Aetna, WashU Physicians reach deal to maintain access for Illinois retirees

Illinois state retirees enrolled in the TRAIL Medicare Advantage program will retain in-network access to Washington University physicians through 2027 following an agreement announced Wednesday, Nov. 11.

The deal secures in-network access through 2027 for Illinois retirees enrolled in TRAIL, the state’s Aetna-administered Medicare Advantage program for eligible retirees.

On Nov. 6, leaders with BJC HealthCare announced a similar agreement with Aetna — weeks after BJC announced it was dropping its participation in the Medicare Advantage plans offered by Aetna due to “administrative burden and payment issues.”

As with the BJC agreement, the new agreement between Aetna and WashU Medicine only applies to members enrolled in the TRAIL program. According to the Illinois Department of Central Management Services, about 5,000 Illinois members who recently accessed services stood to be impacted.

“This one-year transition plan will provide time for the State of Illinois to consider additional plan options for retirees for 2028 and beyond that include in-network services from WashU Medicine providers,” Jessica Church, director of media relations at Washington University School of Medicine, said in a statement shared with Southern Illinois Source.

Following the initial agreement with BJC, Phil Blando, spokesperson for Aetna, said the company remains prepared to help members still facing gaps in in-network access.

“We are available to help members understand continuity of care, answer their questions, and provide information about our robust provider network in the St. Louis, Kansas City and Southern Illinois areas,” Blando wrote in an emailed statement.

While the recent agreements provide temporary relief specifically for TRAIL participants, they do not resolve potential disruptions to those enrolled in other Aetna Medicare Advantage individual or group plans. Overall, more than 72,000 people across the 15-county St. Louis metropolitan area are enrolled in Aetna Medicare Advantage plans, according to an analysis of federal Medicare data.

Christian Morgan, BJC vice president for government relations, said in a letter to Illinois lawmakers that BJC agreed to its new deal with Aetna after ensuring it “would not continue to be subject to the same significantly adverse policies tied to inappropriate denials and reduced reimbursement for service.”

Morgan said BJC will consider similar arrangements with other Aetna Medicare Advantage group plans and has shared that willingness with Aetna.

This story was produced by Southern Illinois Source, the Illinois Press Foundation’s nonprofit news collaborative serving the bottom third of the state in partnership with the Southern Illinois University Charlotte Thompson Suhler School of Journalism and Advertising.

Capitol News Illinois is a nonprofit, nonpartisan news service that distributes state government coverage to hundreds of news outlets statewide. It is funded primarily by the Illinois Press Foundation and the Robert R. McCormick Foundation.