What is changing between BJC and Aetna Medicare Advantage?
BJC says its Aetna Medicare Advantage contract ends December 31, 2026. It lists Aetna commercial plans and First Health with no end date. Washington University School of Medicine physicians and providers in St. Louis are also affected, according to KCTV5.
BJC describes a separate 2027 arrangement for certain Illinois state retirees in the Aetna TRAIL program, explained below. For individual Aetna Medicare Advantage plans, BJC says the exception does not apply.
In its statement of October 21, 2026, BJC said its Aetna commercial agreements are current and that it stays in network for those plans in 2027 and beyond. It said Aetna has not fully explained the higher out of network costs Medicare Advantage members could face. Aetna told KCTV5 it is willing to work with BJC and Saint Luke's.
Does Illinois TRAIL coverage still include BJC in 2027?
BJC says its agreement with Aetna provides in-network-equivalent services in 2027 for Illinois state retirees enrolled in Aetna Medicare Advantage PPO ESA through the Total Retiree Advantage Illinois (TRAIL) program.
BJC describes this as a one-year arrangement. It does not apply to individual Aetna Medicare Advantage plans. Ask Aetna or your retiree benefits administrator how it applies to your own doctors, hospital and care.
Retiree group coverage can have different rules from an individual plan. Check with your benefits administrator before dropping or changing it.
What is the situation with Anthem?
Anthem is the more complicated case, because the Medicare Advantage ending is settled while the rest of the contract is still open.
| Anthem plan type | What BJC says | What Anthem says |
|---|---|---|
| Medicare Advantage | Contract ends December 31, 2026 | BJC will not continue in the Anthem Medicare Advantage network after December 31, 2026 |
| Commercial and other traditional plans | Under negotiation. The current contract ends December 31, 2026 | No changes now. The agreement stays in effect through the end of 2026, and Anthem says it is committed to keeping BJC in network |
| Medicare supplement (Medigap) | Not mentioned | Not impacted |
Anthem says its Medicare Advantage members who are being treated for certain serious conditions may be able to request continuity of care. Anthem also says BJC remains in its network today and members should keep using their BJC doctors and hospitals as they do now. BJC says that if there is no new contract, Anthem patients would face higher out of pocket costs at BJC starting January 1, 2027, and that the negotiation covers all BJC organizations, including 14 hospitals. BJC and WashU Medicine are independent legal entities with separate Anthem contracts.
Which Medicare Advantage plans does BJC list?
| Medicare Advantage plan | What BJC says |
|---|---|
| Aetna Medicare Advantage | Contract ends December 31, 2026; BJC describes a 2027 exception for the Illinois TRAIL PPO ESA plan |
| Anthem (Blue Cross and Blue Shield of Missouri) Medicare Advantage | Contract ends December 31, 2026 |
| Devoted Health | Listed |
| Essence Healthcare | Listed |
| Humana Medicare Advantage | Listed |
| UnitedHealthcare Medicare Advantage | Listed |
A company on the list can sell several plans, so confirm that your exact plan includes the BJC hospital and the Washington University physician you use. BJC says its list is for information and can change.
What are my choices if I have Aetna or Anthem Medicare Advantage?
| Choice | What to check |
|---|---|
| A different Medicare Advantage plan | Your BJC hospitals and Washington University doctors in its 2027 directory, the drug list and the yearly maximum you could pay out of pocket |
| Original Medicare, a Medigap plan and a Part D drug plan | The monthly cost of all three, and that a Medigap insurer can ask health questions if you apply later |
| Stay in the plan and use other doctors | Whether the doctors and hospitals you would use instead are in the plan's network and close to home |
Medicare's annual enrollment period, October 15 to December 7, 2026, applies to everyone. A change you make by December 7 starts January 1. If you are in a Medicare Advantage plan on January 1, you can make one more change from January 1 to March 31, 2027.
Check the Medigap rules before you leave Medicare Advantage. After your first six months on Medicare Part B, an insurer can usually ask health questions and may charge more or turn you down, unless you have a guaranteed right to buy. Anthem says its Medicare supplement plans are not affected by BJC's decision.
If you are in treatment, ask your insurer and BJC whether continuity of care applies to your appointments and what approval is needed. BJC says only the insurer can authorize an exception. Do not assume an exception is automatic.
Want help comparing your options? Talk to a licensed agent. We can help you compare the plans we offer and check your doctors, prescriptions and expected costs.
How many people in St. Louis use the marketplace?
| Area | People who picked a plan | Received a premium tax credit | Average monthly premium after credits |
|---|---|---|---|
| St. Louis city | 22,766 | 87.3% | $140 |
| St. Louis County | 61,362 | 82.0% | $191 |
| Missouri | 365,734 | 86.1% | $173 |
St. Louis County's average premium after credits was higher than the city's and the state's, and 12.8% of its enrollees picked a gold plan, compared with 8.4% across Missouri. These are 2026 numbers. Your 2027 price depends on your income, your household and the plans sold where you live.
Census estimates put St. Louis city at 278,144 residents, with 15.5% age 65 or older, and St. Louis County at 990,911, with 21.4% age 65 or older. Among people under 65, 10.9% in the city and 6.6% in the county have no health insurance.
How can a St. Louis agent help?
An agent can look up your BJC hospital and your Washington University or other doctors in each 2027 plan you are considering, and explain what happens if you are close to a deadline. Have your insurance card, your doctors' names and your prescriptions ready.
Health Insurance Solutions agents are licensed in 22 states and help by phone and online. Marketplace plans cost the same with or without an agent, so the comparison does not add to your premium.
Insurers and hospitals mentioned
Explore the organizations or brands discussed in this article. A mention does not mean every plan or location is covered.
- Insurer · MissouriAnthem Blue Cross and Blue Shield
- Insurer · MissouriUnitedHealthcare
- Medicare Advantage · MissouriAetna Medicare
- Medicare Advantage · MissouriAnthem Blue Cross and Blue Shield
- Medicare Advantage · MissouriDevoted Health
- Medicare Advantage · MissouriEssence Healthcare
- Medicare Advantage · MissouriHumana
- Medicare Advantage · MissouriUnitedHealthcare
- Small-group insurer · MissouriUnitedHealthcare Insurance Company
See our Medicare plans
Turning 65 or reviewing your plan? We'll walk through Advantage, Supplement, and Part D side by side.Medicare enrollment window calculator
Enter a birth date to see when your seven-month Initial Enrollment Period starts and ends.Health insurance in Missouri
Marketplace, Medicaid and Medicare rules for the whole state.We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
Talk to a licensed agent
We compare plans, explain the tradeoffs and help you enroll. It costs you nothing.