in this
MD&A and in Note 15, "Segment Information" of the Notes to Consolidated
Financial Statements included in Part I, Item 1 of this Form 10-Q.
COVID-19
The COVID-19 pandemic continues to impact the global economy, cause market
instability and put pressure on the healthcare system, and we continue to assist
our customers, providers, members and communities in addressing the effects of
the COVID-19 pandemic, including providing benefit coverage for COVID-19
diagnostic tests, treatment and vaccine administration. The COVID-19 pandemic
has impacted, and will likely continue to impact, our membership, our benefit
expense and member behavior, including how members access healthcare services.
Since June 30, 2020, our Medicaid membership grew as a result of the temporary
suspension of eligibility recertification in response to the COVID-19 pandemic,
which we expect will remain suspended at least through the end of 2021. Our
Commercial fee-based membership decreased in this same period due to in-group
attrition likely attributable to the COVID-19 pandemic. See Business Trends -
Medical Cost Trends below for a discussion of the impact of COVID-19 on our
healthcare costs.
Although the COVID-19 pandemic will likely continue to impact our membership and
benefit expense, and continued COVID-19 care, testing and vaccine
administration, and the risk of new COVID-19 variants (which may be more
contagious or severe, or less responsive to treatment or vaccines), are expected
to result in increased future medical costs, we have proactively taken actions
to minimize these effects, and the pandemic has not had a material adverse
effect on our reported results through June 30, 2021. However, this may change
in the future as the COVID-19 pandemic continues to evolve and the full 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
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impact our business. For additional discussion related to the COVID-19 pandemic
and our risk factors, see Part I, Item 1, "Business-COVID-19", Part I, Item 1A,
"Risk Factors" and Part II, Item 7, "Management's Discussion and Analysis of
Financial Condition and Results of Operations-COVID-19" included in our 2020
Annual Report on Form 10-K.
Business Trends
The Patient Protection and Affordable Care Act and the Health Care and Education
Reconciliation Act of 2010, as amended (collectively, the "ACA") has changed and
may continue to make broad-based changes to the U.S. healthcare system. In June
2021, the U.S. Supreme Court issued its opinion and dismissed the latest legal
challenge to the constitutionality of the ACA, leaving the law intact. We expect
the ACA will continue to impact our business model and strategy. In 2020, we
made the decision to modestly expand our participation in the Individual
ACA-compliant market for 2021. 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 103 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 to our affiliated health plan customers throughout the country, as well
as to 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, to CaremarkPCS Health, L.L.C.,
which is a subsidiary of CVS Health Corporation, 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.
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, the cost of COVID-19
vaccines and the return of non-COVID-19 healthcare utilization to our estimate
of normal levels, based on historical utilization patterns. 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 our Individual
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 ("HIP Fee") on health insurers
that write certain types of health insurance on U.S. risks. When applicable, we
priced our affected products to cover the impact of the HIP Fee, including
during 2020. The HIP Fee has been permanently repealed beginning 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.
The COVID-19 pandemic caused a decrease in utilization of non-COVID-19 health
services, which decreased our claim costs in 2020. During the first quarter of
2021, our non-COVID-19 healthcare utilization experience remained below our
estimate of normalized levels, partially offsetting our COVID-19 related
healthcare utilization, which remained elevated from the winter surge in
COVID-19 related hospitalizations. During the second quarter of 2021,
non-COVID-19 healthcare utilization expenses increased toward normalized levels,
while COVID-19 related healthcare expenses declined from the first quarter of
2021 and COVID-19 vaccination administration costs increased. We expect
utilization of healthcare services to continue at or above normalized levels in
the third and fourth quarters of 2021. Further increases and pent-up demand in
the utilization of such services, as well as increases in acuity associated with
deferred services and the long-term health complications of COVID-19, may
increase our claim costs in the future and affect our medical cost trends. Our
expenses in 2020 and the first
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half of 2021 included additional costs to cover COVID-19 related testing,
treatment and vaccine administration. Continued COVID-19 testing, treatment and
vaccine administration expenses are expected to result in increased future
medical costs, and could be impacted by new COVID-19 variants. We continue to
monitor the COVID-19 pandemic and its impacts on our business, financial
condition, results of operations and medical cost trends.
For additional discussion regarding business trends, see Part I, Item 1,
"Business" included in our 2020 Annual Report on Form 10-K.
Regulatory Trends and Uncertainties
Federal and state governments have enacted, and may continue to enact,
legislation and regulations in response to the COVID-19 pandemic that have had,
and we expect will continue to have, a significant impact on healthcare
benefits, consumer eligibility for public programs and our cash flows for all of
our lines of business. These actions, which are in effect for various durations,
provide, among other things:
•mandates to waive cost-sharing on COVID-19 testing, treatment, vaccines and
related services;
•reforms, including waiving Medicare originating site restrictions for qualified
providers providing telehealth services;
•financial support to healthcare providers, including expansion of the Medicare
accelerated payment program to all providers receiving Medicare payments;
•mandated expansion of premium payment terms, including the time period for
which claims can be denied for lack of payment; and
•mandates related to prior authorizations and payment levels to providers,
additional consumer enrollment windows and an increased ability to provide
telehealth services.
The Consolidated Appropriations Act of 2021, which was enacted in December 2020
(the "Appropriations Act") contains a number of provisions that may have a
material effect upon our business, including procedures and coverage
requirements related to surprise medical bills and new mandates for continuity
of care for certain patients, price comparison tools, disclosure of broker
compensation and reporting on pharmacy benefits and drug costs. The various
health plan-related requirements of the Appropriations Act will go into effect
in January 2022, and our first report on pharmacy benefits and drug costs is due
in December 2021.
The American Rescue Plan Act of 2021, (the "Rescue Plan"), which was enacted in
March 2021, contains several health-related provisions that may have a material
effect upon our business, including expansion of premium tax credits for our
Individual exchange business and full subsidization of the Consolidated Omnibus
Budget Reconciliation Act ("COBRA") continuation coverage for those who were
involuntarily terminated or had their work hours reduced. The Rescue Plan's
premium tax provisions became effective in January 2021, while the COBRA premium
subsidization extends from April through September 2021.
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 June
2021, the U.S. Supreme Court issued its opinion and dismissed the latest legal
challenge to the constitutionality of the ACA, leaving the law intact. We will
continue to evaluate the impact of the ACA as any further developments or
judicial rulings occur.
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 2020 Annual Report on Form 10-K.
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Other Significant Items
Business and Operational Matters
On June 29, 2021, we completed our acquisition of MMM Holdings, LLC ("MMM") and
its Medicare Advantage plan, Medicaid plan and other affiliated companies from
InnovaCare Health, L.P. MMM is a Puerto Rico based integrated healthcare
organization and seeks to provide its Medicare Advantage and Medicaid members
with a whole health experience through its network of specialized clinics and
wholly owned independent physician associations. 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.
On April 28, 2021, we completed our acquisition of myNEXUS, Inc. ("myNEXUS")
from WindRose Health Investors. myNEXUS is a comprehensive home-based nursing
management company for payors and, at the time of acquisition, delivered
integrated clinical support services for Medicare Advantage members across
twenty states. This acquisition aligns with our strategy to manage integrated,
whole person multi-site care and support, by providing national, large-scale
expertise to manage nursing services in the home and facilitate transitions of
care.
On February 28, 2020, we completed our acquisition of Beacon Health Options,
Inc., ("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 aligned 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.
In 2020, we introduced enterprise-wide initiatives to optimize our business, and
as a result, recorded a charge of $653 in selling, general and administrative
expenses for the year ended December 31, 2020. 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" of the Notes to Consolidated Financial Statements
included in Part I, Item 1 of this Form 10-Q.
Litigation Matters
In the consolidated multi-district proceeding in the United States District
Court for the Northern District of Alabama (the "Court") captioned In re Blue
Cross Blue Shield Antitrust Litigation ("BCBSA Litigation"), the BCBSA and Blue
Cross and/or Blue Shield licensees, including us (the "Blue plans"), have
approved a settlement agreement and release (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 include certain non-monetary terms. As of June
30, 2021, the liability balance accrued for our estimated remaining payment
obligation was $507, net of payments made. All terms of the Subscriber
Settlement Agreement are subject to final approval by the Court before they
become effective. For additional information regarding this lawsuit, see Note
11, "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.
In May 2021, the Delaware Supreme Court affirmed the Delaware Court of
Chancery's ruling that neither we nor Cigna Corporation ("Cigna") could collect
damages in connection with the now-terminated Agreement and Plan of Merger
between us and Cigna. This matter is now concluded. For additional information,
see Note 11, "Commitments and Contingencies -
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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.
In January 2019, we exercised our contractual right to terminate our PBM
agreement (the "ESI PBM Agreement") with Express Scripts, Inc. ("Express
Scripts") and we completed the transition of our members from Express Scripts to
IngenioRx by January 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
11, "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 ended June 30, 2021, total medical membership increased
1.9, or 4.4%. Our medical membership grew primarily due to membership increases
in our Government Business segment, partially offset by declines in our
Commercial & Specialty Business segment. The increase in our Government Business
membership was primarily driven by increases in our Medicaid membership,
including organic growth resulting from the temporary suspension of eligibility
recertification during the COVID-19 pandemic, which we expect will remain
suspended at least through the end of 2021, and Medicaid membership also grew
due to our acquisition of MMM on June 29, 2021. The increase in our Government
Business membership was further due to increases in our Medicare Advantage
business due to our acquisition of MMM on June 29, 2021 and higher sales
exceeding lapses. The decrease in our Commercial & Specialty Business membership
was primarily driven by our fee-based business, which experienced higher
in-group attrition likely attributable to the COVID-19 pandemic, partially
offset by improvements in our Group risk-based and Individual businesses.
Operating revenue for the three months ended June 30, 2021 was $33,279, an
increase of $4,101, or 14.1%, from the three months ended June 30, 2020.
Operating revenue for the six months ended June 30, 2021 was $65,377, an
increase of $6,751, or 11.5%, from the six months ended June 30, 2020. The
increase in operating revenue for the three and six months ended June 30, 2021
compared to 2020 was primarily driven by higher premium revenue in our
Government Business segment from membership growth, rate increases in our
Commercial & Specialty Business segment and higher pharmacy product revenue in
our IngenioRx segment, partially offset by the impact of lower premium revenue
associated with the repeal of the HIP Fee for 2021.
Net income for the three months ended June 30, 2021 was $1,801, a decrease of
$475, or 20.9%, from the three months ended June 30, 2020. Net income for the
six months ended June 30, 2021 was $3,468, a decrease of $331, or 8.7% from the
six months ended June 30, 2020. The decrease in net income for the three and six
months ended June 30, 2021 was primarily due to declines in operating gain for
our Commercial & Specialty Business and Government Business segments. The
decrease in operating gain for our Commercial & Specialty Business and
Government Business segments reflects the non-COVID-19 healthcare utilization
returning to near pre-COVID-19 levels in 2021 from depressed levels in 2020 and
significantly increased COVID-19 related costs incurred in 2021. These declines
were partially offset by increases in our net investment income and net realized
gains on financial instruments, lower income tax expense and improved operating
gain in our IngenioRx segment.
Our fully-diluted earnings per share ("EPS") was $7.25 for the three months
ended June 30, 2021, which represented a 18.6% decrease from EPS of $8.91 for
the three months ended June 30, 2020. Our fully-diluted EPS was $13.95 for the
six months ended June 30, 2021, which represented a 6.1% decrease from
fully-diluted EPS of $14.85 for the six months ended June 30, 2020. The decrease
in EPS for the three and six months ended June 30, 2021 compared to 2020
resulted primarily from the decrease in net income, partially offset by lower
shares outstanding in 2021.
Operating cash flow for the six months ended June 30, 2021 and 2020 was $4,188
and $8,025, respectively. Operating cash flow was driven by changes in working
capital, lower premium receipts as a result of the repeal of the HIP Fee for
2021 and higher federal income tax payments made in the first six months of 2021
due to our delaying our tax payments in 2020 as permitted by IRS Notice 2020-23.
The decrease was further attributable to lower net income in 2021.
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Membership

In the first quarter of 2021, we updated our medical membership reporting to
better align with how we view our business. Our medical membership now includes
the following customer types: Individual, Group risk-based, Group fee-based,
BlueCard®, Medicare, Medicaid and our Federal Employees Health Benefits ("FEHB")
Program. BCBS-branded business generally refers to members in our service areas
licensed by the BCBSA. Non-BCBS-branded business refers to members in our
non-BCBS-branded Amerigroup, Freedom Health, HealthSun, MMM, Optimum HealthCare
and Simply Healthcare plans, as well as HealthLink and UniCare members. In
addition to the above medical membership, we also serve customers who purchase
one or more of our other products or services that are often ancillary to our
health business.
•Individual consists of individual customers under age 65 and their covered
dependents. Individual policies are generally sold through independent agents
and brokers, retail partnerships, our in-house sales force or via the exchanges.
Individual business is sold on a risked-based basis. We offer on-exchange
products through public exchanges and off-exchange products. Federal premium
subsidies are available only for certain public exchange Individual
products. Unsubsidized Individual customers are generally more sensitive to
product pricing and, to a lesser extent, the configuration of the network and
the efficiency of administration. Customer turnover is generally higher with
Individual as compared to Group risk-based business.
•Group risk-based consists of employer customers who purchase products on a
full-risk basis, which are products for which we charge a premium and indemnify
our policyholders against costs for health benefits. Group risk-based accounts
include Local Group customers and National Accounts. Local Group consists of
those employer customers with less than 5% of eligible employees located outside
of the headquarter state, as well as customers with more than 5% of eligible
employees located outside of the headquarter state with up to 5,000 eligible
employees. In addition, Local Group includes Student Health members. National
Accounts generally consist of multi-state employer groups primarily
headquartered in an Anthem service area with at least 5% of the eligible
employees located outside of the headquarter state and with more than 5,000
eligible employees. Some exceptions are allowed based on broker and consultant
relationships. Group risk-based accounts are generally sold through brokers or
consultants who work with industry specialists from our in-house sales force and
are offered both on and off the public exchanges.
•Group fee-based customers represent employer groups, Local Group, including
UniCare members, and National Accounts, who purchase fee-based products and
elect to retain most or all of the financial risk associated with their
employees' healthcare costs. Some fee-based customers choose to purchase stop
loss coverage to limit their retained risk. Group fee-based accounts are
generally sold through independent brokers or consultants retained by the
customer working with our in-house sales force.
•BlueCard® host customers represent enrollees of Blue Cross and/or Blue Shield
plans not owned by Anthem who receive healthcare services in our BCBSA licensed
markets. BlueCard® membership consists of estimated host members using the
national BlueCard® program. Host members are generally members who reside in or
travel to a state in which an Anthem subsidiary is the Blue Cross and/or Blue
Shield licensee and who are covered under an employer-sponsored health plan
issued by a non-Anthem controlled BCBSA licensee (the "home Blue plan"). We
perform certain functions, including claims pricing and administration, for
BlueCard® members, for which we receive administrative fees from the BlueCard®
members' home Blue plans. Other administrative functions, including maintenance
of enrollment information and customer service, are performed by the home Blue
plan. Host members are computed using, among other things, the average number of
BlueCard® claims received per month.
•Medicare customers are Medicare-eligible individual members age 65 and over who
have enrolled in Medicare Supplement plans; Medicare Advantage, including
Special Needs Plans ("SNPs"), also known as Medicare Advantage SNPs; Medicare
Part D; and dual-eligible programs through Medicare-Medicaid Plans ("MMPs").
Medicare Supplement plans typically pay the difference between healthcare costs
incurred by a beneficiary and amounts paid by Medicare. Medicare Advantage plans
provide Medicare beneficiaries with a managed care alternative to traditional
Medicare and often include a Medicare Part D benefit. In addition, our Medicare
Advantage SNPs provide tailored benefits to special needs individuals who are
institutionalized or have severe or disabling chronic conditions and to
dual-eligible customers, who are low-income seniors and persons under age 65
with disabilities. Medicare Advantage SNPs are coordinated care plans
specifically designed to provide targeted care, covering all the healthcare
services considered medically necessary for members and often providing
professional care coordination services, with personal guidance and programs
that help members maintain their health. Medicare Advantage membership also
includes Medicare Advantage members in our Group Retiree Solutions business who
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are retired members of Commercial accounts or retired members of groups who are not affiliated with our Commercial accounts who have selected a Medicare Advantage product through us. Medicare Part D offers a prescription drug plan to Medicare and MMP beneficiaries. MMP, which was established as a result of the passage of the ACA, is a demonstration program focused on serving members who are dually eligible for Medicaid and Medicare. Medicare Supplement and Medicare Advantage products are marketed in the same manner, primarily through independent agents and brokers. •Medicaid membership represents eligible members who receive healthcare benefits through publicly funded healthcare programs, including Medicaid, ACA-related Medicaid expansion programs, Temporary Assistance for Needy Families, programs for seniors and people with disabilities, Children's Health Insurance Programs, and specialty programs such as those focused on long-term services and support, HIV/AIDS, foster care, behavioral health and/or substance abuse disorders, and intellectual disabilities or developmental disabilities, among others. •FEHB members consist of United States government employees and their dependents within our geographic markets through our participation in the national contract between the BCBSA and the U.S. Office of Personnel Management. The following table presents our medical membership by reportable segment and customer type as of June 30, 2021 and 2020. Also included below is other membership by product. 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.

                                                 June 30
(In thousands)                             2021            2020        Change      % Change
Medical Membership
Commercial & Specialty Business:
Individual                                  738              711            27        3.8  %
Group Risk-Based                          3,851            3,789            62        1.6  %
Commercial Risk-Based                     4,589            4,500            89        2.0  %
BlueCard®                                 6,235            6,171            64        1.0  %
Group Fee-Based                          19,372           19,699         (327)       (1.7) %
Commercial Fee-Based                     25,607           25,870        (263)        (1.0) %
Total Commercial & Specialty Business    30,196           30,370        (174)        (0.6) %
Government Business:
Medicare Advantage                        1,824            1,366           458       33.5  %
Medicare Supplement                         936              921            15        1.6  %
Total Medicare                            2,760            2,287         473         20.7  %
Medicaid                                  9,754            8,180         1,574       19.2  %
Federal Employees Health Benefits         1,631            1,616            15        0.9  %
Total Government Business                14,145           12,083         2,062       17.1  %
Total Medical Membership                 44,341           42,453         1,888        4.4  %
Other Membership
Life and Disability Members               4,732            5,110        (378)        (7.4) %
Dental Members                            6,606            6,400         206          3.2  %
Dental Administration Members             1,497            1,318         179         13.6  %
Vision Members                            7,819            7,457         362          4.9  %
Medicare Part D Standalone Members          433              392          41         10.5  %

Medical Membership Total medical membership increased primarily due to growth in our Government Business, which was driven by increases in our Medicaid membership, including organic growth resulting from the temporary suspension of eligibility

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recertification during the COVID-19 pandemic and growth resulting from our
acquisition of MMM on June 29, 2021. Our Medicare Advantage membership also
increased due to our acquisition of MMM and higher sales exceeding lapses. These
increases were partially offset by a decrease in our Commercial & Specialty
Business Group fee-based membership due to in-group attrition likely
attributable to the COVID-19 pandemic, partially offset by growth in our Group
risk-based and Individual membership.
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. Life and disability membership decreased primarily due to the
loss of a Group risked-based account and membership decrease in our Group
fee-based business. Vision membership increased as a result of growth in our
Medicare business. Dental membership increased primarily due to higher sales in
our Individual and Group accounts and growth in our FEHB program. Dental
administration membership increased due to growth in our FEHB program.
Consolidated Results of Operations
Our consolidated summarized results of operations and other financial
information for the three and six months ended June 30, 2021 and 2020 are as
follows:

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