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CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (Unaudited) - USD ($)
$ in Millions
 3 Months Ended
Mar. 31, 2024
Mar. 31, 2023
Cash flows from operating activities    
Net income $ 739 $ 1,238
Adjustments to reconcile net income to net cash provided by operating activities:    
(Gain) loss on investment securities, net (1) 60
Equity in net losses 24 17
Stock-based compensation 45 38
Depreciation 226 200
Amortization 16 18
Impairment of property and equipment 33 0
Changes in operating assets and liabilities, net of effect of businesses acquired and disposed:    
Receivables (1,890) (1,433)
Other assets 97 (907)
Benefits payable 1,488 754
Other liabilities (422) (238)
Unearned revenues 35 6,934
Other 33 6
Net cash provided by operating activities 423 6,687
Cash flows from investing activities    
Acquisitions, net of cash and cash equivalents acquired (14) (73)
Purchases of property and equipment, net (177) (223)
Purchases of investment securities (1,259) (1,313)
Proceeds from maturities of investment securities 645 267
Proceeds from sales of investment securities 391 50
Net cash used in investing activities (414) (1,292)
Cash flows from financing activities    
Receipts from contract deposits, net 499 2,997
Proceeds from issuance of senior notes, net 2,232 1,215
Repayments of senior notes 0 (60)
Repayments of commercial paper, net (644) (177)
Repayment of term loan 0 (500)
Debt issue costs (5) (4)
Change in book overdraft (20) 108
Common stock repurchases (717) (94)
Dividends paid (109) (100)
Other (29) (106)
Net cash provided by financing activities 1,207 3,279
Increase in cash and cash equivalents 1,216 8,674
Cash and cash equivalents at beginning of period 4,694 5,061
Cash and cash equivalents at end of period 5,910 13,735
Supplemental cash flow disclosures:    
Interest payments 158 97
Income tax payments, net 1 6
Details of businesses acquired in purchase transactions:    
Fair value of assets acquired, net of cash and cash equivalents acquired 22 73
Less: Fair value of liabilities assumed (8) (5)
Less: Noncontrolling interests acquired 0 5
Cash paid for acquired businesses, net of cash and cash equivalents acquired $ 14 $ 73