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, unless the context otherwise requires.
Results of operations, cost of care trends, investment yields and other measures
for the three months ended March 31, 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 nearly 44 medical members through our
affiliated health plans as of March 31, 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 across the country as AIM Specialty Health,
Amerigroup, Aspire Health, Beacon, CareMore, Freedom Health, HealthLink,
HealthSun, 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 50 states and
the District 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 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
In March 2020, the World Health Organization declared the outbreak of a novel
strain of coronavirus ("COVID-19") a global health pandemic. The virus and
mitigation efforts have continued to impact the global economy, cause market
instability, increase unemployment and put pressure on the healthcare system.
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. Our Medicaid membership grew since the pandemic as a
result of the temporary suspension of eligibility recertification efforts in
response to the COVID-19 pandemic, which we expect will remain suspended at
least through the end of 2021. During the first quarter of 2021, our
non-COVID-19 healthcare utilization experience remained below pre-COVID-19
levels, partially offsetting our COVID-19 related healthcare utilization, which
remained elevated. Our expenses associated with COVID-19, including testing,
treatment and vaccine administration exceeded the benefit we experienced during
the quarter from the lower volume of healthcare claims attributable to decreased
utilization of non-COVID-19 healthcare services.
We provided enhanced access and coverage for our members, made changes to select
membership benefits and business operations and modified tools and policies to
assist consumers and care providers at the height of the COVID-19 pandemic. We
continued to waive cost-sharing to our members related to COVID-19 diagnostic
tests, treatment and vaccine administration through the first quarter of 2021.
Although the COVID-19 pandemic has impacted and will likely continue to impact
our membership and benefit expense, and continued COVID-19 care, testing and
vaccine administration, and the
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possible risk of new COVID-19 variants 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 March 31, 2021. However, this may change in the future as the
COVID-19 pandemic continues to evolve and the full extent of its impact
(including new variants of the virus, which may be more contagious, more severe
or less responsive to treatment or vaccines) 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
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. 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, which was argued before the U.S. Supreme Court in
November 2020 and has been stayed pending the U.S. Supreme Court's decision,
could significantly disrupt our business. In 2020, we modestly expanded 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.
Beginning 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. 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. We priced
our affected products to cover the impact of the HIP Fee, when applicable. 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 has caused a decrease in utilization of non-COVID-19
health services, which decreased our claim costs in 2020. During the first
quarter of 2021, non-COVID healthcare utilization experience remained below our
pre-COVID-19 levels, partially offsetting our COVID-19 related healthcare
utilization, which remained elevated. We expect
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utilization of non-COVID-19 healthcare services to rebound and for claim costs
to normalize in 2021. Further increases and pent-up demand in the utilization of
such services may increase our claim costs in the future and affect our medical
cost trends. Our expenses in 2020 and the first quarter of 2021 included
additional costs to cover COVID-19 related testing, treatment and vaccine
administration. During the first quarter of 2021, through various dates, we
continued to provide expanded coverage for certain members for treatment related
to a COVID-19 diagnosis. Governmental action has required us to provide varying
coverage for COVID-19 testing and vaccine administration to our members.
Continued COVID-19 care, testing and vaccine administration, and the possible
risk of new COVID-19 variants, are expected to result in increased future
medical costs. We continue to closely 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
on January 1, 2022, and our first report on pharmacy benefits and drug costs is
due December 27, 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 addition,
the legal challenges regarding the ACA continue to contribute to this
uncertainty, including a federal district court decision invalidating the ACA in
its entirety, which was argued before the U.S. Supreme Court in November 2020
and has been stayed pending the U.S. Supreme Court's decision. We will continue
to evaluate the impact of the ACA as any further developments or judicial
rulings occur.
The annual HIP Fee, which has been permanently eliminated effective in 2021, was
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 all U.S. health risk for those certain lines of
business written during the preceding calendar year. The HIP Fee was
non-deductible for federal income tax purposes. Our affected products were
priced to cover the increased selling, general and administrative and income tax
expenses associated with the HIP Fee when applicable. The total amount due from
allocations to all health insurers was $15,523 for 2020. For the three months
ended March 31, 2020, we recognized $417 as selling, general and administrative
expense related to the HIP Fee.
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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.
Other Significant Items
Business and Operational Matters
On March 24, 2021, we announced our entrance into an agreement with WindRose
Health Investors to acquire myNEXUS, Inc. ("myNEXUS"). myNEXUS is a
comprehensive home-based nursing management company for payors and delivers
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. The acquisition is expected to close by the end of the second quarter of
2021 and is subject to standard closing conditions and customary approvals.
On February 2, 2021, we announced our entrance into an agreement with InnovaCare
Health, L.P. to acquire its Puerto Rico-based subsidiaries, including MMM
Holdings, LLC ("MMM"), its Medicare Advantage plan, Medicaid plan and other
affiliated companies. MMM is an 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. The
acquisition is expected to close by the end of the second quarter of 2021 and is
subject to standard closing conditions and customary approvals.
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.
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.
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 contain certain non-monetary terms. As of March
31, 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.
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In August 2020, the Delaware Court of Chancery ruled 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. Cigna filed a
notice of appeal in November 2020 challenging the trial court's opinion that
Anthem did not owe Cigna a termination fee. Cigna filed its appellate brief in
December 2020, and we filed a response in January 2021. Oral argument before the
Delaware Supreme Court was held in April 2021. The matter was taken under
advisement. For additional information, see Note 11, "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.
In January 2019, we exercised our contractual right to terminate our PBM
agreement with Express Scripts, Inc. (the "ESI PBM Agreement") 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 March 31, 2021, total medical membership increased
1.4, or 3.3%. 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 organic growth in our Medicaid business due
to the temporary suspension of eligibility recertification during the COVID-19
pandemic, which we expect will remain suspended at least through the end of
2021. The increase in our Government Business membership was further due to
higher sales in our Medicare Advantage business exceeding lapses. The decrease
in our Commercial & Specialty Business membership was primarily driven by our
fee-based business, which experienced higher in-group change as a result of
increased unemployment caused by the COVID-19 pandemic, partially offset by
sales in our Individual business exceeding lapses.
Operating revenue for the three months ended March 31, 2021 was $32,098, an
increase of $2,650, or 9.0%, from the three months ended March 31, 2020. The
increase in operating revenue for the three months ended March 31, 2021 compared
to 2020 was primarily driven by higher premium revenue in our Government
Business segment and higher pharmacy product revenue in our IngenioRx segment.
Net income for the three months ended March 31, 2021 was $1,667, an increase of
$144, or 9.5%, from the three months ended March 31, 2020. The increase in net
income for the three months ended March 31, 2021 was primarily due to lower net
realized losses on financial instruments, improved operating gain in our
Government Business and IngenioRx segments, lower income tax expense, and
improved investment income, partially offset by a decline in operating gain in
our Commercial & Specialty Business segment.
Our fully-diluted earnings per share ("EPS") was $6.71 for the three months
ended March 31, 2021, which represented a 13.0% increase from EPS of $5.94 for
the three months ended March 31, 2020. The increase in EPS for the three months
ended March 31, 2021 compared to 2020 resulted primarily from the increase in
net income, as well as a lower number of diluted shares outstanding in 2021.
Operating cash flow for the three months ended March 31, 2021 and 2020 was
$2,505 and $2,515, respectively. Operating cash flow was driven by changes in
working capital, the impact of membership growth in our Government Business
segment and higher net income in 2021 offset by the impact of the repeal of the
HIP Fee in 2021.
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Membership

In 2021, we have 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, 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 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 March 31, 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.

                                                 March 31
(In thousands)                             2021            2020        Change      % Change
Medical Membership
Commercial & Specialty Business:
Individual                                  731              717            14        2.0  %
Group Risk-Based                          3,837            3,841           (4)       (0.1) %
Commercial Risk-Based                     4,568            4,558            10        0.2  %
BlueCard®                                 6,166            6,197          (31)       (0.5) %
Group Fee-Based                          19,515           19,905         (390)       (2.0) %
Commercial Fee-Based                     25,681           26,102        (421)        (1.6) %
Total Commercial & Specialty Business    30,249           30,660        (411)        (1.3) %
Government Business:
Medicare Advantage                        1,538            1,341           197       14.7  %
Medicare Supplement                         930              914            16        1.8  %
Total Medicare                            2,468            2,255         213          9.4  %
Medicaid                                  9,172            7,615         1,557       20.4  %
Federal Employees Health Benefits         1,632            1,614            18        1.1  %
Total Government Business                13,272           11,484         1,788       15.6  %
Total Medical Membership                 43,521           42,144         1,377        3.3  %
Other Membership
Life and Disability Members               4,766            5,158        (392)        (7.6) %
Dental Members                            6,599            6,476         123          1.9  %
Dental Administration Members             1,488            1,311         177         13.5  %
Vision Members                            7,798            7,510         288          3.8  %
Medicare Part D Standalone Members          450              383          67         17.5  %

Medical Membership Total medical membership increased primarily due to growth in our Government Business, which was driven by organic growth in our Medicaid membership as a result of the temporary suspension of eligibility recertification during the

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COVID-19 pandemic. The increase in our Government Business membership was
further due to higher sales in our Medicare Advantage business exceeding the
lapses. These increases were partially offset by a decrease in our Commercial &
Specialty Business group fee-based membership attributable to higher in-group
change as a result of increased unemployment caused by the COVID-19 pandemic,
partially offset by sales in our Individual business exceeding lapses.
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 risk-based account and membership decrease in our group
fee-based business. Vision membership increased as a result of growth in our
Medicare business. Dental administration membership increased due to growth in
our FEHB program. Dental membership increased primarily due to higher sales in
our Individual and group accounts and growth in our FEHB business.
Consolidated Results of Operations
Our consolidated summarized results of operations and other financial
information for the three months ended March 31, 2021 and 2020 are as follows:

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