“we presume that the elevated level of trend we observed in the third quarter persist into the fourth quarter, net of some revenue offsets that represents about $550 million of pressure in Medicare.”

In context

“l health, and OTC and flex cards. So, OTC and flex cards is a differentiator for our 2023 plan design, but it's also an important part of how we're planning to grow in 2024 and part of our bid strategy. The cards allot members a fixed amount of cash typically on a quarterly basis that they can use for OTC as well as food among other purchases. To date, we've seen meaningfully higher levels of utilization in the use of these cards than we had anticipated in our 2023 pricing and in our initial outlook. If you roll that forward to the full-year guide, we've raised the MBR by 75 basis points to 80 basis points. 10 basis points to 15 basis points is primarily related to the exchange product growth in the SEP and its impact on our MBR. The remaining 65 bps is related to Medicare Advantage where we presume that the elevated level of trend we observed in the third quarter persist into the fourth quarter, net of some revenue offsets that represents about $550 million of pressure in Medicare. It's important to note, though, as you look at our full-year guidance, reduction in HCB, there are about 250 million of favorable non-MBR items, which include things like net investment income, fees, and also expenses. And a portion of these tailwinds are expected to persist into 2024. So, as we think about how the MBR pressure in '23 then impacts '24, as I mentioned, our '24 MA bid contemplated higher MA utilization for outpatient and supplemental benefits, although the current experience exceeds the pricing provision. As it specifically relates to OTC and flex cards, we recognized how customers value this benefit that it would be an important part of how we were going to market in 2024 in the sale of our products. And therefore, we proactively assumed higher utilization in those cards,”