ST. LOUIS, Mo. (First Alert 4) – BJC Healthcare announced this week that Aetna and Anthem Medicare Advantage plans will no longer be in-network starting Jan. 1.
Aetna is the insurance provider for Illinois state retirees. Illinois CMS said that group alone totals about 5,000 members. They are a portion of the patients affected by the change, leaving them with the choice of changing providers or plans.
Cindy Minor said Aetna is how she initially found out about the change.
“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.
Minor said her health insurer would go 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.
Minor worked in higher education in Illinois for more than 30 years. Aetna is the insurance provider for her and other retired state employees’ Medicare Advantage plan. She said she and her husband have lived in the Collinsville area for six years, but previously lived in southern Illinois and drove to Barnes to see doctors there. She said her husband has seen some of his doctors for more than a dozen years, including during his 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.
Minor said the change has affected others near her.
“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 also spoke with First Alert 4. She has rheumatoid arthritis and goes to BJC every eight weeks for treatment infusions. She said those infusions would be costly out-of-pocket if out-of-network. She said specialists for her condition are fewer in number and have longer waits to be seen.
BJC Healthcare said that after lengthy negotiations, it was unable to reach an agreement on Medicare Advantage plans.
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.
Our priority is, and always will be, our patients. BJC remains committed to finding a solution that preserves access to the care our communities rely on while minimizing disruption for patients and families. We are committed to supporting patients through this transition. Patient resources can be found on www.bjc.org/medicareinfo and through Chapter Advisory, a free designated Medicare advisor: https://askchapter.org/partners/medicare-help.
The Medicare Annual Enrollment Period begins each year on Oct. 15 and ends Dec. 7, 2026, for coverage that begins Jan. 1, 2027.
On its website, BJC said: “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.”
The change means no in-network access to the primary care providers, specialists and hospitals patients have relied on. Aetna and Anthem said they have resources to help people find in-network providers.
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.
Aetna has a robust provider network in both the St. Louis and Kansas City areas available to care for our members. We are available to help members who have questions, and they can reach us by calling the number on their membership ID card.
Following constructive discussions, BJC and Anthem mutually agreed that BJC will no longer participate in our Medicare Advantage network effective January 1, 2027. We are helping affected members find other in-network providers and supporting a smooth transition of care. We will also help members with certain serious or complex medical conditions continue receiving care from their current providers beyond December 31, 2026, when medically necessary. Anthem Medicare Supplement plans are not affected by this change. Members can learn more at Anthem.com/update/bjc or call the customer service number on their member ID card.
Minor said BJC’s letter suggested Chapter Advisory to help find other Medicare coverage.
“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.
The change leaves patients like Minor exploring options such as finding another Medicare Advantage plan, switching to original Medicare, or changing doctors. Minor said going back to original Medicare would require underwriting approval for gap insurance, and she is uncertain whether she and her husband would qualify given his health history. She said other Medicare Advantage plans she has reviewed are not as good as her current plan.
“I know what my choices are, but I don’t like my choices. I would prefer to stick with what I have,” Minor said.
Illinois state lawmakers said they have heard concerns from constituents.
“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 that 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 retired employees are receiving notices from both Aetna and BJC stating they will be out-of-network, but many are unclear about what that means.
“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 he’s hearing similar things and retirees have described built 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.
Meier said southern Illinois lawmakers sent a letter demanding CMS, Aetna and Barnes-Jewish meet and develop a plan, requesting a response by Nov. 12.
Meier said CMS could address the issue by reaching a direct agreement with Barnes or by adding another health insurance system, such as Devoted Healthcare, Essence, Humana or United Healthcare.
Meier said patients currently undergoing treatment at Barnes will be able to continue that specific treatment past Jan. 1 under a continuity-of-care clause if they have a written agreement with Aetna acknowledging it.
Meier said southern Illinois has limited health care options outside of Barnes, including for specialty treatments such as transplants and gene therapy.
“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.
Stuart said the 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.
Meier said retirees can change plans, but would then pay for coverage themselves rather than the state.
Stuart said the situation reflects broader issues in 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.
Stuart provided a resource guide put together to help people navigate this change.
Stuart said she can be reached at repkatiestuart@gmail.com or 618-365-6650.
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.
Copyright 2026 KMOV. All rights reserved.