BJC Health, Aetna to give Illinois retirees 1-year transition period to change coverage

ST. LOUIS, Mo. (First Alert 4) - BJC Health and Aetna signed an agreement Friday that allows a one-year transition period for Illinois retirees.

It was announced in late October that BJC would no longer be in network for Aetna Medicare Advantage and Anthem Medicare Advantage plans. Now, BJC says it is giving State of Illinois retirees an extra year to transition from Aetna MA to other programs.

Aetna MA coverage that would’ve ended on Jan. 1, 2027, will now be effective for the 2027 calendar year for State of Illinois retirees only.

Medicare enrollment is currently open and closes Dec. 7.

This comes after 5 Illinois State Senators and 9 House Representatives sent a letter to BJC on the matter on Oct. 23:

October 23, 2026

BJC HealthCare

Aetna Inc.

Illinois Department of Central Management Services (CMS)

RE: Retired State Employees’ Healthcare Coverage and Contract Negotiations

Dear Aetna Inc., BJC HealthCare, and Illinois CMS:

We, the undersigned members of the Illinois General Assembly, are writing to express our serious concerns regarding the potential disruption of healthcare coverage for retired state employees who rely on BJC HealthCare hospitals, physicians, and providers throughout our region. Our offices have received numerous calls from our constituents who have been notified that their current coverage may no longer provide access to their providers beginning January 1, 2027.

The loss of access to these trusted healthcare providers would have significant consequences for affected retirees and their families. These individuals dedicated years of service to the State of Illinois and deserve continuity of care and certainty regarding their healthcare coverage.

Furthermore, the availability of alternative healthcare providers throughout our region is limited. We are concerned that the existing provider network will be unable to adequately accommodate the thousands of retirees who could be affected by this dispute. The consequences of failing to reach an agreement extend beyond a contractual disagreement and threaten access to essential healthcare services for our constituents.

Accordingly, we are insisting that contract negotiations resume immediately and continue on a daily basis with the objective of reaching an agreement that preserves retirees’ access to BJC HealthCare facilities and providers.

Should an agreement not be reached by November 6th, we request that representatives of all parties meet with the undersigned legislators to provide a comprehensive briefing on the status of negotiations, the outstanding issues preventing an agreement, and the steps each party is prepared to take to achieve a resolution.

We further request that each party provide a prompt response outlining its current position and the actions being taken to bring these negotiations to a successful conclusion.

Central Management Services (CMS) also has an important role in ensuring that retired state employees have access to health insurance coverage that includes appropriate healthcare providers in their region. We request a detailed explanation of the steps that CMS has taken to facilitate negotiations and the contingency plans under consideration to protect our affected constituents should an agreement not be reached before the anticipated deadline.

Our constituents deserve timely answers and a clear path forward. We expect all parties to engage constructively and make every reasonable effort to resolve this matter before retirees face a disruption in their healthcare coverage.

We appreciate your immediate attention to this matter and look forward to reviewing your responses regarding the status of negotiations and the actions being taken to reach an agreement.

Sincerely,

Senator Erica Harriss, 56th, Senator Jil Tracy, 50th, Senator Jason Plummer, 55th, Representative Charlie Meier, 109th, Representative Amy Elik, 111th, Senator Terri Bryant, 58th, Senator Paul Jacobs, 59th, Representative Kevin Schmidt, 114th Representative CD Davidsmeyer, 100th, Representative Wayne Rosenthal, 108th, Representative Patrick Windhorst, 117th, Representative Dave Severin, 116th, Representative David Friess, 115th, Representative Scott Doody, 118th

The response letter that BJC sent to State legislators is below:

Honorable Senators and Representatives,

Thank you for reaching out on behalf of your constituents and our patients with our shared concern regarding Aetna’s Medicare Advantage plan (“Aetna MA”).

On October 28, BJC Health met with leaders from the Illinois Department of Central Management Services (“IL CMS”) to discuss a one-year solution to alleviate the impact of BJC Health ending its contract with Aetna MA on Dec. 31, 2026 (resulting in BJC providers and facilities no longer being in network for State of Illinois retirees as of Jan. 1, 2027). BJC understands Aetna MA is the only Medicare Advantage plan offered to State of Illinois retirees through the Total Retiree Advantage Illinois (“TRAIL”) program, and BJC would like to be a good community member until additional options may be made available to State of Illinois retirees.

There were two key conditions BJC detailed in the meeting that enabled BJC to agree to a one-year transition period. Namely, BJC would not continue to be subject to the same significantly adverse policies tied to inappropriate denials and reduced reimbursement for services. These were the primary causes of BJC needing to end its network participation with Aetna MA. Since that meeting, BJC began negotiations with Aetna for the one-year transition period specifically for State of Illinois retirees. The terms and conditions for the compromise were discussed, and Aetna has now agreed to accept BJC’s conditions.

The one-year transition agreement was signed by BJC and Aetna today, November 6, and is effective for the 2027 calendar year.

This one-year transition agreement applies only to State of Illinois retirees; those patients will receive letters from BJC informing them of the 1-year agreement. For other retirees enrolled in an Aetna MA group plan who want to stay with BJC as an in-network provider, BJC will consider a similar 1-year transition arrangement and has informed Aetna of this position. Aetna MA individual plan members should consider Original (traditional) Medicare coverage with a Medicare supplement or another Medicare Advantage plan that includes BJC as an in-network provider.

Medicare’s Annual Enrollment Period is open now and ends December 7.

To help State of Illinois retirees have a choice and voice in their health care, we urge you to consider legislation to require the Illinois Department of Central Management Services to award contracts to a minimum of two supplemental Medicare plan options if two or more responsive bidders submit bids during the procurement process.

Please do not hesitate to reach out should you have further questions.

Sincerely,

Christian Morgan

Vice President, Government Relations

BJC Health