ST. LOUIS, Mo. - BJC HealthCare will leave Aetna’s and Anthem’s Medicare Advantage networks effective Jan. 1, 2027, forcing affected patients to weigh changes in coverage or providers against potentially higher out-of-network costs.
The decision follows unsuccessful contract negotiations and affects Illinois state retirees among other patients. Illinois CMS said about 5,000 members belong to the retiree group covered by Aetna.
The announcement comes during the Medicare Annual Enrollment Period, which began Oct. 15 and ends Dec. 7, 2026, for coverage beginning Jan. 1, 2027.
What changes - and what does not
BJC said its Medicare Advantage agreements with the two insurers will end after Dec. 31, 2026. Its Aetna commercial agreements remain in place, while negotiations continue over other Anthem coverage.
Despite lengthy negotiations, BJC HealthCare was not able to come to a satisfactory agreement with Anthem Medicare Advantage or Aetna Medicare Advantage plans in order to renew these agreements after Dec. 31, 2026.
Effective Jan. 1, 2027, BJC HealthCare will no longer be an in-network provider for Aetna’s and Anthem’s Medicare Advantage plans. Aetna commercial plan agreements are current, and BJC will remain in-network for 2027 and beyond. Anthem commercial, Medicaid (Healthy Blue), and HealthLink plans are currently in contract negotiations in an effort to renew these agreements effective Jan. 1, 2027.
Although Aetna has stated that Aetna Medicare Advantage patients can continue to receive care from BJC providers, they have not fully explained that doing so may result in significantly higher costs under out-of-network benefits.
On its website, BJC attributed the decision to administrative and payment disputes.
"After years of trying to resolve administrative burden and payment issues with both Aetna and Anthem, BJC made the difficult decision to no longer partner with these plans. We did not wish this to be the outcome. Like almost 200 other health systems across the country, BJC has had to end its relationships with certain Medicare Advantage plans. We will only contract with plans that have reasonable terms and conditions focused on patients’ best interests."
Aetna said it remained willing to negotiate:
BJC HealthCare/Saint Luke’s in St. Louis and Kansas City, in alignment with Washington University School of Medicine physicians, have unfortunately informed us that they are reducing access for Medicare advantage members. While we remain willing to work with BJC/Saint Luke’s and Washington University School of Medicine physicians to reach a fair agreement that keeps them in our Medicare network, they will no longer be in network for Aetna Medicare Advantage members beginning January 1, 2027.
Anthem described the network departure as a mutual decision. It said it would help affected members locate other in-network providers and support continued care, when medically necessary, for members with certain serious or complex conditions beyond December 31, 2026. Anthem Medicare Supplement plans are unaffected.
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Patients weigh losing longtime doctors
For Cindy Minor, the announcement threatens relationships with physicians who have treated her family for years.
Minor worked in higher education in Illinois for more than 30 years and receives Medicare Advantage coverage through Aetna. She and her husband have lived in the Collinsville area for six years. Before that, they traveled from southern Illinois to Barnes for medical appointments.
"Aetna is how I initially found out about this. They started in September, starting sending letters, which we had at least a dozen of these letters. I called Aetna and talked to them extensively about just what was going on. Then Wash U sends a letter. I called Wash U and talk to them", Minor said.
She learned her insurance would become out-of-network at BJC Healthcare and Washington University School of Medicine.
"I panicked because we do use so many healthcare providers through BJC. My husband has about 10, and I have three. So, my first thought was, ‘oh my gosh, what are we going to do?’ We like our providers. We like BJC. Just the thought of having to replace all of those providers, it was just a little overwhelming", Minor said.
Her husband has seen some of his physicians for more than a dozen years, including during cancer treatment.
"I don’t think they’re replaceable, in my opinion. Yes, we could go to another doctor, but they know you. We’ve gotten excellent care through BJC and Wash U doctors. I would just hate to lose that", Minor said.
She said other retired educators nearby face the same uncertainty.
"Just in my neighborhood, there’s an individual across the street who’s a retired educator, and there’s another retired educator three doors down. So just in this small neighborhood, there have been at least three people impacted. Well, plus spouses. So, yeah, it’s just sort of overwhelming", Minor said.
A retired teacher who spoke with First Alert 4 described similar concerns. She receives rheumatoid arthritis infusions at BJC every eight weeks and said paying out-of-network would be costly. She also said specialists treating her condition are limited and have longer appointment waits.
Minor has begun reviewing alternatives after receiving information from BJC.
"So like BJC, the letter that they sent, they suggested Chapter Advisory as someone who can help us find other Medicare coverage. I had to spend time on that. Chapter Advisory wants a list of all of your providers and their addresses. They want a list of all of your medicine", Minor said.
Her options include another Medicare Advantage plan, original Medicare or different doctors. Minor said returning to original Medicare would require underwriting approval for gap insurance, and she does not know whether she and her husband would qualify given his medical history. She said the other Medicare Advantage plans she reviewed were not as good as her current coverage.
"I know what my choices are, but I don’t like my choices. I would prefer to stick with what I have", Minor said.
Lawmakers seek answers
Illinois lawmakers say constituents are asking how the change will affect ongoing treatment and access to specialists.
"I’m hearing a lot of panic and confusion from folks that really want to make sure they can go to their doctor. They want to make sure that they can continue with treatments they are going through. They just want to know what the future holds. They want to have firm answers if they need to make any changes to what their benefits are. It’s put people in a place where it feels very unsure", said State Rep. Katie Stuart, D-Edwardsville, 112th District and Assistant Majority Leader.
Stuart said notices from Aetna and BJC have left some retired employees unsure whether they can keep seeing their physicians.
"Does that mean I can’t go to my doctor anymore? Depending on what plan they’re in, some retirees have no other option but Aetna. So, they’re not sure what this means, if they can use BJC again. BJC has some really highly specialized areas of coverage. They’re very worried about having to travel to, you know, Nashville or Chicago or somewhere like that in order to get these specialty doctors", Stuart said.
State Rep. Charlie Meier, R-Okawville, 109th District, said patients have emphasized the importance of longstanding relationships with their doctors.
"These are relationships they’ve built with that doctor over the years. That doctor has maybe saved their life through cancer treatments, through heart treatments, and now they’re being told they can’t go and see that doctor again. So there is fear and anger in their voice, and rightfully so. We have to do something", Meier said.
Southern Illinois lawmakers sent a letter demanding that CMS, Aetna and Barnes-Jewish meet to develop a plan, Meier said. They requested a response by Nov. 12.
Meier said CMS could pursue a direct agreement with Barnes or add another health insurance system, naming Devoted Healthcare, Essence, Humana and United Healthcare as possibilities.
He also said patients already receiving treatment at Barnes could continue that specific treatment beyond Jan. 1 through a continuity-of-care clause if they have a written agreement with Aetna acknowledging it.
"This is affecting more than 5,000 people here in Southern Illinois. These are people who’ve worked for the state their entire life. We need an agreement. We need something worked out to protect them. They believe they have health insurance. They need to have it. They don’t want to drive two, three, four, five hours when you can be in Barnes Hospital in 55 minutes", Meier said.
He said southern Illinois has limited alternatives to Barnes for specialized care, including transplants and gene therapy. Retirees can change plans, he said, but would then pay for coverage themselves rather than through the state.
A statement included in the source article also called for an agreement:
Every Illinoisan deserves access to quality, affordable care, and no one should have to worry that a contractual dispute between an insurance company and health care provider will stand between them and the treatment they need. Aetna and the BJC network must do everything in their power to preserve Medicare Advantage health coverage for thousands of Illinoisans who rely on it, including 5,000 State of Illinois retirees across the region. It is greatly concerning that these entities are willing to strip healthcare access for thousands of Illinoisans and we urge them to seriously and fully evaluate all potential options to reach an agreement.
Emergency care remains covered
Stuart stressed that the network change does not affect emergency care.
"I also want to make sure that people understand this doesn’t affect emergency care. If you need emergency care, please go. Please take care of yourself. That is covered, you know, regardless of network status. It doesn’t require prior authorization. So if you have an emergency, if you are having a stroke, if you are having a heart attack, or if you are just worried that’s what’s happening, go get care", Stuart said.
She said the dispute raises wider concerns about how patients navigate the health care system.
"It points to that our medical system isn’t always patient-focused, and that there has to be a better way that we can do that. Obviously, I’m going to do everything I can. I’m going to connect with my colleagues from all over the region", Stuart said.
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