(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 endedDecember 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 toAnthem, Inc. , anIndiana corporation, and unless the context otherwise requires, its direct and indirect subsidiaries. References to the "states" include theDistrict of Columbia andPuerto Rico , unless the context otherwise requires. Results of operations, cost of care trends, investment yields and other measures for the three and six months endedJune 30, 2021 are not necessarily indicative of the results and trends that may be expected for the full year endingDecember 31, 2021 , or any other period. Overview We are one of the largest health benefits companies inthe United States in terms of medical membership, serving greater than 44 medical members through our affiliated health plans as ofJune 30, 2021 . We are an independent licensee of theBlue Cross and Blue Shield Association ("BCBSA"), an association of independent health benefit plans. We serve our members as theBlue Cross licensee forCalifornia and as theBlue Cross and Blue Shield ("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 andPuerto Rico asAIM 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, theDistrict of Columbia andPuerto 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. SinceJune 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 throughJune 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 -44-
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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 theU.S. healthcare system. InJune 2021 , theU.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, toCaremarkPCS 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 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 ("HIP Fee") on health insurers that write certain types of health insurance onU.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 -45-
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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 inDecember 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 inJanuary 2022 , and our first report on pharmacy benefits and drug costs is due inDecember 2021 . The American Rescue Plan Act of 2021, (the "Rescue Plan"), which was enacted inMarch 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 inJanuary 2021 , while the COBRA premium subsidization extends from April throughSeptember 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. InJune 2021 , theU.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. -46-
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Other Significant Items Business and Operational Matters OnJune 29, 2021 , we completed our acquisition ofMMM Holdings, LLC ("MMM") and its Medicare Advantage plan, Medicaid plan and other affiliated companies fromInnovaCare Health, L.P. MMM is aPuerto 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. OnApril 28, 2021 , we completed our acquisition of myNEXUS, Inc. ("myNEXUS") fromWindRose 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. OnFebruary 28, 2020 , we completed our acquisition ofBeacon 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 endedDecember 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 theUnited States District Court for the Northern District of Alabama (the "Court") captioned In re Blue Cross Blue Shield Antitrust Litigation ("BCBSA Litigation"), the BCBSA andBlue Cross and/orBlue 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 ofJune 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. InMay 2021 , theDelaware Supreme Court affirmed theDelaware 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 - -47-
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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. InJanuary 2019 , we exercised our contractual right to terminate our PBM agreement (the "ESI PBM Agreement") withExpress Scripts, Inc. ("Express Scripts") and we completed the transition of our members from Express Scripts to IngenioRx byJanuary 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 endedJune 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 onJune 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 onJune 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 endedJune 30, 2021 was$33,279 , an increase of$4,101 , or 14.1%, from the three months endedJune 30, 2020 . Operating revenue for the six months endedJune 30, 2021 was$65,377 , an increase of$6,751 , or 11.5%, from the six months endedJune 30, 2020 . The increase in operating revenue for the three and six months endedJune 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 endedJune 30, 2021 was$1,801 , a decrease of$475 , or 20.9%, from the three months endedJune 30, 2020 . Net income for the six months endedJune 30, 2021 was$3,468 , a decrease of$331 , or 8.7% from the six months endedJune 30, 2020 . The decrease in net income for the three and six months endedJune 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 endedJune 30, 2021 , which represented a 18.6% decrease from EPS of$8.91 for the three months endedJune 30, 2020 . Our fully-diluted EPS was$13.95 for the six months endedJune 30, 2021 , which represented a 6.1% decrease from fully-diluted EPS of$14.85 for the six months endedJune 30, 2020 . The decrease in EPS for the three and six months endedJune 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 endedJune 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 byIRS Notice 2020-23. The decrease was further attributable to lower net income in 2021. -48-
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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 includesStudent Health members. National Accounts generally consist of multi-state employer groups primarily headquartered in anAnthem 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 ofBlue Cross and/orBlue Shield plans not owned byAnthem 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 anAnthem subsidiary is theBlue Cross and/orBlue 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 -49-
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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
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 onJune 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 ourCommercial & 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 ourIndividual 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 endedJune 30, 2021 and 2020 are as follows:
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