A one-year agreement has been reached to allow State of Illinois retirees to continue to be able to access care at BJC-Barnes Hospital under Aetna’s Medicare Advantage plan.
In a letter to a group of state legislators asking for negotiation on the issue, BJC says they understand 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 an October 30th 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 reasons BJC needed 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 on November 6th and is effective for the 2027 calendar year.
The letter notes 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, BJC is urging lawmakers 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.
State Representative Charlie Meier, one of the legislators demanding meetings, said he is thrilled that Aetna and BJC listened to their concerns and extended their Medicare Advantage plan for state retirees for another year. He said without it, retirees would have faced potentially devastating loss of providers and lack of healthcare. Meier says he remains committed to a long-term solution, but for now Illinois state retirees can rest assured that they can continue to receive good, quality healthcare for another year.
