Hospital systems in four states are walking away from Medicare Advantage contracts at the end of the year, and the dates land in the middle of Medicare’s open enrollment season. Members of Aetna and Anthem plans in the St. Louis area, plans in Zanesville, Ohio, UnitedHealthcare plans in Arkansas and out-of-network plans at Renown Health in Nevada are all affected for 2027. Illinois state retirees on Aetna face an earlier date than everyone else: Nov. 23.
St. Louis: about 85,800 members lose BJC and WashU in network
BJC HealthCare and WashU Medicine are leaving the Medicare Advantage networks of Aetna and Anthem on Jan. 1, 2027, according to Live Insurance News. Contract talks with both insurers failed. The site, citing federal enrollment data, counts just over 72,000 Aetna Medicare Advantage members and about 13,800 on Anthem in the 15-county bi-state metro, about 85,800 in all.
BJC’s 14 hospitals in Missouri and southern Illinois are covered, including Barnes-Jewish and St. Louis Children’s. WashU Medicine physicians are under a separate contract that is also ending. BJC spokesperson Laura High said the system “was not able to come to a satisfactory agreement” with Anthem despite lengthy negotiations. Aetna’s commercial and employer plans are not affected.
Will the hospital still be in network, and does a member have to switch?
The plans stay in place. What members lose is in-network access to the hospital. For a person who wants to keep going to BJC or a WashU doctor, the choice is to move to a plan that still includes them, or stay put and pay out-of-network rates. Live Insurance News says out-of-network cost sharing can run two to three times the in-network amount or more, depending on the plan…