BJC Facilities to Exit Aetna and Anthem Networks in 2027
St. Louis seniors and patients must prepare for coverage changes as local providers drop major Medicare Advantage plans.
Updated on Oct. 21, 2026 in Healthcare
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BJC HealthCare and Washington University Medicine will exit Aetna and Anthem Medicare Advantage networks effective January 1, 2027. This change impacts 85,800 seniors in the St. Louis metro area who will lose in-network access to 14 BJC hospital facilities.
Why it matters
The health system cites lower reimbursement rates and increased administrative burdens associated with processing Medicare Advantage claims compared to traditional Medicare. Operators should note that rising claim denial rates in these plans are forcing high-volume providers to reevaluate their participation in restrictive networks.
The exit affects 85,800 enrollees, comprising 72,000 Aetna and 13,800 Anthem members across 14 BJC hospital facilities. While BJC HealthCare reported a 2025 operating surplus of $454.5 million, the health system remains at odds with insurers over reimbursement benchmarks.
The players
BJC HealthCare
A prominent non-profit health system operating 14 hospitals across Missouri and Illinois.
Washington University Medicine
A large academic medical practice group affiliated with the Washington University School of Medicine.
Aetna
A major health insurer and subsidiary of CVS Health that manages Medicare Advantage plans.
Anthem
A health insurance provider and subsidiary of Elevance Health that offers Medicare Advantage products.
The details
Contract negotiations collapsed after BJC determined that Medicare Advantage plans offered insufficient payment relative to the labor-intensive claim processing requirements. The system notes that these plans are 70 percent more likely to deny claims for incomplete medical records and twice as likely to deny claims for medical necessity compared to traditional Medicare. Patients moving out-of-network face cost increases that can reach two to three times standard in-network amounts.
Timeline
November 16, 2026: Deadline for Illinois state retirees on Aetna to decide coverage
December 7, 2026: Standard Medicare annual open enrollment deadline
January 1, 2027: BJC and WashU exit Aetna and Anthem networks
Market Landscape
This network exit occurs alongside the CMS Medicare Advantage annual open enrollment period, forcing patients to navigate coverage shifts within strict regulatory deadlines. It mirrors a broader trend of health systems terminating MA contracts to avoid lower reimbursement rates and higher administrative denial risks.
Operators in the St. Louis area should prepare for patient confusion regarding insurance coverage beginning in 2027. Businesses providing employer-sponsored health benefits or serving the senior population should verify if their providers maintain network participation.
The takeaway
The move signals a growing resistance among major hospital systems to the reimbursement and denial policies of private Medicare Advantage insurers. Providers and local businesses should monitor insurer contracts closely and refer patients to the Medicare.gov Plan Finder tool to confirm coverage status.
What happens next
Illinois state retirees on Aetna must finalize their coverage decisions by November 16, 2026. All affected Medicare Advantage enrollees face the standard Medicare annual open enrollment deadline on December 7, 2026.
Further reading
For more on local industry shifts, see Healthcare.
More information
Seniors can identify plans that retain in-network access by using the Medicare.gov Plan Finder tool.
Source note: This article includes information reported by Live Insurance News.
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