As Cigna exits Missouri ACA marketplace, BJC says it is near a deal for new carrier [St. Louis Post-Dispatch]

Oct. 24—ST. LOUIS — BJC HealthCare, the region's biggest health care provider, says it is working on a plan to ensure people who depend on "Obamacare" health insurance policies will still have access to its system.

BJC said it plans to make an announcement on an agreement for a new Affordable Care Act coverage option early this week, ahead of the start of the open enrollment period.

The move follows the decision by Cigna to stop offering individual marketplace plans in Missouri and Kansas in 2024. Cigna has been a large carrier of marketplace plans that cover BJC, under the brand "Cigna Connect."

Dan Jung, an insurance agent with MB Health, said that when the news broke of Cigna's exit from the Missouri exchanges this summer, his phone "pretty much blew up." Jung helps clients sign up for and navigate Affordable Care Act plans in Missouri and Illinois. His firm is based in unincorporated St. Louis County, near Affton.

At the time, he told his clients he was hoping some other insurer would come in and pick up the mantle. Then, as time went on, he was surprised that no alternative was announced.

Jung said he started advising his BJC clients to ask their doctors if there were physicians or specialists they could recommend "on the other side of the fence," at other health systems. He worried about patients who relied on specialists at BJC or who participated in clinical trials at the health system.

"If there is really a solution coming around the corner, that would be a great relief for a lot of people," he said.

The federally designated open enrollment period — when people can sign up for or make changes to their marketplace health insurance — is days away. It begins on Nov. 1, and Dec. 15 will be the last day to enroll through the health insurance marketplace for coverage that starts on Jan. 1.

Lev Guter, 43, of Olivette, plans to shop on the exchange for a new plan during the open enrollment period. Guter receives health coverage through a plan from his previous job as a math teacher. Now, as a stay-at-home dad taking care of his young daughter, those benefits will end soon.

Guter was worried when he read that Cigna's individual marketplace plans wouldn't be available for him and his daughter in 2024 and they'd have to find new doctors. Guter has been a BJC patient for about eight years, and his daughter is cared for by a pediatrician affiliated with Washington University. She was born at BJC's Missouri Baptist Hospital.

The family weighed the apparent alternatives. Going without insurance was not an option. Guter and his daughter could get coverage under his wife's workplace, but because her employer doesn't cover health insurance costs for spouses or children, he said that would be prohibitively expensive.

When the couple learned that the health system was near a deal for a new carrier of marketplace plans, they were overwhelmed.

"To have there possibly be action on it is a huge relief," said Guter's wife, Katie Rice-Guter. "We really trust the care we get."

A Cigna spokesperson said this week that the company wasn't able to offer exchange plans in Missouri and Kansas for 2024 that meet its standards at an affordable price. Cigna began selling ACA marketplace plans in the St. Louis area in 2015.

Cigna's commercial, Medicare and individual dental insurance offerings here will not be affected. And for BJC patients who live in Illinois, the health system said marketplace plans will continue to be available under Blue Cross Blue Shield of Illinois.

The Missouri Department of Commerce and Insurance said the federal government will match Cigna's current individual marketplace members to alternate plans for the upcoming year. People can decide to stay in the plan chosen for them or shop for a different one.

The department recommends, in general, that people check with their medical providers about what insurance coverage they accept regardless of what health system they belong to. Individual doctors can have their own contracts with health insurers.

Resources

More information about open enrollment periods, marketplace plans, and other forms of insurance is available at healthcare.gov.

The Missouri Department of Commerce and Insurance has an online map that shows which carriers offer individual plans in each Missouri county at insurance.mo.gov/industry/filings/healthrates/map/. The department also offers a worksheet patients can use to help select a health plan.

The department encourages patients to review and compare the costs associated with each plan, including premiums, deductibles, copays and coinsurance. Some may choose to get help from a trusted insurance agent.

Residents should not select plans based on cost alone: It's important to make sure that any new policy covers needed health services, like anticipated surgeries and prescription drugs. Be wary of advertisements for low or no-cost health coverage.

Patients should check that their doctors are covered by the plan they are considering. Patients should not rely solely on the information in online directories, which can be out of date. They should also confirm by contacting providers directly.

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