BJC reached a deal with a new ACA carrier. Here is what patients need to know. [St. Louis Post-Dispatch]

Nov. 8—Editor's note: People shopping for marketplace plans should be aware that the plans described in this story are not labeled "CareLink" on the main page of search results on HealthCare.gov. You must click on an Aetna plan, scroll down and click on "Plan documents." Then click "Summary of Benefits." At the top of that page, CareLink plans will be labeled "CareLink St. Louis."

ST. LOUIS — BJC HealthCare has reached a much-anticipated agreement for a new Affordable Care Act insurance plan under Aetna, beginning Jan. 1.

The deal will come as a relief to BJC patients who are signing up for ACA plans as the federal open enrollment period kicks off this week. The previous carrier of individual marketplace plans covering BJC — Cigna, which offered them under the brand "Cigna Connect" — is exiting Missouri's ACA marketplace in 2024.

The announcement of that move this summer left some BJC patients wondering if there would be a new option for them by the time open enrollment arrived, or whether they would have to switch medical providers.

J.C. McWilliams, vice president of managed care for BJC, said the health system was aware that Cigna may have to scale back or leave the marketplace here. Since last year, the health system has been in discussions with other insurers, in the hopes of finding another marketplace product to supplement or replace Cigna Connect.

In recent interviews, BJC and Aetna officials laid out the details of the new marketplace option, and what patients need to know.

The Aetna plans that will cover BJC are marketed under the brand CareLink St. Louis.

The federal open enrollment period — when people can sign up for or make changes to their marketplace health insurance — began Wednesday.

Dec. 15 will be the last day to enroll through the health insurance marketplace for coverage that takes effect on Jan. 1. The very final day to enroll will be Jan. 15, for coverage that begins Feb. 1. Some patients may be able to sign up for plans outside of that window if they qualify for a "special enrollment period," available to those who have had certain, major life events like moving, getting married or having a baby.

McWilliams encouraged patients to start reviewing their options early, because Dec. 31 is a hard end date for coverage through Cigna Connect plans in Missouri.

Cigna's commercial, Medicare and individual dental insurance offerings here will not be affected.

Aetna participated in the Missouri exchanges when they first began, in 2014, then exited ahead of 2017 open enrollment. Over the past few years, the company has recommitted to the marketplace nationally, said Vincent Cacciatore, associate vice president of strategy and business development with CVS/Aetna. The insurer re-entered Missouri's marketplace in 2022, and has expanded its footprint here over time.

Aetna will offer marketplace plans in 55 Missouri counties in 2024. But the CareLink plans covering BJC will only be available in nine: St. Louis, plus St. Louis, St. Charles, Franklin, Jefferson, Washington, Ste. Genevieve, Lincoln and Warren counties.

That geography covers most of the areas BJC operates in, McWilliams said. But, he said, patients should note that it does not include people who live in Crawford County, near BJC's hospital in Sullivan, or St. Francois County, near BJC's Parkland Health Center in Farmington.

Cacciatore said Aetna evaluates its footprint constantly, and will consider expanding into those two counties in 2025.

"We've shown every year, we're committed to growing our exposure across the state," he said.

For BJC patients who live in Illinois, 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 would match Cigna's current individual marketplace members to alternate plans for the upcoming year. BJC and Aetna officials said they were uncertain if Cigna Connect patients were matched with the Aetna CareLink plans. Patients should look at what plan they were matched with, and determine whether it is the right one for them.

"Our advice is always: Do your shopping," said BJC Compliance Director Steve Bernstetter.

Patients should check directly with their medical providers about what insurance coverage they accept regardless of what health system they belong to, because there are sometimes exceptions. Patients should not rely solely on information from online directories, which can be out of date.

Some patients may want help from a trusted insurance agent. And BJC offers a free counseling program to help people select marketplace plans. Patients can request an appointment online or by calling 855-747-4994 between 8 a.m. and 6 p.m. The call center will request some basic details about the patient's household, and will provide a list of documents to bring to the appointment. Then, at the appointment, a counselor will help find plans that suit the patients' needs, and determine whether they qualify for subsidies.

The appointments are sometimes held virtually, but are often in-person at BJC facilities. Bernstetter said they are usually scheduled for one hour, but can require more or less time depending on how complicated the patient's situation is, or how familiar they are with the marketplace. More information about that program is available at BJC.org/marketplace.

"Those appointment times are pretty limited, so we would encourage people to call early," Bernstetter said.

Washington University said in a statement that it had also reached an agreement with Aetna, and that CareLink St. Louis will include Washington University Physicians in 2024.

More information about open enrollment periods, marketplace plans, and other forms of insurance is available at healthcare.gov. The federal site also has information about subsidies patients may qualify for.

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 that patients can use to help select a health plan.

___

(c)2023 the St. Louis Post-Dispatch

Visit the St. Louis Post-Dispatch at www.stltoday.com

Distributed by Tribune Content Agency, LLC.