Medicare
Medicare is health insurance for people 65 or older. Medicare's open enrollment period runs from Oct. 15 through Dec. 7 every year. During this time, you can review Medicare coverage options and make changes to your plan. Below are resources to help you understand your options, including a list of plans accepted by BJC providers.
Medicare plans
In addition to traditional Medicare, BJC HealthCare is an in-network provider for numerous Medicare Advantage plans including ones offered by: Devoted Health, Essence, Humana, and UnitedHealthcare.
Please confirm with your current or prospective health plan to make sure that a specific product is one in which BJC participates. Check with your plan to confirm that BJC providers are included in your plan’s network before scheduling an appointment.
For general questions regarding Medicare or Medicare Advantage plans, please call 800-MEDICARE (800-633-4227).
Frequently asked questions related to Aetna and Anthem Medicare Advantage plans
What is changing regarding Aetna and Anthem Medicare Advantage plans?
After years of trying to resolve administrative burden and payment issues with both Aetna and Anthem, BJC made the difficult decision to no longer partner with these plans. We did not wish this to be the outcome. Like almost 200 other health systems across the country, BJC has had to end its relationships with certain Medicare Advantage plans. We will only contract with plans that have reasonable terms and conditions focused on patients' best interests.
After careful consideration, beginning Jan. 1, 2027, BJC HealthCare will no longer participate in the Aetna and Anthem Medicare Advantage plans. Effective Jan. 1, 2027, BJC physicians and other BJC providers will be considered out of network for Aetna and Anthem Medicare Advantage plans.
We understand that changes to the insurance plans we accept can cause concern and uncertainty. We know that finding a new insurance plan or health care provider can be time-consuming and stressful, and we are committed to supporting patients through this transition.
Contact your agent or broker of record to assist with any change you might want to make. For additional information and resources regarding Medicare, visit Medicare.gov or call 1-800-MEDICARE to compare available Medicare plans. To help, Chapter Advisory, our designated Medicare advisor, provides no-cost Medicare coverage information and guidance. They can help you identify plan options that include in-network services from BJC providers and BJC hospitals. You can reach them at 314-936-6108 or online at AskChapter.org/Medicare-Help.
What does this mean for patients with Aetna or Anthem Medicare Advantage plans?
If you remain with Aetna or Anthem Medicare Advantage, beginning Jan. 1, 2027, care you receive from BJC physicians, BJC providers, and BJC facilities will be considered out of network. In most cases, this will result in higher out-of-pocket costs and/or different coverage rules. Generally, patients with out-of-network coverage will be redirected by BJC to a provider outside BJC that is in-network to the patient. BJC redirects patients because we want them to be able to access the highest coverage benefit possible for every service.
Patients who want to continue receiving in-network care at BJC will want to consider Traditional (Original) Medicare coverage with a Medicare Supplement or other Medicare Advantage plans that contract with BJC. BJC will remain in-network with other Medicare Advantage plans in 2027, including:
- Devoted Health
- Essence
- Humana
- UnitedHealthcare
Contact your agent or broker of record to assist with any change you might want to make. For additional information and resources regarding Medicare, visit Medicare.gov or call 1-800-MEDICARE to compare available Medicare plans. To help, Chapter Advisory, our designated Medicare advisor, provides no-cost Medicare coverage information and guidance. They can help you identify plan options that include in-network services from BJC providers and BJC hospitals. You can reach them at 314-936-6108 or online at AskChapter.org/Medicare-Help.
Can I continue seeing my BJC doctor after Jan. 1, 2027?
If you remain enrolled in an affected Aetna or Anthem Medicare Advantage plan in 2027, your care will be considered out-of-network unless covered through a specific out-of-network authorization approved by Aetna or Anthem (e.g., services that are part of an active treatment plan, such as cancer treatments, and require continuity of care).
Generally, patients with out-of-network coverage will be redirected by BJC to a provider outside BJC that is in-network for the patient.
Patients who want to continue receiving in-network care at BJC should consider Traditional (Original) Medicare coverage with a Medicare Supplement or another Medicare Advantage plan that contracts with BJC. We will remain in-network with Traditional (Original) Medicare, most Medicare Supplement/Medigap plans, and other Medicare Advantage plans in 2027, including:
- Devoted Health
- Essence
- Humana
- UnitedHealthcare
Contact your agent or broker of record to assist with any change you might want to make. For additional information and resources regarding Medicare, visit Medicare.gov or call 1-800-MEDICARE to compare available Medicare plans. To help, Chapter Advisory, our designated Medicare advisor, provides no-cost Medicare coverage information and guidance. They can help you identify plan options that include in-network services from BJC providers and BJC hospitals. You can reach them at 314-936-6108 or online at AskChapter.org/Medicare-Help.
Are there any exceptions?
In certain situations, patients may qualify for a continuity of care transition period for services that are part of an active/current treatment plan or may receive authorization from Aetna or Anthem Medicare Advantage for out-of-network services that only BJC can provide in the region. Patients should contact their health plan directly to learn whether they qualify for these options. Only Aetna or Anthem can authorize these approvals of continuity of care.
Generally, patients with out-of-network coverage will be redirected by BJC to a provider outside BJC that is in-network for the patient.
What are my options if I want to keep receiving in-network care at BJC?
- Consider Traditional (Original) Medicare coverage with a Medicare Supplement/Medigap plan (which is different than a Medicare Advantage plan).
- Review and select another Medicare Advantage plan that includes BJC providers in their network.
BJC will remain in-network with Traditional (Original) Medicare, most Medicare Supplement/Medigap plans, and other Medicare Advantage plans in 2027, including:
- Devoted Health
- Essence
- Humana
- UnitedHealthcare
Contact your agent or broker of record to assist with any change you might want to make. For additional information and resources regarding Medicare, visit Medicare.gov or call 1-800-MEDICARE to compare available Medicare plans. To help, Chapter Advisory, our designated Medicare advisor, provides no-cost Medicare coverage information and guidance. They can help you identify plan options that include in-network services from BJC providers and BJC hospitals. You can reach them at 314-936-6108 or online at AskChapter.org/Medicare-Help.
Which Medicare Advantage plans will include BJC in their network for 2027?
For 2027, BJC contracts with the following Medicare Advantage plans:
- Devoted Health
- Essence
- Humana
- UnitedHealthcare
Patients should verify network participation and plan details before enrolling, as plan offerings and networks may change.
What should I do if Anthem or Aetna Medicare Advantage is my only option?
If you cannot choose Traditional (Original) Medicare coverage or another Medicare Advantage plan that contracts with BJC, you will need to either find a new provider who is in-network with your Medicare Advantage plan or potentially pay more out-of-pocket to see your BJC provider on an out-of-network coverage basis for services which qualify for an exception. If your services are approved by your plan for out-of-network exceptions, BJC will submit claims directly to the Medicare Advantage health plan for processing.
Generally, patients with out-of-network coverage will be redirected by BJC to a provider outside BJC that is in-network for the patient. We understand that changes to the insurance plans we accept can cause concern and uncertainty. We know that finding a new insurance plan or health care provider can be time-consuming and stressful, and we are committed to supporting patients through this transition.
Contact your agent or broker of record to assist with any change you might want to make. For additional information and resources regarding Medicare, visit Medicare.gov or call 1-800-MEDICARE to compare available Medicare plans. To help, Chapter Advisory, our designated Medicare advisor, provides no-cost Medicare coverage information and guidance. They can help you identify plan options that include in-network services from BJC providers and BJC hospitals. You can reach them at 314-936-6108 or online at AskChapter.org/Medicare-Help.
If Anthem or Aetna Medicare Advantage are currently your only options, we encourage you to contact your employer or former employer’s benefits leader to request they provide an additional Medicare Advantage plan option that includes BJC facilities and providers.
I have been told or received a letter from my insurance company that some BJC providers will remain in-network with Aetna or Anthem Medicare Advantage plans. Is this true?
No. Effective January 1, 2027, BJC physicians, other providers, and BJC hospitals will all be considered out of network for Aetna and Anthem Medicare Advantage plans.
When can I review or change my Medicare coverage?
The Medicare Annual Enrollment Period (AEP) begins each year on Oct. 15 and ends Dec. 7, 2026, for coverage that begins Jan. 1, 2027.
Contact your agent or broker of record to assist with any change you might want to make. For additional information and resources regarding Medicare, visit Medicare.gov or call 1-800-MEDICARE to compare available Medicare plans. To help, Chapter Advisory, our designated Medicare advisor, provides no-cost Medicare coverage information and guidance. They can help you identify plan options that include in-network services from BJC providers and BJC hospitals. You can reach them at 314-936-6108 or online at AskChapter.org/Medicare-Help.
Can BJC recommend which Medicare plan I should choose?
BJC cannot recommend specific health plans or provide insurance or financial advice. Contact your agent or broker of record to assist with any change you might want to make. For additional information and resources regarding Medicare, visit Medicare.gov or call 1-800-MEDICARE to compare available Medicare plans. To help, Chapter Advisory, our designated Medicare advisor, provides no-cost Medicare coverage information and guidance. They can help you identify plan options that include in-network services from BJC providers and BJC hospitals. You can reach them at 314-936-6108 or online at AskChapter.org/Medicare-Help.
Where can I learn more about Medicare plans that work with BJC?
Contact your agent or broker of record to assist with any change you might want to make. For additional information and resources regarding Medicare, visit Medicare.gov or call 1-800-MEDICARE to compare available Medicare plans. To help, Chapter Advisory, our designated Medicare advisor, provides no-cost Medicare coverage information and guidance. They can help you identify plan options that include in-network services from BJC providers and BJC hospitals. You can reach them at 314-936-6108 or online at AskChapter.org/Medicare-Help.
Who can help me understand my Medicare options?
A couple of resources are available:
Chapter Advisory
- No-cost Medicare guidance and plan comparison support
- Phone: 314-936-6108
- Online: AskChapter.org/Medicare-Help
Medicare
- Visit Medicare.gov
- Call 1-800-MEDICARE (1-800-633-4227)
What if I have concerns about these changes?
We understand that changes to the insurance plans we accept can cause concern and uncertainty. We know that finding a new insurance plan or health care provider can be time-consuming and stressful, and we are committed to supporting patients through this transition.
Our goal is to provide the information and resources you need to understand your options and make the choice that is best for your health care coverage and access to providers. We encourage you to review your options and contact your agent or broker of record to assist with any change you might want to make. For additional information and resources regarding Medicare, visit Medicare.gov or call 1-800-MEDICARE to compare available Medicare plans. To help, Chapter Advisory, our designated Medicare advisor, provides no-cost Medicare coverage information and guidance. They can help you identify plan options that include in-network services from BJC providers and BJC hospitals. You can reach them at 314-936-6108 or online at AskChapter.org/Medicare-Help.
Will BJC bill out of network?
Generally, patients with out-of-network coverage will be redirected by BJC to a provider outside BJC that is in-network for the patient. However, if an exception applies such as coverage approved through a specific out-of-network authorization (e.g., advanced service only BJC provides or continuity of care for an active/current treatment plan), then BJC will submit claims to the out-of-network health plan. Member cost sharing (e.g., copays, coinsurance), services denied for coverage, or inappropriate payment policies applied by the out-of-network health plan may all result in higher out-of-pocket costs for members enrolled in out-of-network health plans.
If I have a Medicare supplement or Medigap plan, am I affected?
No. Patients with Medicare supplement or Medigap plans, including Aetna or Anthem, are not affected since supplement plans are not Medicare Advantage plans. Check with your insurance provider to confirm.
Why are Aetna and Anthem Medicare Advantage plans going out of network with BJC?
After years of trying to resolve administrative burden and payment issues with both Aetna and Anthem, BJC made the difficult decision to no longer partner with these plans. We did not wish this to be the outcome. Like almost 200 other health systems across the country, BJC has had to end its relationships with certain Medicare Advantage plans.
When a health care organization agrees to accept an insurance plan, both parties sign a contract that outlines how the organizations will work together. Insurance companies and health care providers renegotiate these contracts every 3–4 years on average to address many different terms and conditions ranging from health plan payment and authorization policies to reimbursement.
We will only contract with plans that have reasonable terms and conditions focused on patients' best interests.
Resources
Medicare
Visit medicare.gov, the official U.S. government site for Medicare, to sign up or change plans, learn about Medicare coverage choices and more. Call 800-MEDICARE (800-633-4227) to reach Medicare by phone.
Chapter Advisory
At BJC HealthCare, we understand that navigating Medicare can be challenging. That’s why we’ve teamed up with Chapter, an independent Medicare advisor, to provide Medicare support at no cost to you. Call 314-936-6108 or visit askchapter.org/medicare-help.
Missouri SHIP
Missouri SHIP (State Health Insurance Assistance Program) is certified by the federal and state government to provide free, unbiased, and confidential (private) Medicare services. Missouri SHIP has nearly 200 counselors throughout Missouri providing local Medicare counseling in their communities. Learn more at missouriship.org.
Illinois SHIP
Illinois Department on Aging’s Senior Health Insurance Program (SHIP) is a free, statewide health insurance counseling service for Medicare beneficiaries and their caregivers. Learn more at ilaging.illinois.gov/ship
Social Security Administration
The Social Security Administration is an independent agency of the U.S. federal government that administers Social Security, a social insurance program consisting of retirement, disability, and survivor benefits. Visit ssa.gov or call 800-772-1213 to reach Social Security by phone.
Medicare Annual Enrollment
The Medicare Annual Enrollment Period (AEP) is open from Oct. 15 to Dec. 7. Medicare beneficiaries can make changes to their Medicare insurance for the calendar year 2027.
Due to the Inflation Reduction Act passed by Congress, Medicare patients enrolled in a Medicare Advantage plan or a standalone Medicare Prescription Drug plan (PDP) may experience significant changes to their plan benefits and/or premium for 2027.
Carefully review your Annual Notice of Change (ANOC) letter sent by your Medicare Advantage or PDP insurance carrier in early October to verify all changes to your coverage for calendar year 2027.
Medicare Advantage Open Enrollment
The Medicare Advantage Open Enrollment Period (MA OEP) runs from Jan. 1 to Mar. 31 each year and is a specific period for individuals already enrolled in a Medicare Advantage plan to switch plans or return to original Medicare.
Common Medicare AEP situations
My Medicare Advantage plan will not be available in 2027
If you are notified that your current Medicare Advantage plan will not be available in 2027, you have options:
Return to Original Medicare. Because you are involuntarily losing your Medicare Advantage plan, you will be automatically reinstated with Original Medicare starting on Jan. 1, 2027. You also qualify for any Medicare Supplement (Medigap) plan of your choice on a Guarantee Issue basis (no medical underwriting required). You may also decide to purchase a standalone Medicare Prescription Drug plan.
Shop for an alternative Medicare Advantage plan. You can compare and choose a Medicare Advantage plan during Medicare AEP which lasts from Oct. 15 through Dec. 7. Be sure to verify that your physicians and medications are covered by your Medicare Advantage plan of choice.
My Medicare Prescription Drug plan will significantly change in 2027
Most Medicare Prescription Drug plans will experience noticeable changes for 2026. This may include Plan Premium increases or changes to the drugs covered by the plan (formulary). For a complete listing of Medicare Prescription Drug plans available in your area, visit the plan finder tool found on Medicare.gov. You can compare and enroll in the Medicare Prescription plan of your choice.
My Medicare Advantage plan will significantly change in 2027
If you receive your Annual Notice of Change (ANOC) letter from your Medicare Advantage plan and are concerned about changes being made to your coverage for 2027, your options are to:
Return to Original Medicare. Contact your Medicare Advantage plan directly and they will initiate the disenrollment process (or call 1-800-MEDICARE for assistance). Please note:
- If you wish to purchase a Medicare Supplement plan (Medigap), you will likely need to pass the plan’s medical underwriting requirements.
- You may decide to purchase a standalone Medicare Prescription Drug plan.
Shop for an alternative Medicare Advantage plan. You can compare and choose a Medicare Advantage plan during Medicare AEP which lasts from Oct. 15 through Dec. 7 or Medicare Advantage Open Enrollment Period (MA OEP) which lasts from Jan. 1 through Mar. 31. Be sure to verify that your physicians and medications are covered by your plan of choice.